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Health Care Jargon: How Do You ‘Bend The Cost Curve?’

BOSTON — This week, Gov. Deval Patrick began the tough job of selling doctors, hospital executives and other health care professionals on his plan to bring down health care costs in Massachusetts.

Patrick says he wants to use “global payments,” “accountable care organizations” and “medical homes” to achieve “comprehensive payment reform.”

Lost yet? Because health care policy can be dense — but its jargon is even denser. To wade through the jargon, WBUR’s All Things Considered host Sacha Pfeiffer gave a pop quiz to wbur.org reporter and health care novice Andrew Phelps on some of that terminology.

Sacha Pfeiffer: One thing I find a lot as I talk to people about health care reform is they’re obsessed with the term “bending the cost curve.” Do you have any idea what that means? To bend the cost curve?

Andrew Phelps: I don’t, but I could take a stab.

Try it.

The cost curve, Sacha, relates to the ratio of cost to the provider versus the consumer, and we’re trying to push the cost curve toward the provider. But it’s a curvy cost. And it’s — I got nothing.

You’re overthinking this one. The basic idea is health care costs keep climbing. If they were a curve, the curve would keep sloping upward. So now that you know that, what does it mean “to bend” it?

To want to bend it, Sacha, means to slow down the increase so that it’s not so steep.

That’s the point. We’re not trying to reduce heath care costs; that’s too ambitious, really.

We’re just trying to slow them down.

Exactly. That’s the idea. We think that health care costs are going to keep climbing, but at least we can bend that curve downward a little bit. All right, “comparative effectiveness” — heard of that one?

What does “effective” mean in health care is the premise, I guess. Is a patient healthy? And, if so or if not, whose fault is that, I guess. So, to me, the very premise of what is effective is in question.

Maybe the problem with this term is that its definition is so basic that it would be hard to believe that this is what it is.

See, this is always the case with these buzzwords.

Exactly. The buzzwords don’t need to be as complicated as they are. With comparative effectiveness, the idea is that when doctors treat you, they may not know whether that form of treatment is more effective than another form. They just do it because maybe they learned it in med school or the drug rep suggested it. So comparative effectiveness would mean we’re going to compare how effective different treatments are, and we’re going to pick the one that’s most effective.

How about “evidence-based medicine”?

That sounds like one of those obvious ones, right? That we only prescribe based on what has been proven to work?

I think you just got 100 percent on that one. Oftentimes, doctors prescribe things but they may not have evidence that this is best for this patient. And there are so many new drugs and treatments.

Why do they prescribe it, then?

Because that’s what they learned in med school, it’s what the sales person suggested the day before, it’s what most doctors in the group do.

It’s what they’ve always done.

Or something new and fancy comes out, like the DaVinci surgery machine. But is it any better than the basic scalpel? That’s what evidence-based medicine is all about.

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