Reducing unnecessary echocardiograms, Moriates says, one of the next projects to tackle, could turn out to be a huge money saving effort, because patients who really need to have an echo often have to wait another day for their test. It also may avoid harm because "you end up picking up insignificant changes that lead you to further testing, further procedures," some of which may result in false positives or adverse events.
Moriates says that he hopes the efforts of the High Value Care Committee, while they may result in lower revenue from health plan payers, will lead UCSF to a place that is well positioned for new payment models in a higher quality world.
"Reimbursement mechanisms, the way of the world, is changing," he says. "We are in a tricky time. if you cut your utilization down too much —it all depends on your payer mix, and how many Medicare, Medicaid and privately insured patients you have—you can decrease your revenue.
"But that's only true today, and very soon that's going to change. If you find yourself not putting these mechanisms in place, not changing your culture and physician practice in the hospital, you'll find yourself really flat-footed when the payment system changes."
"We're trying to get out ahead. But it's very clear which way this is going."