Neel Shah is not your typical physician. After three years of medical school at Brown University, Shah became passionate about the high cost of healthcare when he saw patients struggling to pay their medical bills. He came to the Kennedy School of Government at Harvard and, after learning more about health policy and economics, founded Costs of Care, a nonprofit dedicated to helping doctors understand the financial impact that their decisions make on patients.
Today, Shah still heads Costs of Care in addition to being an Assistant Professor at Harvard Medical School. He’s also co-authoring a textbook on value-based care. We talked to Shah, who will be speaking at the upcoming MIT BioInnovations conference next Friday, about healthcare costs, new technology, and what physicians can do to avoid harming their patients, physically and financially.
What do you plan to discuss during your talk at the MIT BioInnovations conference?
I’m giving the opening address so I’ll set the stage for the conference. The conference is about redefining value, which is key because if you’re in a service industry and you’re not delivering value, it’s not clear what it is you’re doing.
There a lot of things in 2015 that are really sort of changing the dynamics of healthcare delivery. A way of boiling down what valued care means is that it’s to make sure you’re getting the most bang for your buck. It is quite clear that in American healthcare delivery and in many parts of the world, we’re spending lots and lots of money, and in many cases we’re not getting the benefit that we should get. At a societal level, a government level, and also just with the way healthcare spending has increased, this is hitting the pockets of everyday people. As we continue to innovate and create new technology, we have to think about how we make healthcare affordable for our patients.
I’ll talk a little bit about what’s happened post-Affordable Care Act, too – the implementation in terms of putting top-down pressure to help equilibrate the system, to be accountable how we’re using resources, and more transparency on how patients’ money is being spent and how those dynamics are shifting the healthcare marketplace.
Why should physicians, scientists and healthcare providers attend this event – what makes it unique?
I think they put together a number of great sessions that bring together people that don’t necessarily get to meet. You’ve got a mix of technologists and industry folks, as well as people who are deeply embedded in the healthcare system. It’s going to be a meeting of the minds between people who are innovating in a variety of spaces and people who are actually trying to implement the innovations in real time.
What originally led you to focus on the cost of care?
For me, I was one of the people who was “in the trenches.” I went straight through college to medical school, where you get two years of classroom training. It’s really your third year when they employ you into the hospital, and you see the gap between how you thought healthcare was delivered and how healthcare is actually delivered in real life. There are a lot of opportunities to make a critical impact, but there are still a lot of failure points. One of the failure points that was very obvious to me was that there were people who were struggling to pay their medical bills and although physicians were the ones who were deciding what went on the bill, we had no idea how our decisions were impacting what patients were paying. And it wasn’t just people in my immediate environment, it was true everywhere when I looked into it.
So it’s an issue that I became passionate about, and I left medical school for a little while after my third year and I found myself at the Kennedy School at Harvard, trying to learn a little bit more about healthcare economics, filling in this piece of my education that I felt I missed at medical school that was very important. The timing was very good – many of the people that were writing the laws that eventually became the Affordable Care Act were my teachers. I realized how much power frontline physicians and nurses have to help make healthcare affordable and what motivates them. Because nobody goes to medical school to treat GDP, and yet that’s what we were talking about every day in class. And so out of that came Costs of Care, a non-profit I started whose mission is to help nurses and physicians make value-based decisions and deliver better care at lower costs. At the time we created the website, CostsofCare.org, the phrase “costs of care” was googled thousands of times per day because of the news cycle, so we got a lot of exposure because of the timing.
So what can physicians themselves do to avoid harming their patients financially?
About a third of what we decide to do in healthcare is unnecessary. A lot of people who are well-intentioned in healthcare worry about not doing enough, or about doing everything possible for their patient. The harms from too much medicine are as common as the harms from too little medicine – and those harms can be physical or financial. A patient might get some CT scan they didn’t need that leads to something we can’t interpret and further unnecessary procedures later on that are high-cost and might cause complications. So there’s a tremendous opportunity to be thoughtful about which tests and treatments we order for our patients and make sure that they’re actually the ones that make people better off. Similarly, I think there’s a tremendous opportunity to think about how we’re employing new technologies in healthcare. There are many new technologies that some physicians use regularly without any evidence that they make people better off, and they often come at a great cost.
Want to hear more from Dr. Shah? Attend MIT’s BioInnovations Conference on February 20, 2015. Register now.
Brendan Pease was MedTech Boston's first ever editorial and events intern. He is now a junior at Harvard University where he studies Molecular and Cellular Biology. He’s also the Co-Editor-in-Chief for the Harvard Science Review. Previously, he worked as a Market Intelligence intern at athenahealth and as a research assistant in the Goldberg Laboratory at Massachusetts General Hospital.
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