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Cost of Care, Part 1

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It's 7:30 a.m. Dr. Yuki Asaki is starting her day at the Dartmouth-Hitchcock Medical Center. Her first stop-- meeting with a team of pediatricians.

"Clearly we cannot do what we do in an inpatient world without being a team, but we are only starting to tap into what it truly means to have a team collaborative medicine as an inpatient and outpatient. I don't think that was a huge consideration until recently," Asaki said.

This team is trying to cure a rare illness involving a toddler.

"I always knew she was one in a million when I had her, but this is scientifically proven now," mom Anne-Marie Muscari said.

Eighteen-month-old Elayna-Marie is on the mend, recovering from eye surgery. She came here suddenly because of a growth on her eye. The Brattleboro girl suffers from a plasma deficiency. If untreated, it can lead to clots.

"It can happen anywhere in her body where there are mucus membranes," Muscari said.

Finding the right medicine is now the focus of Elayna-Marie's healing. The team is trying to make sure the youngster does not have to come to the hospital every day for treatment. It's a better solution for the family and the hospital. Keeping patients at home and out of the hospital saves money and often leads to a quicker recovery.

"I think patients get better care when they are able to articulate what's originally brought them to seek care; what has worked, what hasn't worked," Asaki said.

As health care enters a huge change, hospitals are trying to predict the future. Big hospitals like Dartmouth are worried there might not be as much government funding, and patients are left wondering what they will have for insurance and what that insurance might cover. That is why Dartmouth-Hitchcock called together a group that is following the changes. The class included hospital administrators, congressional staffers and those charged with changing the health care system. Journalists were invited to observe. Dartmouth wanted folks to have the real the real-life experience. That's why they gave us the white coats, the access to the doctors, the nurses and the patients. We were allowed to observe patients as they were treated.

The cost of care is huge. Just look at some of the dollars connected to Dartmouth-Hitchcock in the Upper Valley of Vermont and New Hampshire:

  • The hospital's annual revenue is $1.4 billion.
  • It employs more than 8,500 people.
  • Last year, 19,000 operations were performed here and more than 11,000 people were born at this hospital.
  • Thousands receive treatment.

The cost of care can't be ignored. That's why Dartmouth-Hitchcock wants its doctors not to rely on a system that pays them a fee for a service or test. Procedures can lead to a bigger paycheck for doctors and hospitals. But Dartmouth contends more procedures don't always lead to healthier patients. They are promoting a system that pays based on improving health.

"I have yet to find a physician that is doing this that they are just trying to buy a Ferrari and they don't care about patients and want to do a bunch of unnecessary things to hurt people," Asaki said. "I have just never met anyone close to that."

This young doctor is carrying thousands of dollars of debt at a time when there is uncertainty in her field.

"It remains to be seen how it will affect physician reimbursement, how it will affect primary care versus specialty care. I don't think we can make the same assumptions that all my attendants have gone through," Asaki said. "I am not sure what my income is going to be when I finish. It will depend on where I end up practicing and what kind of cardiology I go into."

Headed to Houston soon, but not before finding a treatment plan for a toddler. It's a little girl whose mom wants the best care for her daughter.

"She is not affected by these traumatic circumstances. I think it is more traumatic for me. She is doing really, really well," Muscari said.

"What is nice is, I think, kids and parents and pediatricians are on the same team," Asaki said.

It's a team not only focused on health, but the cost of care.

Related Story:

Cost of Care, Part 2

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