The Great Finesse in Health Reform- Changing The Language

Richard Reece

Posted 10/13/11 on MedInnovations Blog

One man’s words are another man’s poison.

Anonymous

We were reasonably calculating in our approach. We consciously began using the language of the marketplace, rather than the language of medicine. We began talking in terms of “providers and consumers” instead of “doctors and patients,” for example. This, of course, was and still is highly offensive to many people in medicine, and we felt the old language was almost like the language of religion, and, thus, harder to use when trying to affect widespread change.

Paul Ellwood, MD, 1985, “Life on the Cutting Edge,“ Twin Cities Magazine, 1985

1n 1988 in Who Shall Care for The Sick: The Corporate Transformation of Medicine in Minnesota, I said that words matter in health reform, that use of “providers and consumers” signaled a transformation in American medicine, and that these words a “Grand Finesse” of American physicians, effectively distracting them from what was really happening.

I predicted physicians would become serfs of payers, physicians would be disillusioned , and ultimately, a doctor shortage would ensue.

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Another Modest Proposal*: Paying for Physician Training

Paul Fischer

One of the main considerations in physician pay under CMS’ relative value system is the training required to complete a task. This is generally thought to be well understood but is, in fact. a quagmire of controversy.

Take for example the specialty of family medicine compared with dermatology, anesthesiology, or ophthalmology. Family physicians make between 1/2 and 1/3 of what these other specialties make, so one would think that there is a huge training difference. The truth is that each of the four require 16 years before medical school, 4 years of medical school, and 3 years of residency.  The 3 highly paid fields require 1 additional year in a transitional internship.  So the family physician education represents 23/24 or 96% of the length of education required for the others.  Since when is a 4% investment worth a 200% to 300% return?

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The Need for a Level Playing Field for Physician Pay

Paul M. Fischer

Everyone in medicine knows that some physicians are overpaid for the services they provide and some are underpaid. The list of specialties in each category is no secret, though we don’t talk about it much.  It’s part of the same ethic that teaches us not to criticize another doctor’s care.

But the sad fact is that in medicine, money is tied to prestige, power, public credibility, and medical student interest.  If we don’t deal with this problem, medicine will continue to fall hopelessly into the “haves” and the “have nots,” that is, those who “own” lucrative CPTcodes and those who don’t. So the question is how did this inequity come to be and how can it be remedied?

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Experience is not the Answer

Bradley Flansbaum

First posted 8/25/11 on The Hospitalist Leader

I assume, incorrectly perhaps, that mechanics have a basic knowledge of their craft such that routine auto repairs require little effort.  The tasks do not supersede the expected competency of the repairperson, and the customer can expect a car that operates at the time of pick up.  A small percentage of jobs may stretch that assumption, but that is okay by me.  Just like medicine, some mends are complicated. You need assistance from another mechanic or you refer the auto to a specialty garage.  No one is superman.

How does this relate to the practice of medicine?

I frequently notice pharmaceutical ads on Sunday AM television broadcasts, as well as newspaper articles that advertise a medical product, or report on a new device, surgery, or therapy—usually of the latest and greatest vintage.  As the data for these interventions is incomplete, or the costs unknown, the story concludes with a riposte conveying that the reader need not concern themselves with the alien facts—just “consult your health professional” and all will be well.

I also observe that politicians object to “meddling” when EBM-based policies from expert committees passively (or actively) affect the doctor-patient relationship, especially as it relates to decision-making and the counsel we provide.  Just watch the nightly news—sound bites abound.  This relationship is sacrosanct after all, and our advice is authoritative and 98.7% correct.  Who would question a physician after all?

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The Practice of Medicine: From Marcus Welby to ???

Jaan Sidorov and Vince Kuraitis

First posted 8/17/11 on e-CareManagement Blog

Physicians face great uncertainty. According to a survey conducted byThe Physicians Foundation, the great majority of physicians (89%) believe the traditional model of independent private practice is either “on shaky ground” or “is a dinosaur soon to go extinct.”

In the face of this uncertainty, many physicians are jumping to a conclusion that “I have to sell my practice to the hospital.” In this post of our series on The 100 Year Shift, we will examine physician practice.  We’ll show that the economic and clinical environment  is changing rapidly and that selling to the hospital is one option. However, it is not the only option.

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Avatars, Computers and Robots Are Coming To Primary Care

Kent Bottles

First posted 8/19/11 on Kent Bottles Private Views

Within in five years primary care providers will begin being replaced by sociable humanoid robots, avatars, and computer programs. Within ten years you will no longer hear any complaints about medical students choosing specialty residencies over family practice because the role of the physician will be completely redefined to complement a rules based approach to the diagnosis and treatment of many diseases. This transformation is inevitable because of demographics, economics, and progress in artificial intelligence, but the academic leaders of medical education and health policy are largely ignorant and unprepared for this massive disruption.

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More Clinicians Understand That Patients Want To Communicate Online

Jane Sarasohn-Kahn

First posted 6/26/11 on Health Populi

As people take on more DIY approaches in their daily lives for travel planning, photo management, and investing, they’re looking for health care touchpoints to do the same — especially, their physicians. In 2011, more doctors are responding to this patient-driven demand, based on data published in the InformationWeek digital health care issue July 25, 2011, titled The Pain of Change.

Most patients would be willing to change physician practices if their doctors don’t offer online access to tools, based on a recent survey from Intuit which Health Populi covered in March 2011 here.

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Payment Transformation: From Volume to Value

Jaan Sidorov and Vince Kuraitis

First posted 7/7/11 on eCareManagement Blog

This is the 2nd installment in a series on the Strategic Realignment among Physicians, Hospitals and Payers

In our introductory posting, we suggested that a huge shift is underway in the health care industry.  Decades of hospital-physician cooperation are not only eroding, we suggest this trend could accelerate.  Instead of a natural clinical and economic affinity with hospitals, we foresee the potential for physicians forming a new dyad with insurer-buyers.

In this post, we will examine what we and many other commentators view as inevitable: the demise of volume-based payment systems and how the drive for greater value will cause physicians and insurers re-examine their normally antagonistic relationship.

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The 100 Year Shift? Introduction and Overview

Vince Kuraitis and Jaan Sidorov

First posted 7/5/11 on the eCareManagement Blog

Gazing at the horizon, we foresee the potential for a tectonic realignment among physicians, hospitals and payers. Here’s a quick visual representation:

Past100

Next100

This essay is the first of a seven part series. In this first post we will capsulize our vision of this potential 100 Year Shift, answer initial FAQs, and lay out the structure for the rest of the series.

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The Implications Of Smartphones and Tablets in Patient Care

Jane Sarasohn-Kahn

First published 6/17/11 on Health Populi

Physicians who have adopted smartphones and tablet devices access online resources for health more than less mobile physicians. Furthermore, these “Super Mobile” doctors are using mobile platforms at the point of care.

Physicians adoption and use of mobile platforms in health will continue to grow, according to a survey from Quantia Communications, an online physician community. This poll was taken among 3,798 physician members of QuantiaMD’s community in May 2011. Thus, the sample is taken from the community’s 125,000 physicians who are already digitally-savvy doctors. QuantiaMD calls physicians with both mobile and tablet devices “Super Mobile” physicians.

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The Erosion of Physician Independence

Jane Sarasohn-Kahn

First published on 6/13/11 on Health Populi

Doctors won’t be celebrating Independence Day on July 4th — at least when it comes to their professional practices. The days of the cottage industry physician are dwindling as more doctors are losing their independence, instead opting for employment.

There are several reasons for physicians’ exodus from private practice: these include increasing administrative burdens, economies of scale for adopting information and communications technology, security in uncertain futures around reimbursement, and that all-important work-life balance. Accenturepoints out these trends in a summary report, Clinical Transformation: Dramatic Changes as Physician Employment Grows.

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Only Docs Can Do It

Merrill Goozner

First published 5/19 on Gooz News

Do what, you ask? Cut costs. So say Victor Fuchs and Arnold Milstein in a sprightly overview of the roadblocks to cutting health care costs in the latest issue of the New England Journal of Medicine.

The short essay begins with the observation that the most cost-effective and often highest quality health care systems in the U.S. (usually organized as non-profit, integrated groups like Kaiser Permanente or Intermountain Health) deliver care at 20 percent less than the national average. Spread their model to the rest of the system and it could lop a whopping $640 billion off the national health care tab.

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Health Care Reform Revisited – The Elephant in the Room: Part 1

Sean Sullivan, JD

First published 5/17/11 on the Institute for Health and Productivity Blog

I had the pleasure week-before-last of attending one of my favorite health care events – the CAPG 2011 Annual Conference in Palm Desert, California (just a few hours’ drive away from IHPM’s headquarters in Scottsdale, Arizona).

CAPG stands for the California Association of Physician Groups, considered by many the most significant physician-based organization in the country and IHPM’s partner in a new initiative aimed at harnessing the power of the nation’s most advanced medical groups to proven worksite health improvement programs to produce even better outcomes in the working population.

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Average Annual Health Costs for a US Family of Four Approach $20,000, With Employees Bearing 40%

Jane Sarasohn-Kahn

First published 5/11/11 on Health Populi

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context,

  • The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350
  • The car buyer could purchase a Mini-Cooper with $20,000
  • The investor could invest $20K to yield $265,353 at a 9% return-on-investment.

Continue reading “Average Annual Health Costs for a US Family of Four Approach $20,000, With Employees Bearing 40%”

US Physicians are Becoming Health Economists

Jane Sarasohn-Kahn

First published 4/21/11 on Health Populi

Doctors practicing in the U.S. are becoming increasingly conscious of the increasing costs of health care. Most consider themselves cost-conscious, and are considering the impact of their practice patterns — in terms of prescribing medicines, tests, and procedures — on the nation’s health bill. In fact, most physicians feel they have a responsibility to bring down health costs.

This perspective on physicians comes from the survey report, The new cost-conscious doctor: Changing America’s healthcare landscape, from Bain & Company, published in March 2011. Bain spoke with over 300 U.S. physicians to assess their perspectives on managing costs, drug and device usage, and standardized care protocols.

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