Changing the Healthcare Conversation

It is virtually impossible to develop a relationship with poly-chronic, poly-morbid patients with a waiting room full of people with routine issues who pay the bills.

It happens every day, people present with serious health issues and there's barely enough time to manage the conditions, and none to manage the patient.

If you did take the necessary time to manage the patient, it would put your practice in economic peril because the present fee-based system is based upon volume, not value. The value-based systems require you to work in the blind with month's old data and little information. The right analytics are very expensive, and the skill sets to use them are still being learned with the exception of early adopters, who are few and far between.

Legislative initiatives have not worked because health insurance coverage is not healthcare and it is impossible to make a broken system work by spreading its cost among more people. To make things right, the conversation must change.

For example, there is much ado about the erosion of the patient-physician relationship. Fixing it is not all that hard if the power shifts to its owners, patients and their physicians.

Making that change requires a shift in the dynamics of power from hospital systems, which follow doctor's orders, to doctors, who give those orders. Power like that is never ceded without a fight, and, doctors are woefully outgunned, outspent, under-represented and disorganized.

There are legislative steps that can begin to even the marketplace and playing field without disrupting it.

Here are my top four:

Physician Equality in Accountable Care

Physician accountable care organizations (ACOs) consistently outperform hospital-owned programs despite inferior resources and competitive disadvantages. This is a simple matter of economics. Hospital systems can and do work very effectively to improve quality, access, and spending in one area – their self-insured employees. It's their money, after all.

On the other hand, there is no incentive to cannibalize whole dollars in revenues needed to pay for bricks and mortar, payroll, and operating expenses to get a portion of those savings and share it with physicians.

A simple solution is for payers, including Medicare and Medicaid, to set aside budget to give physician owned ACOs proper resources for analytics, education, training, and support to enhance their impact. It is an evolutionary process, not to deny care, but to improve health status.

Merit-based Participation in Accountable Care

Large, ineffective ACOs block smaller, more effective ones from the marketplace. The solution here is simple, direct CMS to create participation rules that require performance.

Put money toward achieving your goals

Budget added funds for independent primary care physicians to discourage and free them from employment by hospitals and hospital systems, and reimburse them to manage patients' care instead of performing tasks. Again, this is straightforward economics. If you can't control the prescription pad, employ the pen. This isn't good for anyone because at over $3 trillion in healthcare spending, twice the per-capita of the next most expensive country and worse than mediocre results, the system is already tipping toward failure.

Mandate Price Transparency

An informed and empowered physician can act as a responsible advocate and purchaser for their patients only if they know the cost of what they are purchasing – including the relative cost of alternatives. Not just unit price, but episodic cost for treating the same condition.

This is probably the simplest, common sense, and vexing of any potential solution.

But, then again, in a healthcare system that defies logic and common sense in so many ways, it is a madness to which we have become inured.

It will take real political capital and political support to take on a $3 trillion behemoth like healthcare. When better, and whom better, to pick up the baton than physicians?