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Physicians must leave their isolation and balance several roles


James C. Salwitz, M.D., says that physicians must learn to balance roles as healers and, increasingly, as financial stewards and information-technology practitioners, each working day.

Among other things, he bemoans that:

“Physicians insist on ordering what they want, regardless of cost or net patient benefit. Doctors do not watch the henhouse, so someone else has to. It would have been a very different world if, from the start, the medical profession had accepted financial stewardship as part of their mission.”

“Look at information technology (IT). Healthcare is the last major industry to transition to a silicon base for decisions and communication. Because doctors have blocked IT every step of the way, nonmedical personnel, who often fail to appreciate the needs of doctor and patient, have written electronic medical record (EMR) software. And, because doctors have not seized on the power of the EMR as a patient care tool, the billers and insurers took control, so that the average EMR is not only clinically inadequate, it is focused on coding, posting, and accounts receivable.”
“If healthcare is to produce the best quality and personal result for every patient, doctors must leave their self-imposed isolation. They must make what can be a very difficult transition — that of changing of thought from the bedside to the boardroom and then back again, often in the same day.”

“The physician who can bring, in real time, the experience of the patient to the leadership process, tempered with an understanding of how complex biology and business systems interact, adds an incredible amount of value to healthcare. This is critical to the development of medical systems that actually work to the maximal betterment of every patient.”


A plug for managed care


Jeffrey Gene Kaplan, M.D., argues here that managed care is the best way to reform healthcare.

Among his remarks:

“Incentive alignment is critical. Capitation does not cut it simply because under it, the incentives are to do less. Also, capitation frustrates because a lot goes on that the provider cannot control. And, we all know the problems of fee for service, private practice, etc. It fractionalizes care and leads to unnecessary services and over-utilization.  Separate primary from preventive care; reorganize care around patient medical or surgical conditions, forming what they call ‘Integrated Practice Units’ (essentially team work).” 

He touts a 2013 by Porter and Lee that recommends:

1.    Separating primary from preventive care and reorganizing care around patient medical or surgical conditions, forming what they call “Integrated Practice Units” (essentially team work).

2.    “Measuring to manage the outcomes from the patient’s perspective and costs of the longitudinal view, the ‘cycle’ of care of every patient.”

3.    Converting from fee-for-service or prospective payments to bundled payments for episodes of care. 

4.    Ensuring that healthcare-delivery systems be made collaborative.

5.    Considering all care, not just local care.

6.     Using information technology to integrate disparate elements of care and understand what happens to “whom,” “where” and “when,” and what works or does not, and communicate to improve efficiency and effectiveness.

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