Saturday, December 12, 2009

Saturday Morning Mournings and Moorings

Saturday, December 12
- This morning I find myself mourning for the golden years of a prosperous economy and a productive profession. But at the same time, I see the American people and American physician sticking to their old moorings. Old Saybrook, Connecticut, where I live, is situated near the sea. Moorings are in short supply, and mooring costs are going up. The word around town is: stick to your moorings. This same principle may apply to health care and practice moorings.

ONE, as a nation, perhaps we ought to stick for a while to the old moorings, with a few incremental reforms. It is becoming apparent, we cannot offer deficit-neutral health care entitlements by superimposing a new system upon the old. Now in its 12 day of debate, The Senate found that out again on Friday. Richard S. Foster, the chief actuary of the federal Centers for Medicare and Medicaid Services, said yesterday that under Mr. Reid’s bill national health spending from 2010 to 2019 would total $35.5 trillion. That is $234 billion, or 0.7 percent, more than the amount projected under current law, he added. Mr. Foster noted you cannot expand Medicare, mandate coverage for most, and tax health plans, device makers, and drug firms without having these entities pass increased costs to consumers. There are no silver bullets and no miracles; expand coverage and you expand costs. You pay your money, and you make your choice between health care security and loss of economic vitality.

TWO, with the economy the way it is, more doctors are sticiking to their old practices, but innovating to cut costs and become more productive A reporter from the American Medical News called me yesterday to ask how small practices might innovate to cut costs. This is an important question because small practices provide 90% of care in the U.S. I have these suggestions: appoint a chief innovation officer, either your practice manager or a nurse among you current staff, save on data entry be having patients enter their chief complaint and history electronically using something like the Instant Medical History, hold a weekly innovation meeting and invite “wild and crazy ideas, offer gift certificates for winning ideas among the staff, compile a patient email list of patients and ask for suggestions, hire a scribe for data entry, buy your staff a copy of Meeting Patient Expectations by Susan Kean Baker and have them focus on “moments of truth” in the typical practice.

Cut mourning short. Now is the time to secure moorings.

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at www.iuniverse and other book websites. For information on speaking fees and arrangements, call 860-395-1501.

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