Government Innovation, Electronic Inquisition, and Practice of Medicine

In America, innovation doesn’t just change our lives. It is how we make a living. Our free enterprise system is what drives innovation.

President Barack Obama, State of Union speech, 2011

In God we trust, all others use data.

W. Edwards Deming (1900-1993), American statistician

January 27, 2012 - As I write, The Health Care Blog and The Center of Medicare and Medicaid Innovation are co-hosting the Care Innovation Summit in Washington, D.C.

The events main speakers are:

• Rich Gifillan, Director of CMS Innovation Centers

• Todd Park, Chief Technology Officer at HHS

• Atul Gawande, MD, a surgeon, policy advisor, and author of Checklist Manifesto

• Don Casey, CEO, West Wireless Heart Institute

• Susan Dentzer, Editor-in-Chief, Health Affairs

• Marilyn Tavenner, RN, Acting Administrator of CMS

These speakers are government officials or supporters of top-down health reform. There is nothing wrong with that, of course, and what they advocate – a collaborative effort between government and the private sector to bring about innovation – is a good thing. And it is worth noting the CMS has launched a Innovation Advisors Program, designed to ultimately recruit 200 advisors from the private sector to help government bring about innovation.

Two Cautionary Notes

As the Advisory Innovation Program goes forward, I would like to insert two cautionary notes,

• One, Government is generally poor at innovation. As I observed in The Health Reform Maze: A Blueprint for Physician Practices (Greenbranch Publishing, 2011), now available as an E-book, there are six reasons for this lackluster performance.

1. Government cannot manage failure.

2. It seldom abandons a project.

3. It is not gambling with its own money.

4. Its success is measure in good intentions not results.

5. It succeeds in growing too big to fail and too influential to stop.

6. It cannot go out of business, can print money to keep on going, and is propped up by taxpayer money.

• Two, Government cannot solve all reform problems by acquiring, analyzing, transmitting, and paying for evidence-based outcomes. It is always tempting to say that data is objective, impersonal, and non-judgmental. But as everybody knows, studies can be structured to give one the results that one wants. This is especially true in the field of medicine, a combination of science and art – in which personal feelings, expectations, and life-death decisions are involved.

The Electronic Inquisition

With the rise of high speed, broad bandwidth, Internet-actualized capabilities, a quasi-religious belief that data will solve all problems is going on. If only government can collect enough data on enough doctors, hospitals, and other health care professionals,all will be well. The U.S. and private health plans will finally have enough data to judge who and what is good, who and what is bad, and who and what justifies federal payment. Data will somehow be the Holy Grail and the Final Enlightment.

In a economic and human sector as fluid, personal, emotional, individualistic, and unpredictable as medicine, this is dangerous thinking. Data alone is not enough to judge performance or assure satisfaction. That is why patient and doctor decision-making, sometimes independent of data, and why market-based behavior, based on freedom and choice, are equally as valuable and credible as data-based judgments.

Tweet: CMS Centers for Medicare and Medicaid Innovation are reaching out to the private sector to reach collaborative innovation decisions.