Wednesday, November 11, 2015

Eight Concrete and Positive Alternatives for Physicians To Seize the Initiative on Health Reform

“The time has come,” the Walrus said, “to talk of many things,

Of shoes – and ships- and sealing wax –
Of cabbages and kings –
And why the sea is boiling hot
And whether pigs have wings.

Lewis Carroll (1832-1898), Alice in Wonderland

With health reform, physicians have been on the defensive too long. We have complained about our limited role in the scheme of things. We have pointed out ObamaCare’s deficiencies. We have said we are demoralized. We have groused we are not part of the health reform conversation.

Those days may be over. The time has come to seize the moment, to unite, and to put forth concrete, constructive, and positive reform alternatives. Because of the widespread unpopularity of ObamaCare and its persistent unworkability, Americans, doctors and patients alike, are looking for alternatives, any alternatives.

Here are 8 alternatives to improve health care delivery.

One, have existing major physician organizations coalesce around positive proposals to improve care and to broadcast these proposals to the American public and policymakers. Under the leadership of Richard Armstrong, MD, the recently formed United Physicians and Surgeons Association has already taken a step in this direction by hosting a summit meeting of health care leaders and organizations in July 2015 (see

At that meeting, physician leaders from SERMO, Doctors4patientcare, the Free Market Medical Association, the Physicians Foundation, and various medical associations presented ideas on how to make the system better. Their talks are available on videos and are available for distribution. In addition, an interview with Dr. Armstrong may be found on my blog Medinnovation and Health Reform (October 24, 2015). Dr. Armstrong explains physicians’ point of view on health reform. Similar interviews may follow,

Two, make electronic health records(EHRs) more useful, affordable, and interoperable among patients and physicians. Over 80% of practicing physicians have these records in their offices. Time is overdue to make EHRs more functional for both patients and physicians. One candidate for president, Dr. Ben Carson, has suggested every patient in the U.S. have EHR from birth, and the EHR be owned by the patient and be portable and accessible when the patient visits doctors. It is imperative that these records be under the patient’s individual control and be electronically secure.

Three, encourage physicians to organize “focused factories” This is Harvard business school’s Regina Herzlinger’s term for physician centers that address and treat specific diseases or perform repetitive procedures on ambulatory patients. Because these centers, which are frequently free-standing, do volume of work on common conditions or procedures, they are efficient and of high quality.

Four, let physicians develop and distribute mobile apps to their patients. We live in an information technology age, and more and more Americans have mobile phones. Why not have apps that help with issues like recovering from surgery, managing cancer-related pain, blood-thinners in patients with atrial fibrillation, anything that enhances physician-patient communication and improves outcomes and reduces emergency room visits or hospitalization.

Five, foster the use of telecommunications in those situations in which access to care in difficult or inconvenient. There are several variations off this theme. Skype connections with patients in rural areas; bedside monitoring of vital signs and visual images of bedridden patients with patients having the ability to initiate a physician encounter if patients perceive they are having a complication; and, of course, monitoring of wearable or implanted devices.

Six, give physicians the ability to prescribe social services – home care, nurse or physician visits, health care transportation, social worker access, home heating or cooling services, and even job placement – by having trained college, technology-savvy, volunteers set up “ help desks” in clinics and doctors’ offices so that these volunteers can direct patients to needy patients. This concept, pioneered by Health Leads, a Boston-based nonprofit, now exists in a half-dozen or more U.S, cities and has been backed by several million dollar grants from the Physicians Foundation.

Seven, encourage collaborative relationships between physicians and hospitals. These relationships do not require physician employment, but instead are based on arms-length relationships. For example, the Surgical Center of Oklahoma , which performs multiple ambulatory surgeries for requiring a one-day visit, is an independent entity that has a contractual relationship with a nearby community hospital to which it sends more complicated cases requiring overnight or more extended care.

Eight, be realistic. Individual or small practices may not hare the managerial or bureaucratic wherewithal to handle all of these problems. Some physicians may choose direct-cash arrangements without third party payment, but most will not be able to do so because of the local competitive. regulatory , or corporate environment. As I suggested in my 1988 book, And Who Shall Care the Sick? The Corporate Transformation of Medicine in Minnesota, “To survive and thrive over the long haul, physicians may have to fight fire with fire and form doctor corporations. These corporations will be limited partnerships, in which independent practitioners, as a group, will have a central management team that will handle billing and employment of personnel, negotiate legal and financial contrasts, response to requests from other organizations for service, and provide benefits for each limited partner.”

The long haul, described 27 years ago, has arrived.

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