Wednesday, October 17, 2007

Clinical Innovation - Physician Advice on Innovation and Reform, #2

My second piece of advice on a speech I'm writing for an academic audience comes from Howard J. Luks, MD, a board certified orthopedic surgeon who specializes in orthopedic sports medicine, arthroscopy, and knee and shoulder replacement. He is Chief of Sports Medicine and Arthroscopy at University Orthopedics, PC, and Westchester Medical Center. He is an academic and practices in Hawthorne and Fishkill, New York. He blogs at

I must say that I clearly fall into your market oriented group.

I believe a multi-tiered system will arise from the rubble. The highest level will be for those who can afford and more importantly, those who want to afford it. They will have access to the most expensive (and potentially unproven) medications, technology and services. There will be a level below that which most employers will offer, but it will limit expenses on meds (Walmart's $4 list) and potentially limit access to "experimental" technologies and services. Somehow the patient will need to share the financial burden of some of their choices eg. MRI for knee pain, etc. But I do not beleive that chronic disease care, or emergency care should be tied to their deductible. You shouldn't be afraid to go to the ER with chest pain because of a deductible.

Ultimately there has to be a safety net program in place. This will assure that the 50 or so million americans who worry about their next illness and the "theft of a brighter financial future" has access to medically necessary care. Unlike Mcaid, even the safety net system will need to be a co-pay based system (even if it is only $5) to prevent some of the abuses that occur with Mcaid.

I strongly believe that the market should be allowed to drive the system. Meaningful, transparent and independent quality and outcome measures must be available to everyone.

Medical errors must be addressed by having a nationwide EMR/PHR system that will monitor for drug interactions, allergies and perhaps disease management too.

Not sure I helped...just my thoughts

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