Friday, May 30, 2008

Employers, physicians business ideas - - What to Do Until The Messiah Comes

Brian Klepper, PhD, a well-known and insightful health reformer, asked me yesterday what I would say if I were to speak before a group of medical society executives. He is being kind. He doesn’t need my advice and will say what he wants to say.

Nevertheless, what came to mind was a country song. When I was growing up in Tennessee, there was a country song “Mother’s Not Dead, She Is Only A’Sleepin’, Patiently Waiting for Jesus to Come.”

When I think of the song, I think of some doctors in practice. Some are sleeping, patiently waiting for some miracle to rescue them from their doldrums.

• The bad news is: Jesus isn’t coming soon in the form of single single-payer , sharp updating of Medicare codes, or a consumer-driven overhaul of an entrenched system, which some have called a “calcified hairball.”

• The good news is the bad news may help doctors and their societies get down to the hard work of creating a new future As Peter F. Drucker, the father of modern management, declared, “ Innovation has to degenerate into work.”

What might his hard work be?

• First, doctors will need capital, not religious fervor, or righteous indignation. This capital may come from hospitals or health systems, venture capitalists, or grants from organizations like the Physicians Foundation for Health System Excellence. Doctors will need this capital to build infrastructure, install electronic systems, build new business models, and recruit new doctors.

• Two, doctors will have to look at themselves through the eyes of health care consumers and patients who want cheaper, better, convenient, and documented quality services delivered in the neighborhood . With gas at $5 a gallon that will be important.

• Three, physicians will have to prove to the public that they can create new business models – for disease managed care, medical homes, and worksite clinics – that coordinate care and guide patients to go where they need to go.

• Four, physicians need to design and develop systems of systematic innovation spelled out and agreed upon at regular meetings that allow physicians to arrive at an agreed upon approach to innovate and please patients , reward doctors, improve care, and achieve camaraderie.

• Five, physicians need to think through and prepare for the day when patient-owned and patient-controlled personal health records arrive. That day will come soon because Microsoft, Google, and Dossia (a consortium including Intel and Walmart) have entered the market. Think of PHRs as wikis – patient records that will need to be continually updated and edited by doctors and that may make medical homes a reality.

• Six, to attract doctors to your state, push for malpractice caps, as Texas has done.

• Seven, consider engaging patients by having your doctors “prescribe” videos – with voice, plain language, and anatomical illustrations- telling them exactly what to expect from surgery; Emmi solutions offer these videos which please patients and drop malpractice actions immediately.

Unlike the Mamma in the song, physicians can’t be patient much longer, waiting for Jesus to come. Do it now, and don’t be caught be a’sleepin’.”


kevinh76 said...

You are so right. No one is going to save us. Not the government, not insurers and not patients. Our current system is like the airlines. People will go across the hall if the copay is $5 less. How are you going to pay your overhead when you are already maxed out on patient visits and Medicare is cutting payments by 10% in a month? I don't know that attracting hordes of new Medicare patients (ie. A medical home) that already pay less than the overhead is going to help out. The only thing that seems certain is that this is still a fee for service environment and what gets paid is more services. Their 10% cut will likely beget a 20% increase in services. The cardiologists who perform unnecessary stress nuclear tests in their office already know this well.

Anonymous said...

The Divine Physician has come and He has the Panacea for all the ills of souls and societies.
Baha'u'llah said:

Regard ye the world as a man’s body, which is afflicted with divers ailments, and the recovery of which dependeth upon the harmonizing of all of its component elements. (Bahá’u’lláh, ESW, p. 55)

The vitality of men’s belief in God is dying out in every land; nothing short of His wholesome medicine can ever restore it. The corrosion of ungodliness is eating into the vitals of human society; what else but the Elixir of His potent Revelation can cleanse and revive it? (Gleanings from the Writings of Bahá’u’lláh, #99)

Be ye as the fingers of one hand, the members of one body. Thus counselleth you the Pen of Revelation, if ye be of them that believe. (Bahá’u’lláh, The Kitab-i-Aqdas, # 58)

That which the Lord hath ordained as the sovereign remedy and mightiest instrument for the healing of all the world is the union of all its peoples in one universal Cause, one common Faith. This can in no wise be achieved except through the power of a skilled, an all-powerful and inspired Physician. This, verily, is the truth, and all else naught but error.(Gleanings from the Writings of Bahá’u’lláh, #120)

Political and economic considerations will be in-effective until the basic issue is addressed. If our country is set up in such a way that it can't do that, then we are in grave trouble.