Sunday, June 22, 2008

Renegotiation of Health Care

I have a quixotic dream physicians can renegotiate conflicts with major health care stakeholders. Surely these stakeholders will listen to reason – to cost and time burdens imposed upon physicians with unintended consequences.

My dream harks back to a 1999 interview I conducted for The Physician Executive with Leonard Marcus, PhD, Director of the Program for Healthcare Negotiation with Conflict Resolution at the Harvard School of Public Health. Marcus published a book Renegotiating Health Care: Resolving Conflict to Build Collaboration (Jossey-Bass, 1999).

I know this may be a pipe dream. Our political system is built on conflict and resolution through compromise. Conflict is in our DNA. It’s by design. That’s why we have three arms of government, two political parties, adversarial hearings, partisan scandal investigations, overheated political campaigns, constant Congressional haggling, and periodic elections to turn the bums out. In the end, the result is usually uneasy compromise.

Why not health care too? Why not try to break the gridlock over health reform? Maybe physicians should seize the initiative and renegotiate conflicts by seeking sustainable innovations to dig our way of the present imbroglio?

The renegotiation of physicians with stakeholders in other major health care sectors might resolve a few of these issues. These stakeholders, after all, depend of physicians for their existence. Perhaps a little conflict will build resolution.

Conflicts with Stakeholders to Be Renegotiated

Managed Care - Underpayment, speed of payment, unrealistic physician rankings, excessive out-of-network payments, unknown reasons for including or excluding physicians from networks, more coverage of patients with pre-existing illness.

Hospitals - Balance between competition and collaboration, reasonable payment for ER coverage and committee duties, coordination between hospital and physician IT systems, recognition that physician-owned facilities may provide better more specialized care.

Government - Relief from overwhelming paperwork, reasonable Medicare and Medicaid payment formulas, common sense on “non-payment” of certain unavoidable complications, raising codes for primary care physicians and Medical Home incentives, simplifying Medical regulations, now running over 150,000 pages, subsidies for those who can’t pay, adopting Federal Employee Benefit Plan, now available to all federal legislators and federal employees (what’s good for the gander out to good for the geese).

Medical Device Industry – Bar codes for devices to track effectiveness, information on relative effectives of imaging technologies, attention to costs and policies effecting “supply chain of medical devices,” one of fastest growing medical costs; a little credit to innovative physicians for developing new devices and sorting out those that don’t work.

Drug Industry
- Initiatives to reduce common generic drug costs, as Wal-Mart has done, regulations to monitor and control misleading Direct to Consumer ads and to limit TV ad time (how many of the virile healthy young men displayed in ads could possibly have ED?), acknowledgment among critics that drug firms support the lion’s share of CME in this country and that drug firms are not as “greedy”. The academic establishment doeth protest too much and too self-righteously about evils of drug marketing, physician –Pharma summits to reconcile differences.

Information Technology Industry – Realistic attitudes towards seamless interactive technologies not being the Holy Grail, understanding that data alone does not cover or render rationale all patient-physician interactions, work on common language and standards linking EMRs and PHRs, development of useful EMR software for different specialties with special needs and common situations, e.g., communicating with ER when you send patient, more attention paid to the expense of data entry.

The American Medical Association - A deeper knowledge that it is in trouble with its main constituency- America’s practicing physicians, who feel the AMA does not consistently act in their best interests, which may be why only one of four physicians belong to the AMA, why primary care physicians have only ½ and 1/3 the income of their specialty brethren, why many physicians have profoundly low morale, why 200 nursing schools are stepping into gap by a plan to produce more “nurse-doctors” to become the equivalent of primary care doctors.
The AMA does not get the credit it deserves for averting many potential legislative bad laws , but it should consider “U-turn” towards improving the lot of physicians.

And that’s just for starters

1 comment:

Meghan said...

Thanks so much for your article, very effective piece of writing.