Tuesday, July 22, 2008

What Can Physicians Do?

This week a Philadelphia psychiatrist, a Sermo.com backer, called. She waxed enthusiastically about Sermo’s open letter to the American public, which now has now 5800 signatures with a goal of 10,000 signers. The letter expresses displeasure with American health care and with physician relationships with HMOs and other health plans.

She said she had spotted me a “pragmatic futurist,” meaning, I gathered, I know what needs to done to right the physician ship and keep it afloat.

After 43 years of Medicare and roughly 25 years of intensive managed care, turning around the ship quickly will be like turning around the Queen Mary on the dime.
Nevertheless, here are a few ideas.

• Publish the Sermo letter and give it wide publicity to show all is not right and doctors are unhappy (As an aside, I don’t think complaining, bitching, and moaning is particularly helpful).

• Conduct a national survey of all primary care physicians to show their stark plight and the threat to their very existence (This is being done as I speak).

• Hold a physician-led national conference featuring leaders of state medical societies interacting with major stakeholders – health plans, drug firms, Medicare, AMA, AHA, device firm, supply chain companies – with the purpose of seeking innovative and systematic compromises. (in other words, quit kibitzing and take the lead).

• Push the hell out of a practical solutions that doctors think will restore sanity to the system, cut costs, put patients in the center, and reduce paper overload (This will inevitably involve streamlined IT systems, and new workable practice models).

• Acknowledge the marketplace, specifically consumers, business leaders, and an increasingly shaky Medicare system, is poised for change and is looking for leadership (Why not from physicians)

It may be a long way from here to there – from Disarray to Tipperary – but perhaps not. In a talk before the American Society of Medical Executives in Minneapolis on July 25, my fellow pragmatic reformer, Brian Klepper, says doctors and their medical societies, ought to face these “market inevitabilities.

1. Data-driven decision support systems
2. More public performance reporting
3. Reduced reimbursements
4. Larger practices
5. More pay for primary care
6. Big box retailing by corporations.

Brian may be right, but these things are just over the horizon. Doctors are at best lukewarm about points 1-4 and show little signs of moving decisively in those directions. There is general agreement primary care doctors should be paid more, but specialists are resisting if it comes out of their pockets. As far as doctors practicing in Big Boxes, retail malls, retail or worksite clinics, this remains a dream of the business community - the CVSs, Walmarts, and Walgreens of the world.

Brian sees Health 2.0 – web-based information platforms to support, aggregate, and reformulate care and to respond to market vacuums – and medical homes in various settings – corporate, retail, and offices – as the next two big waves.

He concludes, doctors and medical societies ought to;

1. Acquire the use IT
2. Understand others are watching and comparing
3. Adhere to best practices
4. Share data
5. Gain scale to enhance infrastructure.

Whatever we do, for physicians, it’s time to take the lead.

1 comment:

Unknown said...

I agree that physicians have been painted into a corner by a number of factors and you point out some valid items that need to be addressed by physicians themselves. However, the "blame" (if there is such a thing) is not all theirs.

One of the biggest problems I see with the current process is that the drug manufacturers have learned how to "game" the system in their favor. Most medical conferences are sponsored by the pharmaceuticals. So is most of the research. In short, "Big Pharma" holds all of the purse strings. To quote your title, "What Can Physicians Do?"

Until this country begins to reign the power that Big Pharma has over the medical community, the "Queen Mary" will continue to sail on its present course.