Tuesday, December 2, 2008

Managed Care, Future - Salivating About Health Reform


Prelude: Today, while organizing my library, I ran across Tom Peters’ book The Circle of Innovation (Alfred Knopf, 1997). Tom cheerleads for innovation as the key to survive and grow and is fond of such sayings as “Whatever made you successful in the past won’t in the future,” “It’s the end of the world as we know it,” and “You can’t shrink your way to greatness.” Tom is a freewheeling irrepressible enthusiast. He often uses italics, cartoons, capital letters – whatever it takes -to drive home his points. This is an updated version of a blog I wrote in September 2007.
Business innovators salivate about fixing health care. They look upon physicians as throwbacks, far behind other industries in adopting innovations to modern times for consumer use, marketing, and organizing integrated units to treat common procedures (hernia repair, joint replacements) and diseases (diabetes, heart failure, COPD, asthma).

Here are a few of his slightly edited thoughts onwhat he sees as the path to a Health Care Nirvana

• Use physician's assistants for routine work.

• Support home care to the maximum.

• Stop 100,000 + needless hospital deaths.

• Stress alternative therapies and wellness-prevention programs.

• Realize demanding "boomers" will determine health care’s future.

• Focus on women as the decision makers, movers and shakers of the system.

• Know "patient-consumer-driven" will change the game.

• Reduce incentives for unnecessary tests through malpractice caps and other means.

• Acknowledge outcome-based medicine is a must!

• Embrace evidence-based medicine as a terrific idea!

• Recognize the Life Sciences Revolution will make the "info revolution" look like small beer!

• Radically increase "best practices" use—inculcate in Med school.

• Push the imperativeness of the Medical School "revolution" —outcome-based medicine, emphasis on wellness & prevention.

• Get information to patients!(Detailed hospital-by-hospital, disease-by-disease, doc-by-doc success records a must—despite controversy).

• Upgrade information technologies throughout the entire system, starting with acute-care institutions.

• Hail the Mega-, integrated-information computer networks – e.g. WebMD.

• Move heaven and earth to implement electronic health records!

• By hook or crook, institute basic universal care , starting with kids, "market-based" as much as possible—but acknowledging it’s not a "perfect market."

• Deal with the enormous HMO perception problem, which is unrealistic. HMOs are necessary

• Blitzkrieg patient/customer/citizen education (e.g., re "outcomes-based health care," "Get the most for your health care dollar").

• Support "Healing-centric"care , e.g. Planetree hospital healing model.

• Emphasize front-to-back "customer care " practices, will cut down on malpractice claims among other things.

• Develop integrated specialized units from common procedures (hernia repair) and common diseases (diabetes).

• Shorten the FDA approval process.

Physician Problems In Implementing Peters’ Vision

• Peters’ solutions don’t address several “monster issues.”

• Who will pay primary care physicians, already in short supply and overloaded with patients, to spend time counseling patients about wellness and prevention?

• If wellness and prevention strategies work, who will care for and pay for elderly patients who survive to die a “natural death?

• Who will protect doctors against predatory lawyers, should demanding boomers not get what they demand from doctors?

• How are patients and their doctors to deal with and master the vast array of new technologies promising better health and greater longevity?

• How can you judge and punish doctors for poor outcomes, when most of those outcomes are due to patient non-compliance outside the physicians’ office?

• Who is going to pay for all of those EMRs, which cost roughly $15,000 to 30,000 per physician per year to implement?

• And how is the federal government going to round up and punish all of those citizens who don’t pay for mandatory insurance?

Peters’ solutions are idealistic, but are they realistic in a world where physician resistance to technologic incursions into the patient-doctor relationship, the right to misbehavior in a democratic society, and death, even death delayed by prevention and wellness, are inevitable?


Tom Peters, business innovation guru, offers his multifaceted program for fixing the U.S. health care system. It combines, among other things, universal coverage, prevention and wellness programs, “best practices” and “evidence-based” education starting in medical school, and universal adoption of electronic health records by physicians. Sounds a little like Obama’s solutions.

My question are: Given the likely $1 to $2 trillion federal deficit for 2008 and the severity of current year long recession, where is the money coming from? And where are the primary care physicians coming from who will be required to implement these ambitious programs? And how will they be paid? And who is going to write the interfaces for these EMRs, now numbering over 100, so the various EMRs can talk to one another?

Will Peter’s principles work? Medinnovation concludes it’s idealistic but not realistic. Maybe Peters should have a saliva test.

No comments: