Monday, January 11, 2010

What Can Physicians Do? A Rallying Cry

What can physicians do to make American a better place to live, die, afford, and receive care ? What can we do to bring about practical reform? What can we contribute?

These may seem odd questions, After all, we deliver care. Care goes through us. But Medicare, Medicaid, and private third parties are big players. They dictate terms of engagement and payment. But the answers lie at the core of the physicians’ dilemma – how do we guide reform without being perceived as acting only in our self-interest?

Ineffective Nationally, Effective Locally

Independent practitioners in groups of six or less deliver 80 percent of care. But by and large physicians have not been effective in resolving national health care issues –such as tort reform, competition of health plans across state lines, and patient-driven care with HSAs.

Politicians and the media apparently believe health care at the national level is too important to be left to individual doctors. But people still admire their own doctors. People still believe , to paraphrase Tip O’Neil on politics, “all health care is local.”

Making an Impact – Three Keys

But how do we make an impact? How do we deliver more effective care without federal intervention? We need to be pragmatic about what works.

The first key is practicing “virtual medicine.“ We must deploy the Internet to organize independent physicians. That way we can deliver quality, less-costly care. We can deliver it at the “point of care” – in our offices where patient meets doctor – but also in the homes. We can deliver it in detached diagnostic and treatment and rehab and rural facilities where telemedicine comes into play (see medinnovationblog, December 20, 2009. “Virtual Medicine: The Lever That Just Might Save Independent Practice.”)

Yes, virtual medicine has obstacles – malpractice, privacy, payment, and turf issues – but these barriers can be overcome. Given the growing adoption of broad band access in homes and businesses, indeed, in every segment of American society, overcoming these pitfalls is doable if we make patients “virtual partners.” We must make it convenient for them to enter their data, including their present complaints and past medical history, requests for refills and help for help for minor ailments.

The second key is recognizing that hospitals remain the health care power and organizing center in most communities. This is because of brand name recognition and the tradition of hospitals as the places to go in times of urgent need, and as natural gathering sites for doctors. Hospitals need doctors. Without physicians, one wag noted, “hospitals are simply institutions with bad food.” Physician executives led the most powerful hospitals and integrated health systems.

It is probably inevitable that most “independent” hospitals and “independent” medical staffs will develop bundled payments, a mix of fee-for-service with capped budgets, for most episodes of hospital care. Based on my experience as chairman of a PHO, I believe hospitals and doctors can develop effective synergistic relationships without rancor or dominating one another. (J. Hawkins and R. Reece, Sailing the Seven “Cs” of Hospital-Physician Relationships – Competence, Convenience, Clarity, Continuity, Competition, Control, Cash,” PSR Publications, 2006).

The third key is developing an overarching online communication source for independent physicians. This source must contain multidisplinary content. It must address the needs, strengths, opportunities, and innovations necessary to overcome fragmentation. It must serve a vast audience of independent physicians in a timely fashion. It must respond quickly and efficiently to their needs. It must bring together reliable content from multiple professional organization . And it must be online.

Because the Internet and search engines like Google and Yahoo ar efficient and low-cost means of delivering information, medical print publications, as well as newspaper organizations and publishing houses, are dropping by the wayside. Computer screens are replacing newsprint. Americans are doing their reading and gathering their information on countless websites. They are getting their daily news from blogs and from the Web. They are buying their books from and, They are do their book reading on Kindle and Nook (for background, see Sven Birkets, The Guttenberg Elegies:The Fate of Reading in an Electronic Age<, 1994). The transition from print to online is well underway and irreversible. Web publications like, which has acquired Modern Medicine and Medical Economics, are rapidly evolving as main sources of information for independent physicians.

Riding the Curve and Getting the Job Done

To make these keys work in their favor, independent physicians will have to ride the Internet Curve. We must acknowledge the world has irrevocably changed. It is moving with accelerating speed. Old business and practice models no longer work. We must move – systematically, organizationally, and purposefully – to a new world order for our own good, the good or our patients, and our survival.

The catch phrase of the Great Depression was “Brother, can you spare a dime?” In the Great Recession, still with us, the new phrase will be, “Brother, can you paradigm - online, realtime, all the time, everywhere?”

If independent physicians can conceive and believe in the new electronic order of things, we can achieve freedom in the clinical streets rather than submit to a new world order dictated by elites – if we have the will, the tools, the collaborative spirit, and the organizational heft – to do the job.

Cursing the darkness will not get the job done.

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