Doctor’s Tip: Needed steps to improve health-care system
Last week’s column discussed what the 2010 Affordable Care Act (“Obamacare”) did and didn’t do to fix our broken and expensive health care system. That column and today’s are based on insights by Robert Pearl, M.D., CEO of the Permanente Group and author of “Mistreated, Why We Think We’re Getting Good Health Care — And Why We’re Usually Wrong.”
As noted last week, the ACA provided medical insurance to many million more Americans, but, among other things, it did not bring costs down as quickly as people wanted.
The architects knew it wasn’t a perfect bill, and counted on bipartisan tweaking over time. The bill was the best that the politics of the time allowed. So where do we go from here?
Health care in America is still considered a privilege rather than a right, with millions still lacking affordable care. One of the first things Americans need to do is to decide whether we are going to join the rest of the industrialized world and make health care a basic right for 100 percent of our citizens. Recent polls indicate that a large majority of Americans now favor universal coverage.
Here are four things that Dr. Pearl thinks we need to do to make our system less costly, safer (fewer system-caused injuries and deaths), more integrated and less fragmented. He calls these “the four pillars of health care transformation.”
Pillar 1: “Physicians working together on your behalf.”
• Hospitals should consolidate — it’s inefficient, expensive and leads to poor patient outcomes for each small town to have a hospital.
• When quality and service outcomes are measured, integrated medical groups (large, multispecialty medical groups such as Kaiser and the Mayo Clinic) score the highest.
• Seventy-five to 85 percent of our chronic diseases are preventable though lifestyle modification. So at least three-fourths of the $3.2 trillion we spent on health care in 2016 is avoidable.
• We need more primary care providers out there preventing disease, and they should get paid more than they do now relative to specialists.
Pillar number two: “It’s better and cheaper not to get sick in the first place.”
• Current pay-for-service medicine “pays health care providers to do more, not better … and enables unnecessary utilization and even rewards medical errors” (e.g. a hospital-caused infection occurs postoperatively, the patient has to stay in the hospital longer, and the hospital receives more money).
• We need to move toward a system where health care is prepaid. One way of doing this is capitation, where doctors get paid a set amount for taking care of a given number of patients. Another way is “bundling,” such as paying hospitals and doctors a given amount for a given procedure such as hip replacements.
Pillar number three: “What your doctor doesn’t know can hurt you.”
• “Health care will need to be technologically enabled, with comprehensive electronic health-record systems, patient access to medical information, and the ability to obtain care using mobile and video technologies.” Dr. Pearl notes that only a small number of hospitals in the U.S. currently apply advanced data analytics to improve patient care.
• There are multiple brands of electronic medical records out there, and they aren’t all compatible with each other, which is not only inefficient but dangerous (when a doctor sees you he or she might not have all the pertinent information). As Dr. Pearl says, we wouldn’t put up with this in other parts of our economy such as banking, but “as is too often the case, health care remains an outlier.”
• “Reinventing the house call” with virtual visits through technology would benefit patients tremendously.
Pillar four: “Who will you trust?”
• “Health care will need to be physician-led, which will require greater leadership training and development.
• Most physicians “care deeply about the lives they affect” and people trust them. Most of us don’t know much about business though. (This is why I joined a group practice, GMA, in 1973: It was big enough to have a business manager.) More than 50 percent of medical schools now have a joint M.D.-business degree.
One of Dr. Pearl’s final conclusions is that what health care needs are the four C’s: cost consciousness, clinical excellence, coordination and compassion. Next week’s column will be the final one of this series, based on “Mistreated.”
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.