How can doctors make America a better place to live?

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

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 physician health organization, I believe hospitals and doctors can develop effective synergistic relationships without rancor or dominating one another.

• 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 Amazon.com and Barnesandnoble.com, They are do their book reading on Kindle and Nook. The transition from print to online is well underway and irreversible. Web publications like Modernmedicine.com, 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.

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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  • http://www.futurewaredc.com Chuck Brooks

    Short answer: Ditch medicine for law and become a lobbyist in Washington.

  • Classof65

    Do not forget, however, that large segments of the population still do not have computers and/or access to them, nor do they even know how to use one.

    Please, doctors, get together and make wish lists that you believe will cut healthcare costs, both yours and the patients’, and yet maintain a high quality of care. You are some of most intelligent people in our nation and we need your input. Yes, we do need to address malpractice issues, but there must be other subjects to address as well…

  • Doc99

    Doctors already make America a better place to live. Doctors generate revenue and income streams far beyond the scope of medical practice. Doctors create jobs, purchase good and services. Doctors pay taxes – sales, property, income and yes, corporate. Doctors contribute to their communities far more than just treating patients. In “Its’s a Wonderful Life,” Clarence showed George Bailey how many people’s lives would be all the worse if there were no George Bailey. I suggest that America without Doctors would be far worse off.

  • Primary Care Internist

    class of 65 – here are a few simple ideas that I believe will cut costs. Of course such a plan will have enemies. But any plan that shifts spending from one group to another will have enemies. The challenge is really to not be a politician and just try to please everyone, rather to make difficult decisions that you yourself believe will make a long-term improvement. Also, it’s extremely important to remember not to let “the perfect be the enemy of the good”. That is, don’t ditch a plan that’s not perfect, just to wind up accepting the status quo, which everyone agrees is inadequate. So here goes:

    1- instead of a whole new public option, for now just expand medicaid to include, say, 80% of the uninsured for starters. If and when savings are realized, ramp up that number (say in 2-5 years) to gradually narrow the subset of the popuation that isn’t covered.

    2- Unlike current medicaid programs (my experience is with NY state), impose a minimal copayment for all services, with higher copays in the ER setting. This forces patients to have “skin in the game”. Improve reimbursements to primary care docs to the level of medicare, to expand the base of MDs willing to accept medicaid. Give patients incentives to remain healthy e.g. lower copays. I find that EVERYONE on medicaid in NY that i’ve ever seen can afford a cellphone, and many even have cars. They can certainly cough up $10 to see the doctor a couple of times a year.

    3- end-of-life care: have patients’ families pay just 1% of their demented dying terminally-ill relative’s hospitalization and ICU stay. This way, the taxpayer is still paying 99% of the cost, so they can’t say they’re being “abandoned” but they are forced to realize that resources are limited. It truly astounds me what some people are willing to put their relatives through as they’re dying. And a two-week ICU stay, intubated, on zyvox, and with multiple CT scans & specialty consults, might cost $300,000 JUST FOR THAT ONE PATIENT. Imagine that money going to vaccinate kids, or to Haiti, for example, JUST FOR THAT ONE PATIENT!

    4-pharma: no reason to give every “me-too” drug prolonged patent extension. A new drug class created, fine, different story. The first ACE inhibitor, or gleevec, eg. deserves to make tons of money, as this represents a true breakthrough. But now we’re up to like 7 or 8 ace inhibitors. What a waste. the only ones who benefit are copycat pharma companies. Now with medicare part D, we all pay the price.

    5-medicare advantage: can be disbanded in favor of traditional medicare plus vision& dental coverage. Some would say “what about people who can’t afford the deductibles & copay of medicare, and with mcr-advantage they get vision & dental too”. But if medicare is paying the advantage plans about 120% of what it’d otherwise cost medicare, then medicare can afford to cover all that stuff without going thru united/oxford/aetna/blue-cross, and still save money.

    Of course any of these moves will alienate some particular group, and on the whole they are not perfect, and will inevitably leave some people uninsured. But as a package this is MUCH better in terms of cost & coverage than the status quo, and probably MUCH cheaper than what’s been floated so far (which I’ve never understood from the beginning).

  • Primary Care Internist

    Oops one more (big) thing i forgot:

    6- tort reform – a “loser pays” rule to prevent frivolous lawsuits, and a cap on legal fees to $100/hr or 10% of settlement. Then let’s see if the lawyers are really still just “looking out for the interests of victims” who probably make closer to $10/hr, and if they can still fool such people into thinking they’re truly advocating for anything but their own undeserved payday. Of course, we know that such a proposal would never fly under this administration, which is just bought by every lobbyist under the sun, chiefly the trial lawyers & bankers. But this would save untold amounts of money.

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