Come, let us build ourselves a city, with a tower that reaches to the heavens, so that we may make a name for ourselves.
– Genesis 11:4
With these words, so begins the biblical story of The Tower of Babel. The tale was written, at least in part, to explain the origin of different languages. Essentially, a group of earth’s early inhabitants started to build a tower to the sky in order to see with their own eyes God’s heavenly home. Alongside grandiose intentions, they worked and worked, up until God finally put a stop to the project by confusing the language of the workers. The building of the tower ceased.
On a daily basis now, my medical colleagues and I have been hoping for a similar divine intervention to take place within America’s health care system. Literally, “Stop the Babel!” sums up our humble request. Babel means a scene of noisy confusion, which is the most accurate description that I can give you regarding the current administration of medicine in this country. The current Tower of Babel is being built with a myriad of uniquely shaped bricks, many of which I’ve previously described to you, including the poor management of health care quality measures by the Centers for Medicare & Medicaid Services (CMS), the failure of the American Board of Internal Medicine (ABIM) to provide value regarding physician certifications, the over-reliance on data in medicine, and the expanding bureaucratic burdens that continue to move medical providers further and further away from being the centerpiece of health care delivery.
A Tower of Babel is being assembled in health care, and more bricks are getting laid every day. Many of us suspect that it will ultimately crumble, but there is something else that you should know. There is no longer just one tower anymore. In fact, unless our Congress allows for rapid movement in a better direction, you will learn quickly about the two towers of medicine.
The two towers of medicine
The first tower is that of Babel, and as I’ve already outlined, we know the direction it’s headed. The other, however, is a structure being crafted by physician businessmen and businesswomen — those with a vested interest in driving health care quality. Let me explain.
You see, the direction health care is currently headed is just not going to work for some people. Can you imagine Mark Cuban, current owner of the Dallas Mavericks professional basketball team, in 9 years (he is currently 56 years old), receiving his medical care from within a CMS-funded tower? I don’t think so. Remember, the Tower of Babel is essentially being constructed so that Medicare and Medicaid recipients can be controlled from within an “integrated health care system.” Ask our veterans how well this type of government-funded program is doing for them. It’s called the Veterans Health Administration (V.A.), and I’ve worked there before. Enough said.
Is Mark Cuban going to wait hours for appointments in an inefficient system? Is he going to stand in line at the pharmacy all morning to pick up prescriptions or wait months for an outpatient exam to be scheduled and completed? The people that work within systems like this aren’t bad people. Quite the contrary. But, their system is overly bureaucratic, burdensome, and the employee motivators are all backwards. When you build systems that have limited incentives to see more patients, people stand in line. People wait instead of work. This is Economics 101.
No, Mark Cuban isn’t going to stand for that kind of value with his health care. And, I suspect that even if you don’t have a billion dollars of net worth, you will feel exactly the same way. You will want to get out of the Tower of Babel.
Physician businessmen and businesswomen
There is a sector within the medical industry right now that has started to boom for one reason — the single fact that it doesn’t accept dollars from government-funded payers like Medicare and Medicaid. This industry is founded predominantly on physician ownership models and operates under the direction of physician businessmen and businesswomen who understand value in health care.
If you are less familiar with this type of thing, take a look at the Surgery Center of Oklahoma, a 32,535 square foot, state-of-the-art multispecialty facility in Oklahoma City, owned and operated by approximately 40 of the top surgeons and anesthesiologists in central Oklahoma. If you live near me, you could even go visit a new free-standing emergency department built just minutes from my house, or any number of similar facilities that are groundbreaking at a rapid pace in my state and surrounding ones.
Why don’t these facilities accept money from Medicare and Medicaid? Isn’t getting a dollar from CMS the same as a dollar from someone else? Well, it’s not, and the main reason deals entirely with red tape. There’s too much of it when you have to work with CMS. You see, innovation in medicine, time and time again, gets squashed by red tape. And, believe it or not, every inch of that red tape costs administrative dollars that ultimately we all end up paying for with our tax dollars. But, don’t worry about any of that, because I’ll give you a better question to be asking. Is all this red tape even necessary to drive quality? Go visit some of the businesses that I mentioned above, and I suspect your answer will be the same as mine. Absolutely not.
Imagine arriving at an emergency department where you are escorted directly into your room. Two flat screen televisions are on the wall, with various informative screens cycling through on the monitors. One screen highlights the names and credentials of the doctors and nursing staff who will be caring for you. Another screen reveals a list of the various tests that have been ordered, with a checkmark appearing next to each item as it’s completed. The same high-definition monitors are used to display exam results as your doctor goes over your treatment plan. Your assessment is rapid, and your follow up appointment is already scheduled by the time you leave. You walk out of the facility with a “thumb” drive containing an electronic copy of all your tests. A video of the physician explaining your diagnosis and treatment plan is emailed to your smartphone just in case you want to review the recommendations again at home.
All of these things and more are already being developed outside of the Tower of Babel. In fact, value actually explodes in the absence of red tape. And, nothing that I’m telling you should be the last bit surprising because when you unhook a heavy cart from a walking horse, the horse wants to run. Every time.
We are headed to a system of two tiers unless marked policy changes occur rapidly. And, I’ll state the obvious here because it’s the most important realization on this entire page. To where are the very best doctors going to ultimately gravitate? In which tower will you find them? The one with the red tape? The Tower of Babel? That’s a rhetorical question.
Just know that I’m going to keep fighting for you and the future of your health care. Remember, we are in this together, and we still control our destiny. I’ll gladly welcome your help in Washington because I’m telling you that the red tape must stop. It’s overwhelming us with Babel. We need to let the poor horse run. If we don’t, you know where you can find me.
Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at BilhartzMD.com