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“Outrageous!” was the reaction of some physician leaders to a recent article in The New York Times by Elisabeth Rosenthal entitled After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know. In the piece, Rosenthal tells the story of a patient negotiating charges for his neck surgery to correct herniated disks even as he was being wheeled into surgery. This patient was asking for price transparency, something many patients are now asking for as they experience the expanding world of Consumer Directed/High Deductible health plans. The patient was subsequently “blindsided” by a bill for $117,000 from an assistant surgeon whom the patient didn’t know. What’s more, the physician was out-of-network, which supposedly allows the doctor to charge any amount. The patient could not negotiate this bill – he was lying unconscious on the surgical table.
I recently met with former CEOs of prepaid group practices (PGPs) that were part of the early years (1984-2000) of the HMO Group—now the Alliance of Community Health Plans—a coalition of not-for-profit, pre-paid group practices. (I was the first president and CEO.) One of the most notable accomplishments of this alliance back then was the creation of HEDIS. Since my trip, I have been reflecting on the similarities and differences of the state of the health care industry 30 years ago and what it is now.
This week, I participated in a tweet chat (#BopChat) hosted by the Commonwealth Fund (@commonwealthfnd). The event, “Incentives 2.0: Thinking Beyond Financial Rewards & Penalties,” echoed the theme of the 2013 Foundation Forum and I looked forward to sharing some of the takeaways from that meeting as well as hearing from others on the subject.
This year’s Forum, Rebooting the System for Service and Satisfaction, addressed elements of the clinical environment that foster or inhibit the quality of patient care and clinicians’ joy in practice. The 150 invitees, all leaders in health care, discussed the unintended consequences of health care technology—particularly electronic health records (EHRs)—on performance measurement and improvement.
Based on a technique advanced by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, during the Forum we conducted a competition that aimed to produce creative ideas around improvements for EHRs and/or measurement. For a conference that could have focused on technical solutions, most of the products attendees came up with were very patient-centered and focused on better documenting patient information, while also making it more accessible to both the physician and patient.
A week has passed since the wrap-up of the 2014 ABIM Foundation Forum: Rebooting the System for Service and Satisfaction, and I’m still buzzing from the incredible energy and enthusiasm of the participants in the room.
The topic of this year’s meeting centered around the role of technology in medicine and obviously touched a nerve. There isn’t a physician among us whose work hasn’t been affected by the proliferation of health IT. It was therefore fitting that, as we discussed various strategies for implementing IT into practices and larger organizations, we also talked about how physicians are suffering high levels of burn-out and strategized ways to bring back joy in practice. While at present, IT and joy in practice seem diametrically opposed (as the pressure clinicians are suffering from is, in part, a result of the increased demands of technology), it is important to realize how one can facilitate the other if the IT system is properly designed and implemented.
From August 3-5, over 150 national leaders representing consumer groups, physician organizations, medical students and residents, policymakers, accreditors, certifying boards, journal editors, researchers, health plans and employers will discuss the positive and negative consequences of technological innovations in medicine and associated regulations on patient care and the effect on physician well-being. Individuals with acute or chronic conditions or disabilities have also been invited to participate – as is the case with every Forum, their contribution is invaluable.
I recently received an e-mail from a frustrated physician who expressed his concerns to me about HealthFair, a company providing screening services at his local academic medical center. Tuned into the Choosing Wisely® campaign, the physician claimed the cardiovascular screenings HealthFair was offering (echocardiograms and electrocardiograms) went against the specialty societies’ recommendations.
“In every job that must be done, there is an element of fun. You find the fun and – SNAP – the job’s a game!”
Who knew that Mary Poppins’ advice could apply to reducing waste in health care? Apparently, the Society of Hospital Medicine (SHM) and the Minnesota Medical Association (MMA) did. To get their members fired up about implementing Choosing Wisely, both organizations are inviting their members to engage in a little friendly competition.
The following is a commencement speech given at the University of Texas Southwestern Medical School’s 2014 graduation ceremony.
Your institution has ceded to me the last 15 minutes of your medical school instruction – how should I use it? One more time through the complement cascade? Or, as Dr. Seldin might have it, a final discussion of salt wasting in chronic renal disease, or, perhaps, the causes of metabolic acidosis? My guess is that you would sleep through that (as I slept through so many medical school lectures), but the good news is that many of those things are going to change–dramatically–over the course of your careers. Change in medicine is a constant, sort of. Many things DO change, but some core things don’t. Let’s spend some time reflecting on that. Read more »
This past April, the Choosing Wisely campaign celebrated its second anniversary. As is the case with the passing of any milestone, I have been reflecting on what the campaign has achieved and what we have yet to accomplish. It also made me take stock of the environment in which we incubated this concept and launched the campaign, as well as how the landscape has changed.
Overtreatment has been on the minds of journalists, politicians, patients and physicians in this country over the past few years. The Choosing Wisely campaign was launched amid the passing of the Affordable Care Act and nascent conversations around health care costs and stewardship. I’d like to think that Choosing Wisely has had an impact on those conversations.