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Impressions of 2012 ABIM Foundation Forum: Room with a View
The ABIM Foundation recently held its annual Forum: Choosing Wisely in an Era of Limited Resources with a group of 140 diverse participants, including: consumers, family caregivers, individuals with chronic conditions, physician leaders, medical educators, residents and students, practicing physicians, payers, purchasers, researchers, journal editors and policymakers.
They gathered together to examine innovations in places where health care is changing for the better – in terms of quality, patient experience and costs. Many innovations focused on how to improve care for the most vulnerable, complex and costly patients.
I personally left the Forum feeling an odd mix of optimism and pessimism about the future of medicine in the U.S.
Optimistic about Our Future
1) Leaders are allowing a move away from fee-for-service medicine in both the private and public sector and are permitting physicians to finally get off the hamster wheel and think about how to improve health for their patients.
2) The Affordable Care Act is driving many positive changes in care delivery, including: increasing access to care through the insurance exchanges, innovations being stimulated (ACOs and PCMHs) and the evidence being produced to inform health care choices (PCORI).
3) Physician professional organizations are demonstrating courageous leadership in advocating for changes in the delivery of care, particularly in the areas of waste and value. Examples include the American College of Physicians’ High-Value Cost Conscious Care Initiative, the National Physicians Alliance’s Good Stewardship Project and the Choosing Wisely® campaign).
4) The public demands more transparency about quality and cost.
5) Younger physicians demand better environments to in which to practice and are intolerant of waste and the lack of price transparency.
6) Leaders in medical education are working to develop competencies for the 21st century physician and developing models of care to meet the needs of a diverse and more chronically ill population.
Pessimistic About Our Future
1) The inability of the innovations to be easily adopted by other delivery systems.
2) The lack of attention and the difficulty of reducing the supply of beds and diagnostic equipment (a la the “a built bed is a filled bed,” concept promoted by Milton Roemer and Max Shain).
3) Monies saved by efficiencies and the removal of waste are not being returned to the people (through lower costs or funding of other important social problems) but become higher margins for providers and health insurers.
4) Many leaders in delivery systems are resisting change, waiting for retirement or thinking changes are a passing fad.
But ultimately, I am an optimist.
The quote by Sir William Osler (1893) provided by a speaker at the Forum, a CEO of a major health care system, gave me the most hope:
“Medical care must be provided with the utmost efficiency. To do less is a disservice to those we treat, and an injustice to those we might have treated.”
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