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The Medical Professionalism Blog

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.” 

5 Comments to Impressions of 2012 ABIM Foundation Forum: Room with a View

  • Lew Sandy's Gravatar Lew Sandy
    August 21, 2012 at 10:04 am | Permalink

    Very good post, Dan. I too am optimistic; the biggest change I’ve seen over the past few years is the widespread recognition among physicians that the status quo is not acceptable or even sustainable, a significant shift in perspective in just the past few years.

    re your “pessimism” list, remember the MLR provisions of the ACA preclude insurers from achieving significantly “higher margins” through reducing health care costs. These savings either turn into rebates, or into lower premium costs.

    (NB/disclosure-I am an employee of UnitedHealth Group; these are my own opinions, and I am not speaking for the company)

  • John Benson's Gravatar John Benson
    August 20, 2012 at 2:14 pm | Permalink

    Daniel, other positives include the facts that 1) half or more of physicians are already salaried, 2) half or more are women, 3) Medicare with or without IMAB will inevitably fund less, 4) patients can demand more as informed consumers, 5) interprofessional education is taking hold, 6) better evidence of effectiveness gets attention, and 7) prevention merits new institutional policy and reimbursement.
    Recognizing that change (not progress) takes 15-25 years I’m optimistic. Think of the problems labor and employment politics face with the ascendance of safe and accurate industrial robots!
    Great to see .the concurrence of thinking among leaders at each Forum. The Foundation deserves confidence that it contributes to cultural change.

  • e-Patient Dave's Gravatar e-Patient Dave
    August 18, 2012 at 11:38 pm | Permalink

    Well said, Daniel.

    You won’t be surprised to hear that in my view, a key enabler of change (eventually) will be when/if consumers get to easily vote with their feet: take their business elsewhere. My own experience with shopping for good affordable care showed how hard that is today – I should write a summary blog post of that multi-month effort.

    There’s one more pair of quotes from the event that I think we’ll look back on, later this decade: one speaker said that as reform rolls out, we’ll see confusion and chaos. No doubt, IMO – but a later speaker enhanced it: there’s going to be confusion, chaos *and blood* as the cash flow situation changes.

    Without a doubt, as our untenable medical spend contracts, there will be pain. I desperately hope to see efforts to help those recipients of our funds find ways to beat their swords into plowshares – to make as much money doing things like prevention, maintenance, etc.

    Thank you for this excellent work. I personally was inspired to see so many good, smart people speaking realistically and thoughtfully. And now, of course, comes the hard work.

  • August 17, 2012 at 9:51 am | Permalink

    Thanks for sharing your story.

  • August 14, 2012 at 4:04 pm | Permalink

    My own recent experience is with the onset of substernal chest pain on 8/1 An EKG was done and was read as negative(which can happen in the ACS- per MMS reports)Request for troponin level was refused, so I requested an ED referral where it and a BNP were normal. If the test been drawn at the onset of the pain,think of how much of medical care dollars could have been saved(or was I too aggressive in my request?)—-Please include more stories from those of us with chronic disease.

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