SUMMARY OF PROCEEDINGS OF L&M SEMINAR, JUNE 11,12, 2010

N.B. Speakers’ comments in normal font.

GS comments in larger font. 

A)    HEALTH CARE REFORM AND THE QUALITY IMPERATIVE,  by Maulik Joshi, PhD.

·        “Physicians get it right 54% of the time”.  (Certainly not my experience).

·        Our transactional payment system is unsustainable.

·        We all need more information.

·        People generally don’t use the information.  But they are becoming more independent.

·        The challenge for hospitals is a + profit margin vs. a – profit margin.  The key is Operations.

·        Connecticut is high cost and high mortality.  (?)

·        What is sought is more integrated care, more “at risk”, and more accountability; more systems analysis, more transparency, increased integration and coordination. 

·        “You can’t improve what you don’t measure”.

This is a management systems analysis.

What we also need is a physician (“provider”) systems analysis.

This always begins with the diagnosis.  Then should come practice parameters, including both clinical experience and more formal studies to arrive at “evidence based practice”.  Then there should be a system of prioritization, dealing with needs and not with “wants”.  This should all be properly documented.  All medical care should be coordinated, by any willing participant and not only by “medical home”.  Clinical results should be tracked as to outcome.  Patients and family should be involved at all stages, incorporating self-determination but not replacing physician judgment as long as the physician is on the case.  And patient personal responsibility for his or her own care should be stressed and required. 

Finally, medical mal-practice reform is critical to reducing and eliminating “defensive medicine”, which may account for up to 30% of health care costs. 

B)    HEALTH  REFORM: NOW WHAT?  By Ian Morrison, PhD. 

·        The quest for Value for all Americans.

·        Change.  Higher Performance.  Value.

·        “The Second Curve” is upon us, with the decline of the First Curve of health care delivery that has been our standard to date.

·        Cost, Quality, Access

·        Our health care system is at a crossroads, everywhere. 

·        The U.S. spends 2X more per capita than any other country…without the results.

·        Economists consider health care as a “superior good”.  But we are spending too much of GDP on it.

·        U.S. has more high tech, high intervention than any other country.  Why?

·        Why the big difference?  1) “The fallacy of “excellence”…it takes a system for proper health care; 2) We have the most bureaucratic system in the world, both public and private, with more coming…; 3) We love “new “ technology; 4) 30% of health care costs are provided in the last few months of life of Medicare patients – for others it is 10-15%; 4) Deferred and delayed medical care by patients; 5) Primary vs Specialty Care: we have 40%- 60% …other nations have the reverse – we need more emphasis on primary care

·        Is this fixable?  A problem of Policy, Management, and payment system change. 

I emphasized the matter of “defensive medicine”.  I challenged the assertions  regarding “quality of care” being provided – certainly not the experience of most doctors.  I emphasized something that is never mentioned: patient responsibility for their health.  I challenged the assertion that there is “little science” behind what we do: there is a mass of clinical experience, equally of value as are formal studies – but often given little credence in academia regarding “evidence based Medicine”. 

There followed a general review of the Health Care Reform Act, with emphasis on reforming the delivery system and on documenting Quality at lower cost.  Meanwhile the “rich”, physicians and China will pay the massive bill, or so Washington hopes.  If not, Medicare and Medicaid might bankrupt the country (not Social Security). 

I emphasized the fact that the hospital and the physicians are in the same seriously leaking boat, and that both must bail together.  And I draw a personal line at any effort to make physicians guarantors of their patients’ health…whether through capitation or through “bundling payments” or through emphasis on “value parameters” that only the patient has ultimate control over.  I will not “…relax and enjoy it”.  I will rather fight than switch.