by Laurence E. Carroll, MD, FASN
In 2007, Dr. Arnold S. Relman, former editor in chief of the NEJM penned a book titled A Second Opinion which included “an open letter to my colleagues in the medical profession.” He called on all practitioners to be part of the process of healthcare reform which he saw coming. (1)
Fast forward to 2009, and does anyone doubt that change is coming? The combination of “uncontrolled costs, unacceptable quality of care and unconscionable lack of access for millions” (2) is finally forcing our society and its politicians to confront these issues.
At the time of this writing, Congress is debating many aspects of healthcare reform. Whether a universal payor that Dr. Relman supports will be enacted is dubious. But as others have pointed out, other societies have moved forward on this issue in their own unique style (“path dependence” (3)) and no doubt if successful, our final compromise will be something uniquely American and not the British, French or even Canadian system.
For healthcare reform to be successful, it will require practitioners to weigh in on the true “value” of care for our patients.(4) This would involve restructuring care to capture the estimated 30% loss (750 billion dollars) deficits in quality. (2) Such as reducing the poor coordination care which results in 20% thirty-day readmission rates and 33% ninety-day readmissions. (5)
Lancaster is certainly not MacAllen, Texas where Medicare costs/years are thousands of dollars above its surrounding counties as well as our county. (6) Our medical community has widely supported PALCO, a voluntary effort to provide care for the uninsured and has a strong family medicine base which makes implementations of new paradigns such as “Medical Home” attractive.
However, we can still strive to do better as our neighbors to the north, Geisinger Health System, has shown by using “warranties” for CABG and other procedures and “bundles of best care,” and rewarding quality rather than unit of work. (7)
So we need to stay involved, to come together, to offer our own “second opinion,” and help forge a “new system” which Relman called for in his letter to the editor in May 2009 letter. (8) Electronic prescription programs and EMR will help, but the role of the committed, experienced physician will be key in achieving “better experience for our patients, better overall health for the population and lower per capita cost.” (9)
References:
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[1] A Second Opinion; Arnold S. Relman, MD; Public Affairs Books; 2007
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[2] Naes, Ralph G; National Coalition on Healthcare; “The Special Otis Bowen Lecture”; University of Notre Dame; March 26, 2009
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[3] Gawande, Atul ; New Yorker Magazine; “Getting There from Here”; January 28, 2009
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[4] Porter, M.E.; The New England Journal of Medicine; “A Strategy for Healthcare Reform—Towards a Value Based System”; June 3, 2009
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[6] Gawande, Atul; New Yorker Magazine; “The Cost Conundrum”; June 1, 2009
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[7] Steele, G.D; Reforming the healthcare delivery system, invited testimony before the U.S. senate Committee on Finance; April 21, 2009
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[8] Relman, A.S., Angell, M; The New England Journal of Medicine; “Taming Runaway Health Care Costs”; May 16, 2009
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[9] Fisher, E.S., Berwick, D.M., Davis, K.; The New England Journal of Medicine; “Achieving Health Care Reform—How Physicians Can Help”; June 11, 2009 |