Health Reform and Academic Medical Centers

April 01, 2011
9:58 am

Dr. Herb Pardes, the president and chief executive officer of New York-Presbyterian Hospital (and a member of the Healthcare Leadership Council), spoke yesterday at the National Press Club and made a number of interesting and valuable points about health reform, the value and future of academic medical centers, and the ability of the healthcare system to provide access to care to a larger insured population. Here are some key excerpts from his speech:

On physician shortages and access to care:

“The Association of American Medical Colleges projects a shortage of 130,000 physicians by 2025.  Since it takes up to ten years to train a new doctor, we are already behind.  We need at least 6,000 to 8,000 new physicians annually on top of the 16,000 that are currently produced each year…..We need measures to increase the healthcare workforce.  The caps on residencies should be repealed.  We should expand the scope of practice for nurses, physician assistants, and other healthcare providers.  Doctors must be trained in quality, safety, reducing cost, and health information technology.”

On efforts to enhance healthcare quality and the challenge faced by hospitals with economically-challenged patient populations:

“Measuring quality correctly is complex.  Many factors are involved, including the nature of the patients – how sick they are, they quality and quantity of previous care, underlying conditions such as poverty and lack of care – and other complicating characteristics.  These are circumstances facing academic medical centers as a consequence of treating the sickest, most complex cases, as well as the poorest and most vulnerable patients.”

On the ability of academic medical centers lead the charge on quality and cost control:

“Because academic medical centers treat a large portion of (patients in poverty and with multiple medical conditions), they are well situated to create innovative new care models that will improve quality and reduce cost.  The partnerships inherent in the academic medical center structure – hospitals, medical schools, physicians, community clinical networks, schools of public health, and others – provide the creative and experiential resources to develop and implement models of care based on quality metrics and cost controls.”

The Deficit Commission and Healthcare

November 11, 2010
4:37 pm

jp-fiscal-articlelargeThe Washington Post and New York Times are ablaze today with top-of-the-page headlines about the proposals being made by the co-chairs of President Obama’s bipartisan commission on deficit reduction.  There may be a bit of an overreaction to the draft report since there’s no assurance it will receive the necessary support of 14 (out of 18) commission members, and Congress is under no obligation whatsoever to adopt the proposals.

Nonetheless, the commission co-chairs Erskine Bowles, former chief of staff to President Clinton, and former U.S. Senator Alan Simpson deserve credit for taking on the tough task of trying to curb the nation’s burgeoning red ink.  Their report doesn’t hesitate to put some political sacred cows on the chopping block in the name of deficit reduction.

The healthcare provisions of the co-chairs’ proposals illustrate the difficulty in trying to reconcile two very important goals Americans want to see achieved – reducing deficit spending and improving our U.S. healthcare system.  The Bowles-Simpson report illustrates how difficult it is to achieve one without potentially undermining the other.

For example, the draft report calls for the creation of a public health insurance option, a policy notion that Congress soundly rejected in the health reform debate.  As we’ve discussed ad nauseum, a public option will certainly drive down payment rates to physicians and hospitals, but those costs would then be shifted to private payers.  And a public option with arbitrarily-low costs would reduce the amount of competition in the insurance marketplace, a development that wouldn’t serve consumers well.

The report calls for strengthening the Independent Payment Advisory Board to an even greater degree than called for in the new health reform law.  This would create an even more potent entity in terms of simply axing healthcare spending, but without a focus on how to elevate healthcare value.

The report says doctors and other health providers will have to be paid less.   At the same time, we’re faced with the need to recruit more people into the medical profession to deal with the tens of millions of newly-insured Americans entering the system. 

Yes, there is an urgent need to address the nation’s rising deficits, and the health sector has to do its part.  But, understanding the challenges we’re facing in the years ahead, with one in every three Americans expected to have diabetes by the year 2040 and other chronic diseases on the rise, we have to look at the healthcare system as more than just numbers on a balance sheet.   

Work needs to accelerate on delivery reform, on payment reform, on changing the tort system (which, to their credit, the commission co-chairs recommend) to reduce defensive medicine costs, on attacking the chronic diseases that account for 75 cents of every health dollar we spend. 

But deficit reduction and quality healthcare should not be treated as an either-or choice.  The commission’s work is an essential exercise in numbers, but we can’t forget the real patients and consumers who would be affected.

NPR Looks At the Nation’s Primary Care Challenge

August 27, 2010
4:28 pm

Our country’s shortage of primary care physicians is going to be felt more acutely in the years to come, as a result of both health reform – which will bring millions more newly-insured Americans into the system  — and the aging of the baby boom generation and the increased utilization of health services that goes with it.

National Public Radio’s Julie Rovner, who I’ve known and respected for years for her skill at digging deeply into complex health policy stories, has launched a three-part series on NPR regarding the primary care challenge and possible solutions for the problem.  In the first segment, she went to Maine to interview a primary care doctor who has developed a successful, satisfying practice.  This physician, however, is 63 years old and is concerned about who will fill her shoes when she retires.

The story is well worth a listen.  You can find it here.

More Warning Calls about Physician Shortages

July 21, 2010
5:23 pm

Yesterday, the Arkansas surgeon general told a state legislative committee that the state’s physician shortage would be worsening once health reform is implemented.  Dr. Joe Thompson testified that 80 to 90 percent of Arkansas’ 500,000 uninsured residents will become newly insured, most of them through an expansion of the Medicaid program.  He emphasized that the state already has severe doctor shortages in its rural areas.

At the same time, Physicians News Digest is quoting a report by the New Jersey Council of Teaching Hospitals which projects that New Jersey will have a shortage of approximately 2,800 physicians (and as many as 3,250) by the year 2020.  In New Jersey, health reform will add roughly 1.3 million patients to the newly-insured rolls.  The Council projects severe shortages in primary care as well as neurosurgery and pediatric subspecialties.

We’re going to be hearing more warnings like these, most likely from every state.  There’s no debating that addressing the uninsured problem in America is a good and necessary thing.  But, we can’t be complacent in believing that expanded coverage necessarily leads to expanded access.  It’s quite clear that our rapid increase in covered individuals is going to outpace the supply of physicians, nurses and other healthcare professionals able to provide care.  As policymakers revisit health reform, which it inevitably will, addressing these shortages has to be an urgent priority.

The Need for Better Self-Policing

July 15, 2010
3:32 pm

Two news stories this week raise serious concerns about the effectiveness of systems intended to act upon physicians and nurses who don’t meet adequate standards for providing patient care.

•       A Massachusetts General Hospital survey of more than 3,000 physicians across multiple specialties found that one of every three doctors rejected the idea that they should report colleagues who are incompetent or impaired by substance abuse or mental health problems.  The survey found that 17 percent of doctors had encountered a physician who was either incompetent or impaired, but only two-thirds of those doctors turned in their colleague.

•       In today’s USA Today, it was reported that nurses who have committed acts of misconduct in some states can easily get jobs in other states that are part of a multi-state compact aimed at getting nurses into regions that need them the most.  The news article cited a nurse in Wisconsin who was fired for stealing narcotics, but still maintained a clean record in the eyes of the multi-state compact and was able to easily get another nursing job in North Carolina.

I don’t want to oversimplify these issues.  Certainly, it is difficult for physicians, in order to maintain open lines of communication and collaboration, to “snitch” on a colleague who has an addiction problem or who may even be suffering early signs of dementia.  And, for nurses, the idea of multi-state cooperation is a good one because innovative steps need to be taken to address the nursing shortages that exist in so many parts of the country.

In the end, though, the patient has to come first, and patients can’t be put at risk by any lessening of standards when it comes to the quality of physicians and nurses.  There is a need here for associations representing both professions to be proactive in ensuring that all members in their ranks meet the highest standards.