January 24, 2012
3:40 pm
If you’ve ever watched the movie “The Sixth Sense,” you see what a talented director and writer can accomplish by withholding critical information from the audience. In that movie (and, no, I’m not going to spoil it if you haven’t seen it), M. Night Shyamalan holds back an essential fact about Bruce Willis’s main character until the very end of the film. When that fact is revealed, it changes the entire context of what we thought we knew about the story.
What works well, though, in the cinema isn’t necessarily a sound methodology when it comes to public policy matters that affect lives. Transparency is public matters is virtually always a good thing, but when the practice of transparency reveals facts without context, it can be counterproductive.
Dr. Thomas Stossel, a professor of medicine at Harvard Medical School, discussed this issue in a Wall Street Journal op-ed this week, “Who Paid For Your Doctor’s Bagel?” In his op-ed piece, he discusses the Physicians Payment Sunshine Act, a new law that will require medical innovation companies to disclose any transfer of value to physicians. The Centers for Medicare and Medicaid Services (CMS) has recently issued draft guidelines for implementation of the new law.
Again, in principle, this type of transparency is a good thing. But when the new law results in a list of consulting fees and other payments made by pharmaceutical and medical device companies to physicians, there will be a piece of the puzzle still missing. What is the purpose of that exchange beyond a minimalist bureaucratic definition such as “consulting fee?” What was the impact for patients and for the current and future practice of healthcare? Without this context, negative inferences can be made about any exchange of value.
As Stossel wrote in the Journal, “The media already exploit disclosures….to demean physicians compensated by royalties from useful inventions that they license to companies, or who were paid consulting fees for advice concerning the optimal use of products, or for educating other physicians about products.”
The fact is that collaborations between physicians and industry have led to some of the most important medical breakthroughs of the last several decades. Physicians help guide industry on how to make new innovations beneficial for patients. Companies train physicians on the optimal use of new drugs and devices. This sharing of knowledge is essential to the advancement of healthcare.
We’ll be discussing this issue in greater detail in the months ahead. HLC launched an initiative called the National Dialogue for Healthcare Innovation and, through this effort, multiple organization representing healthcare providers, health industry sectors, academia and patients have been developing a consensus set of principles to help guide future physician-industry collaborations. More to come.
August 12, 2011
10:49 am
The Republican presidential candidates who participated in last night’s Iowa debate put on quite an interesting, as well as entertaining, show. With political analysts pointing out that this weekend’s Ames straw poll could winnow the field, the gloves came off as the eight candidates fought to maintain a critical mass of voter support.
Anyone who turned on the debate, though, to learn the candidates’ visions for healthcare in the United States would have come away disappointed.
We learned, to no one’s surprise, that the GOP presidential contenders have a steadfast dislike for the Affordable Care Act that President Obama signed into law last year. Most of the candidates also believe that the individual health insurance mandate contained in the ACA is unconstitutional.
It was also clear that, as long as former Massachusetts Governor Mitt Romney is the frontrunner, he will be criticized for what rival Tim Pawlenty calls “Obamneycare.”
But future GOP debates need to do more than reaffirm what the White House aspirants are against. There are indeed widespread concerns about the current health reform law, including questions over affordability, healthcare quality and whether an unprecedented expansion of Medicaid is the best approach for reducing the uninsured population. Those who would take Mr. Obama’s place need to spell out for us how they would do things differently. The questions they need to answer include:
• Do you support eliminating pre-existing conditions as a barrier to health coverage? And, if so, how do you achieve that without an individual mandate to ensure that consumers don’t wait until they’re sick or injured to purchase health insurance?
• How do you slow down the growth in healthcare costs without undermine healthcare quality, access or innovation?
• How do you address the question of Medicare sustainability?
• What are your answers to the projected workforce shortages in healthcare? How do we ensure enough medical professionals to treat a growing patient population?
• With the CDC calling for a huge escalation in the number of Americans with diabetes, how do you propose to address the rise in chronic disease cases that are driving healthcare costs?
With these questions and many others, there’s an important health policy debate to be had among the Republican presidential contenders. It just hasn’t happened yet.
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.”
January 10, 2011
4:43 pm
Even before Congress passed the Affordable Care Act, the actual process of reforming our healthcare system was already taking place at locales throughout the country. In all sectors of American healthcare, we’re seeing innovators who are developing new and better ways of delivering high-quality, cost-effective care to patients.
The publication SmartBusiness spotlighted one of these innovators, Barry Arbuckle, Ph.D., the president and CEO of the MemorialCare Health System in southern California. In an interview, Dr. Arbuckle discussed how physicians in the MemorialCare system are practicing evidence-based medicine that is bringing about patient outcomes that “frequently exceed state and national averages for most diseases.”
In the interview, Dr. Arbuckle, a member of the Healthcare Leadership Council, also discussed the critical role of electronic patient records and offers advice for employers on the questions they need to ask to ensure the best possible healthcare for their employees.
The theme of best practice, evidence-based medicine is one we’re going to hear about frequently as the nation’s healthcare system continues to transform itself.
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.
CATEGORIES: