Now that healthcare reform legislation is in fact law, President Obama has been the object of unrelenting and persistent criticism due to many of the law’s provisions. While I disagree with many of these criticisms, I do share a feeling of disappointment in the lack of definitive and specific cost reduction actions. With the exception of the scheduled reductions in Medicare Advantage payments, other expense cuts rely on initiatives which are neither proven nor predictable.
One thing is clear and certain. Without greater leadership on the part of physicians, the goal to decrease healthcare expenditures will never happen.
Medicare intends to align payment with quality by moving to value-based purchasing. Payments will be reduced if readmission rates to hospitals and the level of hospital-acquired infections are not reduced. Comparative effectiveness research will evaluate the effectiveness of treatment options. Accountable Care Organizations (ACOs) will give hospitals and physicians the opportunity to share in savings realized from innovative payment and service models that improve quality and reduce costs. All these rely on the support and participation by doctors in order to be successful.
In the April issue of the Harvard Business Review, author Thomas Lee, a physician, tackles these issues in an article titled, “Turning Doctors into Leaders.” Dr. Lee explains that the biggest driving force of rising healthcare costs is medical progress with new drugs, tests and devices and new ways to use them. He says this explosion of knowledge is going off within a system too fragmented and disorganized to absorb it.
Lee explains the need for physicians to organize themselves for performance. He says this can be accomplished by developing clinical and operational measurement systems, building effective teams and improving processes of care. Physicians will need to eliminate cultural barriers which Dr. Lee defines as the “deep-seated belief that physician autonomy is crucial to quality in healthcare.”
“A shift to value-oriented, performance-driven healthcare requires doctors to adapt or even reject some of the workings that are embedded in medicine’s past,” says Dr. Lee. But he remains optimistic that a new generation of physicians will emerge to lead the way. In truth, Dr. Lee notes, “they have no choice.”
Mike Stephens blogs regularly at Action for Better Healthcare.