For a while I was dismayed by the inept and misinformed legislation dressed up as 'health care reform' by our representatives in Washington DC. 'If they mess it up we'll never be able to improve this beast, we'll be stuck right where we are and where we are is awful!' I feared.
This fear stems from all the observation that policy regarding how we pay for health care is the single most important roadblock to better care and outcomes at lower cost.
To join the ranks of high performing health systems we must double our investment in primary care so that primary care may live up to its full potential.
This investment would reduce the frequency of unnecessary specialist interventions, inappropriate testing, wasteful emergency room use and avoidable hospitalization. None of these things are benefits to patients. The evidence of Wennberg & Fisher* tells us in fact that these things hurt patients.
With the dramatic savings (estimated to be between 15-20% even when factoring in the full funding of primary care) we could improve access to care and reduce the crushing financial burden on individuals and employers.
So what are we going to do if health reform from DC goes down or if it comes out so corrupted by special interest that fails to change the status quo? Premiums will continue to spiral out of control, benefits will shrink, the out of pocket costs to employees will skyrocket, fewer people will be able to afford access, the hassle factor interventions from insurance companies will continue to drown primary care pushing even more into retirement and exacerbating the primary care shortage.
But this Dickensian 'worst of times' comes coupled with a shining opportunity. The status quo is so broken and so toxic to employers, employees, governments and the uninsured that some of these people may discover a willingness to engage in true innovation - to break from the status quo and try something really new.
This is the time to step up and deliver care that astounds, delights, and performs. We know the attributes of high performing primary care. We can deliver care in a way that achieves brilliance and excellence, so that the people we serve can say:
- 'I have access to care when and how I need it'
- 'I have a PCP/nurse who know me as a person'
- 'My PCP meets the bulk of my health care needs'
- 'My PCP coordinates any care I need in the health system'
This is not incremental change, this is not for the faint of heart or those who think that the health system is doing pretty well.
For any who are sick of the status quo and close to burnout, it is time.
For those who suspect a crushing administrative burden hidden behind the pennies of a misinformed 'patient-centered medical home' initiative, it is time.
For those in the emotional and ethical purgatory of hamster wheel care where we feel forced to deliver less than what our patients want and need, it is time.
For those who see 'help' extended through high cost consultancies pushing volume and valuing dollars more than patients, it is time.
It is time to reinvigorate our profession with the ethics and passion that attracted us in the beginning.
Learn from the vanguard practicing in new models of care, using technology to enable low overhead and high quality. Learn from those who have been able to discover solutions to toxic payment policies.
Let our combined strength and data help the nation see what is possible when our full potential is unleashed.
*
Fisher ES, Wennberg DE, Stukel TA, et al. The implications of regional variations
in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273–287.
Fisher ES, Wennberg DE,
Stukel TA, et al. The implications of
regional variations in Medicare spending. Part 2: health outcomes and satisfaction
with care. Ann Intern Med. 2003;138:288–298.
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