This new publication is devoted to physicians, and that says a lot about the direction the healthcare industry is moving--toward physicians--which is the right direction.
Our healthcare system has been transforming at a rapid pace, and we are making progress in improving accountability. Indeed, the growth of managed care has led to more efficient and more cost-conscious healthcare.
Unfortunately, serious imbalances and inequities continue to surface.
Polls show the public's opinion of the American healthcare system is declining. Americans are not willing to accept outpatient mastectomies and other forms of "drive-through" healthcare.
The groundswell of patient-protection legislation across the country tells us the same thing. Clearly, adjustments need to be made.
As the majority of Americans will attest, the healthcare focus is too much on profit and cost-cutting, and not enough on patients and care.
As this imbalance has evolved, few among us have spoken up as advocates for our patients or for ourselves. Instead, physicians, administrators, nurses and others in healthcare have accepted roles that are often inappropriate for them and that have had a rippling negative impact on patients.
Physicians have allowed themselves to be nudged to the sidelines in a number of ways. Managed-care plans, with their gag rules and "drive-through" tactics, have put a wall between physicians and their patients. Hospitals have purchased physician groups as referral mechanisms, treating doctors as employees rather than partners.
It is no surprise then that physicians are generally a stressed and unhappy lot these days.
As the caregivers closest to patients, doctors must have a central and growing influence on the evolution of the new healthcare system. They must be more than mere employees. Clinical decisionmaking and clinical team building are at the heart of quality care.
As some in our industry have begun to say--and as every physician should realize--we need to look at the bond between doctor and patient as a relationship, not a transaction.
George Anders, a well-known reporter for the Wall Street Journal, recently wrote a book on HMOs and the state of trust in healthcare. "Doctors, nurses and hospital managers should speak up," he says. "Managed care's crusade against medical extravagance and inefficiency should be weighed against the professional judgment of people on the front lines of medical care.
"Some managed-care efficiency programs are wisely conceived and should be accepted by all. At other times, though, HMOs cut into necessary care or pursue false economies. In those cases, doctors and other providers can and ought to fight for better care," he adds.
I could not agree more. It's time for everyone who cares about healthcare to stand up for a more balanced system, one that better serves professionals and patients. We need to re-establish the physician's role as patient advocate, a role that puts physicians at the center of the healthcare system.
In addition to our responsibility to speak out on behalf of patients, patients have responsibilities, too--responsibilities that are growing under managed care.
Patients need to learn to use outcomes and comparison data for their own benefit, something physicians and other providers can help them do. And they need to take responsibility for themselves by practicing healthy living habits. Then they will become true partners with their physicians.
Yes, we are making progress as we build new health networks, but we have much more to do, particularly in the areas of outcomes, patient satisfaction, quality, integration, governance and information systems. So far, we have seen a lot of competition on the basis of price and very little on the basis of quality.
By placing new emphasis on quality--and some added compassion--we can restore the public's confidence in our healthcare system.
Unlike in many industries, the process of assembling data on the quality of healthcare is in a primitive stage of development. With automobiles, if consumers want to know which cars protect passengers best in a crash, or which have the best gas mileage or the best record of reliability, such information is widely available. In healthcare, however, we have yet to determine a fair price for, say, a hip replacement or the appropriate length of a hospital stay--much less what quality means.
This is where benchmarking of costs and productivity will help. Like mapmaking, benchmarking helps measure where we are and helps us understand where we need to go.
With that in mind, the Medical Group Management Association's Center for Research in Ambulatory Health Care Administration is creating a comprehensive database of comparative information. More than a dozen of the CRAHCA's research projects are generating this information.
The CRAHCA benchmarking research system is designed for all segments of our membership. We want data from practices of every size, scope and structure. The database will be interactive, so participating practices can find and sort the information they need to measure and to compete, not just receive what researchers think they want.
It's important to stress that benchmarking data are for comparative purposes only, intended to enable physician and administrator teams to assess how they can improve; to evaluate the merits of one practice pattern or another; to reassess certain policies and procedures; and to look at where costs can be cut.
As we build our interactive database, we want to create a clear agreement and understanding regarding what should be done with this vast store of information.
To do this, we will be hosting analysts and practice leaders at a benchmarking symposium in June.
As we convene these stakeholders from a representative variety of our MGMA member practice settings, we will determine what our benchmarking plans and goals should be. This kind of discussion should become more commonplace in our industry.
Being measured and accountable is not easy, but it's necessary. We are beyond the argument that medicine cannot and should not be measured. Managed-care organizations, employers, consumers, government and other purchasers simply will not accept double-digit healthcare inflation and little or no information on what their healthcare dollar buys.
If we in healthcare don't fix the problems, others will.
Adams is executive vice president and chief executive officer of the Medical Group Management Association. The Englewood, Colo.-based association comprises more than 19,000 administrators and managers and 6,500 group practices representing more than 162,000 physicians.