You have to marvel sometimes at the magnitude of inertia in healthcare. With a world of change bearing down on them, many of its leaders seem to be hoping to take cover under the sheer size, complexity and decentralization of the industry. Quality of care? Pay-for-performance? High costs? Ethics? Charity care? All will take care of themselves, they seem to say. Let's focus instead on real problems like reimbursement and tort reform.
What all this intransigence may reap is that new rules of the game will be written without the comment of the players who will be most affected and who know most about healthcare.
Our May 30 issue is Exhibit A of this point:
Michael Romano, in his cover story (p. 6), told of how doctors are acting like pay-for-performance isn't really happening and now are belatedly trying to affect how these programs are structured. In typical fashion, the American Medical Association has come up with a list of qualifications for any such programs, including, of course, that physician participation must be voluntary. As Bruce Bagley, medical director of quality improvement for the American Academy of Family Physicians, told us: "Pay-for-performance is now seen as something that physicians need to be protected against."
In another example from the same issue of our magazine ("Exemption inquiry," p. 8), hospital leaders were told that there is little visible difference between for-profits and not-for-profits in the provision of charity care. I happen to believe this is not the case, but Congress seems set to act on this belief, rewriting the rules on how charities must act. A most telling quote from that story comes from Jim Unland, president of the Health Capital Group, a consulting firm for hospital-physician negotiations: "As someone who's been watching the subject closely, it seems that if the American Hospital Association and the Catholic Health Association would have stepped up and showed leadership on these matters in 2003, we would not be watching these hearings on Capitol Hill today."
And then there is Laura B. Benko's story ("Conflict questions," p. 10) about how an array of managed-care executives are taking lucrative governance posts with healthcare vendors and don't see what the big deal is, even though insurers determine which drugs and medical devices members may use.
We're not the only ones covering such stories. The New York Times has been reporting on how Guidant Corp. failed to tell doctors and patients that its popular implantable heart defibrillator had failed in a small number of cases because of an electrical flaw3/4a fatal problem. However, after Guidant proclaimed that it had fixed the flaw in devices made after mid-2002, it failed to tell anyone it had continued to sell the flawed devices for months thereafter. The Times also reported how the drug industry has failed to live up to its promise to make public all clinical research data, so we don't have another Vioxx scandal.
Meanwhile, the industry continues its relentless pursuit of tort reform as a panacea for its problems, despite all evidence to the contrary. A new study out last week on Health Affairs' Web site found that average payments on tort cases rose at 4% per year from 1991 to 2003, or less than health cost inflation. As the authors say, "A preoccupation with data on judgments, extreme awards or specific specialties results in an incomplete understanding of the growth of physician-malpractice payments."
I don't want to tar everyone with the same brush. Many in healthcare are working every day to reinvent our system of care. The problem is that there aren't nearly enough of these people.
What do you think? Write us with your comments. Via e-mail, it's [email protected]; by fax, dial 312-280-3183.