Monumental events have riveted public attention in the past year with the historic presidential election, economic upheaval and now the new administration in Washington. More history will be made as we expect to finally address the issue of fundamental healthcare reform. As a physician and a healthcare executive, it seems that inexorable forces have combined to drive change: The increasing number of uninsured or underinsured, a lack of preventive care for children, rising insurance costs to employers, an unconscionable lack of transparency and the persistence of ethnic and racial health disparities. These forces may result in an earthquake-like radical restructuring of healthcare or perhaps incremental change leading to greater stability. Either way, healthcare reform is coming.
Careful approach needed for healthcare reform
I believe that the overarching principle of meaningful reform must be greater patient and physician control of healthcare decisions. Transparencythe universal availability of meaningful data regarding risk and potential benefitis critical to every decision. Finally, we must measure outcomes and use the data. With these principles in mind, we can approach the very difficult issues of access and cost.
As an advocate of physician-owned hospitals, I believe the experiment in patient-focused care is already under way and that physician hospitals can contribute significantly to the coming healthcare reform.
Essential to the success of healthcare reform is control over healthcare decisions by patients, their families and their physicians. Reform must deliver this. Implicit in greater patient and physician control is health coverage allowing all Americans to choose their physician, their hospital and treatment. I believe that doctorsin partnership with patients and their familiesare excellent judges of how to get people the best treatment with the lowest risk and the lowest cost.
In the Internet age, consumerism in healthcare is a practical reality. But the complex nature of care and its inherent risks requires a foundation of trust and cooperation between the patient consumer, the physician provider and the hospital.
Transparency provides that foundation, giving patients as consumers access to reliable, accurate information about their diagnosis, treatment, quality of healthcare facility and physician experience. Patients and their families (ideally in concert with their physicians) are then able to choose the when, where and what among their treatment options. The information must be accurate, meaningful and verifiable.
The implication of transparency and consumerization is, of course, competition. I will be emphatic about this: Competition in healthcare is the best thing since the total hip replacement. It makes us as individuals better at our jobs. It makes our organizations leaner and more adaptable. Competition gives us the laser-beam focus to innovate and measure results. Moreover, competition keeps us humble because every good idea is just waiting to be overtaken by a better idea. Competition in healthcare has driven down infection rates, modernized facilities, lowered patient-to-nurse ratios and shortened hospital stays, which resulted in lower cost. Competition keeps us focused on what matters most: improved patient outcomes.
To get to improved patient outcomes, we must obtain meaningful data. To be meaningful, measured data must directly impact decisions. Data must also be universally available: no hiding the dirty laundry in the closet. Finally, measurement must be standardized to the point that comparisons can be made between providers, facilities and treatment options. Some measurements are simply statistical problemsfor example, infection rates. But other measurements demand nuance such as grading the entire patient experience. Organizations responsible for the public welfare can help standardize meaningful measurement. These include government agencies, the professional organizations such as the American Medical Association, the American Hospital Association and specialty societies. We need to get everyone on the same page.
For healthcare reform to be successful it will require all players in the healthcare field to work together. In a cooperative effort, we can find the innovations that really work and implement those changes that ensure all Americans can access healthcare that does not bankrupt the nation. Physician-owned hospitals are developing the clinical and organizational innovations that one day can improve outcomes at all hospitals.
Contrary to the opinion of a commentary writer in Modern Healthcare (Dec. 15, 2008, p. 20), physicians who own facilities do not desire the demise of the community hospitals in which we have worked for decades. The opposite is true: We would like all community hospitals to achieve the same success in reducing complications and improving care that we have seen in our own facilities. Orthopedic specialty hospitals like ours, for example, have been shown to have a 50% lower complication rate for hip replacement than peers. Our physician-owners understand that we must reduce complications and lower costs to save healthcare in America. If everyone improves care, then costs go down, and we are all a little safer. Yet, some continue to repeat the same untrue allegations that have been leveled against physician hospitals for years, even though they are disproved by both public and private studies. Contrary to allegations, most physician-owners are focused on patient care and not monetary gain.
We started the 37-bed Indiana Orthopaedic Hospital, Indianapolis, to improve patient care. The 2009 HealthGrades Report gave five-star ratings to our joint and spine specialties and rated the hospital in the top 5% of hospitals in the country for joint replacement surgery. Reducing complications saves healthcare dollars. Innovations developed in physician-owned hospitals can help others.
Whatever shape reform takes, physician hospitals are ready to work with community hospitals, legislators, the executive branch of government and others to ensure the delivery of patient-focused healthcare.
Access to quality healthcare is a critical American value, but expanding access is difficult. It is worth remembering that as Americans, we hold that core belief that no problem is too large for us to conquer. Years ago, I was an inexperienced young surgeon-in-training, bent by a heavy night in the trauma ER, when my superior told me to just go and do the right thing. Thats good advice for healthcare reform. Let us all put away the turf battles and focus on doing the right thing for all Americans.
John Dietz Jr. is chairman of Indiana Orthopaedic Hospital and a physician.
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