A recent survey of some 2,500 doctors conducted by Dr. Jon Tilburt at the Mayo Clinic and published in the Journal of the American Medical Association was full of good news for those of us who believe that, as physicians, we have a big role to play in controlling healthcare costs. It reveals near-universal understanding of the savings that can be attained by engaging doctors to improve quality, efficiency and value in the practice of medicine.
Part of the solution
Physicians can and want to improve quality, lower cost of healthcare
That, unfortunately, is not what the public heard.
Following the study's publication, many news reports focused narrowly on the reluctance of doctors to explicitly endorse changes to how they are compensated. Dr. Ezekiel Emanuel, a former adviser to the White House, and his colleague Andrew Steinmetz wrote in the New England Journal of Medicine that this reluctance was “a denial of responsibility.”
That is a riff on the old perception of doctors being financially motivated, aloof and unwilling to change. But in a world of skyrocketing healthcare costs, doctors do understand that they must be part of the solution
To be sure, 70% of those surveyed were opposed to eliminating the traditional fee-for-service system, which pays doctors based on volume and lacks accountability for cost. This is not at all surprising. It is a classic human response of loss aversion, and it is far from the most important part of the story.
Here's what the public didn't hear about and should have: Ninety-five percent of the physicians surveyed said they have a responsibility to reduce healthcare costs. That is more than the 86% who said the same of malpractice lawyers, who are deeply unpopular among doctors.
Nearly 90% of respondents said doctors should avoid pricey treatments of little net benefit to patients. More than 9 in 10 supported limiting corporate influences, expanding access to quality and safety data, and promoting comparative trials of competing treatments.
These responses do, in fact, show that doctors accept that a problem exists and believe they can do things differently to help solve it. That acceptance is a part of the foundation upon which payment reform can be built and embraced by an understandably skeptical medical community.
When doctors are engaged in the design of high quality, satisfying and more affordable care and supported with the tools needed to improve patient outcomes, they are likely to embrace change. We know this from experience as medical leaders at HealthPartners, an integrated healthcare and insurance organization that partners with doctors and other health professionals in our care group and with a regional network of 38,000 clinicians in Minnesota and western Wisconsin.
For the past 15 years, HealthPartners has been on a mission to improve clinical quality, patient experience and cost performance. Our organization also recognized that changing this fundamental financial aspect of doctors' practices would be possible only if we understood and engaged their misgivings.
HealthPartners' transition to value-based physician payments was first met with skepticism, but that skepticism was overcome by bringing physicians in as partners in the process. Today, 85% of HealthPartners Plan members go to care teams paid based on agreements that assign some financial risk—and reward—for avoiding costs through evidence-based decisionmaking, care coordination, disease management, prevention and wellness.
These physicians see patients at virtually every clinic in our market. In the time we have done this work, patient satisfaction and clinical quality based on publically reported measures have improved across the board. In our own medical group, that change has come while simultaneously improving our doctors' satisfaction with their practices—from the 23rd percentile as compared to the rest of the country in 2005 to the 84th percentile in 2012.
This is not to say that change is easy. However, there is ample evidence that resistance can be overcome and doctors can find great satisfaction in a practice that accepts accountability for cost while delivering top-notch quality and patient experience.
Physician attitudes suggest an overwhelming commitment to the things that will make this change possible: quality, transparency, care coordination and evidence-based care. That's hardly a “denial of responsibility.” We ought to support and cultivate these attitudes instead of finding any reason to perpetuate tired stereotypes that no longer hold true.
Dr. Brian Rank is executive medical director, and Dr. Patrick Courneya is medical director of HealthPartners, Bloomington, Minn., the nation's largest consumer-run,not-for-profit healthcare organization.
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