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The rising costs of health services, as well as concerns for quality and access, have been near the top of our national agenda for decades. Since the Medicare Act of 1965, the Federal Government has developed and implemented a broad range of legislative tactics in attempts to stem the costs of care.
Among these past Government initiatives are a “cost-based” reimbursement system, HMO’s, capitated reimbursement, and accountable care organizations.
Yet fifty years later, we are still facing the same issues we were facing in 1965.
The old adage remains true: “if we always do what we’ve always done… we’ll always get what we’ve always got.”
What Are the Alternatives?
I spent most of my career as the CEO of large healthcare provider organizations including Chief Operating Officer of a large university teaching hospital, CEO of a hospital system encompassing 139 general acute hospitals, and CEO of a healthcare LEAN technology company.
I have also served as MHSA faculty at several universities and on the management teams of their university hospitals including the University of Minnesota, University of Florida, Tulane University, and the University of Wisconsin.
I have reached this conclusion: we will not achieve sustainable, high-quality, cost effective care, until we accept the fact that our historical efforts to control costs and quality solely from the “top down” are simply not good enough. Not now, not ever.
It is clear that the most powerful instrument for reducing waste, containing costs, and improving quality over the long-term, is the pen of the practicing physician.
Only an informed (“business-savvy”) physician, who understands the business consequences of his clinical decisions, can control the costs of care by such actions as; avoidance of an unnecessary laboratory test, a timely discharge of his patient, or the prevention of a medical error.
The Informed Physician
It is important, therefore, to “rethink” the process by which we educate physicians during their clinical rotations. The student must also gain a better appreciation for the business environment within which he must practice medicine.
For example, he should learn that the nursing unit within which his patient is receiving care, is also a complex “business center”, and that this business center must operate within difficult cost constraints, has frequent medical errors due to faulty support systems and sometimes lacks poorly trained leadership.
LECOM has created a unique distance learning tool enabling our medical students to gain “situational awareness” through observation of their business environment .The student is guided through highly structured analytical processes, which help him “ask the right business questions” during each clinical rotation.
“Business savvy” simply requires the physician to be aware of and appreciate the people, systems and organization upon which he depends for the care of his patient.
The Benefits
We have learned that the “business savvy” physician is often very interested in a broad range of business matters affecting his patient, including financial management, nursing staffing, and patient safety systems.
Positive behavior changes have come from a better informed physician, and are consistent with my personal findings as CEO of a healthcare technology firm; “good information in the hands of good people, always lead to improvement.”
I believe that an essential step in achieving our health care goals lies in the hands of our medical and business educators, who must take a much more interdisciplinary leadership role in their joint approach to the clinical rotation.
Admittedly, this strategy requires a long-term view of our healthcare system, in which an innovative approach to medical education will enable us to change the system from “within.”
Only then will we be on the road toward cost-effective, high quality care which is sustainable for generations to come.
