Myths, Realities & Possibilities Myths, Realities & - - PDF document

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Myths, Realities & Possibilities

Myths, Realities & Possibilities

Charlotte Jefferies Horty, Springer & Mattern

The U.S. has the best health care system in the world! The U.S. has the best EMERGENCY CARE system in the world!

In 2006, the U.S. ranked:

• 37th in performance
• 39th for infant mortality
• 43rd for adult female mortality
• 42nd for adult male mortality
• 36th for life expectancy
• #1 for health care spending

U.S. medical technology has not translated into better health statistics.

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Myths, Realities & Possibilities

Spending more does not make us healthier.

“20% to 30% of spending is waste that yields no benefit to patients.”

Donald Berwick

Areas of Waste

• Overtreatment of patients
• Failure to coordinate care
• Administrative complexities
• Burdensome rules
• Fraud

Physicians control over 80% of health spending:

• Hospital care
• Prescription orders
• Nursing home orders
• Testing
• Physician services

It is impossible to become more efficient and cut costs without the input and assistance of physicians. Being the best requires cooperation and sacrifice on everyone’s part.

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Myths, Realities & Possibilities

Making sick people pay more for health care will cut unneeded care!

“The only thing worse than a high-priced policy you can’t afford is a low- cost policy you can’t use.”

Massachusetts State Senator Mark Montigny

High patient payments will do nothing but deter essential and needed care. Physicians should decide what is vital to diagnose and treat patients while respecting both effectiveness and cost of care.

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Myths, Realities & Possibilities

Patients don’t get better because of their lifestyles!

For every complex problem, there is a solution that is simple, neat, and WRONG! Lifestyle issues are difficult and complex. You can’t solve this problem alone! More information does not necessarily result in more compliance. Socioeconomic circumstances, residence and work strongly influence health status.

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Myths, Realities & Possibilities

Four groups of patients:

• Cruise Control
• Taking Charge
• Overwhelmed
• Disengaged

Listen for the patient’s values:

• Physicians value compliance
• Patients value convenience, money,

cultural beliefs, habits, body image, attitude

• Speak the language of feelings

My patients care more about our personal relationship than convenience or cost!

Retail clinics rose to 11.2% in 2011 (up from 3% in 2010).

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Myths, Realities & Possibilities

Convenience and price key factors. Retail clinics are 40% cheaper than similar care at a physician’s office and 80% less expensive than an emergency room visit.

Emory Healthcare Joins CVS Walk-In Clinics

WEDNESDAY, NOVEMBER 30, 2011

The Atlanta Journal-Constitution (11/30, Williams) reports, “The Clinic on North Highland Avenue is

• ne of 31 such CVS Caremark MinuteClinics in

metro Atlanta teaming up with Emory Healthcare.” The new partnership “means patients see nurse practitioners as they did before, but now the nurse practitioners can turn to Emory doctors for help with diagnosis and treatment.” William Custer, a healthcare expert at Georgia State University, said, “This is the latest in an increasing number of partnerships between health systems and other types of medical providers that aims to keep people

Well Visits

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Preventive care is too expensive!

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Myths, Realities & Possibilities

Chronic disease is the dominant source of mortality in the U.S. and the most costly. Preventive care has the potential to control risk factors, thereby reducing the prevalence of costly chronic disease conditions. Could the cost to reduce risks offset any savings? Focus on improving health in a fiscally sustainable manner.

But for the malpractice crisis!

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Myths, Realities & Possibilities

What malpractice crisis?

Very few hospital medical injuries ever become tort claims. Doctors still face harsh medical liability realities. Insurance business practices rather than malpractice payouts are primary source of volatility.

Malpractice fears and abuses drive:

• “Defensive Medicine” practice
• Physicians to leave medical field

A very small number of physicians appear to be responsible for most of the malpractice that occurs.

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Myths, Realities & Possibilities

The failure to self-regulate through peer review and disciplinary processes creates malpractice and litigation risks.

ANY doctor is better than NO doctor!

What happened to the “best interest of the patient”?

Hospital has a corporate legal duty to:

• Appoint and privilege only those who

are safe, competent and professional

• Monitor the performance of those who

they appoint during the term of appointment

• Renew and reappoint only those who

have demonstrated that they are competent, safe and professional

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Myths, Realities & Possibilities

Legal duty requires action when care is not competent, safe and professional.