Why Can't Healthcare Solve Its Own Problems?

This article appears in the October 2012 issue of HealthLeaders magazine.

In our annual Industry Survey of healthcare leaders, a majority (59%) said too much self-interest among the different stakeholders is the reason that the healthcare industry can't solve its own problems. Only 6% said the industry will be able to find a solution, given more time. What are the greatest opportunities and threats to improvement at the industry level and the organization level?

Marcia Donlon, RN, BSN, MS
Vice President, Medical Center, and CNO
Holy Family Memorial, Manitowoc, Wis.

The enemy within: A quote from Pogo comes to mind, and that is, "We have met the enemy and he is us." My honest answer is, I don't know how we are going to solve this. If any of us had that answer, we'd be rich and have speaking engagements all over the country. For one person, something is an opportunity, and another stakeholder sees that as a threat, and that is where we need to come together. If we don't find ways to build trust and collaborate and sacrifice, we are never going to get there. We can blame whoever we want, but we are all equal stakeholders.

The challenges ahead: Perhaps if we reduce duplication of services and reduce red tape and bureaucracy—whether it is an insurance company or the government, value-based purchasing, core measures—they seem to all have good intent but we get so bottlenecked in all the fine details. Some of it is game-playing. You set rules that are impossible to abide by or to meet the challenges and guidelines that are going to move us forward. Things like the RAC audits, value-based purchasing, and HCAHPS.

Rewarding quality: The idea is awesome. The concept, if it worked, is exactly where we need to go. We get excited to hear about the shift away from fee-for-service with quality and patient safety and outcomes involved here. But then you hear what the rules are and it is almost impossible to do. The other thing is it takes so many resources to meet the requirements that sometimes you ask, "Are we spending more to supply the data and to work on this initiative than we are ever going to get back for it?" Is it going to improve outcomes? Maybe. Maybe not. Some of them haven't been proven to do that.

The shifting political landscape: The other thing is the changing political landscape and healthcare reform. It's so nebulous that nobody knows where to go. Even when we do want to work together, it depends on who is going to be elected. We know the final ruling now on Obamacare, but what is it really going to be after the elections?

Scott D. Hayworth MD,
President and CEO
Mount Kisco (N.Y.) Medical Group

Up until now there have been too many stakeholders. With the consolidation going on, I am optimistic that we could solve our problems on our own. You are seeing doctors leaving smaller practices and joining either larger multispecialty groups like mine or joining hospital systems. It is much easier to transform a larger group of hospitals and doctors working together than it is changing multiple individuals.

The greatest opportunities come from working together. There is no more money in the system, so we all have to figure out how to provide better quality care for less money. We can do it more on the system level than on the individual level.

There is going to be a lot more regulation. Good regulation is excellent; unfortunately, a lot of regulation that comes down gets in the way of what we need to do. These mandates do nothing about liability and that is a key cost driver and a key issue for all of us taking care of patients.

Robert E. O'Connor, MD, MPH
Professor and Chair, Department of Emergency Medicine
University of Virginia School of Medicine, Charlottesville, Va.

It is imperative that providers are part of the solution for reducing healthcare costs but there is not an easy answer to it. It is such a complex matter to try to shift the paradigm of how services are paid for so that we can provide healthcare at the highest possible quality with the lowest possible costs. It is going to take a concerted effort between the healthcare providers and the insurers and regulators.

The first thing we have to look at is liability reform. A lot of defensive medicine is practiced at a cost of billions of dollars per year. If we were to protect providers who adhere to certain treatment protocols to a certain level of indemnity, while still allowing patients to recover damages when harmed, that would go a long way to reducing costs. It would also embed high-quality low-cost care into the system because providers would have guidelines to follow pretty much for every ailment. They'd know they would be protected from liability and they'd also follow proven and acceptable practices for everyone to provide reasonable healthcare.

Jerry Fingerut, MD
Medical Director
Blackstone Valley CHC, Pawtucket, R.I.

It will be very difficult and will take a considerable amount of time based on fragmentation silos and the history in healthcare. Even though healthcare may be viewed as a single industry at a macro level, when it gets into care delivery you have hospitals, specialists, primary care physicians, and long-term care vendors all appropriately with a level of self-interest, even with the end goal of common patient care. It is very difficult to align the goals and rewards when it's left to the individuals who have legitimate business and clinical interests. It is their livelihood as well as their mission and profession in wanting to do the right thing.

Bundled payments, in many ways, creates its own set of problems because you deal with the same silos in day-to-day operations. To do it in a timeframe where it will truly be redesigned is going to take an external pressure, which becomes the government or the political will to do it. That is difficult to do even regionally because of different practice patterns, public and private hospitals, not-for-profit and for-profit hospitals, and the disparity in payments that exist within the system.


Reprint HLR1012-1

This article appears in the October 2012 issue of HealthLeaders magazine.