From MGMA: Ezekiel Emanuel calls for high-touch healthcare

HealthLeaders Media Staff, October 12, 2009

Ezekiel Emanuel, MD, PhD, didn't mention any of the controversy from the heated political debates of August as he delivered an opening address at the MGMA annual conference in Denver on Sunday. Instead, he presented his vision for achieving what he called the "holy grail" in healthcare: Improving quality, lowering costs, and expanding coverage.

Emanuel, special advisor to the director of the White House Office of Management and Budget for health policy, found himself at the center of a political storm earlier this year when Betsy McCaughey—and subsequently Sarah Palin and Representative Michelle Bachmann—used some of his writings about medical ethics to justify claims that reform would lead to "death panels." Fact-checking organizations later said the Emanuel was being taken out of context.

It is ironic that Emanuel would be accused of supporting patient death panels given his solution for the healthcare crisis. During his hour-long address to MGMA attendees, Emanuel advocated redefining the physician-patient relationship toward more "high-touch healthcare."

By that, Emanuel means spending more time with patients and focusing on potentially avoidable complications that represent nearly 15 cents of every healthcare dollar. In addition to many of the typical statistics and graphs that are often seen in healthcare conference keynote presentations, Emanuel pointed to disproportionate spending on a small portion of the population. Physicians average less than 15 minutes per patient visit, but should spend significant more quality time with the 15% of patients who account for nearly three-quarters of all spending. More attention to chronic conditions is needed to improve overall quality, he said.

Emanuel certainly isn't the first to point out that the current reimbursement system discourages a more high-touch care model. He concluded his presentation by calling for a change in the physician reimbursement system, and specifically suggested bundled payments as a potential model.

To work, a bundled payment system would need to be risk-adjusted and discourage potentially avoidable complications; physicians who improved care and reduced avoidable errors could split the savings with a gainsharing model, he said.

Emanuel noted that there aren't enough well-tested bundled payment models, and more experimenting is needed.

The current healthcare reform bills don't included significant payment changes, and although the Obama administration hinted at a switch to a bundled payment system when it released a budget proposal earlier this year, bundled payments haven't been a focus of the more recent healthcare reform debate.

Still, Emanuel believes a payment system change is coming, and he urged MGMA members to consider whether they are ready to adapt to a new model.

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