What Have I Said So Far?

Stanley Feld M.D.,FACP,MACE

• The patient is the most important stakeholder in the healthcare system. The physician is next. They are the primary stakeholders.
• There would be no need for a healthcare system without patients and physicians. 
• The government, the insurance industry, the employer, and the hospital are facilitator stakeholders. They are the administrators of the patients’ healthcare dollars. They are the secondary or facilitator stakeholders
• Patients should be the administrator of their healthcare dollars.

It is easy to notice that most of the discussion in the media is about the facilitator stakeholders:

• HCA going private.
• HCA fighting with United Healthcare.             
• Government changing DRG system to reflect hospital cost rather than hospital charges.
• Insurance industry raising fees on health insurance.
• Insurance industry restricting health insurance on self employed sick patients.
• Hospitals have multiple tier fee schedules with uninsured charged the most.
• Hospitals and medical device companies fighting off the government price reductions.
• The government lowering physician payments.
• The government mandating electronic medical records.
• The government developing a pay for performance plan.

Unfortunately, we have been programmed to be information junkies. The media feeds scandals to us. We hunger for media reports. This media circus keeps us in a constant state of fear and anxiety. States of fear and anxiety are bad for our health. We also miss the essential questions:

• How do we reduce the cost of medical care?
• How do we provide affordable insurance for the 45 million people uninsured?
• How to we provide affordable medical care coverage so that all the patients can have access to medical care?
• How do we align all stakeholder incentives?
• How do we construct a system so that all the stakeholders make a reasonable return on investment?
• How do we close the holes in the system to eliminate abuse by stakeholders?
• How do we restore trust between stakeholders?
• How do we restore trust between the patient and physician?
• How do we stop secondary facilitator stakeholders from continuously destroying the patient physician relationship?

I have suggested some solutions in the past few months. I will cover these solutions in greater detail shortly. Developing methods to achieve the solutions are in themselves business opportunities that can help society. The appropriate use of information technology can help greatly. These solutions have to be coordinated and introduced simultaneously. Unfortunately, the government with its present administrative structure and political influences will find it difficult. The solutions have to be market driven by the customer (the patient) in order to be accomplished. The patients have the power to drive the solutions with the government’s help:

• Price transparency is an essential beginning. No only must the retail price be published but all of the discounted prices. The net effect of this complete transparency will be lower the prices paid on some services. I can visualize debate going on for several years with no resolution under the present systems. The voters must say we want real Price Transparency
• Elimination of a two tier payment system with hospitals receiving more for procedures than outpatient physician office payments for the same procedure.
• Consumer driven healthcare using Medical Savings Accounts and not Health Savings Accounts.
• Develop Centers of Excellenceand Focused Factories both Hospital based and Outpatient Clinic based. Payment for service for hospital and outpatient clinic should be the same for educational services.
• Payment for early evaluation and recognition of chronic disease
• A sophisticated information system connecting the cost of medical care with financial outcomes and not simple incorrect algorithms to measure procedures needed for quality of care to be accomplished. 
• Disease management to lower the complication rate for chronic disease and reduce the cost to the healthcare system by more than 45%.

These solutions have to be instituted with authority and leadership.

Responsibility for follow up care and compliance must be in the hands of the patient. The physicians are the teachers educating patients to be experts in their disease self- management. If patients do not comply there should to be a monetary as well as a quality of life penalty. The patient has to;

·         Be responsible for the purchase of care.

·         Have ready access to care.

·         Be responsible for the appropriate compliance for care and medication regime given by the physicians

If this is accomplished, and it can be, with the appropriate leadership and will of the public, we can turn this ship around.