ATLANTA – Looking at the road ahead for healthcare, Brian Silverstein, MD, of industry consulting firm SG2 (Evanston, Illinois), said that the traditional view of practicing medicine as art and practiced uniquely by each physician is now moving toward standardized care as the healthcare industry has become big business and issues of quality are moving to the forefront.
Speaking at the VHA Leadership Conference here last week, his talk, which was titled “The Road Ahead for Healthcare: Showdown a the Fork Between Physicians, Administration and Purchasing,” held that “there is no question that some standardization” can improve healthcare.
The VHA (Irving, Texas) conference at the Georgia World Congress Center was attended by about 1,200 hospital executives and nursing and pharmacy managers, and about 1,200 suppliers.
In 2005, he said, $1.9 trillion was spent on healthcare in the U.S., or averaging $6,000 per person, compared to $1.8 trillion in 2004. Drivers of change in the healthcare system include changes in the population, the economy, socio-cultural factors, changes in payment structure, a shift to outpatient care and technology.
As an example of a socio-cultural factor, he asked for a show of hands in the audience as to how many walked to school as children, compared to the number of children who walk to school today. A seemingly harmless change in behavior is playing a role in the increase in Type II diabetes in children, and ultimately on healthcare and economic costs, Silverstein said.
There is an increase in diseases or other healthcare problems caused by lifestyle choices ranging from stroke and hypercholesterolemia to alcohol-related motor-vehicle injuries.
Another change affecting healthcare is the fact that employers are shifting more of the cost of healthcare to employees.
“Consider how your behaviors are going to change when it’s your money [paying for your care],” Silverstein said.
Much of the change will be created by a focus on quality performance from healthcare providers and paying for performance. He cited as an example the fact that the Centers for Medicare & Medicaid Services (CMS: Baltimore) began offering quality information on hospitals on its web site as of April as part of an effort to allow patients to make their own decisions about the site for a procedure or other service.
“This way, people are going to make decisions based on information,” said Silverstein.
Another example of how quality is coming into play, he said, is that the California Public Employees’ Retirement System (CalPERS; Sacramento) told a number of hospitals that the organization would not pay them a requested increase in fees, because the hospitals had not demonstrated a comparable increase in the quality of the care they delivered.
And a Minneapolis-based health plan told its physicians that if they perform “the wrong surgery” on a patient, they would not receive payment for that procedure.
But it is the clinical arena where most of the change is being seen, Silverstein said, through advancements such as molecular medicine. “You can see differences with gene expression that you can’t see with a microscope,” he said.
Also changing medicine, according to Silverstein, are procedures such as carotid endarterectomy, involving the placement of carotid stents in a minimally invasive procedure, which has a high efficacy rate and a shorter length of stay in the hospital. Other minimally invasive procedures that are creating healthcare savings and improved results are robotic prostatectomies, cerebral aneurysms being repaired with platinum coiling without requiring craniotomies, which is the current standard of care, and deep brain stimulation.
The emergency department also will change, he said, with the increase in non-invasive imaging of the heart when a patient presents in the ED with chest pain.
“New technologies change markets around,” said Silverstein.
As for the technology purchases that will enable improve patient care and outcomes, he noted that most of those purchasing decisions are made in administrators’ offices in response to a request from physicians. But the “real decisions,” he said, are being made on the golf course and on ski slopes, where salespeople persuade physicians on big-ticket buys.
In terms of technology adoption, Silverstein said that with most equipment, especially when major medical devices go unused, it’s not because it is “bad equipment; it just wasn’t the right decision.”
“Be proactive about changes [and] evaluate clinical practice in the context of greater organizational goals,” he said, noting again that if there is a problem with technology, “it’s probably not about the technology.”
If administrators make a mistake in purchasing or fail with their overall technology goals, Silverstein said, “Don’t sweep it under the rug.” Instead, confront it and determine ways to correct the problem through dialogue.
As an example of how physicians and hospitals are often working at cross-purposes, he said a study showed that one-quarter of first-year residents said they wished that they had chosen another profession, compared to 5% a few years ago. As a result of the tensions between physicians and hospital administrators, there has been a move toward physician-owned surgery centers and colonoscopy centers, as well as other types of centers, away from the hospital complex.
However, Silverstein said there are opportunities for administrators to bring technology goals in alignment with physicians. Those opportunities include information system networking, facilities joint ventures, specific joint ventures, collaborative brand development and marketing, practice development support, and coordinated and funded clinical research with physicians in key leadership and operations roles.