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A Physician Call to Action: ‘Stop Whining & Lead’

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These are complex and troubled times in medicine, and the health care industry at large, whether you consume, provide, pay, supply, sell or consult into or for the ‘whack-a-mole health care borg’. Given it’s insatiable and even rapacious share of GDP appetite, as well as its many implementation complexities, everyone, even the PPACA advocates and supporters, are mildly to significantly ‘nervous’ about what comes next: see Atul Gawande’sNow What?’, or MoneyWatch.com Special Report: ‘What’s Next for Taxes?’ or even the proactive Patient Centered Medical Home (PCMH) and Healthcare Reform: Avoiding Drowning in an Ocean of Opportunity.

Most of us (with the exception of the rhetorical ‘repeal and replace…. ahem, I mean revise’…. or worse, the ‘frivolous‘ perhaps politically motivated State AG ‘sue em’ crowd) are into action focusing on the many pilot and demonstration opportunities now written into law. Note:  for a deep dive and excellent summary of some of those opportunities, see Vince Kuraitus’ superb work (and I mean, with proper ‘fluff’ a consultant might charge $5,000 – $15,000 for these timely and laser focused insights), in ‘Pilots, Demonstrations & Innovation in the PPACA Healthcare Reform Legislation‘. Kuraitus pulls some of those ‘opportunities’ upfront, at least those impacting ‘e-care management’:

I count at least 5 pilot projects and 30 demos in the PPACA legislation.

Here are some of the pilots and demos that I believe will be of most interest to e-CareManagement readers. (A full listing of pilots & demos is shown at the bottom of the post).

Pilots

Sec. 3023. National pilot program on payment bundling

Sec. 4202. Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries
Sec. 4206. Demonstration project concerning individualized wellness plan
Sec. 10326. Pilot testing pay-for-performance programs for certain Medicare providers

Demos

Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization
Sec. 2705. Medicaid global payment system demonstration project
Sec. 2706. Pediatric Accountable Care Organization demonstration project
Sec. 3024. Independence at home demonstration program
Sec. 3027. Extension of gainsharing demonstration
Sec. 2601. 5-year period for demonstration projects. (for dual eligiblebeneficiaries)
Sec. 3140. Medicare hospice concurrent care demonstration program.
Sec. 3510. Patient navigator program.
Sec. 4206. Demonstration project concerning individualized wellness plan.

So what is ‘disorganized medicine’ to do?

  • Will we revisit the ‘circle the wagons’ days when Bill Hsiao proferred the landmark fair valuation system aka RBRVS, only to witness a special interest orgy demanding and even suing for re-balancing of certain procedural vs. cognitive events?
  • Will we go the direction of certain specialty societies, or more broadly represented yet so-called ‘national’ physician organizations (one with 2 State chapters), who opposed health reform?

Or will medicine step up and lead? Can medicine lead? Afterall, we do know what works, we certainly know the root problem(s), so why all the internecine fighting so endemic to political medicine, and where are patients in this conversation?

For me, Jack Cochran, MD, CEO of the Kaiser Federation says it best on a recent panel at the National Governors Association starting at 01:24:00

lets step up, and in the conversation and represent what a different future could look like

or, paraphrased by me ‘stop whining and get busy.

So where will you put your focus? Will it be to demonstrate the financing and delivery system of the future? Or, continue the ‘echolalia’ of pessimism and Armageddon so rampant in this run up to change?

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Written by 2healthguru

April 9, 2010 at 2:20 PM

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