Lately I have been confronted with variations on a theme: The growing call for physician leadership in our changing health care environment.
The AMA’s State Legislative Strategy Conference, which I moderated last month, is a multi-faceted annual gathering of medical society leaders and other stakeholders from all 50 states. This year, both speakers and stakeholders literally were begging for physicians to lead the way through the confusion of Medicaid expansion, rollout of the Affordable Care Act, implementation of delivery and payment reforms, and exploration of new avenues for reducing costs while improving health outcomes.
This message was underscored for me again only a couple of weeks ago at a meeting of the corporate members of the Joint Commission. The meeting had only three agenda items, and one was the organization’s new physician leadership and engagement initiative. The Joint Commission knows their clients cannot be best-in-class without physicians taking the lead.
I agree physician leadership will be vital to the success of health care reform and have made this message a centerpiece of my term as AMA chair. We are facing big, big problems—one of the biggest is simultaneously improving health care quality while reducing costs. Yet I take heart when I hear others saying what we have known all along: Physicians are best equipped to find the sweet spot between the two.
Historically, physicians always have been looked to as “owners” of health care quality. We also have known that we have the power to influence costs: A physician’s pen is a mighty instrument. Until recently, though, costs were considered “someone else’s problem.” All parties—patients, payers, hospitals and physicians—want to be good stewards of our health care resources, but today there is a realization that physicians are in the best position to take the lead in working with our patients, payers and hospitals to solve the cost-quality conundrum.
However, many aspects of the system work against us. Defensive medicine drives up spending. The per-unit cost of tests, treatments and hospitalization is rising and varies greatly. Meanwhile, the system’s lack of transparency is one of the greatest barriers to reducing spending. We are just beginning to acquire information regarding quality of care, but it is limited and often hard to get. Useful cost information remains elusive.
For example, we may know in relative terms that a CT costs more than an ultrasound and an MRI more than a CT, but we generally don’t know how much a given test or procedure actually costs at hospital A, B or C, or at a free-standing facility down the road. Without cost and quality information at the point of decision, we can’t help our patients make informed decisions regarding their options for care.
Yet this is slowly changing. I see physicians taking the lead in calling for increased transparency from payers and providers, and many states are creating all-payer databases to help shed some light on claims data. Many payers are exploring ways to move toward value-based rather than volume-based payments which will require cost and quality transparency.
As highly trained clinicians who have dedicated our careers to our patients’ well-being, we are uniquely positioned to lead our patients and American health care into a new era of quality, efficiency and efficacy. We know what it takes, and we must step up and use our collective knowledge and expertise to get us there.
So when we hear medical groups, hospitals, health insurers, other organizations and our patients calling for physicians to take the lead as we move forward, we should pay attention and respond. This is a phenomenal opportunity—one we cannot allow to pass us by.
