By: Hank Duffy, President JHD Healthcare Partners
November 8, 2016, had a surprising presidential election outcome that many people, including myself, didn’t see coming. For us in healthcare, it’s very likely there is a wave of changes coming our way.
Yogi Berra said, “Making predictions, particularly about the future, can be very difficult.” So we don’t know what will come in the next few years under the Trump administration, but my sense is the endangered aspects of Obamacare are:
- The “Individual Mandate”
- The role of the Exchanges
- The approach to Medicaid
- Possibly, the role of CMMI
However, one aspect about our industry I am convinced will not change is The Prime Directive to reduce the cost of healthcare. Whether we have Value-Based Reimbursement, Bundled Payments, Fee-For-Service or Capitation, the pressure to bring down the cost of care is going to continue. This means reducing the Total Medical Expense Ratio – the cost of the clinical care process – not freezing salaries, cutting nurses or Medical Assistants, or closing floors.
There is a golden ticket to succeed at reducing the clinical cost of care – it’s the physicians.
Today, enough focus isn’t on positioning the physicians as the leaders in driving quality up and clinical cost down. They need to be:
- Better equipped
- Better supported
- Incented to focus on larger patient populations
- Recognized as the “healers” of successfully reforming healthcare
In the midst of the potential chaos, how do we, as an industry, get the golden ticket?
- Integrating Technology: The technology is here, but we are not putting enough effort into “optimizing” its use for the physicians and their care teams. As was the case with the introduction of the EHRs, we made the day-to-day work of the physician more difficult. Having the technology is great, making it work to the needs of the specific physicians is essential.
- Fix Clinical Support Staffing: As an industry, we are not adequately preparing for the coming physician shortage, and we can do more to better leverage the clinical support staff mix. At some point in the future, a Primary Care Panel will be 6,000 – 7,000 lives, which is unmanageable with the current staffing model.
- Make Clinical Data Usable: A lot of progress has been made in the availability and use of clinical metrics, particularly through CMS programs and the successful ACOs. As physicians take on changing care patterns/pathways and creating true integrated care management, the data needs to be:
- More credible
- Easier for them to use
- Embraced by them
- Strengthen Financial Incentives: If the physicians are the engine in driving down clinical cost, they need to have the same incentives as the industry. Physician arrangements should be crafted to reward:
- Clinical quality
- Clinical cost
- Patient satisfaction
- Citizenship in the clinical enterprise.
- Facilities: Our ambulatory facilities need to be more user-friendly and designed to support integrated care. It’s a long-term investment, but we will not reduce the cost of care without moving away from antiquated small physician offices.
Physician satisfaction has been decreasing for the past 15 years or more, and we need to start here to succeed with any healthcare change. So while we wait to see what “Trumpcare” brings, it is in everyone’s interest to find a way to:
- Make the physician work environment easier
- Align incentives faster
- Embed the clinical quality and cost data into the care process
- Accelerate the movement toward clinical integration as a means to bring down clinical cost