The American College of Physicians (ACP) is the largest medical specialty organization in the United States, with 152,000 members in more than 145 countries. On Thursday, the organization kicked off its annual scientific meeting, Internal Medicine 2018 (or #IM2018 as it’s known on Twitter).
Held in New Orleans this year, the event is the nation’s largest gathering of internal medicine doctors, featuring more than 200 sessions on broad array of clinical and practice management topics.
During an educational session sponsored by Humana, I had the opportunity to speak about the disruption of healthcare and what that would mean for American medicine.
This, it turned out, was a hot-button topic among internal medicine physicians, many of whom believe the current healthcare system is unsustainable. With only enough seats to hold 170, hundreds more attendees lined the sides and back of the room, spilling out into the exhibition hall. The talk was highlighted and captured by Kat Gentner, a talented “live” artist who translated my remarks into the following visual display.
To set the tone for my discussion, I outlined the road map for healthcare transformation from Chapter 7 of my book “Mistreated: Why We Think We’re Getting Good Health Care – and Why We’re Usually Wrong,” copies of which were given to the first 170 participants.
For health care to be stable in the future, it will need to stand on four pillars:
- Health care will need to be integrated, both horizontally within specialties and vertically across primary, specialty, and diagnostic care.
- Health care need to will be capitated, moving away from pay-for-volume toward paying for value and superior outcomes.
- Health care will need to be technologically enabled, with comprehensive electronic health record systems, patient access to medical information, and the ability to obtain care using mobile and video technologies. Add to these the full suite of emerging technologies such as blockchain and AI, and the possibilities are massive and exciting.
- Health care will need to be physician led, which will require greater leadership training and development.
Much will need to change to get there. Today’s healthcare system rewards volume, not quality, and relies on outdated information-technology systems. These have a negative impact not only on patient outcomes, but on physician fulfillment, as well: A third of all physicians report feeling depressed. More than 400 doctors commit suicide each year. And more than half of doctors would discourage their children from entering medicine. It may not be easy to reverse these troubling realities, but change is essential.
My talk was followed by an energetic and positive Q&A discussion.
Q1: How can #IM2018 participants make change happen? I emphasized that the doctors in attendance are leaders – in their hospitals and their communities. And as leaders, they have the opportunity and ability to develop greater specialization, reduce medical error and lower costs. One way to accomplish this goal is to form multi-specialty medical groups capable of being capitated for populations of patients, and also establishing relationships with single hospitals to generate higher volumes with superior clinical outcomes.
Q2: Why are healthcare’s biggest players seemingly reluctant to move from the current model to one that focused on better clinical outcomes and greater operational efficiency? It’s not the challenge of getting leaders to support the destination. It’s the challenges that come up along the way that cause healthcare leaders to veer off course. It’s one thing to want to be a higher-performing hospital. But for many inpatient facilities, doing so would mean lowering utilization in half and, as a result, going out of business before they were able make up for the decreased revenue. It’s one thing for insurance companies to want to capitate, moving away from fee-for-service reimbursement. But the first step is finding enough doctors in large enough groups to accept the risk. In most locations, that’s tough to do.
Q3: What’s the role of primary care in the totality of healthcare? Primary care plays a central role in preventing disease, avoiding complications from chronic illness, and coordinating medical care. Done well, primary care physicians can reduce deaths from stroke by 40%, heart attacks by 50% and colon cancer by 50%. How? Blood pressure control, blood lipid management and FIT testing.
To close, I offered the audience a provocative idea: Imagine if every American paid $10 a month (the cost of a Spotify subscription) to their primary care doctor so that physicians could manage panels 30% smaller and make the 15-minute visit a relic of the past. That may not sound like an unrealistic proposition. But for it to happen, patients and physicians must demand it.
Without question, healthcare will be disrupted. It happens to every inefficient industry at one point or another. I believe the process and outcome will be best if it is led by physicians and patients. I am optimistic that some of the #IM2018 attendees will lead the way.
Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD.
