At a time when the coronavirus is disrupting our personal and professional lives, it’s important that we take advantage of any opportunity to connect, learn from one another and grow.
Today, healthcare professionals from all over the country did just that, joining together digitally for MGMA20: The Operations Conference Online.
From the “stage” of my living room, I had the privilege to address hundreds of COOs, CMIOs and practice professionals with a virtual keynote called “The Future Of American Healthcare: Four Pillars for Transformation.”
Over the past two months, healthcare’s status quo has been turned upside-down by COVID-19. As doctors, nurses and staff charge into battle against an invisible enemy, hospital administrators and private physician practices are being forced to rethink their operational models and prepare for the uncertainty that awaits all of us in a post-pandemic world.
The Four Pillars Of Transformation
To help attendees think through these challenges, I explained the four key changes that will equip U.S. practices for the future:
- Integration
- Capitation
- Technology
- Physician leadership
These are difficult changes, which I spent 18 years instituting as CEO of The Permanente Medical Group alongside thousands of talented colleagues. Combined, these four pillars lead to better clinical quality, lower costs and greater convenience for patients.
Getting there as a nation will not be easy but it will be necessary for the survival of the American healthcare industry and for the well-being of patients going forward. Each pillar is explained in great detail in my book “Mistreated: Why We Think We’re Getting Good Healthcare—and Why We’re Usually Wrong,” for which all proceeds benefit the nonprofit organization Doctors Without Borders.
How Context Shapes Perception
As I explained to the audience of MGMA20, we now have an unprecedented opportunity to change the context of medicine. I have learned that context—the circumstances we find ourselves in, the instructions we are given, and the incentives we’re offered—have the power to shift our perceptions (often without our ever knowing that a shift has occurred). Context has a profound impact on what we see, hear, and feel. It also has the power to change our behavior.
In the context of a fee-for-service model, for example, clinicians are rewarded for maximizing the quantity of services offered rather than the quality. They are not rewarded as highly for focusing on preventive health, limiting complications from chronic illness or avoiding preventable medical errors. Similarly, there is no financial incentive to eliminate redundant or unnecessary services.
How Culture Shapes Medicine
As the United States enters a potentially long and painful recession, patients and businesses will become far less tolerant of medical care that delivers substandard quality and poor service at luxury prices. The time to change is now.
To do so, we must recognize and resolve the systemic barriers to better care—they include today’s fragmented delivery system, the perverse payment model, the outdated technology and the absence of physician leadership.
Consider, for example, the use of telemedicine in the United States. Although “virtual visits” ensure patients receive excellent quality and convenience at a lower cost than in-office visits, insurance companies and government agencies have historically placed major restrictions on their usage and reimbursement. In effect, the traditional healthcare system has penalized telemedicine. As a result, fewer than 10% of all Americans have ever received care virtually before the coronavirus outbreak.
But the system wasn’t the only thing holding telemedicine back.
In addition to the systemic barriers, we must also recognize and resolve many of the cultural issues that have prevented physicians from delivering optimal, 21st-century care. The physician culture in the United States has long maintained that patients can only receive excellent care in a hospital or an exam room—not over a video screen.
Now that many physicians have no choice but to offer video visits for routine care (to keep patients and themselves safe from infection), both parties are beginning to see the benefits firsthand. As such, I predict that the coronavirus pandemic will continue to alter many of the norms, rules and expectations that have been central to the physician culture.
It’s important to recognize that physician culture has served patients very well throughout history. From medieval plagues to today’s pandemic, doctors have always demonstrated courage, dedication and selflessness in times of crisis. These qualities are foundational to physician culture and they will remain critical to delivering better care in the future.
I concluded my comments by predicting that the current economic consequences of COVID-19 will accelerate the disruption of American healthcare. Doctors in the private community and large medical groups will need to make a choice: lead or get left behind. The clock is ticking.
* * *
The culture of physicians will be the focus of my upcoming book, due out in Spring 2021. Get more information about that and other important healthcare issues by signing up for my monthly newsletter.
For more information, check out my discussion with Daniel Williams on the MGMA Podcast. Visit the MGMA website, along with the organization’s COVID-19 Resource Center for additional resources and information.
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.
