re: Gawande Nails It on Healthcare Costs

menoalittle — Sat, 06 Jun 2009 04:17:06 GMT

Bob,

The cardiac surgeon in McAllen observed, "We took a wrong turn when doctors stopped being doctors and became businessmen". I ask, what was the genesis of this transformation. The answer is not as simple as greed.

Gawande opines about approaching the fix; "This will by necessity be an experiment. We will need to do in-depth research on what makes the best systems successful", an all encompassing comparative effectiveness evaluation of health care delivery to get the sweet spot of the right box of the two by two, if you will. The number of new delivery approaches is scant and ideas for others are pedantic as intimated by Gawande. Politics and big business interests are an impediment and this includes, but not limited to, the Leapfrog Group and the HIMSS membership. Look what Six Sigma has done for GM. The highest priorities of medical care are more comparable to those of the military than of GM or Motorola.

Survival, injury, and mental health tip the balance. And we see that “intolerable” (according to the US Army’s Surgeon General’s Congressional Testimony) HIT systems are also and impediment, here:

http://www.usmedicine.com/article.cfm?articleID=1906&issueID=123

Unfortunately, the health care system evolved to where it is over decades and it will take that long to get it out of the worst quadrant. To understand the powerful forces that created the current crisis, Economics 101 and Economic History 101 is requisite. Speaking of economics, the Mayo clinic could do it even cheaper if they did not repeat most tests that had been done at outside facilities.

It has been interesting to see the evolution of CMS thought on concierge care delivery, itself an organization (albeit small) of maximum accountability. CMS went from attack to adoption, at least partially. There is a CMS program that now pays doctors more to provide care to patients with complex multiple co-morbid conditions. Pure concierge care and this variant ought to be part of the comparative effectiveness evaluation.

The question for the creative Gawande is how to instill the pride of accountability and the Oath back in to the noble profession.

Best regards,

Menoaliitte

re: Gawande Nails It on Healthcare Costs

Bob Wachter — Sat, 13 Jun 2009 05:17:23 GMT

Atul Gawande gave a talk to graduating students at the University of Chicago's Pritzker School of Medicine, and the indefatigable Maggie Mahar covered it in her blog. Atul's appeal to the students to "join in the battle for the soul of medicine" is inspirational and well worth reading.

A Health Policy Addict's Summer Reading List

Wachter's World — Sat, 20 Jun 2009 19:41:17 GMT

If you’ve been following health policy for a generation, as I have, these past few weeks have been the

re: Gawande Nails It on Healthcare Costs

bgj 4 transformation — Thu, 09 Jul 2009 04:27:07 GMT

Yes, yes, it is good to hear others in healthcare speak to the need to see health care reform as a bigger issue than who pays. We have to start the reform with the end in mind and find a way to transition from our current model of care delivery to the one we design for our future all the while making sure there is still a way to make a living in this industry.

Thanks for th link to Atul Gawande's piece.