In all of the commentary written here and elsewhere on how to control health care costs, little attention has been given to the potential contributions that could be made by physicians – those at the center of the health care system.

But maybe the idea is beginning to catch on.

Two separate articles on the same day in two of the nation’s most respected publications have highlighted the role of the physician in containing health care costs.

Alan Sager and Deborah Socolar of Boston University, writing in The Boston Globe, boldly state that “doctors’ decisions essentially control almost 90 percent of health care spending…yet cost controls have ignored, marginalized, or sought to manipulate doctors instead of working with them.”

The pair, arguing that “a financial, legal, and clinical peace treaty between payers and doctors” is required to develop a health care system that covers everyone and eliminates waste, offered one approach: develop “small clusters of primary care doctors and other professionals that live within budgets, accepting capitation payments calibrated to patients’ health. Raising primary care doctors’ incomes by half would sharply increase their supply and their time to listen to patients and coordinate care.” [Italics added.]

Separately, in the business pages of The New York Times, economist Milt Freudenheim wrote about experiments around the country by federal and state governments and insurers to cut health costs by paying doctors more. Read more…

The recent report that a debt reduction program aimed at recruiting clinicians to community health centers in Eastern Massachusetts exceeded expectations was good news indeed. Launched in 2007 with funds from Bank of America, the program placed 35 physicians and 12 nurse practitioners at 23 health centers that serve many low-income residents.

State officials were euphoric, and everyone in the medical community should take heart that this kind of program is having solid results.

I would urge, however, that while we keep our enthusiasm over this development, we must temper it as well. Read more…

The Massachusetts Medical Society asked 2 consultants to evaluate new programs in place that rate physician performance and reward doctors who do better than others. The press release that explains the conclusions is below. Health insurers and employers are doing this, they say, to help patients get the best care and best value for their money. Many us will soon, if we don’t already, have a higher co-payment when we see doctors with less favorable ratings. But are the ratings fair? Here’s the Medical Society’s assessment…

Waltham, Mass. – Jan. 15 – Independent physician consultants have found that several aspects of the Massachusetts health plan methods of rating physicians on cost and quality do not conform to the Massachusetts Medical Society’s (MMS) principles for fair, accurate and clinically relevant physician tiering systems. The consultants, John D. Freedman, M.D., M.B.A., and Bruce E. Landon, M.D., M.B.A., said these findings “raise concerns about the potential for these programs to adversely affect patients and physicians.” Read more…

The state’s Health Care Quality and Cost Council faces a challenge that is bigger than the Big Dig. After all, that project took 20 years to spend 15 billion dollars. The state spends that much in health care about every four months. If our health care access legislation is to succeed, the Council must find a way to bring one sixth of the state’s economy, the state’s largest industry, under control.

At the first meeting of the Council in the New Year on January 2, Dr. Don Berwick, president and CEO of the Institute of Healthcare Improvement and an elected member of the nation’s prestigious Institute of Medicine, provided just the right analogy when he compared our health care system to a “commons” – the space at the center of colonial towns where folks would bring their livestock to graze. If everyone acted only in their self-interest, the land would soon be overgrazed and all would lose. The challenge, he said, was to find a way to inspire those involved to view their duty as not only a personal gain, but also as a contribution to the good of the community. One needed to only look at those attending the meeting – consultants and those advocating for various constituencies – to know that this would be a hard sell. But we ignore him at our own peril. Read more…

While the discussion goes on about the issues of cost and quality, one thing that no one can debate is that to improve, those delivering care need good data. Whether we choose to view it as a deficiency of the current system or an opportunity, the fact is that those delivering care do not now have access to enough information to get us from where we are to where we need to be.

The health plans currently control most data that exists in an electronic format (No one believes that using paper-based data can be useful over the long run.). But there is no agreement among the plans regarding making this available to providers in a uniform format. At this time, plans release information in differing formats (sometimes paper based), covering different spans of time and different subjects. From this, providers of care are expected to try to provide a uniform standard of care to all of their patients and improve what they do.

This has not worked and it is not hard to see why. Read more…

As the health care access bill rolls out we are increasingly concerned about how cost is going to come under control without compromising quality or access. In some ways the cost issue is very easy to understand: we either impair access (by diminishing the supply of providers), ration care (by denying coverage or access to certain treatments), or work together to both engage our patients in healthier lifestyles and find more efficient ways of delivering the care that is needed. Nobody wants the first two choices. But a concerted and innovative effort will be necessary for us to make significant progress with the third option. What we are doing now is not working. Read more…

Boston may be a world center of health care, but you’re going to have to start waiting a little longer to see a doctor. Maybe a lot longer. A new study from the Massachusetts Medical Society says there’s a worsening shortage of physicians here in primary care and six other specialties. Among the specialists in short supply are cardiologists, gastroenterologists, anesthesiologists, urologists, and neurosurgeons.

Click below to listen to Bob Oakes and MMS President Dr. Dale Magee discuss the shortage and the impact on the state’s effort to cover the uninsured.

Are you waiting longer to see a doctor?
What do you think the state, insurers or medical community should do?

Since this blog began, articles have appeared on affordability, eligibility, what businesses must do, insurers’ and policymakers’ perspectives, physician shortages, and congratulatory pieces on how far we’ve come to lead the nation in health care access for all citizens.

There’s been little written, however, on how this health care revolution will address one of our state’s most pressing problems: health care disparities. Read more…

Embedded in the Health Care Reform Law is a provision for a health care quality and cost council, charged with establishing “health care quality improvement and cost containment goals…designed to promote high-quality, safe, effective, timely, efficient, equitable and patient-centered health care.”

This is a serious responsibility. Indeed, the Boston Globe, in a May 15 editorial, called the council’s work “Item #2 on healthcare agenda.” The council has great promise, but unfortunately has languished to date, a fact noted by the Globe editorial: “Unlike the connector, the council has not made much of an impact.”
Read more…

Health care has become a jewel in the Commonwealth’s Crown. Our excellent medical schools educate dedicated, capable physicians. Our hospitals provide state-of-the-art, world-renowned care. Health care has even become our state’s number one industry, our primary economic engine for the future. It is fitting then that our state has been the first to take the step toward universal care. Massachusetts physicians, long supporters of universal care, are particularly gratified to see such progress.

But a nagging, critical question remains: Can we fulfill the promise behind the law if our healthcare workforce remains under increasing stress? Read more…