MGMA Saves the Best for Last: A Panel Discussion with Three Wise Men

Today’s panel discussion on improving the quality of care through quality, innovation, and service included some all star presenters. If this team were a baseball team they’d be the Yankees; we’re talking about some big names. We have Dr. Delos M. Cosgrove, president and chief executive officer of Cleveland Clinic; Dr. William Wright, Executive Medical Director Colorado Permanente Medical Group; and Dr. Gary S. Kaplan, Chairman and CEO of the Virginia Mason Health System. Each panel member had an opening statement, introduced themselves, mentioned what roles they have in their respective organizations, and spoke on a few different issues.

Are solo practitioners an endangered species?

Moderator William F. Jesse, MD, astutely noted that many of the members at MGMA likely came from much smaller practices and organizations than panel members, and asked them how their experiences would translate to the audience. Dr. Cosgrove was the first to respond, noting that, in reality, only 10% of physicians are either in a solo practice or are with one other physician, and that this statistics speaks to a trend that seems to be growing each year. He mentioned that there are many reasons for this: an exploding body of knowledge; the financial aspect (ie, the complexity of contracting, measuring quality, EHRs, etc); and a huge change in generations - no longer do physicians want to be on call 24/7. They want a work/life balance and team up with others to accomplish this. Dr. Cosgrove used cardiac surgeons and cardiologists as an example, as these two medical practitioners have been teaming up all over the country.

In order for healthcare reform to be successful, incentives must change – and soon.

This was the most popular topic of the discussion, and it seemed that every answer came back to incentives. All three panel members felt very strongly about this issue, and were all in agreement. Part of the problem with the healthcare system right now is that 75% of the cost of care is a result of patients with chronic conditions. In other words, there’s a major lack of effort in prevention. The panel stressed the importance of making a patient a facilitator in their own care. In addition, the members stated that the incentives are in the healthcare system are all wrong: hospitals and practices create more care, and insurance companies only care about money. Truly positive healthcare reform will consist of two major changes: caregivers must cut out unnecessary tests, and patients must be incented to be active in preventative health.

To the first change, Dr. Kaplan mentioned a Virginia Mason program that involved a collaboration with both Starbucks and Aetna. Starbucks believes their baristas should have health insurance, but they worry about the cost. Through some research, Virginia Mason discovered that back problems were very common among the baristas, and that many times they were recommended an MRI. Unfortunately, an MRI in this situation is rarely beneficial in determining a cause of the pain, and Virginia Mason made sure that these referrals stopped. So, by cutting out this costly test, they may have taken a hit in their bottom line due to the cost of the MRIs, but in the end they were helping to provide care in a much more cost-effective way, and changed the model in which care was delivered, benefitting everyone involved. The focus was shifted to the patient instead of profit margins.

To the second change, Dr. Wright mentioned that Safeway had recently put a program in place that he hopes will lead to a chain reaction. He encouraged the audience to find more information about it online. In a sentence, “Safeway introduced a plan in which preventative care was covered completely, and included a health saving account of $1,000 per person that Safeway funded. Health care costs above that are covered by employees.” Read more about this program here. The bottom line is that patients who are living an unhealthy lifestyle and are subsequently causing a strain on the cost of healthcare in this country should be hit hard where it hurts them the most – their wallet.

This discussion was a very interesting session to sit in on, and it involved some physicians who are at the forefront of enacting change in a broken healthcare system. On second thought, maybe these presenters are more like hockey players. Dr. Kosgrove answered an attendee’s question about health reform with a reference to Wayne Gretzky, known in the sports world as “The Great One.”

“One day a reported asked Gretzky what made him so great. Do you know how he responded?” After it was apparent that there were no hockey enthusiasts in the audience, he continued. “He told the reporter that he always had a sense of where the puck was going to be. So not only did he always know where it was, but he knew what to expect next. That’s the type of leader we need in healthcare reform.”

I was lucky enough to sit in on a discussion betwe three Wayne Gretzkys today.