{"id":411,"date":"2013-11-19T17:50:10","date_gmt":"2013-11-19T06:50:10","guid":{"rendered":"http:\/\/blog.panicola.com\/?p=411"},"modified":"2013-11-19T17:50:10","modified_gmt":"2013-11-19T06:50:10","slug":"the-brutal-view-from-medicines-front-line","status":"publish","type":"post","link":"https:\/\/blog.panicola.com\/?p=411","title":{"rendered":"The brutal view from medicine&#8217;s front line&#8230;"},"content":{"rendered":"<ul>\n<li>despite the noise regarding safety, quality and health reform, and in particular payment reform from fee-for-service to value-based-payment, the truth is that practically all providers and provider organisations are simply focused on one thing: MAXIMIZING REVENUE<\/li>\n<li><em>It\u2019s fun to read about cool technology, big data, and innovation incentives, but the reality is that in the trenches, many (I\u2019d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago.\u00a0 <\/em><\/li>\n<li><em>Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative \u201cquality\u201d metrics that rarely capture the complexity, or essence, of the patient experience.<\/em><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Source:\u00a0<a href=\"http:\/\/www.forbes.com\/sites\/davidshaywitz\/2013\/11\/12\/the-brutal-view-from-medicines-front-lines\/\">http:\/\/www.forbes.com\/sites\/davidshaywitz\/2013\/11\/12\/the-brutal-view-from-medicines-front-lines\/<\/a><\/p>\n<div>\n<p><strong>The Brutal View From Medicine&#8217;s Front Lines<\/strong><\/p>\n<div>\n<div><a style=\"font-size: 1rem; line-height: 1;\" href=\"http:\/\/www.forbes.com\/sites\/davidshaywitz\/2013\/11\/12\/the-brutal-view-from-medicines-front-lines\/#comment_reply\" data-initialized=\"true\"><a style=\"line-height: 1.714285714; font-size: 1rem;\" href=\"http:\/\/www.forbes.com\/health\/\">Health<\/a><span style=\"line-height: 1.714285714; color: #444444; font-size: 1rem;\">\u00a0policy discussion these days focuses extensively on the<\/span><a style=\"line-height: 1.714285714; font-size: 1rem;\" href=\"http:\/\/www.forbes.com\/sites\/davidshaywitz\/2013\/09\/15\/key-question-for-innovators-isnt-where-healthcare-is-going-but-when-it-will-get-there\/\" target=\"_blank\">\u00a0idea that medicine is changing<\/a><span style=\"line-height: 1.714285714; color: #444444; font-size: 1rem;\">, moving (maybe slowly, maybe rapidly) from a fee-for-service to a fee-for-value world, where providers and hospitals own risk, and are incentivized to reduce costs and improve care, a win-win situation for all.<\/span><\/a><\/div>\n<div><\/div>\n<\/div>\n<\/div>\n<div id=\"leftRail\">It\u2019s possible such change is happening \u2013 somewhere, or in some parts of some organizations.Yet, most providers with whom I\u2019ve been speaking tell a starkly different story.\u00a0 The view from the front lines suggests that hospitals and care delivery systems are obsessing like never before on doing whatever they possibly can to maximize their revenue.\u00a0 They are consumed, utterly consumed, by this objective.<\/p>\n<p>It\u2019s touching to read\u00a0<a href=\"https:\/\/blogs.sph.harvard.edu\/ashish-jha\/improving-leadership-in-healthcare-a-strategy-for-everyone-else\/\">accounts<\/a>\u00a0from\u00a0Ashish Jha and others describing benevolent CEOs concerned about patient care and safety; the hospital executives I\u2019ve been hearing about tend to talk a good game about safety, and may even genuinely care about quality, but they are focused on, driven by, and hired for their skill at maximizing revenue \u2013 a prime directive that quickly percolates its way through the entire care system.<\/p>\n<p>I know of examples at non-academic centers where doctors are refusing to see patients who don\u2019t carry \u201cgood\u201d insurance, citing miserable rates of reimbursement \u2013 rates they point out can be lower (sometime much lower) than what professional trainers often make.<\/p>\n<p>At academic centers, publishing papers is certainly encouraged, but making your \u201cRVUs\u201d (i.e. seeing enough patients) is prioritized \u2013 and failing to do so can get you canned.<\/p>\n<p>Hospital records are routinely reviewed in detail to ensure every opportunity for \u201crevenue capture\u201d has been identified.<\/p>\n<p>The reason to highlight what seems to me the current state of medicine (and yes, this is anecdotal, but I suspect that if anything, this description understates the magnitude of the situation) isn\u2019t so much to critique it as to surface it, and remind readers what healthcare actually looks like today \u2014 a reality that seems far more Hobbesian than what\u2019s often imagined, presented, and discussed.<\/p>\n<p><em><strong>It\u2019s fun to read about cool technology, big data, and innovation incentives, but the reality is that in the trenches, many (I\u2019d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago.\u00a0 Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative \u201cquality\u201d metrics that rarely capture the complexity, or essence, of the patient experience.<\/strong><\/em><\/p>\n<p>It\u2019s hard to envision this is sustainable \u2013 you can only increase the speed of the treadmill so much.<\/p>\n<p>Rather, the question is what comes next for medicine \u2013 how will care be delivered, and who will be delivering it?<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>despite the noise regarding safety, quality and health reform, and in particular payment reform from fee-for-service to value-based-payment, the truth is that practically all providers and provider organisations are simply focused on one thing: MAXIMIZING REVENUE It\u2019s fun to read about cool technology, big data, and innovation incentives, but the reality is that in the &hellip; <a href=\"https:\/\/blog.panicola.com\/?p=411\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">The brutal view from medicine&#8217;s front line&#8230;<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9,22],"tags":[],"class_list":["post-411","post","type-post","status-publish","format-standard","hentry","category-healthcare","category-policy"],"_links":{"self":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/411","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=411"}],"version-history":[{"count":1,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/411\/revisions"}],"predecessor-version":[{"id":412,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/411\/revisions\/412"}],"wp:attachment":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=411"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=411"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=411"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}