Reading List: Fredric Tobis, 'The Healthcare Crisis: The Urgent Need for Physician Leadership'
In The Healthcare Crisis: The Urgent Need for Physician Leadership ($12.95, Amazon Digital Services), author Fredric Tobis, a cardiologist, takes a look at the healthcare crisis and proposes that the industry needs to be rescued by physician leaders. Tobis talked to Healthcare Finance News about his book.
Q: Please give us a brief description of your book, and share with us what you think is its most important take away for readers.
[See also: Reading List: Stanley Chao, 'Selling to China']
A: The book has three missions:
1. To define the healthcare crisis as primarily a COST crisis.
2. To provide much needed background information for the interested public and policy makers about skyrocketing costs and their etiology.
3. To urge physician leaders to get directly involved in creating value in healthcare (quality/cost) to sustain a healthcare system accountable to patients and not federal bureaucrats.
[See also: Reading List: Steven Dinkin, 'The Exchange Strategy for Managing Conflict in Health Care']
Q: How do you define physician leadership and why do you think it is so lacking and so urgently needed?
A: Leadership is defined as the ability to influence others to forsake narrow and parochial interests in the pursuit of the common good. Instead of lobbying for our own interests (as our various medical specialty groups are currently doing), we should be leading reform.
Physicians have been indoctrinated into not focusing on cost (someone else’s problem). While this is appropriate in the one-on-one conversation with a patient, it is dysfunctional in the bigger picture. By abdicating the cost issue to others (i.e. the federal government and insurers) we have given control to people who have no idea how to solve the problem. How could they? They don’t have the experience and expertise to know the difference between fat (excess testing and procedures, unneeded duplication, unexplained variance, etc.) and muscle (good patient care).
Q: You say doctors should be leading financial reform but do not have the incentive to do so. How would they lead financial reform? Is your solution of fee-per-patient an incentive that would cause doctors to lead financial reform? What is fee-per-patient?
A: The way physicians are currently reimbursed is dysfunctional for a variety of reasons:
1. It rewards quantity not quality.
2. It is focused on disease and not health.
3. It rewards procedural-based medicine and punishes primary care.
4. It is unnecessarily complicated and opaque.
5. It is less “consumer friendly” than the post office at Christmas time.
We physician leaders need to work closely with other providers (nurses, pharmacists, drug and device companies, hospital and other facility administrators) to create competing integrated systems that can bid for a set fee-per-patient per-month to provide healthcare (not disease care) for populations. This fee structure provides incentives to the entire integrated system to provide the best comprehensive care at the lowest price. Just as importantly, it creates financial disincentives to overutilize precious resources.
Q: You say that the discussion on healthcare's skyrocketing costs is distorted. How is it distorted and where should the focus be instead?
A: It is distorted primarily because our current reimbursement “system” incentivizes the very behaviors that are driving the costs to unsustainable levels.
In addition to the items covered in the last answer, our current reimbursement system perpetuates the fragmented silos of care that currently exist. Instead of creating a variety of small pies (competing integrated systems) that allow the participants in the pie to slice it how they choose, the government and insurers are deciding how to slice the pie.
The result is that those in the pie with the best lobby (specialty medical groups, drug and device companies, some private insurers, etc.) manage to retain their share of the pie, while others (primary care providers, in particular) receive progressively less of the pie. Meanwhile the pie keeps growing because no one inside the pie is actually accountable for its overall size.
Too bad the Marx brothers aren’t around any more.
Q: You say that patients should be encouraged to question the value of tests and procedures ordered by their doctors. Do doctors take the lead in this – educating patients about overtreatment?
A: They, no doubt, will when they are incentivized to do so. When every unneeded test, procedure, drug, device, hospitalization, etc. puts the integrated system at financial risk, everyone in the system, especially those physicians ordering these unneeded expenditures, is accountable.
Q: Is there something about your book that I haven't asked that you would like to add that you think is important for readers to know?
A: It’s important to people to recognize that I have no axes to grind and no financial conflicts here. The book was a challenge to me given by my kids and their very smart friends. Over dinner one night we got into a chat about healthcare and I was amazed at how little they understood about the subject. When I expressed this to them, they suggested I “write a book” … out of the mouths of babes.
