The 11 Monsters of Healthcare (Part 2 of 2)

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HMR-thumb1Yesterday, we looked at the first five monsters of healthcare that Donald Berwick, MD, former acting administrator of CMS, believes need to be defeated for true reform to take place in America.

Here are the final six, as reported by Cheryl Clark of HealthLeaders Media:

Sixth, Berwick urged healthcare leaders to “resist innovations that don’t help.” He remembered walking through an exhibit hall at a convention in 2012 at which 6,000 healthcare professionals were in attendance. Incidentally, there were also 6,000 vendors touting their wares.

“There was fiber optic this and robotic that, ceramic this, and disposable everything. And I am absolutely sure that somewhere in the acreage of innovation there was something that could help patients that was definitely worth the money,” he said. “But every instinct I have is telling me that what is offered as innovation in healthcare is certainly not always and maybe not even mostly truly helpful, but adds complexity and risk and we need to tell the difference.”

His seventh point was perhaps the most controversial of all. He advocated expanding the “roles and scopes of practice for non-physicians.” He emphasized the need for unity in this matter, saying “We need help from the (professional) guilds, not their opposition.” He also cited the need for changing the legacy payment systems that “don’t encourage these changes.”

Eighth, “defend the poor,” he said, and begin seeing “healthcare as a human right.”

“‘The social safety net is vulnerable and the will to protect’ social services for the poor ‘needs constant reinforcement that government can’t provide without hospitals’ support,’” he stated.

Ninth, the “tragic silence” on palliative and end-of-life care needs to end, he proclaimed. Although he did not name names, he was referring to the fear that resulted from many commentators, chiefly Sarah Palin and Glenn Beck, equating “sensible discussion of advance directives and preferences with ‘death panels.’”

Now, nobody in government wants to discuss the issue, he said, but it needs to be discussed and explored perhaps as much, if not more, than many other healthcare matters.

Tenth, he wants hospitals to not just cure diseases, but to also “create authentic prevention.”

“Prevention doesn’t have any cathedrals. The result is continuing misallocation of effort,” he observed. “And if the Martians came here to visit, they would call this insane. We let bad things happen and then [hospitals] fix them. Well, why don’t we stop them from happening? Simply put, we just haven’t built the institutional structure for prevention.”

Finally, he backed the creation of transition models. Clark writes, “Berwick referred to Alaska’s Southcentral Foundation ‘Nuka System of Care,’ a project that won the Baldridge award for its success in emptying hospitals and decreasing the need for specialty care, as a care-transition model monster that is scaring hospitals.”

“It reduced hospital bed days for the population by 53 percent,” Berwick marveled. “Specialty visits fell 65 percent. These are the highest quality scores I’ve ever seen. And the highest patient satisfaction and staff satisfaction in history. And if we had results like NUKA’s at a national scale, it would totally solve the U.S. government’s healthcare problem without harming a single patient.”

Yet no matter how enthusiastic physicians may be about these models, he lamented, healthcare CEOs tend to shut down at the very thought of emptier hospitals.

But, he asked, “Wouldn’t you want a healthcare system that makes itself as unnecessary as possible?”

What are your thoughts on the monsters Berwick believes healthcare needs to slay? What is the executive’s role in slaying them? What innovative initiatives has your organization implemented to improve in these areas?

-by Pete Fernbaugh

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