The time has come to stop talking change and start leading change. U.S. health care is at a crossroads, and physician anesthesiologists are poised to take a leading role.
“Health care is changing at an astounding, even alarming, rate,” said Karen Domino, M.D., M.P.H., Professor and Chair of Anesthesiology and Pain Medicine at the University of Washington, Seattle. “We must change our specialty to meet the demands of the 21st century. We have a powerful imperative to change.”
Dr. Domino delivered a rousing call to arms during the Rovenstine Lecture, “Heath Care at the Crossroads: The Imperative for Change” Monday. If physician anesthesiologists fail to seize the reins of change, hospital administrators, nurses, payers and other medical specialties will determine the future of health care, including anesthesiology and pain medicine.
Dr. Domino also spent time in Washington, D.C. as a Robert Wood Johnson Fellow working with the House Ways and Means Committee on health care policy and spending.
The need for change is not new, she said. Payers, insurers, hospitals, politicians and the general public have long realized that the current fee-for-service system is failing.
U.S. health outcomes are among the worst in the developed world. Life expectancy has fallen from the longest in the developed world to shortest, according to both the Institute of Medicine and studies in the Journal of the American Medical Association.
The Commonwealth Fund rates U.S. health care at the bottom of its list of the top 11 developed countries. Top scores in the 2014 evaluation went to the United Kingdom.
But while U.S. health outcomes trail, U.S. per capita health spending is 2.5 times higher than any other developed country. Health care spending in the U.S. rocketed from $4,878 per capita in 2000 to $8,402 in 2010. That represents an increase from 13.8 percent of gross domestic product to 17.9 percent of GDP.
Rising health care spending is already squeezing other sectors, Dr. Domino said. When health spending hits 20 percent of GDP around 2020, expect severe consequences in education, social services, science research, infrastructure and other vital sectors.
“Economics is driving change,” Dr. Domino said. “The fundamental debate over ‘Obamacare’ is the role government should play in changing health care. Both sides agree that change absolutely has to come. If we physicians don’t take a leadership role, bureaucrats, hospital administrators and payers will step up.”
Payers are driving health care reform, she said. Insurance companies are sometimes little more than conduits and administrators.
Federal and state governments account for about 50 percent of health spending, the business sector 30 percent, and consumers 12 percent and rising. All three sectors are demanding a move away from fee for service – which emphasizes volume – toward value-driven care that emphasizes quality.
The new health care landscape features four dramatic changes.
Consumers have more skin in the game. They are shouldering more of the costs of care themselves – an incentive to seek higher-quality care.
Payers are moving to reference pricing, an “average” price for any given procedure in any given geographic area. Patients are free to use providers who charge more than the reference price, but must pay any excess themselves.
Consumers and payers are both demanding greater transparency in costs and quality. Providers who don’t cooperate won’t get the business.
Payers are moving toward value-based purchasing. On the business side, that means companies such as Boeing contracting with the Cleveland Clinic for specific procedures like CABG. On the consumer side, it means traveling to non-U.S. centers, such as Singapore, for total hip replacement.
“The quality of care around the world is fabulous,” Dr. Domino said. “Other countries are providing state-of-the-art care at a far lower cost than U.S. providers. We need to speak up and improve our processes of care.
“This is no time for business as usual. The forces driving change are enormous, but they can be guided. The clock is ticking, and the time to act is now.”