Fall Member Summit 2012

Fall Member Summit2012

Keeping the Care In Health Care(Are we barking up the wrong tree?) John C. Nelson, MD, MPH Chief Medical Officer, Leavitt Partners Former President, American Medical Association Month Day, Year

The Practice of Medicine Ethics Patient/Physician Relationship Science Caring

The Patient/Physician Relationship • The cornerstone of American medicine. • Based on principles of good interpersonal relationships: • Dignity. • Respect. • Confidentiality. • Care of the patient is paramount.

Fundamentals of the Patient/Physician Relationship • Pt. has right to information. • Pt. has the right to make own decisions. • Pt. has the right to respect, dignity, responsiveness, timely attention. • Pt. has right of confidentiality. • Pt. has right to continuity of care. • Pt. has right to have available adequate healthcare. CEJA: AMA

The Triple Aim • Improving the patient experience of care (to include quality and satisfaction.) • Improving the health of populations. • Reduce the per capita costs of health care.

The Practice of Medicine • History: 85% of the diagnosis. • Physical Examination: 10% of the diagnosis. • Clinical Laboratory: 5% of the diagnosis.

Desired Attributes of Care • Safe. • Effective. • Patient centered. • Timely. • Effective. • Equal.

Goals of an Accountable Care Organization • Improve the experience of the patient. • Improve the health of the population. • Decrease per capita and overall costs of health care.

The Care of the Patient • Doctor and Patient • Papers on the Relationship of the Physician to Men and Institutions. • Francis Weld Peabody, MD • Professor of Medicine, Harvard Medical School, Director of the Thorndike Memorial Laboratory; Visiting Physician and Chief of the Fourth Medical Service, Boston City Hospital 1921 to 1927 • 1930 • The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal.

ACO Effects on PPR Possible Positive Effects Possible Negative Effects • Use of evidence base. • Shared decision making. • Increased use of HIT. • Attention to population health. • Team approach to care. • Co-ordination of care. • “Cookbook medicine.” • May stifle innovation. • Intrusion between patient and caregiver. • Clinical decisions too closely controlled by costs. • Paternalistic • Liability concerns

Francis W. Peabody, MD “…man is not merely an aggregation of organs or of symptoms – he is first of all a human being whose proper care involves an appreciation of his body as a whole, together with the circumstances of his life.”

The Successful ACO Business Success Patients’ View of Success • Meets the goals of the Triple Aim. • Is accepted by the local community. • Is transparent in its dealings. • Decreases costs. • Appropriate array of services. • Is MY doctor a part of the ACO? • Is the relationship between patient and caregiver respected? • Decreases costs.

Scourges of our Society • Obesity. • Sexually transmitted diseases (STDs.) • Teenage pregnancy. • Violence. • Suicide. • Accidents. • Alcohol abuse. • Tobacco use.

Louis S. Goodman, MD, PhD “Don’t be the first to use a new drug nor the last to discard an old one.”

Francis W. Peabody, MD “…the experience of the centuries should neither be disregarded, nor subjected to modifications which, because they are new, may be too readily considered good.” “Any reorganization of the medical profession that threatens the personal bond between doctor and patient is to be viewed with suspicion, even if the object appears at first sight to be more thorough and thoughtful practice.”

ACO v. PPR? • Improve pt. care • Improve population health. • Decrease health care costs.

Francis W. Peabody, MD “For the secret in caring for the patient is to care for the patient.” Lecture at Harvard, 1927

Fall Member Summit 2012