A Physician's Role in National Healthcare Reform

As the national association representing physician-owned hospitals, Physician Hospitals of America (PHA) is primary concerns on the subject of healthcare reform are very similar to many others. Like many other players in the national healthcare marketplace, we recognize access, cost and quality of care as three of the primary areas in need of reform. However, as representatives of industrious and patient-focused physicians, we approach reform with the primary objective of achieving patient-centered care. When considering reform, PHA believes the critical perspectives must be that of the patient and the patient/physician relationship and all too often, that perspective is overlooked.

In healthcare there are five primary players: the government, health insurance, large hospital systems, physicians and patients. In the struggle over who gets what financial piece of the healthcare pie, the true needs of the patient are often overlooked. And physicians, who stand in the position to be the most direct advocate for the patient, are losing ground and the ability to affect patient-centered health reform. PHA believes that to achieve a system of care that is truly in the best interest of the patient, we must first consider what patients truly need, and consider as a second step how that can be accomplished. Because they provide a crucial perspective, physicians, not just the institutions of government, insurance and provider networks, must be represented in these conversations.

The question arises, “How can physician-owned hospitals and the conscientious physicians we represent assist the process of healthcare reform?” At PHA, we believe there are several ways in which we can play an important role in this process:

Care Coordination, Efficiency and Effectiveness

First, in examining the issue of healthcare cost from the patient perspective, we must ask “how do we make the relationship and experience between a patient and physician as effective and efficient as possible?” A major step is to remove the barriers between physician and patient, thus reducing the administrative expense now associated with medical interaction and streamlining the process. By removing those barriers and putting the physician in charge of care coordination, preventative medicine can also be stressed and an overall health plan suited specifically for the individual patient can be achieved. The physician-owned hospital provides a perfect example of such care coordination and the quality and cost savings that result.

Another positive choice for patients is to provide care in the most efficient place possible, consistent with patient safety and good medical outcomes. Healthcare facilities do not necessarily need to provide every conceivable medical treatment or service — be all things to all people. Rather, there is a place for more efficient, specialized “focus factories,” who treat medically appropriate patients and focus on one disease or specialty. Both heightened efficiency and cost effectiveness can be realized in these types of facilities, which physician hospitals are once again, great examples.

Implementation of New, Cost Effective Technologies

Second, implementation and the use of modern tools for data collection and transmission certainly stand to positively impact healthcare spending over time. In a time when medical technology is rapidly improving, it is truly unfortunate that our healthcare system continues to rely on old technology that does not allow for the type of seamless connectivity needed to provide the safest, most efficient and cost-effective care for our patients.

The success of new technologies is measured not only by outcomes but also by the ensuing cost. New technologies may offer amazing advances in care. However, many may not be the most efficient or effective. As hospitals that believe in implementing the best and newest technologies, physician hospitals can demonstrate to the public and other healthcare players which technologies work, which ones don’t and which are worth the expense.

Quality Improvements through Physician and Patient Involvement

Third, any discussion on health reform requires examination of the quality issues currently facing our healthcare industry. From the patient’s perspective, considering what healthcare in America costs, we should be able to assure the highest quality care. Unfortunately, that is simply not being born out. In order to keep healthcare costs under control, there must exist a degree of individual patient responsibility balanced in conjunction with a level of social responsibility. Patients must have a stake in the game, so to speak.

At Physician Hospitals of America, we believe the patient can be the best regulator or watchdog of quality care, but only if given the appropriate tools to make informed choices. Therefore, transparency, both of quality and cost, are an absolute necessity. Patient-centered care requires informed choice. It is completely unacceptable that patients do not currently have the tools they need to research the care options available. Physicians can play an important role at the local, state and national levels working collectively with hospitals to hold all parties accountable and assisting in the creation of a system of transparency and reporting that is both logical and useful to patients. In addition, as smaller, more manageable hospitals, physician hospitals may volunteer as “beta-sites” or model facilities for the purpose of testing transparency/reporting systems.

Physician/Hospital Partnerships

Finally, in order to accomplish the goal of achieving patient-centered reform, it will be very necessary that all segments of the industry work together. Public/private partnerships, federal/state partnerships and certainly hospital/physician partnerships are all in the best interest of the patient. Physician hospitals in partnership with larger hospitals or systems provide a valuable example of how healthy relationships can form between doctors and hospitals.

Access to Care and “Universal Healthcare”

At this time, a great deal of energy is being spent in Washington, D.C., on the issue of access to care — covering the uninsured. This is certainly a necessary step. The problem of under-insurance, patients with woefully inadequate plans, is another problem begging to be addressed. However, at PHA we find it unfortunate that conversations regarding “universal healthcare” are so unnecessarily focused on improving access through a single payor system. There are other ways of improving care without looking at socialized medicine.

We firmly believe that discussion aimed at a single payor system is overall uninformed and unwise. Under these systems it has been clearly shown that patients are made to sacrifice free market healthcare, choice and innovation, and physicians are made to sacrifice many rightful qualities of their profession. It is true that physicians need a seat at the table when decisions are reached; but physicians should never sacrifice their principles of professionalism, quality and patient-centered care to achieve that seat.

In summary, at Physician Hospitals of America we believe that in any discussion regarding healthcare reform, patients’ needs must be considered first and foremost. We believe that physicians and their opinions must be truly valued as those in charge of and responsible for care in America. We believe that as patients and physicians we must demand efficiency in care delivery, high quality care and the ability to make an informed choice. We also believe that expectations must be realistic — healthcare is not free in any country.

Molly Sandvig, JD, is executive director of Physician Hospitals of America.