Salve Expensum Reformatus
In a recently published viewpoint in JAMA Network, Dr. Don Berwick references an ancient fresco in Pompeii on which the words Salve Lucrum (Hail Greed) are etched. He uses this to frame his viewpoint that the U.S. health care system has now been overrun by greed and gives ample evidence of greed by the main actors in the system -- health plans, pharmaceutical companies, and even providers.
Don also points to the harm that this greed is causing, and it's plentiful. And we know it, and we've known it for a long long time. Dating back to the beginning of this century, the then Institute of Medicine pointed out the increasing harm to patients due to sins of omission and commission. The system was already failing patients, employers and individual clinicians. It's just gotten worse because it's gone unchecked and even encouraged by egging on providers to consolidate into better "systems of care."
Among the main culprits of that harm was -- and still is -- the underlying way in which clinicians, hospitals, health systems and everyone else involved in the delivery of care are paid: fee for service. Back then, on a number of occasions, many of us interrogated Don about the need to reform payment in order to slow down and potentially halt the bad behaviors that FFS encouraged. And his reaction was always the same...
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It was as if admitting that fee-for-service, and therefore payment, was responsible for encouraging system failure meant that clinicians could somehow be influenced by money, and he simply refused to believe it. He was (and still seems to be) convinced that the professional ethos would overcome all. But closing your eyes, ears and mouth to the reality doesn't change it. In fact, it is the incentives, stupid! How in the world could any of us expect any professional to counter the effects of trillions of dollars encouraging the overproduction and overpricing of every single service of care, whether it's of high value or no value?
And now, 23 years later, Don's recommendation to solve the problem is to ask clinicians to put pressure on their guilds and organizations to stop jacking up prices and be greedy ?!?!?! Are you f@#*$#^g kidding me?
No, Don, that won't work, just like ignoring the problem for 23 years didn't work. Only payment reform will work. So let's all salve expensum reformatus and get real.
Vice President Biopharma @CoverMyMeds | CHIEF | Board Member
1 年Francois de Brantes as always wisdom and straight forward, to the point truth. I’m honored to know you.
Commercialization consultant for cell & gene therapy manufacturers
1 年funny that so much attention is paid to incentivizing physicians and healthcare systems but few thoughts given to incentivizing patients to make smart decisions related to their care. A huge driver of wasteful healthcare spending is the fact that the user of healthcare services (patient) is not the one footing the overwhelming portion of the bills for those services (employer groups, Medicare, etc). if I am a patient, I don’t see much incentive to change my healthcare decision making because it’s usually not directly related to what my health insurance premiums. different story when we’re talking about my auto insurance premiums and the correlation with my speeding tickets.
Co-Founder @Alva10 | Recasting the payer-diagnostic industry relationship | Board Member @ Cellens | CHIEF Member | Speaker/SME for Precision Medicine, Market Access and Payment Innovation
1 年Completely agree. But when I look at the insane overspending and overutilization in healthcare multiplied by the crippling fear of medical malpractice lawsuits, I see a different kind of problem emerge. The stunning lack of valuable upstream clinical tools that gives physicians the confidence to do the right thing earlier, do less with more constant monitoring, do less costly things vs more costly things... this is a lack of existence/utilization of valuable diagnostic tools that would give physicians the clinical confidence to be paid differently, because they would then know what would work and what wouldn't, vs today's largely trial and error approach.
Moved out of the bodyshop world. Looking forward to the next adventure!
1 年Francois. You know I love you for your brilliance and 1000 other things. Now add use of colorful language to get your point across! (we talk like that to each other in the bodyshop world all day) There is no changing" the healthcare "system" from the inside. Dr Berwick, respected and beloved- can't. All other constituents are too disjointed to do the job. Its' been tried. Over and over. This job falls on The Federal government. We created and must fix the problem via payment methods. Good luck with that! Wait. Those deficit hawks in Congress- whose party ballooned the Federal deficit? The "no extension of the debt ceiling without deep cuts in Federal spending" guys? Which can't be done without reduced spending in Federal entitlements - including- Medicare... Medicare value based payments is a potential solution both parties could get behind. (Classic fix- projects the answer into the future and is too complex for anyone in Congress to understand) . The next target to be "educated" needs to be the CBO. They will "get it". But only as the we enter a national budget crisis. Not before. We'll "choose paying doctors and hospitals differently" before "cutting seniors health care benefits". Hey, I could be wrong. I run a bodyshop.
Orthopaedic spine surgeon and physician executive
1 年Payment models remain key drivers of clinician burnout. BOTH the clinical delivery and financial models needs to be aligned. Work to do.