Is it time for a dose of DOSE?

According to the WSJ, "Lost amid Donald Trump ’s nomination blitz this week was what might turn out to be his best idea: He has handed Vivek Ramaswamy and Elon Musk the job of running a new Department of Government Efficiency (DOGE) to reform and shrink the federal government...none of this will be easy. Lawsuits will proliferate. Mr. Trump’s own cabinet officers will resist cuts in their budget and regulatory sway. The iron triangle of the bureaucracy, interest groups and Congress will conspire to portray every decision as a threat to public health and safety. The press will pile on."

Is time for a dose of the Department of Sick care Efficiency (DOSE) at the federal and state levels too?

Jarid Polis, the Governor of Colorado, thinks so and has started to chip away at waste and reducing sick care costs. In 2019, Governor Jared Polis signed an executive order that established the Office of Saving People Money on Health Care, with the goal to study, identify and implement policies that will lower health care costs while ensuring access to affordable, quality care for Coloradans.

Opportunity targets abound including almost every stakeholder.

Take training institutions, for example. They are those that deliver health professional education include public and private universities and colleges, individuals affiliated with the delivery or administration of health professional education, and trade or professional associations representing these institutions, organizations, and individuals.

The cross hairs would target:

1. Hospital administrators and CEOs
2. Faculty tenure and promotion policies and procedures
3. Student selection procedures
4. Workflow and process maps
5. Business models
6. Wasteful and redundant silos
7. Administrivia
8. Costly professional credentialing, privileging, and certification
9. Fraud, waste, and abuse
10. Costs and workforce resizing in non-clinical care areas, particularly those impacted by artificial intelligence.
11. Filling jobs with non-college graduates
12. Unnecessary care

Everyone who touches patients knows that there is substantial variation in how much a given doctors spends to treat a patient with a certain condition. But why? Here are some possible reasons:

They get paid more if they do

They don't care if they get penalized for spending more

They have no clue what things cost

Patients and their families demand unnecessary tests and interventions

Insurance companies and third-party intermediaries require worthless tests like getting a plain X-ray of something when an MRI will inevitably be ordered

There is no Moor's Law in medicine

Tests ordered by inexperienced house officers

Poor clinical judgement

Hospital systems are wasteful and vary from region to region

Poor hand offs and lack of care coordination during a hospitalization

Process mapping, affectionately know as care pathways in sick care, is one way to drive out waste.

As noted, Musk and Ramaswamy won't have an easy time.

But this is not our first rodeo:

It should be borne in mind that there is nothing more difficult to arrange, more doubtful of success, and more dangerous to carry through than initiating changes. The innovator makes enemies of all those who prospered under the old order, and only lukewarm support is forthcoming from those who would prosper under the new. Their support is lukewarm ... partly because men are generally incredulous, never really trusting new things unless they have tested them by experience.

Niccolo Machiavelli

Repeat after me:

This ain't my first rodeo

This ain't the first time this ol' cowboy's been thrown

This ain't the first I've seen this dog and pony show

This ain't my first rodeo

But just in case you didn't get the memo, here is a guide to your first rodeo.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack