An essay posted by Fareeha Kahn, MD (“A hospitalist’s struggle to find teamwork in academic medicine“), raises an important issue. The problem of lack of collaboration is not unique to academic medicine. The problem is the result of misaligned incentives.
Having read the work of Harvard Business School professor Michael E. Porter, I better understand the goals and challenges of value-based care. If we look at the premise of Dr. Kahn, the hospitalist complains about the lack of effective hand-off, and the abandonment of the patient to the outpatient “ether.” Dr. Kahn is scrambling when attempting to schedule an outpatient visit for a soon-to-be discharged hospital patient. There is fewer staff handling more patients in doctors’ offices. That includes the job of scheduling appointments. One essay from my upcoming book refers to the chaos in the emergency room, particularly when an ER physician attempts to transfer a patient to a tertiary hospital for an invasive procedure unavailable in his community hospital. When push comes to shove, success on the 23rd phone call by the ER physician is not a success but rather a sign of the lack of a sense of responsibility for the patient.
Dr. Kahn talks about bolstering her consult by justifying “metrics” that impact the hospital’s revenue, including the readmission rate after 30 days. If the patient continues to deteriorate outside the hospital because no one has been responsible for that patient’s care as an outpatient, then the likelihood of readmission increases for similar or related health problems.
“What is best for this patient?”
That is the question that every care team member must address, each in his or her own context of expertise. But for a team to have good chemistry and an attitude toward execution, individuals must defer self-interest. When every care team member has skin in the game (compensation based on best medical practices with an eye to reducing cost), the goals for the patient and the team’s goals align. Dr. Kahn regrets the lack of compassion shown by health care workers who have been stressed to the point of burnout. That is not unique to academic medicine, to be sure. When health care professionals collaborate effectively, everyone gains.
As models for value-based care mature, in which goals and methods work to bring greater value to what is being spent on a patient’s care, we may begin to see what real patient-centric care looks like. Collaboration by health care professionals is an essential element.
Paul Pender practiced clinical ophthalmology for 38 years, specializing in the medical and surgical treatment of eye diseases. He completed his residency at the world-renowned Wills Eye Hospital. His honors include a lecture series in his name by the New England Ophthalmological Society and the Secretariat Award from the American Academy of Ophthalmology for his work on webinars for clinicians.
Pender is passionate about patient-centered care. He believes that the patient-physician relationship should serve as the fundamental building block for health care reform. He is an advisor to Vxtra Health, a company committed to collaborating with physicians to earn trust and to reduce health care costs. By limiting the drain on health benefits budgets by intermediaries (health insurance companies, pharmacy benefits managers, and hospital systems), Vxtra Health establishes a path toward a new model of care, based on price transparency and fiduciary responsibility, starting with self-insured middle market employers.
He writes on timely medical issues on his website, his KevinMD author’s page, and other popular social media. He is the author of Rebuilding Trust in Health Care: A Doctor’s Prescription for a Post-Pandemic America (2020) and the ebook Standing Up and Speaking Out for Patients and Doctors: First Steps Toward Focused Health Care Solutions (2023).
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