Stanley Feld M.D.,FACP,MACE
Matthew Modleski has been following Repairing the Healthcare System for several years. He is a former jet fighter pilot. Now he is a strategic planning consultant.
His firm is Stovall Grainger Modleski Inc. His comments over the years have always impressed me. He has a grasp on the big picture. Most people concentrate on the short term solutions.
I am publishing, in full, his last comment to me. I feel it is an extension to the point made in my last blog. President Obama’s healthcare reform bill is non-strategic. His healthcare reform bill adds on to a non-strategic healthcare system rather than converting the system to a strategic healthcare system. .
It has non enforceable mandates with penalties rather than encouraging self responsibility by patients and physicians. The regulations are restrictions on healthcare delivery. It lacks a Six Sigma strategy( continuous quality improvement modality).
You cannot put patches on a broken system especially when those patches restrict the freedom to choose, think and be innovative and be successful. The result of these restrictions will inevitably result in costly unintended consequences
The government’s job should be to make the rules and then get out of the way. If the rule book needs slight modifications because it forgot something then add a new rule.
A rule change example would be the NFL rule book. The rules committee forgot to include the rule that you cannot hit the quarterback after he throws the ball. The rule was added for quarterbacks’ unprotected safety.
Another nice blog, I would add:
1. There is a lack of accountability for one’s health and the consequences of poor choices in maintaining it. We are all going to die. The three questions that currently go unanswered is “when” (we’ll never know until the day), how much money are we going to spend between now and then, and who’s money will it be (mine or someone else’s)?
Someone should have the courage to say, “if you can’t/won’t modify poor behavior you are going to die earlier”. All the data collected in healthcare over the years supports that reality.
2. The current healthcare delivery system is non-strategic and therefore makes a lot of mistakes and lacks both efficiency AND Quality. If we kill between 4000 and 8000 people per month due to mistakes and errors (most Americans have NO IDEA), we have to get a better, more strategic delivery system in place and we have to measure results.
In order to make the measurements meaningful, we must compare apples to apples. Only then, with meaningful information on provider quality, based on the results they achieve per dollar spent (over a period of time), can consumers make meaningful choices in terms of the value they get for what they spend.
Without information, we are blind in our purchasing power. I know you don’t want to address a disparity in the quality of care delivered across the spectrum of providers (they’re your peers), but it is significant. I do agree with meaningful information and financial as well as healthcare consequences for their purchases in healthcare, that consumers can drive meaningful change.
Who’s going to provide that information, and when will providers begin to align into a more focused delivery system that permits excellent results at a lower cost? The answer is when the reimbursement system rewards results over time versus an activity not linked to results.
3. In my former business, no one wanted to be last in terms of “how good we were at our job”. There were huge egos on the line and everyone in that business graduated at the top of their class and had a high level of skill at what we did. We were driven by a professional work ethic and sound principles.
In our business we ranked each member of our team on their performance and published the results on the wall for everyone to see EVERY DAY. The results of that clear measurement was that if you were last on the list or near the bottom, you sought out someone at the top of that list and asked “how do you get the results you get because I want to be better”?
My old business was the Jet Fighter Business and if we were bad at our job, we could die quickly. The same is true in medicine, except 4000-8000 patients die each year, not providers.
Let’s put a comprehensive plan together Dr. Feld, it could be the blue print for meaningful healthcare reform in our country!
I am game.
1.Quality has to be judged correctly and not artificially as it is done by the healthcare industry and the government.
The consumer has to put pressure on the physicians and hospitals, not the healthcare insurance industry or the government.
2 The fighter pilot example is a single point example. There are many elements to evaluating quality medical care. The definition of quality medical care is much more than the measurement of life or death.
3.Physicians must be inspired and motivated to improve quality once quality is defined appropriately. A jet pilot is certainly motivated by the nature of the job. Physicians can learn to do a better job once the definition of a better job is clearly defined in a non punitive environment.
Again. I am game. Let us do it.