A “pretty comfortable briar patch,” reminders of a chair & more
Welcome to the RightCare Weekly, a newsletter that will help you stay on top of all the important news in the ongoing quest to move the U.S. health care system toward the right care. We’ll bring you the most important stories, news articles, and opinion pieces of the week, along with our interpretation of why they’re important and what they mean for patients, doctors, and communities.
Paul Levy, a former hospital CEO and author of the Not Running A Hospital blog, writes about Massachusetts Attorney General Martha Coakley’s agreement with Partners Healthcare System. Under the agreement, Partners is allowed to acquire two new hospitals, but will face restrictions on its spending growth, negotiating power, and ability to buy new physician practices over the next five to ten years. According to Levy, the deal sounds impressive, but it actually sets Partners up to be even more dominant (and extract higher spending) in the future. He quotes Gene Lindsay: “To steal a concept from Joel Chandler Harris and the tale of Br’er Rabbit, Partners has been thrown into a pretty comfortable “briar patch” with this deal. […] A five to ten year deal in healthcare is no deal at all.”
Levy’s final note is that the media, the government, and the people of Massachusetts seem to think massive consolidation and high prices are normal for health care – or even that they’re required for high quality! “The state has become habituated to the idea that higher rates and market power are correlated with clinical expertise and advancement. That is Partners’ real accomplishment and it is a doozy.”
In a similar vein, Richard Gunderman in The Atlantic this week pondered, “Should Doctors Work for Hospitals?” While many of the most effective hospitals in the country employ doctors directly, those places also tend to have a particular kind of patient-centered culture that many hospitals don’t share. Gunderman worries that as more and more physician practices are purchased by hospitals, morephysicians will feel they are losing control of their profession. There are real dangers when doctors are no longer in charge of patient care – hospitals can offer financial incentives for referrals to other facilities owned by the hospital, and hospital-based services often cost much more than equivalent services performed in doctors’ offices because of extra facility fees. Most importantly, putting hospitals in charge risks putting patient care second to the hospital’s financial interests (see our previous comments, and Bill Gardner at The Incidental Economist).
A Washington Post report suggests that although back pain is one of the most common reasons cited for a visit to the doctor, there is little evidence to show that medical attention makes any difference in a patient’s recovery. For most patients, back pain goes away on its own within a few weeks – for those patients, intensive testing is unhelpful and can only lead to incidental findings or unnecessary surgery. The American Academy of Family Physicians and Choosing Wisely have pointed out that imaging tests for back pain (like CT, MRI, and x-ray scans) are commonly overused, and can easily be avoided.
Last week, Eileen Beal at Crain’s Cleveland published a story on changes in how the next generation of health professionals is being taught. In response to the changing nature of medical practice, and requirements in the Affordable Care Act, students are spending more time learning in inter-professional teams. By working together, students in medical, dental, public health, pharmacology and other programs learn to see the whole patient, developing common language and goals. This is an important step forward for those students, and represents the beginning of a moment of important change in medical education.
We mentioned last week that Lown Institute President Vikas Saini and Senior Vice President Shannon Brownlee spoke at the University Hospital of North Norway in Tromsø. The videos of their talks are up! Shannon’s is a great overview of how overuse is harmful, and woven into the fabric of modern medicine, even in systems like Norway’s that are very different from the health care system in the US. Vikas’s talk on “Science, Magic, and Complexity” is a high-level, philosophical take on doctors on “shamans of the digital village,” in which he explores the role of medicine as society changes.