Monthly Archives: April 2016

The Most Valuable Resource in the Health Care System? A Physician’s Time

So why hasn’t the health care system in the US been fixed?   Could it be that there are those in the system that really don’t want the system to change despite their public rhetoric?  Or is it that no one really is focusing on issues that will result in meaningful change?  Maybe they really don’t know how to fix it.

There has been a great effort to develop a value-based health care system.  The message has been that if we focus on value, defined as quality/cost, then the system will be improved.  This makes intuitive sense.  Patients will receive better care at a price that is affordable in a system that is sustainable.  But despite now years of talking value there is no clear evidence that value is improving.  No one seems to have the blue print for a value-based health care system.  In fact, in keeping an open mind is it possible that current initiatives may be making things worse?

The essence of health care is the patient-physician relationship as mentioned in a previous post (Relationships Over Transactions).  It is the hard target for health care value.  How does one optimize the patient-physician relationship to maximize value?  Simple.  Optimize and protect a  physician’s time and hold the physician accountable for utilizing that time in a manner that is beneficial to the patient and the profession.  Doing so allows for better preparation and execution.  Value will be maximized when a well prepared physician practicing evidenced based medicine engages a patient in a non-hurried manner so that a genuine professional and personal relationship is developed.

It seems as if the current environment is doing just the opposite.  An electronic medial record is a good thing but not when it is focused on documentation instead of care and occupies 20% of a physician’s day.  The insurance industry has certainly cut some of the bloat out of the system but the pendulum has swung too far in the opposite direction and physicians and staff spend a great deal of time getting care approved at the expense of preparation and execution of value-based health care.  The list of care “process and procedures” grows exponentially and most have nothing to do with improving value.  Process won’t fix health care (Quality, Evidence and Avedis Donabedian).  Compliance training is another enormous time vacuum.  Someone please provide the evidence that a physician’s time is not better spent preparing for and executing patient focused health care.  In general HCR does not believe that business-oriented initiatives are good for health  care but it may be time for a Toyota lean approach to eliminate what is likely an enormous amount of wasted physician time.

Is this not obvious to everyone?  One really has to question the motivation of any person or organization that doesn’t believe that this is worth at least a discussion.