Guest Blog: The David Petraeus of Health ... By Dana Blackenhorn

[CC-Conrad Clyburn-MedForeSight]

Colleagues,

As I have said in the past, Dana Blackenhorn is thoughful and thought provoking ... Let me see what you think of this blog on the recent recess appointment of David Berwick to become the new Administrator of CMS (Centers for Medicare and Medicaid Services). Excerpts below ....

ENJOY!

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Who wants to spend half what they do now, on something really important, and get just as much of it as before?

I know I do. The only arguments against such a thing would be ideology or the self-interest of those selling the product.

The product in this case is health. Not health care, health. And it’s the difference between these terms that is the real ideological divide of our time.

The current Administration has launched a war, through the new health care law, to get our costs into line with those of our competitors without reducing our nation’s health.

Dr. Donald Berwick (above) is the President’s general in that war. As head of the Centers for Medicare and Medicaid (CMS), he now controls 4% of our Gross Domestic Product, more than the Department of Defense.

He is the David Petraeus of health...

What Dr. Berwick, a pediatrician by training, has fought for his entire career is patient-centered
health. (Sort of like Petraeus has focused on counter-insurgency)

As Berwick said in a now-notorious speech celebrating the 60th birthday of Britain’s
National Health Service (NHS):

It means that we who offer health care stop acting like hosts to patients and families, and start acting like guests in their lives.

Berwick’s critics have focused on the fact of that speech, and its praise for the NHS. They have ignored the 10 major criticisms he offered, of which this is the central one.

Berwick believes your bank balance should not define your health. A bureaucrat should not define it. Even your doctor should not define it. You should.

This is controversial. Health insurers don’t like it. Doctors’ associations don’t like it. I don’t think the NHS liked it. It’s certain conservatives don’t like it.

But I like it, and at the end of the day I suspect you like it too.

Here is what Dr. Berwick really said in that NHS speech:

1. Put the patient at the center of everything you do.
2. Stop restructuring. Change what happens, not who reports to whom.
3. Build integrated, local health care systems, not a giant national one.
4. Invest in primary care.
5. Don’t place all your faith in the market.
6. Avoid supply-driven care like the plague.
7. Develop a single, integrated approach to measuring health and care.
8. Heal the divide among doctors, management, and those who pay for care.
9. Train for the future, not the past. Focus on safety, teamwork, and patient-centeredness.
10. Aim for health, not health care. Focus on preventing sickness, not just curing it.

These are the 10 health commandments Berwick will now try to impose on Medicare and Medicaid, where the largest portion of our national health budget is spent. That is now his battlefield.

Argue against his strategy if you want, but don’t just build ideological straw men you can knock down. That’s not helpful.

Read on at: http://www.zdnet.com/blog/healthcare/the-david-petraeus-of-health/3...

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Soundview Executive Book Summaries

[Stephen C Schimpff]

The ten aims you refer to could be the basis for really improving the health of the nation and, with it, the way medical care is delivered. Start with just the first one about patient-centered care. Whether we like to admit it or not [“we” here referring to providers [doctors, nurses, hospitals, etc] of which I have been one for many decades] medical care is provider-centered, not patient-centered. Certainly most physicians want to and do try hard to give the patient the best they possibly can. But still we do it on our terms, not the patients’. Because of that focus, and also because of misplaced incentives, providers do not spend the time needed to give really good preventive care and do not spend the time needed to coordinate the care for those with chronic illnesses. If we could just get the system to correct these two glaring deficiencies, the quality of care would go up, it would be much safer, and the costs would come way down.

The fix is not simple but straight forward. We need more primary care physicians [today we have 30% PCPs and 70% specialists; every other developed country has the reverse.] We need them to have a patient load that is not overwhelming [about 500 rather than the typical 1200 or more] so that they can have the time per patient needed. And they should be paid in a manner that allows them to reap a reasonable income with that many patients [my recent blog post here suggests that we pay our PCPs out of pocket thereby creating a professional contractual relationship as we do with all of our other professional encounters like lawyers, architects and accountants. Today, the contractual relationship is between the doctor and the insurer, not us as patients.]