Posted on | June 12, 2014 | 2 Comments
In a September 6, 2012 article in the New England Journal of Medicine written by leaders from the Center for Health Equity Research and Promotion at the University of Pennsylvania and Wharton titled “What Business Are We In? The Emergence of Health As The Business of Health Care.”, the authors write:
“….whereas doctors and hospitals focus on producing health care, what people really want is health. Health care is just a means to that end — and an increasingly expensive one. If we could get better health some other way… then maybe we wouldn’t have to rely so much on health care…If health care is only a small part of what determines health, perhaps organizations in the business of delivering health need to expand their offerings.”
Nearly two years later, we see clear evidence that the House of Medicine remains locked in a debate about “who should lead” rather than demonstrating innovative and responsive leadership that might yield new offerings. This week, the AMA’s House of Delegates took about an hour of their valuable time to debate the exact wording to clearly communicate to the Joint Commission on Accreditation of Healthcare Organizations that they were offended by its recent restatement that leadership of “primary care medical homes “ was not the exclusive domain of physicians ( a position also taken by the National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and the Utilization Review Accreditation Commission).
The American Association of Nurse Practitioners wasted no time in advantaging the opening, deliberately aligning with patients’ needs versus physician needs. Their statement: Leadership should not be “defined by a profession…Instead, we believe that team-based care is best thought of as a multidisciplinary, non-hierarchical collaborative centered around a patient’s needs.”
Lost in the back and forth is the fact that the “Medical Home” concept from its inception was stale and undervalued the role of individuals and families (“Too Much Medical, Not Enough Home”). In reality, the health marketplace is already reshaping it’s workforce for new health delivery approaches. Consider these recently published numbers from Health Affairs:
Nurse Practitioners: 6,611 in 2003 to 16,031 in 2013, an increase of 142 percent over the decade.
Physician Assistants: 4,337 in 2003 to 6,607 in 2013, an increase of 52 percent
Pharmacists: 7,488 in 2003 to 13,355 in 2013, an increase 78 percent.
RN (Taking Licensure Exam): 76,688 U.S. nurse graduates took the NCLEX-RN for the first time in 2003. This number grew to 155,018 in 2013, an increase of 102 percent.
As Medicine continues to demand its perch at the top of the health hierarchy, others from the ranks of both health providers and health consumers see the current high cost and low performance environment as begging for new models of care. When they do their competitive analysis, what do they see?
1. Primary Care physician recruitment is inadequate to meet the demand.
2. Nearly 40% of patients already see a specialist or non-physician for primary care.
3. Coordination of care and referral to specialty care and hospital services can be managed by non-physician providers.
4. Consumers increasingly will co-manage their own records and continuity of care.
5. Less expensive providers, down-stream even from the caring professions listed above, may be better suited for chronic disease management, health coaching, health planning, and health prevention.
6. Less expensive providers are more willing and able to put in the time and effort to accomplish #5.
7. Primary care physician access is often inconvenient, inefficient and expensive compared to other emerging service providers.
8. Primary care physicians are over-trained for the majority of their daily encounters in ambulatory practice.
9. Primary care empathy levels decline during training; satisfaction levels vary widely, and burnout is high.
10. Health workforce mobility, mobile diagnostics and information technology, if aligned with consumer choice and consumer empowerment, could in many carefully selected cases help avoid a doctor’s visit and manage the care decision in the home.
Both the AMA and the AAFP have spent too much time already on the issue of who’s in charge. If they really want to be the leaders of new approaches to care, they will need to earn it by demonstrating concrete innovative leadership. Fewer words, more action.
For Health Commentary, I’m Mike Magee