A Doctor’s Perspective on Health Care Reform

BLOG HAS MOVED

2010-03-17T14:45:00.000-07:00

Thanks for stopping by! Dr. Carter is still blogging, but he's using a different site. Visit his new blog here.

Watch for Dr. Carter’s new blog!

2010-02-25T08:31:00.001-08:00

Dr. Carter will be posting a new blog soon. Please check back.

Capitation- The Goose that Laid the Golden Egg in Health Care

2009-08-10T05:52:00.000-07:00

In my last posting, I mentioned the virtues of capitation both in controlling costs and promoting quality improvement. I also cited group practices, such as mine, who strongly prefer the capitated model of payment over fee-for-service. Yet, the popularity of capitation as a payment method for physicians has declined since its peak in the 1990s. Why has this happened? I would like to use the experience of my community, Houston, Texas to show how capitation has been treated in the health care marketplace.

At its peak in the 1990s, Houston had 8-10 physician organizations accepting capitation. Now we are down to three, and many health plans indicate that they would prefer not having any capitation. As I mentioned previously, capitation involves paying a physician group a certain amount per patient per month to cover all professional services. This means that the physician group accepts what’s called the insurance risk for these services.

This financial risk comes from the unpredictability of patients’ health. Most patients are healthy and their cost of professional health care services is low. In fact it is less than the capitated payment rate for these individuals. Some patients are ill, or become ill, and their cost of professional services can be quite high and significantly more than their capitated payment rate.

Insurance companies are very familiar with these risk calculations, and they make their living from predicting how much it will cost to cover a certain population and then charging employers enough to cover that cost with enough extra for profit. Most medical groups do not have this expertise and that is where many of them ran into trouble. In fact, our medical group nearly went out of business in the late 1980s because we underestimated how much capitation payment we needed to take care of the population covered by this form of insurance. Needless to say, we learned quickly and have not made that mistake again.

Even when a medical group has a good handle on what capitation rate they need to be successful, it is very difficult to get health plans to pay the needed amount. Even after over 20 years of experience with capitation, both on our part and on the part of the health plans we contract with, the negotiation over the rate we receive is routinely very contentious with threats to terminate contracts not being unusual.

The fact is that most medical groups do not have the experience at managing risk and the toughness needed at the negotiating table to succeed at capitation. Also, health plans often underestimate the benefits of having capitated medical groups within their network. They see a lot of money going to a medical group, but they don’t always understand that the group now has an incentive to take very good care of their patients, which results in fewer hospital admissions, shorter hospital stays, more cost-effective testing and prescribing, etc., which results in a significantly lower total medical cost for the population being cared for. The health plan is essentially paying the medical group to manage the total cost of that population, but because much of the savings comes from reduced hospital or drug costs, the health plan doesn’t credit the medical group that is actually responsible for the savings.

The result is that health plans try to reduce the capitation payment past the point at which it no longer covers the medical group costs. If they succeed, then the medical group either stops taking capitation and goes back to fee-for-service, or else it just goes out of business. This is called Killing the Goose that Laid the Golden Egg, and it has happened repeatedly in our community. At the end, only a few groups have been able to be successful with capitation. This would not be a big deal, except that the virtues of capitation with regard to controlling costs while improving quality are in severely short supply in the U.S. health care system. Further erosion of the market share of capitation will only serve to continue the uncontrolled increase in health care costs.

Well, in view of all this, is capitation a lost cause? I don’t think so, and in my next posting, I will discuss how capitation is coming back in certain health plans, and how health care reform can assist in encouraging this superior payment method.

Capitation: Don’t Try Health Care Reform Without It!

2009-08-03T12:17:00.000-07:00

In my last posting I discussed the adverse incentives of the current fee-for-service system of physician payment in the U.S. These incentives are widely felt to increase overutilization of medical services and significantly increase health care costs without actually improving health care. Well, what are the alternatives? Today, I will discuss capitation, which in my opinion is the best way to pay physicians.

If I had the power to make a single change in how health insurance is done in the U.S., I would make it mandatory that all health plans at least offer to pay physicians by capitation. I would also institute incentives for physicians, health plans, and employers to adopt capitation of Physician-Led Accountable Care Organizations as their primary payment modality.

Capitation is the practice of paying large, accountable physician groups a certain agreed-upon amount of money every month to take care of a given population of patients. The physician group provides all needed medical services for the patients. If there are services that the physician group can’t provide, it pays other health care providers for these services.

I’m sure it’s obvious to you that by paying physician groups this way, you immediately eliminate the single most powerful incentive to increase costs, which is the direct financial incentive to physicians to perform more medical services (whether needed or not) in the fee-for-service system.

Capitation has been around for a long time, and has been very successful in reducing total medical costs by anywhere from 15-30%. Kaiser-Permanente, which is the health care organization that took care of President Obama’s grandmother, has paid its physicians by capitation for over 50 years. My medical group, Kelsey-Seybold Clinic, as well as many others, have accepted capitation since the mid-1980s and much prefer the capitated payment model over the standard fee-for-service system.

Fears of some observers that, under capitation, physician groups will withhold needed care, have never materialized. In fact, capitated group practices, and the health plans that contract with them, have been in the forefront of the Quality Improvement movement within the health care industry. They have had to demonstrate that their patients are receiving all recommended health services, which has resulted in higher quality care, rather than any withholding of necessary services.

Unfortunately, capitation is not widespread, and in fact has been declining in market share over the past few years. We’ll discuss why this is in my next posting.

Are We Getting What We Pay For? Yes!

2009-07-27T09:48:00.000-07:00

“That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to made one despair of political humanity”
-George Bernard Shaw, Preface on Doctors, 1911

“Many health care experts believe that one main reason we spend far more on health than any other advanced nation, without better health outcomes, is the fee-for-service system in which hospitals and doctors are paid for procedures, not results.”
-Paul Krugman, New York Times, 2009

“You want to look at anything that will move us away from a fee-for-service model, the core perversion in the system.”
-David Brooks, New York Times, 2009

I have been using the first quote above, from playwright George Bernard Shaw, for years when I speak to new physicians at our medical group about health care economics and the adverse incentives inherent in the fee-for-service way that most doctors are paid in America. The other two quotes, one from the generally liberal Nobel Prize-winning economist Paul Krugman, and the other from the generally conservative New York Times columnist David Brooks, both appeared in my hometown newspaper, the Houston Chronicle, last Saturday.

These quotes are right on the money in regard to the powerful incentive for doctors to overutilize when they are paid strictly on a fee-for-service basis. While paying people for what they do is a time-honored compensation mechanism, the way it has played out in American medicine has been a major reason for the up to 30% of “care” that is provided for which there is no good evidence of effectiveness. Many astute observers have commented that getting rid of this unnecessary care is going to be a key to reducing U.S. health care costs.

The way that the fee-for-service system works for physicians is that doctors are only paid for seeing a patient face-to-face in the office or in the hospital, and the doctor is paid more for each additional service that he or she provides. One problem with this system is that you, the patient, often can’t really tell if the service the doctor provides is necessary. This is similar to taking your car to a mechanic and being told that you need an expensive repair. Unless you are also a mechanic, it will be difficult or impossible for you to know whether that repair is really necessary. The result is that patients can, and often do, get services that they don’t need and which increase health care costs significantly without actually improving anyone’s health.

Another problem is that a fair amount of health care can be done easier and cheaper without a face-to-face office visit. In my own practice, which is largely geriatrics, I routinely do a lot of care over the phone. I have my nurse discuss test results with patients and may even do simple diagnoses or medication changes by phone. Patients like it because they don’t have to take the time and incur the expense associated with an office visit. Many physicians, including my medical group, are also starting to use the internet and e-mail for these sorts of issues. Unfortunately, even though doing this reduces costs and improves service, doctors do not get paid for these activities in the fee-for-service environment.

What is particularly maddening about all this is that the doctors who try to do the right thing and not order unnecessary testing, office visits, and procedures wind up shooting themselves in the foot financially, as they forgo the income that their colleagues receive for doing all of these things. In fact the current Medicare methodology for adjusting physician fees, called the Sustainable Growth Rate model, reduces fees to compensate for this overutilization. Of course this mainly penalizes the doctors who don’t overutilize. The others just crank up utilization even more, to make up for the fee cuts.

Bottom line: We actually are getting what we pay for; it’s just that we’re paying for the wrong thing! It’s time to seriously look at getting physicians off of the strict fee-for-service payment system. It’s an antiquated way to pay for health care and patients and the nation can no longer afford it. In my next post I will discuss alternatives to the fee-for-service system.

Taming Healthcare Costs: See what’s Working Now!

2009-07-17T11:43:00.001-07:00

The latest headline coming out of Washington is that Douglas Elmendorf, director of the Congressional Budget Office, has pointed out that the healthcare reform bills currently circulating through Congress have been skewed more toward expanding coverage than controlling costs. The result is that overall healthcare spending will go up significantly, a prospect that has many legislators calling for a slowdown or halt in efforts to pass healthcare reform legislation this year.

Well, it can’t be considered shocking news that expanding coverage to over 40 million uninsured patients will increase costs. It’s not that these patients aren’t already generating costs, but the costs were less obvious. Costs of caring for uninsured patients take the form of bad debt for doctors and hospitals, whom then shift these costs onto health plans, other patients, or local or state government in the form of higher fees, or budget deficits for public hospitals.

Providing access to care for those who previously did not have it is bound to increase total medical costs, similar to when Medicare was introduced in 1965. This might not be so alarming if health costs for the currently insured in America were anywhere close to what is seen in other developed countries. About 16% of our Gross Domestic Product (GDP) goes into health care, which comes out to over $7,000 per capita. And this is with 46 million uninsured! The large, industrialized, countries that are commonly felt to be our socioeconomic peers, such as France, Germany, Great Britain, Canada, Australia, and Japan, range from 8% to 11% of their GDP devoted to healthcare and all of these countries have universal health coverage.

So do we need to completely change our style of health care to a European-style, government-managed system? Many observers have stated their opinion that practically any attempt on the part of Congress to reform healthcare will necessarily result in this.

I don’t think so.

The fact is that many physician-led, market-based healthcare systems in the United States, such as Kaiser-Permanente, the Mayo Clinic, Geisinger Health System, and the system I work for, Kelsey-Seybold Clinic in Houston, have achieved significantly lower total medical costs than their peers both locally and nationally.

The key to these systems’ high quality, low cost and high patient satisfaction is that they are Physician-Led Accountable Care Organizations. In most cases they receive a fixed amount of money per patient, either in the form of capitated payments from health plans, or in the more familiar form of insurance premiums, if they have their own health plan. In turn, they are accountable for providing all health care to their members. This accountability is not just financial. These systems, having prominent brand names in their communities, must also demonstrate high quality of care, as well as high patient satisfaction.

This completely turns around the incentives in the typical fee-for-service arrangement for doctors and hospitals to do as much as they can (and charge as much as they can) whether or not there is any evidence that what they are doing will actually help patients. So far, although many reputable organizations and commentators have pointed out the advantages of Accountable Systems of Care, Congress has been hesitant to be seen as favoring this style of health care organization.

I think incentivizing the development of Accountable Care Organizations will be essential to control health costs going forward in America and will be key in avoiding a more intrusive, government-managed system.

Presidential Candidates and the Risk Pool: Sink or Swim? Part 2

2009-07-13T06:22:00.000-07:00

The key feature of Senator John McCain’s proposal for healthcare reform consisted of changing the way that health benefits are taxed, then using the money from this to offer all Americans who are not covered by employer-sponsored health insurance a tax credit to be used for them to purchase health insurance on the individual market. The money would come from eliminating the income tax exclusion for employer-sponsored health insurance. This feature of the tax policy is a remnant of World War II-era price controls and has been an important factor in causing the predominance of employer-sponsored health benefits in the U.S.

Elimination of this exclusion would cause employees with employer-sponsored health insurance to pay more income tax. The tax revenue generated by this would be significant- estimated to be some $3.6 trillion over the next 10 years. Senator McCain is not the only one who has noted problems associated with this tax exclusion. The biggest gripe has been that it is unfair, particularly in two aspects. One is that it is only available to employees of companies that provide health benefits. Millions of working Americans do not have access to employer-sponsored health benefits and so are not eligible for this tax exclusion. The other issue is that it is worth more in savings to higher-income individuals due to their higher marginal tax rate. Senator McCain’s plan would eliminate these issues of unfairness.

With regards to the risk pool, Senator McCain’s proposal is significantly different from either of the main Democratic proposals. Both Senators’ Clinton and Obama proposed plans that tried to get as many people as possible into large risk pools. Senator McCain’s proposal would tend to have the opposite effect. His idea is to give the uninsured a tax credit so that they can purchase insurance on the individual market. As I mentioned in my June 29th entry, individual health insurance policies, as opposed to employer-based group policies, must charge sicker individuals much higher premiums than healthy people. What this means is that almost certainly, the tax credit available to sicker, uninsured persons would not be nearly enough to actually cover the cost of an individual policy. The result of this is that a large uninsured population would still exist.

I believe that the proposals offered by the Democratic and Republican candidates in last year’s presidential election really do highlight the philosophical differences between the parties. The Republicans generally emphasize individual freedom and responsibility and their health care proposals reflect this. Individuals are responsible for obtaining their own health insurance, and they are expected to pay any additional cost associated with poor health status.

To the extent that poor health status is the result of bad lifestyle choices such as smoking, lack of exercise, obesity, and motorcycle riding (Full disclosure: I do ride a motorcycle, but I swear I only ride on Sundays at 20 miles per hour while wearing full Ninja-Turtle type protective gear!) this approach makes some sense. However, having been a primary-care doctor for over 20 years, I am pretty skeptical that most bad lifestyle choices can be significantly affected by financial disincentives. In addition, unfortunately this approach also tends to leave those with poor health status that are generally not lifestyle-related, such as cancer, birth defects, and diseases due to genetic or unknown causes, out in the cold.

The Democrats have typically promoted a view of government having the responsibility to assist those in need, whether financially, health and nutrition-related, or otherwise. The well-to-do help the poor, healthy people pay for the sick, with the government as the broker. Their health care proposals also reflect this, with large insurance pools overseen by the government ensuring that enough healthy people are in the plans to pay for the sick members. Of course, this leaves them open to the charge that there is no incentive for unhealthy individuals to take charge of their lives and health care in order to get better. They also need to overcome the widespread feeling that the government is the last entity one would pick to broker anything!

For the time being, the Democrats have the ball, and they are attempting to run with it. I should have plenty to write about in the next few months.

Presidential Candidates and the Risk Pool: Sink or Swim? Part 1

2009-07-06T07:18:00.000-07:00

We’ve been talking about risk-pooling in my last few postings. As I mentioned, risk-pooling is really central to the debate about health system reform. In the last presidential race, differences between the candidates in their approach to risk-pooling caused much of their disagreement about health care reform.

Of the two “finalists” in the Democratic race, Senator Clinton’s proposal did the most to get everyone in the pool. She basically said that if you don’t mandate that all Americans obtain health insurance, then you run the risk that those of the employed uninsured who consider themselves healthy will continue to refuse to pay for coverage and rely on a safety-net of emergency care should they ever need it. These “free-riders” are problematic as insurance pools need their money to pay for the sicker members of the pool.

President Obama, when he was Candidate Obama, did not insist on mandatory enrollment of all Americans into health plans. The centerpiece of his plan is a mandate for all employers above a certain size to either offer health insurance to their employees, or pay a payroll tax to the government, which would in turn take measures to ensure that health insurance is offered to all Americans. These measures consist of a national private health insurance exchange and a competing government-sponsored health plan. All three of these proposals are intended to encourage as many individuals as possible to participate in large health insurance risk pools without mandating that everyone have coverage.

In my next blog, we’ll talk about Senator McCain’s take on risk pooling.

Dr. Carter Goes to Washington

2009-07-01T14:32:00.000-07:00

I recently visited Washington D.C., where I spent a day and a half trying to spread the gospel about the advantages of multispecialty group practice in achieving many of the goals of health care reform. I was one of about 50 representatives of the American Medical Group Association, which represents most large multispecialty group practices in the United States.

Right now, health care reform is being considered by two committees in the Senate and at least three in the House of Representatives. While the overall goals of covering most (or all) of the currently uninsured without bankrupting the country are shared by most of our legislators, there is considerable disagreement about how to get there. I don’t think it’s too far off the mark to say that there are a considerable number of legislators who feel that the costs, both financial and social, of achieving anything near universal coverage are too much for the nation to bear. These legislators are advising caution and making recommendations that I would describe as piecemeal, such as allowing adult children to remain on their parents’ policy up to age 25.

The Democrats, who now control both houses of congress, are intent on passing comprehensive health care reform this year. In order to do this, all the committees I mentioned above who have jurisdiction over at least some aspect of health care reform need to come up with legislation, which then must be reconciled with all the other committees’ recommended legislation in order to produce a final bill that can pass both houses.

Just getting a majority of Democrats to agree on enough features of health care reform to get the ball really rolling has proven difficult, with the liberal wing of the party in favor of a single-payer system, the center of the party favoring private insurance but including a government-sponsored insurance plan, and the conservative wing rejecting any such “public option” and demanding all non-Medicare/Medicaid insurance remain private.

Most of those I spoke with in Washington are of the opinion that the Senate committees are taking the lead in crafting legislation that might actually have a chance of passing. One reason for this is that, traditionally, the Senate has placed a higher emphasis on cooperation and bipartisanship than the House, and many believe that without at least some Republican support, any legislation passed may have a short lifetime before it is struck down or significantly changed.

The bipartisanship of the Senate arises from two major differences with the House. One is that for almost all legislation, the Senate requires a supermajority of 60 votes to pass a bill. This means that unless a single party has at least 60 seats out of 100, some support from the other party is necessary to get anything done. Even now, with the Democrats in the strongest position they have been in for years, they only have 60 votes, counting two independent senators who normally vote with the Democrats and with Al Franken being declared the winner in Minnesota.

The other main difference between House and Senate is that Senators only need to run for reelection every six years, while House members must run every two years. The longer period between elections seems to result in Senators finding less reason to constantly emphasize their differences with the other party.

Of the two Senate Committees considering health care reform, the Finance Committee, chaired by Senator Max Baucus of Montana and with ranking Republican Charles Grassley of Iowa, is viewed as the most likely source of legislation that could gain support from both parties. The other committee, Health, Education, Labor, and Pensions (HELP) is seen as having a more liberal philosophy, making its proposed legislation less acceptable to Republicans. In addition, the real power behind that committee, Chair Senator Ted Kennedy, has been ill and unable to do the kind of personal leadership and negotiating that is really necessary to get things done in the Senate.

Our group arranged a private reception for Senator Baucus and he very graciously gave us a brief summary of his views on where health care reform legislation is going. He emphasized several times his strong belief that any health care reform bill must have some Republican support. Several legislative staffers that I spoke to indicated that one of the strengths of the finance committee is the good relationship between Senators Baucus and Grassley. This was very evident in his remarks to us. He identified the two biggest stumbling blocks that are currently threatening the progress of health care reform legislation. One is the question of a public option, a health insurance plan operated by the federal government in competition with private plans. The other is the total cost of reform measures over the next ten years.

There has been plenty of ink spilled in the press and whatever gets spilled online (bytes?) recently about the public option. Depending upon the writer, the public option is either the Savior of Western Civilization, a major sign of the Apocalypse, or just about anything in between. If I can manage to get my courage up (and my affairs in order), I might attempt to write a blog about the public option. For now, I think it’s fair to say that the Republicans have indicated that they will never under any circumstances vote for anything with a public option for health insurance that will compete for the same patients with private insurance. If they stick to this, and remember this is politics, so “never under any circumstances” is subject to interpretation, then either the Democrats will have to find some Republican defectors or give up on bipartisan support for their final bill.

Cost, both “how much is the cost?” and “how are we going to pay for it?” is the other major issue that needs to be settled. The senate finance committee’s proposal was scored by the bipartisan Congressional Budget Office as costing about $1.6 trillion over the next 10 years. The HELP committee’s plan was estimated to cost about $1.0 trillion, but would only cover an additional 17 million of the 45 million currently uninsured. Basically, both plans need significant rework to get to where the final plan needs to be. And where is that? Well, something like coverage of 80-90% of the currently uninsured at a cost of no more than $1.0 trillion over the next ten years in a form that would get at least a couple of Republican senators to vote for it would probably do.

Glad I don’t have to come up with it!

Health Plans: Necessary, Evil or Both? Part 2

2009-06-29T07:45:00.001-07:00

Today, we are continuing our discussion of risk pooling and why health plans sometimes reject members with pre-existing medical conditions.

The problem with pre-existing conditions arises with smaller employers that don’t have a large enough covered population to dilute the risk of a few sick members. In this case, the members with pre-existing chronic diseases can cost more than all of the other members combined. Unless these members are excluded, the health plan will lose money on this account. Taking this to the logical limit, when a health plan offers policies to individuals in addition to or instead of groups, the plan must evaluate each member’s health status. When patients have health problems that are likely to cost more than could be reasonably charged in premiums, the health plan will either decline to cover them or possibly exclude any coverage of their pre-existing medical conditions.

Bottom line: Health plans, in general, are not evil; they do what they have to do to survive. However, what they have to do to survive in the market can be pretty hard to swallow, with consequences that can be unfair to patients and doctors. In a larger context, the problem of the uninsured in America is at least partially due to the necessity for health plans to eliminate sicker patients from their risk pools.

As you might expect, this issue of risk pooling is a very important component of discussions about health care reform in the United States. In my next posting, we’ll start talking about how this played out in the last presidential election.

Health Plans: Necessary, Evil or Both? Part 1

2009-06-22T06:51:00.000-07:00

Unlike many doctors, I don’t hate health insurance companies. Without the widespread adoption of employer-based health insurance provided by third-party insurers (and assuming no universal government-sponsored health insurance), most American doctors would still be getting paid with chickens and canned goods or patients wouldn’t be able to afford care.

Having said that, health plans can be the source of seemingly unending annoyance with their often infuriating rules, denials and other hassles for physicians and patients alike. Like any business, health plans must take in more money than they pay out, and most of the hassle factors cited by physicians and patients revolve around health plans’ efforts to ensure that they don’t pay out too much.

In my previous blog post, I talked about risk pooling and the common practice of health plans rejecting patients with pre-existing medical conditions. Control of risk is central to a health plan’s ability to survive in the market. The health risk is quite predictable given a large enough pool of patients with a normal health status distribution. A health plan will be able to accurately predict how much money it is going to have to pay out to cover the health needs of the population.

If the pool of patients is large enough, it is a safe bet that it will include enough healthy patients to pay for the usual number of patients with pre-existing health conditions. This is why employees of large companies with employer-sponsored health benefits typically are not rejected for coverage, even if they have pre-existing health problems.

So, when do pre-existing conditions become a problem? We’ll discuss that in my next posting.

Diving into the Risk Pool

2009-06-15T08:00:00.000-07:00

America’s Health Insurance Plans, an umbrella organization representing health insurers, recently proposed dropping its practice of varying premiums based on health status. Many things drive people crazy about health insurance, but one of the biggest peeves is “pre-existing conditions,” which can affect the ability to get insurance and the price paid by those fortunate enough to obtain it.

Basically, what happens is this: When you apply for health insurance, the application asks whether you have had a long list of conditions. If you have any one of the conditions listed, you might be rejected for coverage. It’s the old Catch-22. “We would be happy to offer you health insurance, unless you happen to have something, such as a health problem, that would cause you to actually need health insurance.”

Insurance in general relies on a “pooling” of risk. All of us are at risk of something bad happening to us, such as a car wreck, house fire or health problem. For most of us, that risk is thankfully small. But if one of these bad things happens, it can be financially catastrophic to us as individuals. The solution is to band together with a large number of other people, who each pay a relatively small amount into an account that then can be used to pay if anyone of us suffers a covered loss.

In my next posting, we’ll discuss how health plans approach risk pooling.

Coordination is Key to Health Care

2009-06-08T08:00:00.000-07:00

During the last presidential election, the candidates didn’t agree on very much. But they did agree that the way to reduce escalating health care costs in this nation—and to make health care affordable and accessible—is through coordination.

What does coordination mean? It means that primary care physicians, specialists, diagnostic imaging providers, lab staff and others in the health care chain all share information, expertise and resources to achieve the best outcomes for patients.

It’s a pretty simple concept, but it unfortunately isn’t all that common in the health care industry. Most patients who have insurance receive care from “networks” of physicians that insurance companies cobble together. Most physicians in these networks operate as independent business owners. These artificial networks cannot deliver efficiency and collaborative care like physicians working together in cohesive teams. And patients who don’t have insurance obviously face even bigger hurdles.

There are organizations out there providing coordinated care, but as I noted in my first blog post, they are the exception rather than the rule. Multispecialty practices give patients access to care from a medical village. Physicians regularly confer about treatment, and that improves effectiveness.

Coordinated, multispecialty care is more affordable because it emphasizes prevention and chronic disease management. In short, preventing illness and managing chronic diseases in physicians’ offices costs much less than caring for acutely ill patients in hospital emergency rooms when their diseases get out of control.

Thankfully, federal policymakers seem to understand that our nation’s health care vehicle needs much more than a tune-up—it must be replaced by a more efficient model. This new framework should reward coordination, not fragmentation.

My Blog and Welcome to It

2009-06-01T09:00:00.000-07:00

Welcome to my new blog. I will be writing about the state of health care in the United States from what I hope will be an interesting perspective—that of a practicing physician–leader in a large group practice. Group practice physicians have for years been an important, although I think somewhat unknown, part of the medical profession.

American physicians have gained a reputation as often being fiercely independent practitioners with a “don’t tread on me” attitude, at least when it comes to anyone trying to affect how they run their businesses or care for patients.

Group practice physicians might be thought of as being guided by another famous Revolutionary War phrase: Benjamin Franklin’s “We must, indeed, all hang together, or most assuredly we shall all hang separately.” Multispecialty group practices are made up of anywhere from dozens to thousands of physicians, all believing that large, well-led groups of physicians who work closely together provide medical care that is greater than the sum of our individual abilities.

My group practice, Kelsey-Seybold Clinic in Houston, Texas, has about 350 physicians and has been around since 1949. My specialty is family medicine and geriatrics. My jobs, in addition to seeing patients, include serving as Chief of Family Medicine and as Medical Director for Care Coordination and Quality Improvement.

Stay tuned!