Communication, Transparency Can Improve Healthcare Value

There is also recognition that greater care integration across physicians, hospitals, and other healthcare delivery providers can achieve cost savings and provide well-coordinated care. Thus, hospitals are purchasing physician practices in an effort to integrate care, allowing hospitals to provide ambulatory services and receive higher reimbursement from CMS and other payers. These mergers can be attractive to physicians, who may see an opportunity to give up their private practices in exchange for a steady outcome, better work-life balance, lower malpractice insurance costs, and a reduction/elimination of practice issues.

All told, however, there is a “huge jump of cost when you become part of a health system,” said Kathleen L. Yaremchuk, MD, chair of the department of otolaryngology-head and neck surgery at Henry Ford Health System in Detroit. “As much as we talk about clinical

integration in health system acquisitions and mergers, it’s about the dollars.”

Such mergers may also create barriers to access. Earl H. Harley, MD, FACS, FAAP, associate professor in the department of otolaryngology-head and neck surgery, specializing in pediatric otolaryngology, at Georgetown University Medical Center in Washington, D.C., gave voice to the needs of underserved populations. He explained that he grew up in the inner city of Detroit, where patients tend to be sicker and have limited access to healthcare. This limited access meant that many patients obtained care in the emergency room, said Dr. Benninger, noting the “paucity of well-trained primary care physicians.” Dr. Harley explained that he now uses physician assistants so that he can see more patients, increasing patient access to care.

A Growing Understanding of Value

“A lot of these topics are interesting, intriguing, and scary,” said Dr. Benninger. Value will be defined, and doctors can either participate or not participate in the process. In order to contribute the most to the discussion, they likely must expand their understanding of value and quality. Most physicians consider quality to be the actual surgery itself. Patients, however, will likely expand quality to include physician accessibility, surgery, their post-surgery experience, and their physician’s responsiveness to post-surgery problems. Of these, perhaps the most important two criteria are patient perception and accessibility. As Dr. Eibling acknowledged, “The stakeholders that are most critical are patients.”

Lara Pullen is a freelance medical writer based in Illinois.