With Change Looming, Head and Neck Surgeons Look in the Mirror

The time for change is now, he told the room of surgeons at the AHNS. The tension that we went through when we experienced top-down, Hillary-care is gone, he said. The current national efforts are multi-stakeholder collaborations [of those] who appreciate the crisis and are moving toward solutions. And we’ve actually got to move to the Beltway to join these health reform efforts and assume our leadership role.

A recent Central Budget Office report suggested that waste in the health care system totals $700 billion a year. He said institutions have to move from silos of care to becoming part of systems.

Our current care is focused on what a surgeon needs at that very moment, rather than on what the patient needs to get from a diagnosis to complete recovery, he said. We need to create the roadmap for each condition for each patient, and create reliable, standardized systems with tight coordination across all the health care providers.

Leading our profession through such challenges means we have to listen with a broad set of perspectives, he told the surgeons. Listen not only as physicians and surgeons who really represent your patients, but listen as your patient, listen as the purchaser, and listen as the payer. Because you’re the only one really capable of doing all that.

Dr. Opelka described four areas that need to be changed to get to a high-value health care delivery system. Values and goals must become patient-centric. The focus on medical conditions needs to shift from the disease of the moment to longitudinal, continuous care. Measurements of quality have to include criteria from the clinical, to claims, to cost to the experience of patients. And payment systems must shift from volume-based financial rewards to alignment with the value of the services delivered. These changes could lead to alternative payment systems such as bundled payments or accountable care organizational payments, Dr. Opelka said.

Left to the government, the results won’t be pretty, he said. It’ll be a very heavy hatchet that cuts into us, a vise that squeezes down on us, leaves us in the current system, and it just is not the answer, he said.

Medicare now spends more than it collects in taxes. It has seven or eight years before it will require new financial support, Dr. Opelka said. We must shift from a current state to a future state which is designed on the best value for the care delivered, he said.