Another great annual SHM meeting is in the books. Although we as a profession have lost that new car smell, you get the overwhelming feeling that none of us has any buyer’s remorse. It is quite remarkable to go to these meetings year after year and hear the same message: We are still growing and nothing seems to be slowing us down. Thirty thousand strong, and most of us would gladly hire more doctors if we could. We are the doctor bubble that will not burst.
On a personal note, I was sporting three ribbons under my name tag (Fellow, Leadership Alum and Judge). That’s up from only one the year before. If I remain on this exponential projection, I will achieve my ultimate goal: to one day stroll around the conference with so many ribbons that I have to hang them from my face, creating a faux beard and looking akin to the “bearded bee man.”
But as per my usual, I digress.
I left the meeting with five words, stated by our fearless leader Larry Wellikson during his state of the union address, reverberating in my head: “Something is going to happen.” Remarkably, the wager is no longer about if or when health care reform will take place, but rather what will it look like. As an aside, can you say bundling? It was the conference buzzword and will likely be the topic for much future discussion.
No one can be faulted for putting all their chips down on imminent health care reform with so much daunting news about the state of our health care system coming in each and every day. Quite simply, we are going broke and, like, soon.
As we were all making final travel plans for the conference, the Obama administration was busy releasing new numbers that suggested that the Medicare fund will run out of money in 2017, which is two years earlier than expected. Like most government projections, I suspect they are too good to be true. Perhaps 2015 is even more realistic given that we are mired in a “Great Recession” that does not seem to be losing momentum.
So 2015 minus 2009 is six years! Usually such dire projections are so far off in the future that they lack any real visceral impact. Not so this time around. Simply put: scary.
And if Obama is reading the New York Times, and apparently this president does, he will undoubtedly have noted David Brooks’s criticism of the administration’s early ideas for health care reform entitled “Fiscal Suicide Ahead,” which was published the day before the SHM conference began.
Brooks writes: “Obama aides talk about ‘game-changers.’ These include improving health information technology, expanding wellness programs, expanding preventive medicine, changing reimbursement policies so hospitals are penalized for poor outcomes and instituting comparative effectiveness measures.”
He goes on, “The first problem is that most experts … don’t believe they will produce much in the way of cost savings over the next 10 years. … The second problem is that nobody is sure that they will ever produce significant savings.”
My take home point is this: Lukewarm reform is not good enough. If costs are going to be controlled, true game-changers are needed that radically change how hospitals and physicians are paid for how we practice. Those in Washington, who are armed with–and disciples of–the Dartmouth data, must believe physician autonomy is almost as dangerous as a rogue nuke nation. That data showed that we spend twice as much here in New Jersey as in Wisconsin for the same outcomes.
So we are left with, “Something is going to happen.” I believe the focus of next year’s meeting will be trying to decide if the “stuff that happened” was good for the health of Americans and hospitalists alike. Given SHM’s growing political strength–and I got the impression that half of its prominent members were jetting off to Washington after the meeting to extol our virtues when it comes to cost control and quality improvement–I am optimistic.
Optimistic that we will continue to be the physician bubble that just won’t pop. But even more, optimistic that perhaps health care reform will result in a sustainable system. That system will allow us to practice the efficient, efficacious care we were all trained to provide without being bogged down with perverse financial drivers that often coerce us directly and indirectly to provide excessive (and potentially detrimental) care.
That would be more than just reform. That would be a relief.
