Posted on 01/19/2015 9:39:03 AM PST by struwwelpeter
CHICAGO — “Some folks might think that I’m just a paranoid old guy who feels that the world is coming to an end and we had a great ride…but there are major disruptive changes in health care on the horizon, and unless we understand them and respond, I think, personally, the future of our profession is in jeopardy,” Paul Berger, MD, chairman, Partners in the Imaging Enterprise, and past founder and former chairman of NightHawk Radiology, said at RSNA 2014.
The disruption Berger was referring to specifically is the trend of population health. Population health is an idea with varying definitions that are general and complicated, but a well-accepted definition is from an American Journal of Public Health article proposing it as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”
“Population health turns the economics of the health care system absolutely on its head,” Berger said. “The current system is called a sickness system, when somebody gets sick, we benefit.”
Berger explained that in the world of population health, the health care team is paid a “reasonable” sum of money with which physicians need to do what’s best for that patient, because every resource used comes out of the initial pool of money.
Berger addressed the concern that physicians may withhold care in order to keep more in the pool, but he argued that physicians wouldn’t withhold care because then patients would get more sick and use more resources.Paul Berger, MDPaul Berger, MD
“We start focusing on prevention, we start focusing on wellness, when someone gets sick, we want them to get well very, very quickly,” Berger said. “We are incented to improve processes and do the right thing for the patient.”
In general, radiologists tend to fall outside of the box with health care initiatives, population health seems to be no different, but Berger argued that with a current economically unsustainable health care system, radiologists can’t afford to fall to the wayside.
“We’ve got to stop protecting the world as we know it,” Berger said. “It’s changing…and we have to embrace that change and redefine and further define the radiologist’s role in a greater level of integration as a member of the health care team.”
In a population health model, a component of the payment will be related to radiologists’ value to the system, with value defined as quality or outcomes divided by cost, Berger said. Quality has been a notorious and persistent challenge to measure in radiology.
“We want to avoid bad, we want to avoid catastrophe, but until someone can clearly demonstrate to us what quality is, we aren’t worried about quality, we think we are doing a fine job,” Berger said.
Berger urged that radiology needs clearly defined, meaningful, and measurable metrics. “Quality criteria really depend on who is deciding what quality is that matters,” Berger said.
For example, Berger said, for the referring physician, radiologists’ quality can be measured by how easy it is to schedule appointments, how much collaboration or consulting you are available for, and whether your reports are actionable and helpful in managing the patient. For the patient, quality may mean a rapid diagnosis, assurance that their scan was performed safely, and that they were treated with compassion and with excellent communication skills.
The need for measurable quality metrics in radiology is mandatory, Berger said. “It’s up to us to preserve our turf, so to speak, so that we set those qualities very, very high.”
“We need to re-engineer the delivery of what we do and how we do it to enable value-based care,” he said.
The initiative will require strong, decisive, visionary leaders, who really understand the need for change, Berger said. “This course has to change, this course is going to die if we don’t let it change.”
Berger plead with the RSNA session attendants to be those visionary leaders. “The opportunity [to become radiology leaders] is spectacular,” he said.
NICE rejects Dendreon’s Provenge… againThe article is short and interesting, but the comments are very interesting:
George Berger, on January 15, 2015 at 5:44 pm said:
It gets worse, Sitemaster. NHS England has rejected 20 to 25 cancer meds, two or three days ago. See this and note the dates.
Sitemaster, on January 15, 2015 at 9:12 pm said:
George:
This had been announced as a high probability several months ago. The NHS has a fixed budget each year that they have kept exceeding. You can’t run a household that way, or a business, or a nation. Things that have very limited supplementary benefit inevitably “have to go”.
George Berger, on January 16, 2015 at 5:11 pm said:
I know. I had to analyse the NHS England Commissioning Intentions document, of October 3, 2014. It is such a strange text that some considered it to be a diversion from other matters. Or a test of public opinion, to see what cuts NHS England could get away with without much opposition.Perhaps there was little opposition. If so, that just might explain the Blitz of dropping more than 20 cancer medications in one day, from provisions within the Cancer Drug Fund. I do not claim to know this. However, these drugs were dropped, and some people I know well now have such limited supplementary benefit to their corporate and entitled masters, that they inevitably “have to go.”
We have this - and not only is care being denied - but it'll be the nightmare of the future... Yep, this crap will usher in death panels ... it's called 'Medicare Advantage'.
Insurance companies get a set amount from the government to 'care' for the elderly - and anything they don't spend they get to keep. I've seen this thing working... great for people who are relatively healthy ... past that it's the incentive system from hell.
What it’s going to come down to is unless you’re wealthy, you had better keep yourself VERY healthy.
After you are 65 or older, you will be on borrowed time, because no one will keep you alive if you get into trouble, unless you can write a big check to someone.
In the short term, maybe.
In the long term, it will usher in the complete destruction of the medical profession, and its replacement by robots.
Doctors are incredibly stupid not to realize this.
They're probably thinking it won't happen in their professional lifetimes. They are in for a nasty surprise on that one.
It seems to me that a radiologist is generally brought in as a referral after visiting a primary doc.
However, just in the last year alone, radiologists have played a HUGE part in the healthcare of many wife, my mother, myself, and even our dog. From broken/displaced bones to cancer, radiologists have provided imaging and treatment in big “doses” to our family.
While the author of this article may be concerned about the affect of Obamacare upon his chosen profession (as we all should be)...there is no doubt in my mind, the need for his services will continue to grow.
Thank you, Radiologists!
As one who is about to get 5 SBRT fractions, I’m a customer of radiologists.
Also well aware of Provenge. It works well under lower PSA starts. I’m budgeting for it should Medicare not pay.
This guy, like others, also mentions a lot of cliches about incentivizing "prevention" vs. simply getting paid for sick care What does all this mean? I'm trying to wade through his double-speak.
Does prevention mean you will be told what to eat? If you can or can not keep guns in your house? Or with regard to group outcomes - If black people have worse "health outcomes" than white people, I assume progressive social engineers will start saying the system is racist - with then obvious consequences.
Very sad....
I remember when I was a kid, this was during the 80s. I remember being sick and my grandmother dropped me off at the Dr office. Imagine the HORROR of LEAVING a 8 year old kid somewhere! Today the police would have been called and she would have been arrested!
Before going in, she wrote a $35 check for the visit, and that’s all there was to it. No insurance involved. We’re in a small town, and back then we seemed to be 10 years behind the rest of the world. With how fast things catch up now, we’re probably only 3 or so years behind the rest of the world now.
Liberals seem to use the buzzwords “Wellness” and “Sickcare”.
When I hear people using those words, that’s a trigger to me that tells me where they are coming from, and where they’re probably going.
“Wellness” is a code word for them wanting to control your life basically. Do.... THIS... Or face a penalty of some sort. Right now those penalties tend to be financial, but eventually it could mean life or death for you or a loved one. We are truly going to places where we never should.
Our hospital co-pays have been increasing for the last 2 years because of obama’s cuts to Medicare Advantage but that as been the only change.
All of that. Actually preventive medicine is costlier than actual fixing of diseases. Preventive medicine concentrates on warding off lots of stuff you will never get and you still get some of the stuff being warded off. They know this. The other stuff, total social control, is why they are pushing it. Once the government is responsible for your health, the government can require or forbid any damned thing at all. geographic mobility will brought to an end fairly soon. Remember that was a big part of Hillarycare- mobility control. If you were going to leave your “healthcare area” you were going to have to file travel plans with the health commisar.
The technology changed such that data was transmitted over the inter net, and diagnosis done remotely.
The problem with their co was that the initial partners were making twice as much as the new ones.
The future of medicine is: you will have a chip embedded in your brain that will transmit your health stats to your IPAD, and when symptoms occur you will be notified by NSA that you need to do a particular procedure or get a drug (weed) to solve your health problem. No doctors involved, all on WEB MD.
OH yes, when you reach 75 the chip will release a poison.
He's got his so what is there for him to worry about? He wants a social justice legacy - that's all.
Now that’s a “glowing” tribute.
(I could not resist a lil pun) :)
Afraid you’re correct.
Docs are experts in the orthodoxy of their studies. Critical thinking - not any better than the population at large.
Their main lobbying group, the AMA, actively advocated for Obamacare, and premature push for EMR, ICD-10.
Docs are catching on - AMA membership has steadily been declining, because they have discovered that most trade org / unions work for their own leader’s interests often to the detriment of rank and file members.
That was a great company he founded. The hospital I worked for used their service. After a certain hour at night, all of our radiology stuff was sent to their radiologists in Australia overnight, because our Radiologists didn’t want to be on call all night. I maintained the VPN connection and interfacing for our system to theirs, should any issues arise with networking/communications. I bet they made a dammed fortune off that system.
"Look at he recommendations for PSA tests. They cut those to nothing as there were "too many subsequent biopsies performed". They basically threw baby and bathwater out w/o replacing it with any of the newer diagostic tools. Talked to my insurance carrier and let them know how much more they had to spend as a result of that policy change. For a $50 PSA and maybe $100 (for) Free PSA they could have caught my PC 18 mos earlier, saving the carrier money, me an RP (resection of prostate) and ADT (androgen deprivation therapy) for two years.
"It has to come from the bottom up because the wonks are not looking out for anyone but their policy."
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