We’re witnessing an explosion in beneficial technological inventions such as sophisticated robots to assist with minimally invasive surgery. We’re on the cusp of a new era of regenerative medicine where we’re discovering how stem cells can help us rebuild parts of the human body that have been injured or damaged by disease. We’ve finally begun to understand that being a doctor isn’t just about fixing what is wrong but helping patients avoid illness and injury by offering great advice and comprehensive preventative care.
In orthopedics, if you want to see what is truly possible right now (not at some distant point in the future), then you need only look at the type of care afforded to professional and elite athletes. Their body is their livelihood and so getting back to their sport in weeks, not months, can be the difference between a career that continues and a career that falters. They need the best care.
At high-end sports medicine hospitals and clinics, doctors have a seemingly unlimited time to spend with each person. They offer extremely high-quality diagnostic skills and tools with the best of testing and interpretation. They bring in world-class physical therapists to guide a patient’s recovery from injury. These are therapists whose skill at manually manipulating soft tissue far exceeds the skill of an average therapist and they use all kinds of gadgets and technology to speed recovery.
The doctor and his or her team partner with the patients. They consider nutrition guidance, preventive health care and proactive fitness training as part of the healing journey at every visit. This nurturing and highly skilled environment leads to extraordinary results. For the clinics practicing at this level, cost is always a considered factor but not a limiting one when it comes to delivering the very best care.
All of this is promising, and exciting for those who practice and who have access to this care. Yet at the same time, there has never been a worse time to be involved in medicine. The majority of people are not getting the care that they deserve, budgets are stretched, time is tight. Doctors are suffering from declining reimbursements, making it difficult to run their offices with the staff and new computer systems required to collect money from a wide assortment of payors. This is all impacting the quality of the care that they can offer their patients.
The way it works is that insurance companies try hard to find the doctors who are willing to give discounted high-volume care, which is less costly for the insurance companies. They called it “best practices,” which is often code for most efficient care, not necessarily the best. Insurance companies also insist that all care follow guidelines. Unfortunately, recent studies have shown that most guidelines in medicine are based on very weak studies and often on opinions not backed up by solid data. The guidelines are mostly used to standardize, and therefore commoditize care.
The doctors with declining revenues are put in a desperate position. They must sign up with as many of the insurance plans as possible to maintain a high enough revenue to keep the doors open. Everyone in this mix is becoming a discount house.
So where does this leave patients? We need to be realistic, not everybody will have access to the kind of treatment that professional athletes get and not everybody needs it. But what all patients do need and deserve are doctors who have the time and incentive to personalize their care, to become knowledgeable about their injury and disease, to recruit the resources to deliver the effective treatments, and to educate and deliver preventive health care. These skills could be fostered throughout the entire health care system, but only if the payors realize that quality today and preventive health care for the future are eventually the most cost-effective parameters.
As we work to improve the health care system in this country, we must do all we can to insist that that doctors are inspired and incentivized to work hard at improving the care they offer, as opposed to today, where the incentives are mostly about decreasing cost and increasing volume.
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments. For more info, visit www.stoneclinic.com.