He went on to explain that hospitals must lead the way for digital medicine, as they are the institutions with the most opportunity for cost reductions in healthcare, the most opportunity for error reduction (“I’m not saying hospitals have the most errors, but that the corporatized process allows them to reduce errors that occur there,” he clarified), and the best site for innovation to move to a virtual model such as e-ICUs and new tele-specialties.
“And who can we turn to who ‘gets it,’ who can make all this happen?” asked Dr. Brailer of the innovations. “It won’t be the cardiologists, or the emergency department doctors. The obvious answer is that it will be the hospitalists.”
He warned that in order for hospitalists to be change agents, they must first take on the role of leaders of other doctors in inpatient care. “Some [hospitalists] don’t want to take on this role; others are already doing it,” he said. “I think that doctors need this leadership and I can’t think of a better group to do it than hospitalists. They’re going to have to step up to the plate on this.”
Dr. Brailer listed big issues coming up for hospitals, predicting that they will become “the hub of chronic-care management, leaders in adopting state-of-the-art technology, and leaders in quality improvement. Hospitalists are attached to each of these.” He explained that in chronic-care management, patients with chronic illnesses are cared for in a continuum-based way. Currently, inpatient care is the anchor not just for treatment, but for monitoring weight or assessing daily function levels. With chronic-care management, doctors can monitor patients without having them come into the office or the hospital.
“Primary-care doctors won’t be able to perform this off-site monitoring; they don’t have the time or the infrastructure,” explained Dr. Brailer. “But this is exactly what hospitals already do. Electronic monitoring is a real opportunity for them—and for hospitalists—to expand their care offerings.”
In spite of this expansion, he warned that hospitals will be in danger if they don’t change with the times. “The world is moving away from hospital-based care and toward [patient]-centered care,” he stated. “This is apparent in the current push for portability of patient-care information, and in today’s healthcare transparency issues. These are not hospital-friendly measures; in fact, they threaten hospitals to some degree. I hope that these trends will challenge hospitals to question how changes apply to them.”
Dr. Brailer ended with an update on public policy regarding healthcare—not a pretty picture from his insider’s view.
“Not much will happen in the next two years,” he predicted. “The FDA will pass the Prescription Drug User Fee program, and SCHIP [State Children’s Health Insurance Program] will pass in Washington D.C. I don’t think anything else will make it through the thicket of everything else going on.”
He also warned that regardless of who the next president of the U.S. is, nothing much will happen with healthcare reform. “It’s a high-priority item, but not high enough to warrant significant attention,” he said. “In the long term, it will get major attention, but probably only as a result of a catastrophe.”
Factors That Will Shape Our Future
On Friday morning, attendees heard from Jonathan B. Perlin, MD, PhD, MSHA, former under secretary for health at the Veterans Affairs, and currently the chief medical officer and senior vice-president of quality for Hospital Corporation of America (HCA) in Nashville, Tenn.—the nation’s largest hospital group.
In presenting, “Healthcare 2015: Challenges and Opportunities in the Decade Ahead,” Dr. Perlin threaded together the factors that will drive healthcare to a new level in the next eight years: the health needs of the population, including aging and the complications of diabetes, the increased requirements for delivering value, the economic pressures, and the technological changes and decentralization of healthcare delivery. Dr. Perlin, a leader in healthcare transformation and health information technology who has been termed a “clinical futurist,” pointed out that the result of these factors will be a transformation from an industrial to an information age model of healthcare.