How to Calm the "Perfect Storm"/Response from a Feature Author (2007)

SCOTT LARSON, M. D. THIS ISSUE OF Frontiers of Health Services Management features two important articles pertaining to hospital and physician relations. From my vantage point, the observations and recommendations made by the feature authors could not be more timely. Both articles suggest that the current Stressors within our nation's healthcare system, while potentially divisive, can and should lead these parties to better cooperation and understanding. These articles very nicely address the why and the with regards to achieving the highly desired outcome of cooperation and collaboration among all providers. I would like to offer for consideration some tactics for implementation. Both articles make reference to a sea change in healthcare delivery that has grown frustrating for physicians and hospitals. Competition for shrinking revenues has become fierce and has resulted in a reinforcement of traditional, defensive tactics that are being deployed by the competing parties. The magazine HfifHNvery accurately forecasted this perfect storm in its cover story five years ago entitled Dr. Disconnect (Haugh 2002), It would be easy to oversimplify the present milieu by saying that it's all about the money. Although money is an obvious driver, much more is in play and at stake here. Our healthcare system will never achieve its true potential until physicians and hospitals abandon an egocentric agenda and establish a true partnership. The forces of stress to which these articles refer fall into three categories: (i) the state of our economy, (2) the changing marketplace, and (3) governmental regulation. In America today, the baby boomers rule, at least for the moment. With this reality comes a high consumer expectation for service, value, affordability, portability, convenience, and transparency. Please note, my reference to consumers includes both patients and payers. Unfortunately, the same baby boomer demographic is simultaneously populating the Medicare eligible ranks by the tens of thousands on a daily basis. When we do the math, (and many have), the conclusion is not pretty and is certainly not sustainable in the current or future economic environment. As a result, the marketplace has responded in a very predictable fashion with every faction looking to discover and develop new revenue streams or obtain greater value and efficiency for their time. Physician-owned hospitals and outpatient surgery centers, cross-specialty privileging, and pay for call increasingly occupy the agendas of credentials committees and hospital boards. Patients are feeling the pinch as well through higher copays and limited drug formularies. Convenience care clinics now cornP6*6 for low-acuity care at the local supermarket. Hospital systems are buying and selling facilities in strategic markets. And let's not forget the payers who continue to leverage the clout of their enrollment network and huge cash reserves. The waves from this sea change are even being felt internationally. I am told that the construction of new hospitals in and around Delhi, India, is accelerating at a pace faster than in the United States. Who are the targeted patients for these beds? United States citizens looking for bargains on high-end, high-cost treatments such as open heart surgery, cancer care, bariatrics, and aesthetic surgery. These developments are really not surprising given the continued preoccupation of our federal government with microregulation and continued scrutiny of physician-hospital relationships so eloquently referenced by Mr. Petasnick. In the face of these rising tides and stormy seas, the frustration of hospital administrators and physicians continues to grow because they don't what to do to improve the situation. And so, when you don't what to do, you do what you know. Unfortunately, what physicians and hospital leaders know best is how to defend their turf, often demonstrated by being unwilling to listen and understand, acting on subconscious bias, applying blame, seeking self protection, avoiding risk, and using defensive reasoning. …