Perspective: Healthcare reform and the future of medicine: a med school dean shares his views

Charles J. Lockwood, MD, MHCM, dean of the College of Medicine andvice president for health sciences at Ohio State University, recentlyshared his thoughts on healthcare reform and the future of medicine withEditor-in-Chief Lois A. Bowers, MA.

A: In states that have a greater percentage of uninsured patients, there's going to be a lot more spending, and that's going to drive healthcare delivery reform, almost certainly in the form of some kind of global fee or capitation. I see rapid consolidation of health systems across the country. They'll be competing for those capititated lives and either offering their own insurance products, partnering with insurance companies, or being bought by insurance companies. There will be kind of a brave new world of healthcare delivery. Health systems will begin to focus on prevention, community health, and general wellness approaches.

A: To accommodate primary care, we'll develop a multi-tiered system. The first tier will be retail clinics and midlevel providers providing basic vaccinations, point-of-care testing, anything that can be algorithm-driven, where you really don't need a physician. That currently takes up about 30% to 40% of primary care practice time, and it's one of the reasons why PCPs would have to work 18 hours a day if they really did everything they were supposed to do for an average panel in terms of prevention and acute care treatments. Tier two would be family physicians, general ob/gyns, pediatricians, and general surgeons who would provide preventive care and some urgent care. They would focus on wellness and on the initial management of diseases such as diabetes and thyroid disease. At the heart of the third tier would be comprehensivists who would coordinate the care for patients with more complex conditions. Most importantly, they would focus on the patients-almost all of whom have lots of co-morbidities-who account for much of the costs. They would leverage electronic health records and social networks to keep them out of the hospitals, keep them as healthy as possible, and make sure that there's no replication of testing and treatment. This activity will really drive down errors, drive down costs. I call them multispecialty patient homes. But the key with any complex health system is simple rules. And the simple rule that I think will change healthcare delivery will be to move from fee-for-service to global fees.

Q: What can doctors do to be part of the solution to what ails the system?

A: We need to advocate for ourselves in the sense of tort reform and ensuring that we continue to be reimbursed at an appropriate level given the quality of care that we provide. But we also need to be willing to adapt, with the constant focus being that we need to provide value to our patients, which means better and better outcomes, higher and higher quality care, higher and higher patient satisfaction, for lower and lower cost. We have to wring out the wastes and expenses of the system while improving efficiency.

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