Taking Expense, Unpredictability Out of Healthcare

Doctors, working together, are the key

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By: Toby Cosgrove, MD

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Americans talk about our healthcare “system.” But it’s not really a system at all. It’s a hodgepodge. We have about 800,000 doctors in the United States. Some doctors work in hospitals. Some work in groups. About 40 percent are on their own. These small-scale practitioners deliver healthcare as kind of a cottage industry: intimate, craftsmanlike, with lots of personal attention. But as doctors, we need to ask ourselves what’s best for the patient. Many people believe that healthcare is best delivered by larger practice entities – and I agree. Let me tell you why.

Small or cottage industries can deliver finely crafted work. But costs to the producer are higher, and the product is usually more expensive. There may be little oversight, leading to wide variability in quality. The result is a product that is expensive, unpredictable and scarce – which sounds like how many Americans describe their healthcare.

What healthcare can learn from other industries

Industries begin in cottages, but they quickly leave them behind for larger production and delivery systems. Large, coordinated entities can assure standardization, reliability, quality improvement, wider distribution and all the other factors that have made more goods and services available to more people, more cheaply today than at any other time in history. Yet healthcare lags behind in this area.

The good news is that the same strategies that have revolutionized every industry from textiles to farming over the past 250 years can be applied to healthcare. The first step is to organize doctors differently – bring them together into larger groups led by doctors, not professional managers.

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How a large group practice benefits patients

Cleveland Clinic is what is known as a large group practice – the second largest in the world. We have more than 3,000 doctors in our practice. They work as a team, not as competitors. We collaborate to give every patient the best outcome and experience. The group owns the hospital and other facilities, and physicians oversee all administrative decisions. The group pools its medical resources and pays every doctor a regular salary.

The organization has its share of non-medical administrators. They are experts in business, human resources and supply. But our doctors are in charge. Doctors bear the ultimate responsibility for the health and well-being of their patients, so it makes sense that doctors, rather than laypersons, make the decisions about the functional activities that surround patient care.

The authority granted to doctors may be one of the reasons Cleveland Clinic physicians score so well on employee engagement surveys: Their collective power is commensurate with their responsibilities. The judgment of medical experts ensures that every policy and procedure serves the goal of providing patients with the best care possible.

‘Highest quality, lowest cost’

The recent national debate on healthcare reform threw a spotlight on the group practice model. We learned that we have supporters at the highest levels of government. In 2008, for example, President Barack Obama told a national television audience that Cleveland Clinic, Mayo Clinic and similar practices “offer some of the highest quality of care in the nation, at some of the lowest costs in the nation.”

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Four years later, both President Obama and Governor Mitt Romney mentioned Cleveland Clinic approvingly in their first presidential debate on October 3, 2012.

Dealing with the ‘lone wolf’ mentality

Still, resistance among doctors dies hard. It’s not easy to cast off the “lone wolf” mentality. Some doctors believe that their individual brilliance will be stifled in a collaborative setting. Others maintain that getting doctors to agree and work together is a hopeless task.

There are good arguments on both sides. But the success of Cleveland Clinic, Mayo Clinic, Intermountain Healthcare (Utah) and other group practices testifies to the value of this model in delivering exceptional and efficient care.

Editor’s Note: This post is adapted from the first chapter of The Cleveland Clinic Way by Delos M. Cosgrove, MD, which will be published in early January, 2014 by McGraw-Hill Education.

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