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Pie in the Sky—or a Grassroots Call to Action?

As I sat in the audience at the 2009 meeting of the American College of Medical Quality (ACMQ), listening to Janet Corrigan, President of the National Quality Forum (NQF), describe to the mostly interested audience the national priorities and goals for transforming health care, a skeptical audience member sitting right behind me sniffed, “This is all pie in the sky.” That critical comment crystallized for me what I believe is the real barrier to improving today’s health care environment. Too many physicians in clinical practice are failing to “get it,” to recognize the strong winds of change buffeting health care, and too few are proactive in trying to influence and modify the changes to their needs. There are various reasons for this: Doctors in clinical practice are often too busy taking care of patients to step out of their clinical roles and view the “big picture.” They are focused on taking care of patients one at a time, which keeps them occupied and possibly content. Others appear simply disinterested or ostrichlike. They have little stomach for the cut and thrust of trying to influence public and payer policy and the time that that takes. They leave it to the government and nonphysician leaders to decide what is best and do not do anything until they have to contend with legislation and regulations that are not to their taste. But by then, it is too late. Make no mistake—according to Dr Corrigan’s pronouncements, current trends being pressed by the payer community are going to have major effects on clinical practice. They will dictate clinical care by the power of the purse—deciding what they will reimburse and the conditions attached to it. Soon the ability of every physician who works under a reimbursement system to practice medicine as he or she does today will be gone. And unless doctors stand up and make their voices heard, they will have lost by default. The popular media is full of stories about what is said to be the poor performance of the current health care system. Leaders of large health care provider groups have complained that the United States is not even close to getting its money’s worth in health care and that not only is American health care inefficient and wasteful but much of it is dangerous. And that brings up the case for addressing health care priorities and establishing realistic goals. The reasons detailed by Dr Corrigan for setting national priorities are not that difficult to understand. It is clear that costs are going north, whereas the economy is heading south. That is a matter of concern. It is making health care planners question just about everything—the value of care as it is delivered now and what is seen as overuse and underuse. Many would like to see improvements implemented but not everyone agrees on which should be done first. But most agree that they are concerned that the pace of current improvement projects is very slow. For example, the Agency for Healthcare Research and Quality estimates that the rate of completion of improvement projects is <2% per year. Changes in the way health care is provided and reimbursed are inevitable—and the health care community should be at the forefront of influencing this. After all, who really knows the realities of health care? Physicians, for their part, should know about the players and who are their allies and adversaries. They should know about the AUTHOR’S NOTE: Dr Callan is at Callan Consulting, Lake Forest, Illinois. Corresponding Author: Clair M. Callan, MD, MBA, CPE (email: callanconsulting@aol.com).