NEJM: Physicians need to lead healthcare reform

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Physicians can and should play a leading role in achieving healthcare reform, according to a perspective published online May 21 in the New England Journal of Medicine. The authors believe that this entails working toward comprehensive reform of the way healthcare is paid for and delivered, helping achieve a guaranteed 1.5 percent annual cost savings.

In "Achieving Health Care Reform-How Physicians Can Help," co-authors Elliott Fisher, MD, from the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., Donald M. Berwick, MD, president and CEO of the Institute for Healthcare Improvement in Cambridge, Mass., and Karen Davis, president of the Commonwealth Fund in New York City, wrote that achieving savings that are sufficient to cover everyone is possible, and "need not impose a hardship on patients or providers."

They wrote that slowing the growth of healthcare costs by 1.5 percentage points annually would allow spending--including total provider income--to rise from $2.6 trillion in 2010 to $4.3 trillion in 2020, while saving the healthcare system $3.1 trillion of the estimated $40 trillion the United States is projected to spend in that 11-year period.

The authors said that to achieve real reform, voluntary efforts to achieve savings may not be enough, and legislation may be needed that will allow the federal government to reduce updates in Medicare fees if the 1.5 percent annual savings target is exceeded. Further, the savings should be linked both to health insurance coverage for all and comprehensive reform of the healthcare delivery and payment systems.

The authors cite reforms physicians could champion to eliminate waste and avoidable complications, through integrated systems of care, "innovative payment models" including shared savings, bundled payments, or global fees for primary, acute, or comprehensive care and performance measures that promote care coordination.

"U.S. physicians are leaders in providing excellent medical care, and can also be leaders in the effort to achieve a U.S. health system that is also excellent," Davis said. "A high performing U.S. health system is what all physicians and patients need and deserve for the future health and economic security of our nation.

The authors concluded that "physicians can become our most credible and effective leaders of progress toward a new world of coordinated, sensible, outcome-oriented care in which they and their communities will be far better off. Defending the status quo is a bankrupt plan for the United States, and physicians have an opportunity to help us all see beyond it."

"This is a clarion call to U.S. physicians to seize this once-in-a lifetime opportunity to achieve healthcare reform that deserves the name reform," Fisher said. "Physician leadership can be the key to ensuring success. Let's not miss this chance."