Home » Dr. Jayne » Currently Reading:

EPtalk by Dr. Jayne 12/28/17

December 28, 2017 Dr. Jayne 2 Comments

I’ve been following the reader comments regarding the recently-opened $1.2 billion Stanford Children’s Hospital. There is plenty of cynicism about whether the expenditure will lead to better outcomes or a healthier community. I see this in my own community with several multi-state health systems competing to have the most beautiful and indulgent facilities, with far less advertising of their actual patient care.

My own hospital experience earlier this year was in a lovely private room with a flat screen TV four times larger than what I have at home, along with on-demand dining in a brand-new hospital wing. It was also accompanied by lackluster nursing care, delayed antibiotics, and failure to use bar-code medication administration systems as required to ensure patient safety. There was also a missing pathology specimen and a weeks-long delay in seeing my discharge summary in their patient portal. At least the hospital in question was spared a penalty under the Hospital-Acquired Condition Reduction Program

Although I received belt-and-suspenders prevention against deep vein thrombosis with both heparin injections and pneumatic compression devices, I’m not sure whether it was as effective as my early-morning ambulation, as I got dressed and packed up as quickly as possible to avoid staying any longer than absolutely necessary.

I caught up with some grad school friends who were in town for the holidays. A summary of our get together reads like the opening line of a bad joke — a doctor, a drug rep, and a hospital administrator go into a bar… All of us have worn many different hats over the last two decades, so it was interesting to hear each other’s perspectives on the evolution of Meaningful Use, the current state of this mess we call a healthcare system, and whether physicians are hanging in there or readying themselves to retire or pursue second careers.

I go back and forth in the latter category. Although my work is rewarding when I can help organizations make meaningful change, it can be depressing as frontline primary care groups struggle with trying to deliver more to sicker patients with fewer resources. Although value-based care is supposed to “fix” this, the learning curve can be steep and it’s hard for many organizations to figure out how to spend money they don’t have to make money they may or may not actually receive.

Many of the physicians I work with experience less satisfaction in their work lives than even a few years ago. Some of my former family medicine colleagues have moved into niche practices such as cosmetic treatments and vasectomy reversals. I know already that a couple of my favorite clients are planning to pursue early retirement in 2018. I’m sorry to see them go since they’re not even in their sixties, but given the diminishing returns on their professional labors, they feel backed into a corner.

As solid members of Generation X, we did have some common thoughts on what we think we’ll see in healthcare’s next decade. First, practices, hospitals, and health systems will continue to compete with each other to some degree even when it would make sense to collaborate. We see health systems that refuse to participate in collaborative ventures that would help not only patients but their own bottom line, out of fear of losing control. At least in our respective parts of the country, we don’t see this changing.

Second, there will be continued focus on profitable service lines despite the push to steer patients to enhanced primary care models. Community-based exercise and weight loss programs aren’t profitable, but knee replacements certainly are. It’s challenging for primary care physicians in the trenches to motivate patients for the months and years needed to solidify lifestyle changes (assuming the same provider even continues to be in your network) and the US population will continue to ask for high tech interventions where there is a possibility for a quick win.

There isn’t any excitement around funding the major cultural changes needed to truly transform how we live, what we eat, and how we manage our health, although we will continue to see glimmers of hope with greater patient engagement and patient empowerment.

Third, the cost of healthcare will continue to be a hot button issue. When left with the individual decision of investing in their health through preventive care or to purchase insurance against major health expenses, many people will lack the money to fund those choices. Others will choose to spend their money on other priorities. Since healthcare isn’t going to get any less expensive, this will continue to cause medical bankruptcies and significant hardship. The cycle of unfunded care and cost shifting to insured patients will continue.

As we chatted, we wanted to be hopeful about things such as machine learning, diagnosis algorithms, and predictive analytics, but it’s difficult to support the bluster from the reality in many cases. The next year or so will be very telling for these technologies and I think we’ll get some real data for how they’re going to play on a broader scale.

The reality, though, is that non-sexy interventions such as public health projects and simply getting people to move more and eat less are going to be increasingly important as we continue to try to reduce the burden of chronic disease. I think often of one of my favorite shows “Call the Midwife” and the untapped potential of community health interventions. At least one health system in my city is working towards greater community outreach, establishing new school-based clinics that not only provide healthcare, but serve as food pantries and distribution sites for clothing and other necessities.

Hopefully the New Year will bring continued focus on corporate stewardship as we continue to figure out how to make something sustainable out of dysfunctional systems that seem constantly on the brink of collapse. Healthcare impacts such a great deal of our economy and daily lives, so I was excited to read about a large health system that was willing to look at issues outside their “normal” areas of activity and consider other impacts such as water use, greenhouse gas emissions, and plastic waste. Healthcare organizations employ an increasing percentage of the US workforce and may be uniquely poised to transform workplace culture over the next decade as we evaluate how we care for aging Baby Boomers and whether we will put systems in place to reverse some of the negative health trends we’re seeing.

What challenges do you think we’ll see in the New Year? Is your organization looking to lead change? Leave a comment or email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only

HIStalk Featured Sponsors


Currently there are "2 comments" on this Article:

  1. I continue to see communities and health systems in large cities investing in “innovation” with all of the buzz words from #AI and #BigData at the same time they are cutting public health.

    At the state level here in Washington, we have a 5 year $1.5 billion CMS innovation project and they are attempting to change the payment model for Medicaid to be value based with a shift to primary care at the regional level via accountable communities of health https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation
    There are some hopeful first steps at integrating mental health and primary care but the bottom line will drive healthcare for the foreseeable future.
    On a personal level, my very healthy sibling is about to drop her individual policy (no subsidy) as it went from $530 to $808 starting January 1st.

  2. Thanks for including healthcare cost in your discussion. The politicians seem to be more concerned about the cost of insurance and fail to discuss or attack the root cause of insurance increases, the rising cost of healthcare.

Subscribe to Updates



Text Ads

Report News and Rumors

No title

Anonymous online form
Rumor line: 801.HIT.NEWS



Founding Sponsors


Platinum Sponsors































































Gold Sponsors















Reader Comments

  • Rebecca: Thank you, Ed. I always looked forward to your posts - they were a validation to me that you don't have to have to be a...
  • Lee David Milligan: Rob: thanks for the comment. Agree with your point re: unique expectations and complexity....
  • Shelly: Thank you Ed for taking the time to invest in the industry as you have done - with this blog as a sounding board for CIO...
  • Appreciatve: Thanks,, Ed. This was a very nice piece, and telling of what you cherish most. There is one topic that I am not cert...
  • Rob Price: Excellent information and quite consistent with my experiences since 1999 working with three different software companie...
  • Cosmos: Thank you for the interesting article. FYI - the terms "Severe Sepsis" and "Septicemia" are no longer in common use, ...
  • Joel: Thanks for sharing for all of these years. I have appreciated the insight and will miss it!...
  • Ann Farrell: Janet - insightful as always. I remain a fan. Concerned staffing levels "at max" knowing early pt. surveillance syst...
  • James: Another beautiful piece!!!! Lesson to many and impressed about your journey. Thank you for all you share....
  • Bob: Actually Equinox/Solstice (angle of the equator w.r.t. the solar plane) are independent of the Aphelion/Perihelion (dist...

Sponsor Quick Links