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Experts at Albany forum: ‘Cowboy’ medicine costly, dated

Health care forum cites cooperation as essential

Thursday, January 17, 2013
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— One of the world’s acclaimed thinkers in health care called the Capital Region one of few places in the nation able to achieve a high quality of care at a low cost.

Atul Gawande, a surgeon, journalist and expert on reducing error, told a crowd of about 1,300 people at the Egg Wednesday night that industry leaders are watching what Albany is doing. His remarks were part of a forum, titled “Health Care in the 21st Century: A Community Call to Action,” that kicks off a series of conversations that area health care leaders hope to have in the new year about the rapidly changing health care industry.

“The fact that there are places that are achieving great quality of care at lower costs means that there is hope,” said Gawande. “And I’m delighted to be here, because Albany is one of those places. You are a positive deviant. And that means that you’re a place we can learn from.”

Gawande is a surgeon at Brigham and Women’s Hospital in Boston, an associate professor at the Harvard School of Public Health, an associate professor of surgery at Harvard Medical School, a journalist for the New Yorker and Slate, and an award-winning author of “Complications,” “Better” and “The Checklist Manifesto.” He has been named by both TIME and Foreign Policy magazine as a top thinker across the globe.

His visit to Albany was highly anticipated, and a chance for Capital Region leaders to take a step back and see if what they’re doing fits into the larger picture of quality, low-cost health care reform.

As area hospitals are bracing for cuts to Medicare and navigating new paths to coordinated care, several of the forum’s panelists spoke out Wednesday about the need to forge better relations and stop viewing each other as competitors.

“We’ve been used to being competitors forever,” said James Barba, president and CEO of Albany Medical Center. “Those barricades have got to be broken down and overcome. But I think you’re looking at three hospital providers who are sitting here and willing to get beyond that to share ideas.”

The presidents and CEOs at Ellis Medicine and St. Peter’s Health Partners — James Connolly and James Reed, respectively — agreed, stating their desires to work more as a community-wide health system than as separate hospitals with separate goals.

The panelists also used the forum as an opportunity to highlight the programs, initiatives and strategies that have distinguished the region as a leader in health care reform.

Albany Medical Center, for example, undertook a pilot project just eight days ago that will give patients with high levels of co-morbidity a clinical care coordinator to keep track of and coordinate every aspect of their care — from the physician treating their congestive heart failure to the nurse monitoring their diabetes.

“The metaphor here is a symphony orchestra,” said Barba. “If your strings, your horns, your brass all attempted to play together without coordination it would be cacophony. But if they play together under a director, then you get Beethoven and Brahms. Then you get the symphony. We are expecting to see that complex patient’s plan of care can become a symphony. And we expect it to lower the cost of care.”

The concept drove home a point that Gawande mentioned earlier in the forum about modern health care players working as a pit crew rather than as individual cowboys. When penicillin became widely used after World War II and was found to treat a number of previously serious diseases, the world expected the future of medicine to be just as easy, he said.

“It was so simple and effective, just an injection. And it made us think: this is the future. It will just be an injection to treat heart disease and just an injection to cure cancer. But instead, it’s been nothing like that. It’s been quite the opposite. It’s been something more like surgery, with groups of people, technologies, risks, all needing to be brought together and successfully deployed to achieve great results.”

Gawande recalled accompanying his mother for a three-day stay at the hospital in which she underwent a knee replacement. He got bored quickly, he said, so he started counting all the different people who interacted with his mother to give her care.

“I counted the person who changed her medication or measured her blood pressure, helped get her to the bathroom or do her physical therapy, and so on,” he said. “Over the course of a three-day stay, there were 63 people involved in her care from start to finish. Our ethics, our structures, our whole payment system was based on the idea of the autonomous physician who could know everything, master everything and do everything.

But we live in a world where 63 people deliver care to one person, said Gawande. Where the person you see for physical therapy in the morning doesn’t talk to the person you see for physical therapy in the afternoon.

“That world is a disaster,” he said. “And that is the world that we have. We have trained, hired, and rewarded our clinicians to be cowboys. But it’s a pit crew that we need. We need a team that comes together as a system where the diverse components fit and work together in concert.”

 
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