Doing more with less is one of the more derided phrases in a world where cost-cutting and downsizing have been the go-to strategy for many segments of corporate America.
But that approach may be a hero for healthcare’s future, which will thrive only if health systems and the larger medical industry can solve patient engagement and innovative around healthcare delivery.
For about four years now, Dr. Victor Montori’s go-to phrase is “minimally disruptive medicine,” which posits that healthcare should get more hands off with its most troublesome patients: those with multiple problems like diabetes, depression or heart disease. Instead of check ups that require coming into the hospital, imagine appointments over the phone or in the home. Plus, think about how to treat patients in a way that empowers them to take better care of themselves (treat the depression so they’ll be better able to do what’s needed to help heart disease or diabetes).
Montori is the director of the Health Care Delivery Research Program at the Mayo Clinic and one of the keynote speakers at MedCity ENGAGE, MedCityNews.com’s summit on patient engagement and healthcare delivery on June 5-6 in Washington, D.C. Here’s a capsule of Montori’s vision, which you’ll hear about at ENGAGE.
Can it change healthcare for the better?
The premise. Treat patients in a way that also lets them get the treatment they need, treat themselves and let them continue to live their lives. The way healthcare is currently treating patients with chronic diseases can have as much to do with issues like making sure patients take their medications and the poor results of treatment of diseases like diabetes. Minimally disruptive medicine tailors treatment in a way that cuts down on multiple doctor visits, numerous medicines and complicated instructions that can make it harder for patients to treat themselves.
In short: stop focusing on phrases like on “controlling their blood sugar” and instead thinking about letting patients do what they want to do. “If I am a breadwinner of the family, I still need to be able to do that,”Montori says.
Montori and his colleagues think four steps are critical to make their idea work:
- “Establish the weight of burden.” Find a way to measure how much of a burden medical treatment puts on a patient’s daily life.
- “Encourage coordination in clinical practice.” Create incentives that encourage holistic approaches and coordinating care.
- “Acknowledge comorbidity in clinical evidence.” Develop approaches that will deal with the issues when a patient has more than one chronic disease (diabetes, heart failure, chronic obstructive pulmonary disease, etc.)
- “Prioritize from the patient perspective.” Get patients involve, including lettering them help decide which illness to treat and how deeply to treat it.
Suddenly, through this approach, patients will have more customized care that could include fewer medicines, be more straight-forward and offer easier-to-accomplish instructions at a lower cost. As Baby Boomers age the overall cost to healthcare becomes more manageable because patients are more likely to succeed with their treatment.
For many patients, it becomes less complicated to stay alive.
Dr. Victor Montori is one of the a diverse chorus of empowering and insightful speakers taking part in MedCity ENGAGE, MedCityNews.com’s summit on innovations in patient engagement and healthcare delivery on June 5-6 in Washington, D.C. Review the agenda, look at all the speakers and then join us in Washington D.C. in June.
Excellent ideas. The main problem
Of health care in the Netherlands and perhaps also in America is that it has financial incentives, not human/holistic incentives, it is doctors/medical industry driven, not human/patient driven.
Mr. (?Dr.) Murali,
I appreciate your concerns with getting reimbursed for adjunctive care practices.. ie returning phone calls, reviewing labs, completing forms, getting prior authorizations.. And probably many more that I am unable to come up with at this time. I truly believe that the inability to bill for these types of services, which are necessary for good patient care, at least partially drive up the care of medicine. Under this model, Providers are encouraged to bring patients in for visits sometimes simply to justify the time spent on their care, which is inefficient and costly.
I also agree with your comments regarding "quick fixes" such as substituting "mid level practitioners" for those with a medical doctorate. However, you infer that utilizing nurse practitioners and physician assistants are detrimental to patient care, and that simply isn't true. There have been many studies stating the opposite. And what's more, patients who have had experience with NPs and PAs often state they are happy with the level of care.
I hope that you can agree that not every health care provider is well suited for every aspect of health care needed. I would hope that you wouldn't be the provider giving physical therapy unless you had special training in physiotherapy. As health care providers we must recognize our limitations of our expertise and enlist the help of others when we fall short, or our time is better spent in other ways. This is where NPs and PAs can help augment health care practices.
I am a nurse practitioner. And I rely on the opinions of my physician colleagues. But I do not want to replace them. Nor would I want them to spend time doing what I have special training in. As health care becomes more specialized, it is impossible to function independently and maintain high quality health care. Medicine is evolving, and so must our model of health care.
Thanks Dr. Murali for the links. If anyone has questions, i'll be happy to answer them b/c i realize this is different than what most are used to. Thanks.
here is a working link. looks like youtube may not work when linked...
Great idea. That is the way to practice Internal Medicine / Family medicine or Pediatrics. It should make docs think many times over before signing on to PQRS type of programs that understand numbers but not the nuances of care. Those of us in busy private practices already take care of patients to help them on their terms. . To practice proper medicine proper training and experience is necessary. Mid-level driven volume care is detrimental to the health of a society. The Obamacare type of algorithmic medicine drive by EMR prompts will just not cut it. Even if you are a salaried doctor in a hospital running a clinic, it is hard to practice properly without getting paid for all that phone time etc. Some doctors are doing exceedingly well in a retainer-fee model where they are not overloaded with patients or wasting time filling EMRs.. Look at these docs who have outstanding patient satisfaction and practice happily: