Earlier this year, Cleveland Clinic Chief of Staff Joseph Hahn announced he would retire after nearly 40 years at the health system.
Since starting his career at the influential health system, Dr. Hahn, a neurosurgeon, has been on the front lines of rapid change and upheaval in the industry, from the early adoption of medical imaging technology to the Affordable Care Act to dramatic shifts in the patient-doctor relationship.
Among other roles, in 2003 Dr. Hahn launched Cleveland Clinic Innovations, establishing a means by which physicians with the system could commercialize their medical discoveries.
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Dr. Hahn will retire at the end of 2014. He recently shared some of his parting thoughts – from advancements in technology and medicine to the cost of healthcare and access to it – with MedCity News.
Q: You joined Cleveland Clinic in 1976 — eons ago in terms of healthcare technology and medicine. How would you sum up the most significant changes you’ve seen transpire, at the Cleveland Clinic and across the industry in general? What have been some of the more positive develops?
Dr. Hahn: When I arrived at the Clinic we were testing out CT scanners. The institution I left, the University of Virginia, did not have scanners of any type and were still doing myelograms, which is the injecting of dye into the spinal canal to look for discs as well as tumors and things like that, and injecting air into the brain cavity to see if there were any distortions in the brain. Needless to say, the advent of CT and MRI scans has had an enormous impact on how we evaluate patients. I don’t have to go into much detail for anyone to understand how cell phones and email has impacted everything we do, especially in medicine. You can now transmit electrical waves from the heart to virtually any place in the world. Back in 1976, things like this were unheard of and the possibility of it very difficult to conceive.
Q: What remain, in your mind, the biggest industry challenges based on your years of experience at one of the top hospitals in the country?
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Dr. Hahn: The biggest challenge is providing affordable health care to everyone. The dilemma of having everyone have access to care has not been resolved. Many, many attempts have been made at managed care, capitation, and other types but no one has really cracked this problem. Healthcare is getting more and more expensive and yet we need to provide everyone with the ability to access the healthcare system. There are statistics that anywhere from 60 percent to 70 percent of the disease burden is related to behavioral issues. Such things as overeating, smoking, excessive drinking, use of drugs, etc. adds to the healthcare burden. Imagine what our healthcare expense would look like if we could get these things under control?
Q: You launched Cleveland Clinic Innovations in 2003. How would you say this has advanced medicine and healthcare technology at the Cleveland Clinic? What’s a good example that would point to?
Dr. Hahn: CC Innovations was developed to take the technology that was being invented at the Clinic and putting it to use with our patients. Basically, it is taking intellectual property and commercializing it. Probably one of our most significant inventions had to do with deep brain stimulation. It had already been evaluated for use in treating Parkinson’s disease. We were able to show that this could be used in other areas of the brain to control problems such as obsessive compulsive disease. It also has been used to ameliorate seizure problems. I would say that many of the innovations in the neurologic area came through CCI and added to what was available to help people with neurologic problems. It is one of my most satisfying achievements.
Q: What would you say to younger physicians entering the field now? Are you encouraged by the rapid change in healthcare, or do you think younger physicians will find it more difficult?
Dr. Hahn: I would still encourage everyone who has any interest in helping others to go into medicine. I’ve looked at this as a field that has enormous responsibilities and great satisfaction. The responsibilities come from helping others who are suffering. Whether the suffering is due to mental problems, behavioral problems, physical problems or congenital problems, the reality is there is nothing greater than to offer assistance to another individual who is suffering. The changes in healthcare are just a fact of life but the underlying value is helping another human being.
Q: Without getting too political, is it fair to say that the ACA has so far spurred positive change? Or more complicated change?
Dr. Hahn: Our attitude, and certainly mine, is that the ACA is the law of the land and we should be working with it. It certainly has made healthcare more complicated. For example, how anyone can make a five-year long term plan is just not possible any more. Things change so rapidly and so often that activities that you might plan on today are changed within six months. I think that the ACA is trying to address availability of healthcare for all; however, it did not do anything to get expenses under control and so far is just taking small steps to get that in the right direction.
Q: As a physician, what are your thoughts on the evolving notions of patient engagement and so-called “consumer-driven” healthcare? Has it improved over time? Likewise with the shift from hospital settings to primary care, prevention and outpatient care?
Dr. Hahn: When I started my career at the Clinic, doctors were the authority figure and whatever was said was taken as appropriate. It has been long overdue for patients to get more involved in their health care and to start asking more and more questions. The marketplace has driven this home in the last five years. By that, I mean, as patients have had to pay more of their care they are beginning to ask questions about what is the appropriate treatment. I think that the age of consumerism is going to get more intense, especially as patients are asked to pay more. For this reason, the market is going to drive patient engagement to become more treating patients in the appropriate way and to satisfy their needs and demands. I think this in entirely appropriate and I am actually glad to see it happen. I think we have made great efforts to change this perception at Cleveland Clinic and I think it has worked.
Q: What would you say has been the single biggest technological advancement in healthcare in your career, and how did you/Cleveland Clinic work to incorporate it into practice?
Dr. Hahn: I would say the biggest change was the development of scanning and especially MRI scans. It allows for visualization of intricate parts of the body-everything from knees, ankles, elbows, lungs, brain, spinal cord, etc. This has enhanced our ability to make rapid diagnoses. Prior to scanning, the only way to diagnose things such as torn anterior cruciate ligaments in the knee was by invasive procedures called arthroscopy. This has been beneficial as a screening tool and has allowed us make early diagnoses for those patients that need our care.
