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March 19, 2012

Getting Integrated Care Right for the Kidney Community


2 Comments to “Getting Integrated Care Right for the Kidney Community”

  1. Steven Schwartz said,

    March 30, 2012 @ 4:01 pm

    Dr.P.,

    Although Obamacare, itself, may be suffering terminal Supremecourtitis, if seems abundantly clear that how medical care is delivered in America will radically change in the next few years. It has to because it is too expensive and too Byzantine. So we see the various interest groups angling to be “first pig to the trough”. Hospitals want to dominate the scene, nitch players (such as ESRD) are attempting to secure a footprint, and the Insurance companies (never forget the insurance industry) is trying to partner with/purchase players across the spectrum.

    Actually, it would be nice to see physicians back at the apex of the pyramid. But that probably will never happen. If you assemble 10 physicians, you can be pretty sure they will have at least 13 opinions.
    Greed, and arrogance, and self-serving appear to be eternal impediments
    to a cohesive voice.

    The truth of the matter is that whether we wind up with ACO’s or ICO’s the physicians are going to be at the back of the line. The old Golden Rule being firmly in play. For physicians to choose among the competing behemoths is ludicrous. Ultimately, from a physican’s standpoint, it will be sort of like having to choose between a bucket of puke and a bucket of crap. A nephrologist with a medical directorship and a noncompete will have virtually no leverage. We will soon learn the fallacy of the
    “indispensable man”. We can all be replaced…and will be unless we toe
    the company line. This is probably the future reality. But it seems disingenuous to blog nephrologists to support ICO’s (translated as the major dialysis companies) when there will be minimal, if any, benefits bestowed on those docs. We all hear about patient care when, in the end, finances trump patient care in virtually every instance. Just think of the hoops we have to jump through to get a 250 dialyzer for a 300 pound patient!

    I am approaching the end of a long medical career and most of the change will not occur for another five years or so…about the time for me to hang up my spikes, so to speak. But is still nice to reminisce about times when physicians actually commanded respect and had some authority. Obviously, some controls are imperative, but if you believe that what is coming down the road is an improvement, just look at the VA as the ultimate in government managed care.

  2. Robert Provenzano said,

    April 2, 2012 @ 8:45 am

    When we wake up tomorrow we will still be physicians, care givers, held in a special place in all societies. We certainly are not dispensable as you suggest, unless we make ourselves so. One can look back and lay blame on payers, government, physicians or even patients. I do not view that as productive since Monday morning quarterbacking never serves us well when moving forward.

    As you stated; “it would be nice to see physicians back at the pyramid”, but “greed, and arrogance, and self-serving appear to be eternal impediments…” No doubt we have played a major part in arriving were we are, but that said, leaders learn from the past and move forward, and move forward we must.

    I would posit that changing the framework of payment, placing patients (and outcomes) at the center of the care paradigm, allow physicians to focus on coordinating more efficient, timely care; serving their communities, being a resource.

    Processes need to be developed; value needs to be determined, all with the patients in mind. If we are not willing to step up and lead, you can be sure someone else, an administrator, bureaucrat, or politician, because someone must.

    If hospitals, or LDO’s, or whatever care entity, is unable to achieve agreed upon quality care-there will be no “trough to feed from”, they will be weeded out. Something we have really never been able to do within our owe ranks! They cannot achieve excellence without physicians.

    We must step up, understand the broader issues here, not just what serves us-and take American Healthcare into the 21st Century.


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