Health care futurist and consultant Jeff Bauer, PhD, coauthor of the book Paradox and Imperatives in Health Care: How Efficiency, Effectiveness, and E-Transformation Can Conquer Waste and Optimize Quality (Productivity Press, 2007), has raised eyebrows by suggesting that meaningful health care reform faces tough odds on Capitol Hill. He spoke with ImagingBiz.com about his belief that reform has to happen from the grassroots up, highlighting strategies for transforming health care from the provider’s perspective.
ImagingBiz: Recent research indicates that the United States lags behind many Western countries in terms of widespread, interconnected health IT. What should be done to overcome this lack of interoperability?
Bauer: There are lots of systems in this country that do a wonderful job of interoperability. Mayo has done it, Kaiser has done it. It’s not that interoperability can’t be done; it can be done very well. The problem isn’t interoperability and technology. I’ve got consultants that can go out and do it for you next week. The problem is that we’ve got too many people waiting around for the government to solve it, or believing in the idea that there will be this regional cooperation.
I don’t find that interoperability is a really serious problem unless you approach it on a really large scale. If you’re trying to do it at a partnership level, with a couple of major carriers, a couple of major employers, a health system or two, and the large medical groups, it’s a piece of cake. It’s doable. There’s no interoperability problem; it’s just too many people trying to do it at the inappropriate level—waiting for government to take the lead (or government telling us it’s going to take the lead) and we sort of blindly fall into place.
ImagingBiz: You’ve stated that the United States is long overdue to modernize its health care delivery system. What needs modernizing, and how might that alter payment structure and physician–hospital relationships in the United States?
Bauer: I really think that we have hit the limits of the paper trail. I cannot imagine any solution in health care delivery that is still based on paper records. In other words, quit talking about improvements in health care delivery: cost, quality, and access. For anything you want to talk about reforming, overhauling, or making better, if you don’t premise that on digital data networks, forget it.
I think we’re absolutely there. Nobody wants to invite me to Washington, because until they want to get serious about really doing something, such as providing a digital backbone for health care, it’s not going to happen. If we are going to talk about health care at the national level, everything must be digital. Physicians and health systems must also be on the same wavelength. The fact that the physicians are on a different balance sheet than the place where they do their work makes no sense. It’s 19th century, not even 20th century; the system is more than a century behind.
That’s one of the reasons that so many other countries (in fact, virtually all other countries in the developed world) are ahead of us. They get far more bang for 50% fewer dollars. Physicians aren’t able to compete with hospitals on the balance sheet. You get admitted to a hospital in virtually any other country, and the physician who treats you is an employee of that hospital.
We’ve really got to get the physicians on board, and I think that’s the answer to your question. It’s perfectly rational for physicians to have any economic interests within the medical community and the hospitals. This, by the way, was an issue. I asked people, “Do you think that you need to start taking seriously the fact that your radiology group is going to work for the hospital?” Half of the people said yes. We have always resisted, but we are beginning to realize that this is not going to work out as long as we can have our OICs force us to do different things. I don’t ever say that the physicians have to work for the hospitals, but I think the physicians and the hospitals need to be under the same balance sheet.
ImagingBiz: You are among those who spoke at the recent RBMA conference on the importance of performance-improvement programs that can help optimize human resources and save costs. What is the low-hanging fruit in radiology services?
Bauer: I can count on two hands the number of radiology groups that have addressed the discrepancies between the treatment