In the wake of the speech, the Voice caught up with local medical community leader Richard Slavin, M.D., executive vice president of the Palo Alto Medical Foundation (PAMF). Dr. Slavin is a general, thoracic and vascular surgeon, and has served as CEO of Camino Medical Group and as the chief of the Surgical Department at El Camino Hospital.
Q: Do you think we're in a health care crisis? Is reform necessary?
A: Our country cannot afford the Medicare program going into the future. We have a $35 trillion unfunded liability which we are passing on to our children. So, the cost inflation in health care must be controlled.
The number one problem is the rampant escalation in cost. That is driven by new medical technology and pharmaceuticals, both of which are wonderful. Second, it is driven by a cost-unconscious consumer. The consumer has no idea what the real cost of health care delivery is, because they've been shielded from it by the employer-based health insurance industry.
Third, we do have a segment of the society which is uninsured and essentially for those individuals, health care is being paid for by those who have insurance. So there is tremendous cost shifting from the employer-based insurance system to pay for the uninsured and the underinsured.
That's the problem. The solutions that President Obama has suggested attempt to address part of that. I personally believe that what's called comparative effectiveness research is very, very important, and this is trying to define the value in what is done, trying to find the value in the procedures that are done and the care that is delivered.
The PAMF cost of care is far less than cost of care elsewhere in the country because the physicians and staff work together in a coordinated model of care. The same comment is true for care delivered in the San Francisco Bay Area, and that's attributed to Kaiser and the coordinated care model, which our multi-specialty group exemplifies.
In health care reform, hopefully there will be recognition of the value provided by the coordinated care model and there will be appropriate reimbursement for that. As an aside, the cost of care in Mountain View is half the cost of care in Miami or New York, Boston, or parts of Texas — that's in the senior population, the Medicare population. It's because we try to do things right the first time and be efficient in the way folks are cared for.
As far as what will happen? I don't know. Right now it's what I would call brutal politics with self-interest groups lobbying. And those self-interest groups are the insurance industry, hospital industry, medical industry, pharmaceutical industry — all trying to preserve their current business.
Q: What do you mean by "reimbursement" for coordinated care?
A: The more data, the more measurement of performance and measurement of efficiency of performance — I hope the new system will reward that.
Much of California has some organized systems of care. (There are some in other parts of the country, like the Cleveland Clinic and the Mayo Clinic.) Most of the health care in the country is still delivered by individual doctors or small groups of doctors in specialty classes.
Q: What is the responsibility of the individual in keeping health care costs down?
A: The health care system has to be transparent in pricing. If you're going to have a baby, you have to know the cost of a two-night stay at El Camino Hospital. You don't know that. I don't know that! And you have to know what the cost is for the obstetrician's time and the anesthesiologist's time, who are not hospital employees. That has to be transparent.
Number two, the individual needs to take greater responsibility for their own personal health, and that means both preventative care and wellness. If they have a chronic disease, they need to learn how to best manage that independently, with the health care system acting as educators and support rather than being responsible for their care. The role of the health care system should be education, support, guidance, but the individuals have to learn about and take individual responsibility for managing their problems.
Rather than walking into the doctor and saying "fix me," it's more a matter of "teach me how I can take care of my problem."
Q: How can PAMF before more efficient?
A: We are working very hard to reduce our costs so we can become even more efficient in our operation. We have some opportunity to be more affordable to our population.
We have huge programs looking at what we call primary care delivery redesign. We have programs in what we call variation reduction and specialties. All the specialists are working by department and looking for ways to be more efficient.
The primary care physicians are looking at how care delivery can be redesigned ... how the business office can be redesigned.
We already use information technology vary extensively. We had the first electronic medical records on the West Coast as a medical group. (El Camino had the first electronic medical records as a hospital.)
Q: How much does defensive medicine contribute to high costs?
A: Doctors want to do the right thing for their patients. In California there is not the malpractice crisis that is present in many other states. I think that there is some waste in defensive medicine but it's small. But if I was in Miami or Florida or Pennsylvania I would have a completely different comment. So there is regional variation by state in malpractice risk.
Q: President Obama said in his health care speech that reform would not add "one dime" to the deficit. Is this possible?
A: No. Mr. Obama is a skilled, intelligent politician and is trying very hard to bring about change in a very expensive system. I do believe that there is waste in our national system, but I doubt very much that we would be able to provide coverage to 50 million or 48 million uninsured without increasing taxes.