12 Mar Ferrari Medicine: We don't need more horsepower
Horsepower (hôrs’pou‘ər) n.
- A unit of power in the U.S. Customary System, equal to 745.7 watts or 33,000 foot-pounds per minute.
- The power exerted by a horse in pulling
I had the opportunit to present to the Managed Care Executive Group yesterday in Chandler, AZ. In a beautiful desert setting, this group of executive IT folks from regional health plans gather to share ideas that will propel them forward in the year ahead. I was the final keynote of three densely packed sessions. The other key noters did a wonderful job describing in thorough detail with graphs, charts, and well documented trends the challenges in our health care system. Given their depth of coverage, all that was left for me was to highlight as succinctly as I could was my perception of the problem with our current health care system:
Ferrari Medicine - Overcapacity leads to Worse Outcomes
I call it Ferrari Medicine. The United States is culturally geared to bigger, faster, stronger mentality that is under-girded by a pervasive me-me-me affluenza that demands the very best (as long as someone else is paying for it!) at all times regardless of the cost. The above Ferrari is an amazing machine – one of the most advanced in the world. It has incredible horsepower, finely tuned instrumentation, plush interior with the finest woods and leathers, and exquisite styling and exterior. Unfortunately, given its expense and care requirements, it is not very useful for the 98% of times that you just need to transport yourself from point A to point B. It would be unthinkable, in fact utterly absurd, to use such a masterpiece as this as a pizza deliver vehicle.
However, for alot of what we do in health care, we just push on the gas pedal. We build in more horsepower, more features, more functionality, more procedures, more capacity, and more of everything. However, despite all the appeal of the latest and greatest, the evidence shows that all the capacity within are system actually make the care and outcomes worse! More is definitely not better, and in fact, it is often worse. This has given rise to the concept called Slow Medicine, being advanced by the wonderful folks at Dartmouth. We can often do better with less, being more thoughtful, including the patient in the decision making, and doing the simple things that allow each patient to move from point A to point B in the way and manner in which is appropriate and desired by them.
We should begin to educate patients about the perils of too much horsepower, and instead reserve Ferrari Medicine for the health care equivalent of the Autobahn.
Tom Stitt
Posted at 00:59h, 13 MarchHow do you convince 4 large big brand hospitals competing for patient and physician attention, trust and admissions in a common urban service area that each does not need identical state-of-the art medical equipment (or a Ferrari, to use your symbol) with $1M plus price tags for elective procedures? How do you convince physicians that they should not open hospital-adjacent, state-of-the art private surgical clinics that effectively and efficiently compete with hospitals for high margin elective outpatient procedures like colonoscopies? Slow Medicine is a great concept but doesn’t address the underlying drivers of increased healthcare costs and inefficient utilization of high price tag medical equipment. No argument that advanced medical equipment – like robotic surgery systems – save lives and deliver better patient outcomes. But does every hospital need a robotic surgical system? Might it be cheaper to buy plane tickets for patients who can benefit from robotic surgery?
Scott Shreeve, MD
Posted at 13:16h, 13 MarchTom,
Thanks for your very helpful comments. You must work or consult for a hospital feeling threatened by some of these perverse incentives?
The “Medical Arms Race” that you describe is an artifact of unenlightened hospitals fawning to the patients perception of quality – the latest, greatest, and most expensive. Instead of touting the latest technology, they should be touting their surgical infection rates, quality outcomes for various procedures, and the systematic improvements they increase value that have built into the patient experience. It is analogous to the situation with car rentals – you have been to places where all the car rental shops have different locations, different lots, different sizes, etc? Well what happens (liken in PHX) when they build one common place where everybodies “storefront” is the same size and all those variations are removed? Quality goes way up, costs go way down, and everyone has to compete not just on price but on value. That is my message – have hospitals compete on value (outcome/price). This requires some re-education of the consumer (tall order I know!).
In terms of the speciality surgical centers eating away at hospitals business – I am ALL for it. If they can do the procedures cost effectively with higher outcomes then they should do it. Big hospitals with conflated business plans are in real trouble . . . but that is a topic for another post.
Keep commenting!
Bryan K. O'Rourke
Posted at 12:44h, 13 MarchYes Scott your analysis is spot on. Ironically, what you describe is consistent with what exists in many “legacy” industries and organizations. The circumstances surrounding the “health care” business just make the situation more apparent; hence your Ferrari delivering a Pizza. This excellent analogy however is no different than many common practices that go unnoticed; from employers still requiring office workers to commute to work each day to elementary school children still being taught with chalk boards and text books. Much of what happens is unexamined and opportunities for improvement abound.
The reality is that until the status quo breaks down, people rarely change. Unfortunately, without the pain there will be no gain.
In the end, the most effective markets entail increasingly educated consumers motivated by their own self interests to freely choose from a number of alternate competitive suppliers in a transparent marketplace. As you are aware, most protectors of the status quo stand at the gate armed to keep the fore mentioned at bay because failing that they might have to consider that a Honda does a much better job for the money than their Ferrari.
Tom Stitt
Posted at 19:14h, 13 MarchScott – I’m a consultant who has often heard hospital executives privately complain about the need to stay current in the Medical Arms Race in order to be competitive and attract top talent. Paul Levy is the only hospital CEO I can recall who has made the resulting utilization and cost factors a public matter and then reluctantly agreed to a surgical robot purchase for competitive and talent reasons.
Your mention of the shared common storefront approach in PHX explains why there are always long lines of happy patients in wheelchairs waiting to depart on Southwest flights at Sky Harbor Airport. Domestic medical tourism is the new reality because it delivers lower costs, better outcomes and happier patients. Hospital geographical proximity and 100% physician directed admission are being replaced by patients & physicians sharing in the admit decision based on where the optimal outcome can be obtained at the most reasonable cost. In many cases, I also see the availability of superior patient/family amenities at a remote location being a deciding factor in the admit decision.
Instead of private surgical clinics competing with hospitals for lucrative outpatient procedures and margins, why don’t hospital CEOs reach out to the relevant physicians in open practice scenarios and build the state-of-the art outpatient surgical centers that have comparable economics for the physicians and endorse practices that deliver better outcomes for the patients? Otherwise, we’re just encouraging another Medical Arms Race, albeit with less expensive equipment in many cases. (Disclosure: Sure, I chose a private surgical clinic for a typical over-50 male elective procedure for all the reasons you mentioned. The heated blankets were a nice touch I’ll always remember.)