Complacency and Complicity in Health Care?

Thursday, May 19, 2016 | Larry Sobal

 

Last week, I was in Washington, D.C., visiting with legislators as part of a Cardiology Advocacy Alliance (CAA) Board fly-in. I've always enjoyed events that allow us to meet with our elected officials—and usually their health staff—to discuss current issues and convey our thoughts. 

The fact that half our group consisted of practicing cardiologists from around the U.S. made the dialogue much more powerful, as they were able to translate the impact of legislative changes (past and future) to the real-life delivery of patient care.

I can say that some, but not all, legislators understand and share a vision of thoughtful and necessary transformation of U.S. health care; enough to give me reason to hope, but not enough to declare its imminent arrival. How does this lead to the topic of complacency and complicity? Let me explain.

On one hand, complacency is a complex phenomenon and its roots run deep in health care.   Maybe it's because maintaining homeostasis is a basic human need. We seem inclined to cling to predictability and our first reaction to change is usually fear.

It’s still more common than not to encounter health systems with a top strategic priority of growth, versus preparation to compete on value. Maybe they are paralyzed by the change fatigue of previous initiatives, or they are not yet convinced that a disruption of their world is near enough to begin preparing for.

I frequently encounter organizations, especially their leaders and physicians, who simply do not believe they have to change, even though their health care market is being transformed by mergers, declining reimbursement, non-traditional competition, or other forces likely to have real impact on them. 

It’s still more common than not to encounter health systems with a top strategic priority of growth, versus preparation to compete on value. Maybe they are paralyzed by the change fatigue of previous initiatives, or they are not yet convinced that a disruption of their world is near enough to begin preparing for. Although trying to grow may seem the opposite of complacency, in some cases, it’s complacent ignorance.

Another form of complacency—potentially scarier—is when an organization has a core group with a vision for change, but for a variety of reasons, the vision is not shared and embraced. In some cases, it seems as if there is greater energy spent on resisting the change than would be spent on understanding and adapting to it. Whatever the reasons, many supporters rally behind defending and protecting the status-quo at all costs.

You can probably relate to these examples of complacency, but what about complicity in health care?  If you follow my line of thought—complicity as an accomplice to a wrongful act—I can think of many acts related to health care that just seem wrong, or at least plain ridiculous. 

Let’s start with a very timely act, namely the Medicare Access and Chip Reauthorization Act (MACRA). What started out to be a fix for the much maligned Sustainable Growth Rate (SGR) and an attempt to consolidate various federal incentive programs (such as Meaningful Use), MACRA has turned into a complicit piece of legislation. It will be the focus of MedAxiom’s upcoming webinar and a big topic at the 2016 Cardiovascular Service Line Symposium. Unless immediate and significant changes are made to the Meaningful Use program and the interoperability of Electronic Health Records (EHRs) is addressed, value and better patient care facilitated by health information technology will remain unattainable ideals and physicians will bear the financial penalty.

I can think of many other examples of complicity, such as when individuals or organizations fail to address disruptive behavior in a medical setting, or when clinicians fail to speak up when they feel a colleague has not followed accepted standards of care in their treatment plan. Like complacency, I suspect you can think of your own examples.

So, let me ask you a question. I bet most of you will agree that one of the biggest problems in Washington is when elected officials closely stick to the agenda of their respective political parties, resulting in the gridlock that permeates D.C. When elected officials follow their party line, instead of their own minds or the desire of their represented citizens, is that complacency or complicity? Tell me what you think.

Tomorrow, CMS is expected to release its plans to launch a comprehensive bundle of Coronary Artery Disease (CAD). If it contains what we heard in Washington, it will be a radical move, to say the least. I hope to offer some early insight in next week’s blog.

---

 

Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

---