Emanuel urges doctors to overhaul the way they practice medicine

By Bernie Monegain
07:43 AM

Ezekiel Emanuel, a White House adviser on healthcare policy, says high-touch is the way to fix the nation’s failing – and costly – healthcare system. In his keynote talk at the Medical Group Management Association in Denver on Sunday Emanuel called for patient-centered, data-driven physician practices.

“Doctors’ offices need to be restructured,” he said.

Emanuel, a bioethicist and oncologist at the National Institutes of Health and Harvard Medical School, is a brother of Rahm Emanuel, the White House chief of staff to president Barack Obama.

He titled his speech “High-Touch Medicine, the Future of Physician-Patient Relationship.”

“It’s a speech crafted especially for you,” he told his audience – a mix of physicians and medical group administrators.

And, while he advocated for switching the focus from high-tech to high-touch medicine, he supported the use of information technology to make the vision of a data and analytics-drive practice a reality.

High-touch, he said, means more patient contacts, more proactive monitoring of patients, more data-driven care, more access to physician offices and more coordinated care. He believed, he said, this approach could be the Holy Grail that enabled the nation to provide better care and also reduce costs that have become so large that no one can comprehend them.

In 2007, the United States spent more than $2.2 trillion on healthcare, he noted. It’s a number that rises year after year.

“It is an astounding number, very hard to get our arms around,” he said. “All that spending has not bought us the best system,” he said. “For life expectancy we rank 50th. That money is not buying us value.”

Almost half of healthcare spending is used to treat 5 percent of the population, according to a March 2009 study by the Kaiser Family Foundation.

The new system Ezekiel envisions is akin to the Patient-Centered Medical Home promoted by the American Academy of Family Physicians and the MGMA and more than 500 other groups, including, employers, labor unions, consumer groups, health plans, hospitals and clinicians.

Ezekiel also advocated “bundled payments,” a way to pay physicians for treating the patient from the beginning to the end of an ailment. He acknowledged the approach was not proven yet, but the method would help take the focus of practicing medicine away from volume, to outcomes.

Physicians must change the way they practice medicine so that they know their patients better, he said. Today, doctors spend about 55 percent of their time face to face with patients. And, because of the fee-for-service approach for reimbursing doctors, volume reigns. The average doctor-patient visit is 14.9 minutes.

“The flip side is patients are also worried about their own quality of care,” he said. “Physicians need to slow down.”

He recommended that they begin to see patients through the lens of high-touch rather than high-tech, that they move away from volume-driven care to coordinated care, that they better focus on chronic care – for diabetes, asthma, COPD, hypertension and congestive heart failure – that they provide more proactive contacts with their patients and follow-up contacts.

Patients are often re-admitted to hospitals before their next doctor’s appointment.

“We didn’t send them home with an appointment,” he said. “We send them out and tell them to go get an appointment.”

He suggested that better access to physicians could curb the misuse of emergency rooms. He noted that people who show up in ERs are not necessarily without insurance. Both the insured and uninsured use the ER as primary care.

Extended office hours, use of e-mail and online visits, same day appointments and house calls would go far to help change the paradigm, he said. For the patients, increased education, patient-shared decision-making and sustained lifestyle changes would do wonders.

“We need to have patients engaged in changing their lives.”

All of these needed changes highlight the need to restructure doctors’ offices, he said. The idea is to create a team that includes nurse practitioners and care coordinators. They could relieve physicians of some of the tasks they do not necessarily have to do themselves. Everyone would be supported by data and analysis.

“There may be more time to do the right kind of care,” he said, “for doctors to do more high-value work.”