By Tim van Biesen and Josh Weisbrod The long, fierce debate over the Affordable Care Act has focused largely on who pays the healthcare bill for millions of Americans. But neither the ACA nor the new Senate legislation significantly affects how healthcare is delivered or how large the bill is. As a result, we have seen few improvements in the quality or cost of healthcare, and the US continues down an unsustainable path. The Medicare trust fund, for example, is projected to be insolvent by 2028, according to the latest Medicare trustees report. To shrink the size of the healthcare bill, or even limit the growth of spending, our recent research suggests that medical institutions need much closer engagement with a neglected group: physicians. We know it sounds odd to suggest that a group of elite professionals is neglected. But in this regard, it’s true. Bain & Company recently surveyed 980 US physicians in eight specialties, 100 health system finance officers, as well as 100 health system procurement officers — the people in charge of buying supplies for hospitals. What we found was startling: Physicians understand the cost challenges of clinical care and prescription drugs, but many don’t feel sufficiently inspired by their employer and don’t have the autonomy to help rein in costs. Indeed, many feel overruled, with mandate after mandate from hospitals and from Washington being done to them, not with them. There are bright spots that hold out hope. For example, doctors and their employers do see eye-to-eye in the purchase of medical technology, ranging from artificial knees to catheters and hospital beds. This was not always the case. A decade ago, surgeons and other high-status practitioners were the only relevant decision makers, choosing products based on their own experience and clinical preferences. Then about five years ago, the pendulum swung hard toward the procurement staff, which sought to select medical devices based mainly on lower prices. Many hospitals and clinics wound up alienating surgeons, who had the means and the motivation to take their services elsewhere. Related: Reinventing The Role Of Medical Affairs Resistance from physicians and the gradual realization by procurement staff that clinical quality mattered as much as price has returned some balance to these decisions. More than 80% of surgeons and procurement officers told us they now work in collaborative partnerships to purchase medical equipment, and surgeons broadly support this arrangement. Today, many hospital systems will not buy from suppliers who lack a distinctive product that can contribute to a better medical outcome and who lack the scale to meet the complex needs of a hospital. Providers need to find a comparable arrangement for clinical care delivery. If medical institutions want to move to a system in which physicians are pushing for both quality and lower costs, they will need to listen closely to doctors about how to do that. Our survey found that more than 70% of physicians prefer the existing fee-for-service model, despite acknowledging the high cost. And more than 60% said it will be more difficult to deliver high-quality care over the next two years because of complex regulations, growing administrative paperwork, and frustrations associated with the move to electronic medical records. After years of experimentation, doctors now want evidence that new models for healthcare management, reimbursement and policy will actually improve clinical outcomes for their patients. Without it, they see little reason to alter the status quo. Clearly, bringing physicians back into the decision-making process would help spur useful change. When we used Employee Net Promoter Scores (a key metric of loyalty) to gauge doctors’ perceptions of their organizations, we found a 108-point swing (+47% vs. -61%) between those who said they were highly engaged in decision-making and those who were not. The US healthcare industry is still in search of a cure—a breakthrough model that can deliver high-quality care at lower cost. Whatever legislation finally passes in Washington will not directly affect either the cost or quality of healthcare services. Look instead to doctors on the front lines of medicine. Steeped in a field that requires lifelong learning, many physicians are natural innovators and quick to test new systems and tools. But they staunchly resist new approaches that could put patient care at risk. During this next big shift in healthcare, we cannot afford to relegate doctors’ voices to the sidelines. Read more: Front Line Of Healthcare Report 2017 Tim van Biesen and Josh Weisbrod are partners in Bain & Company’s Healthcare practice.
The long, fierce debate over the Affordable Care Act has focused largely on who pays the healthcare bill for millions of Americans. But neither the Senate nor the new ACA legislation significantly affects how healthcare is delivered or how large the bill is.