Guest column: The future of healthcare

Photo with no caption

Editor’s note: From the text of remarks to an annual meeting of the Naples Friendship Health Clinic, on Pine Ridge Road, at Telford Auditorum on the NCH Downtown Naples Hospital campus on April 4.

Plain and simple, America has a health-care problem.

The United States spends about twice as much per person per year on health care than other developed countries, but we are not receiving “value,” as measured by many objective outcomes.

Every day for the next 20 years, 10,000 Americans will turn 65. People over 65 use four times the health care and take four times the medication as those under 65.

Eighteen percent of Medicare patients have surgery in their last month of life. In other developed countries, this is not the case.

Variations in the cost of care across our nation are monumental. The University of California, San Francisco studied 20,000 routine appendectomies in 289 hospitals. Charges ranged from $1,529 to nearly $183,000 — a 120-fold difference. Time magazine devoted an entire recent issue to the outrageous range of health-care charges across the nation.

Meanwhile, the quality of health care varies around our nation and even within our state. The Commonwealth Fund rates most of Florida in the third quartile of overall health-system performance — a clear call for improvement.

Fortunately for all of us, Collier County remains in the top four of 67 counties in Florida for overall health for the past four years, according to the Robert Wood Johnson Foundation annual rankings.

Exacerbating these challenges is a federal government that is stressed with a $17 trillion dollar debt, which saddles a $53,000 debt on each of us. At the root of our nation’s budget problem is the cost of health care — 17.9 percent of the gross domestic product and growing exponentially. Some experts estimate that more than 30 percent of medical spending is waste in the form of ineffectiveness, redundancy, misuse, overuse, fraud, abuse and/or defensive medicine.

As I said, clearly we have a health-care problem.

So the question is: What can — what must — we do about it?

As the former administrator of the Centers for Medicare and Medicaid Services, Dr. Don Berwick, once said, “It is possible to improve care and dramatically lower costs.”

How?

One answer lies in using evidenced-based medicine (meaning, objective evidence to diagnosis and treat the sick) that will help everyone in the wellness continuum — patients, physicians, hospitals and insurance carriers. Evidenced-based medicine lies at the heart of Choosing Wisely, a campaign from the American Board of Internal Medicine that offers scores of suggestions to combat ineffective and unnecessary procedures, tests and treatments.

Another answer lies in emphasizing wellness or disease prevention. That means getting out of the “repair shop mentality” to control health-care costs and improve outcomes. Smoking cessation alone adds a decade to a person’s life. NCH stopped hiring smokers 2½ years ago, with a significant improvement in the health of our colleagues and their families.

Imagine our entire community being smoke-free.

Excessive weight is epidemic in our state, with more than 61 percent of Floridians overweight, obese or morbidly obese. The Safe and Healthy Children’s Coalition of Collier County has launched a successful pilot program in three elementary schools to encourage exercise and a good diet.

Unless we embrace efforts like these, the current generation of children will predecease their parents due to the medical complications of obesity.

The good news is that information technology — once considered space-age fantasy — has become reality, changing the way we care for the community we serve.

Picture being a seasonal resident and having year-round access to your physicians, using FaceTime or Skype when you are out of the region. One participant in this changing reality is Watson, the IBM computer so successful on TV’s “Jeopardy!” that it is now assisting physicians and insurance carriers with suggested diagnosis and treatments. In a recent study, Watson reviewed 500 cases and came up with alternative, evidenced-based care paths that outperformed human decision-makers both in terms of cost and in boosting patient outcomes 30 to 35 percent.

Such technological innovations give us hope for the future of health care.

Now, against this backdrop, what can a health-care institution like NCH do to help ensure the wellness of our future residents and visitors?

There are five mandates which we believe will be beneficial for the quality of life we all enjoy:

1. Grow the capacity of the primary-care network by adding new physicians, physician’s assistants and nurse practitioners to Southwest Florida.

2. Integrate care to create seamless boundaries so patients avoid inconvenience and waste.

3. Strengthen the already robust information-technology network that has assisted hospitals like NCH in achieving the level of quality and value we must realize for our citizens.

4. Improve our population’s health to become the healthiest county in the country.

5. Maximize the value of the NCH-Mayo Clinic affiliation.

“The world has changed and so must we” is a mantra in which we at NCH continue to believe. How well all of us — health-care professionals and citizens alike — respond to that challenge will determine the ultimate wellness of our community.

At NCH, we look forward to this journey and are committed to succeeding.

© 2013 marconews.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

  • Discuss
  • Print

Comments » 0

Be the first to post a comment!

Share your thoughts

Comments are the sole responsibility of the person posting them. You agree not to post comments that are off topic, defamatory, obscene, abusive, threatening or an invasion of privacy. Violators may be banned. Click here for our full user agreement.

Comments can be shared on Facebook and Yahoo!. Add both options by connecting your profiles.

Features