Baby Boomers: health care crisis?

By Anna Mitchell  

JULY 21, 2010 6:26 a.m. (0)

A bottleneck in health care is coming fast as the first wave of Baby Boomers reach Medicare age next year, obesity sends more people to the emergency room and coverage is expanded to millions.

At the same time caps remain on the number of American doctors coming out of medical training each year, doctors approaching retirement will almost double in the next decade and government reform is increasing demands that hospitals deliver better care with less money.

But hospitals can help themselves, Joanne Conroy, chief health care officer for the Association of American Medical Colleges, told an auditorium of Greenville physicians Tuesday, if they get smarter, more innovative and more collaborative in the way they do business.

Costs vary widely among hospital systems – with care at NYU Medical Center almost three times as expensive as it is at Stanford University Hospital.

“There’s a valuable truth here,” Conroy said. “Across the U.S. we are looking at unnecessary variations in the cost to care. We are talking about practice preferences as opposed to actual outcomes.”

She cited wellness visits, health education among the poor, ramped up use of nurse practitioners, better follow-up care and investment in outpatient clinics among the success stories for quality and cost she’s seen nationwide. Greenville is among the nation's 400 teaching hospitals, where federal subsidies help cover the cost of residents but profits are consistently lower than non-teaching hospitals.

Conroy was in town this week meeting with Greenville Hospital System executives and set aside time to speak directly to physicians about the need for hospitals and their medical staff to work together to promote efficiencies and better care. At stake, she said, was the survival of medical institutions - many of them the largest employers in any given community.

“As a former CEO, I can’t tell you how much time and money was spent on correcting errors,” Conroy said, offering as an example medication errors in the hospital pharmacy. “If you focus on quality and safety, finances fall in place.”

The most expensive piece of equipment is a doctor’s pen, said Donald “Chip” Wiper, a gynecology oncologist with the system, after Conroy’s hour-long presentation.

“It’s not because they are bad people, but they are not thinking about the efficiencies of the entire system,” Wiper said.

Wiper said the medical community needs to get on board with addressing a broken health-care business model whose time would have come regardless of policy changes in Washington. He called it this generation’s “manifest destiny.”

“Covering 32 million people. Who can argue with that?” Wiper said.

Part of any discussion about delivering safe, effective care for less money, though, has to include how to pay for it, Conroy said. On the personnel side, would-be doctors are facing $200,000 in medical-school debt; meanwhile, CEOs are losing sleep over whether to expand hospital space at or near capacity with the Boomer wave approaching.

Spence Taylor, a surgeon and the hospital system’s assistant dean of academic affairs for resident education, said the hospital system’s roster of physicians has grown from about 200 a few years ago to almost 700 this year. Having specialists from every possible field under one roof has helped standardize care, assuring every patient gets the same treatment regardless.

But students coming out of medical school, he said, seem almost genetically engineered wrong when it comes to teamwork.

“We have to educate them,” he said.

“Which is why we are doing out medical school,” Wiper finished.

This past spring, the Greenville Hospital System announced a possible collaboration with the University of South Carolina to establish a Greenville medical-school campus. Although a decision will not be announced until next month at the earliest, Taylor said the system is shooting to open in 2012.

Conroy said Greenville Hospital System seems to be one of the institutions embracing reform, with doctors there brought into the discussion with executives on the direction of care.

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