Moving Reform to the Bedside

Abstract

AS THE HEALTH CARE REFORM DEBATE HAS BECOME more fractious and politicized, the need for clear, productive, and patient-centered input from physicians has increased. The cumulative actions of individual physicians can have a substantial effect on meaningful and lasting reform. For the medical profession to assume a leadership role, individual physicians will need to (1) acknowledge the inequitable and dysfunctional nature of the current health care system and the role of physicians in perpetuating that system, (2) examine his or her professional responsibilities to the public, and (3) take action with specific concrete behaviors that will facilitate and guide efforts to improve the health care system. Physicians have learned to work within a dysfunctional system—committing extra hours to arguing with insurers to obtain a medication for one patient, a computed tomographic scan for another, and a surgical procedure for a third. The annual cost of challenging third-party payers has been estimated at $68 000 per physician. The system has become so unmanageable that some physicians are willing to use deceit to secure insurance coverage for a medical procedure. These burdensome practices and costs, however, have not been effectively challenged by physicians—even during this time of reform. For many physicians, it may simply be a matter of having limited time or a distaste for politics. Others may be resigned to working within a system that is familiar, despite its dysfunction. Whatever the reason, in remaining silent, physicians have perpetuated a system in which patient access to medical care is too often reliant on the physician’s willingness to participate in, and at times game, a highly inequitable system. The American College of Physicians’ charter addresses the professional obligations of a physician, encouraging physicians to work at the societal level to improve access to care, reduce discrimination, manage conflict of interest, control medical expenditures, and facilitate a just distribution of scarce resources. In accordance with these principles, there are immediate and concrete steps physicians can take both at the bedside and in the community to help reshape the health care system and fulfill their moral and professional duties to the public. Work Daily to Provide High-Quality Care Physicians must commit to improving quality in their daily practice. Nearly half of patients do not receive evidencebased medical care, chronic illness is often poorly controlled, and many patients do not receive clinically needed preventive services. Physicians must respond by adopting new approaches to measuring and improving the quality of care they are providing. Physicians and group practices can receive incentive payments for participation in Medicare’s physician quality reporting initiative. Additionally, professional societies and insurers often have mechanisms for collecting and reporting quality data. These data can be used by physicians to improve performance and patient care.