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Knowing the Limitations of the Healthcare Industry


A pediatric roundtable at MGMA16 led to the realization that there's wisdom in identifying the industry forces that we cannot change.

A few weeks ago, Leann had the honor of moderating the pediatric roundtable at the Medical Group Management Association's annual conference in San Francisco.

The roundtable was a thoughtful, interesting mix of practice managers, traditionally the decision makers of our industry, from all over the United States. The lively conversation lasted for two hours and addressed several different topics. We talked about changing from fee-for-service to value-based payments, rising technology and employee benefit costs, varying state regulations, and debated over best practices for setting the schedule of a pediatrician. Interestingly all the topics came back to our focus: the Triple Aim, specifically how the pressure to integrate care is influencing primary care. At one point, someone even mentioned the Serenity Prayer reminding the group that while we should feel empowered to change the things we can, it's critical that we have the wisdom to identify those industry forces that we cannot change.

At MGMA16, it was clear that payers and large hospital/academic groups currently control integration and the push of Triple Aim, removing much of the decision making away from the practice managers. After all, consider this: The EHR that we, at our little practice, are being forced onto next year didn't even have a booth at MGMA16. Why would they? That's not where the decision makers they need to reach are.

As we wrote last month, we agree with what Dr. Don Berwick wrote eight years ago when he first introduced the concept of Triple Aim: "The remaining barriers to integrated care are not technical; they are political." As a Medicare-for-all advocates, we asked MGMA16 conference attendees and vendors how they felt about single payer. The results are admittedly unscientific, but interesting none the less.

The group was split, much like our presidential politics, with half of MGMA16 vendors and attendees we polled expressing support for single payer, and the other half against. Here is what we found most interesting: When someone said that they were against single payer, they quickly followed it up by saying they thought single-payer was inevitable. Conversely, when someone at MGMA16 said they were excited by the prospect of single payer, they quickly added that they didn't think that it would happen in their lifetime. It must be some trick of basic human psychology that we have difficulty envisioning a future where we get what we want.

As practice managers, we can articulate what we think our practices, patients and communities need, but how much decision making power do we currently really have? The group expressed a belief that the value of industry events like MGMA16 lie not only in professionals sharing experiences and goals, but in coming to the realization of the limitations that exist in our industry. What do you think?

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