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New Directions: More Professionalism, Less Regulation

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OCR for page 15
Medicare: New Directions in Quality Assurance PART II New Directions: More Professionalism, Less Regulation

OCR for page 15
Medicare: New Directions in Quality Assurance This page in the original is blank.

OCR for page 15
Medicare: New Directions in Quality Assurance New Directions: More Professionalism, Less Regulation Introduction William S. Hoffman This part of the conference proceedings is entitled ''More Professionalism, Less Regulation.'' The professionalism that the study committee described and discussed was not the aspect or dimensions of professionalism that are more associated with secret, perhaps elite, concerns that might be called trade association economics or the exclusivity of a profession. Rather, we were talking about the more virtuous aspects of professionalism—the assumption that an individual wants to grow not only as an individual, but with the science and in his or her commitment to patients. It is that kind of professionalism that we will be discussing. Committee member Leo M. Cooney, Jr., M.D., Humana Foundation Professor of Geriatric Medicine at Yale University School of Medicine, presents the committee's views; Lonnie Bristow, an internist in the private practice of medicine in California, offers a response. In much of the committee discussions there was a continuum of concerns. Commitment to individual growth, a collegial atmosphere, moving from legalism and detecting problems as opportunities for improvement—all of this ran through committee discussions. At the same time, none of us was comfortable enough to come out fully and say there are examples of quality assurance systems based solely on this notion of professionalism that will work throughout the whole system of health care. Generally, current quality assurance programs tend to place more emphasis on costs, utilization, and on detection and control, and less emphasis on professional growth, outcomes, and improvement of health. We have to find a point between rigid regulation at one end of the continuum and unexamined professionalism at the other.