Changing Health Care Systems and Rheumatic Disease (1996) / Chapter Skim
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3: Keynote Address
3: Keynote Address
Pages 21-30
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From page 21... ...
I will discuss some broad trends in medical care today, comment on the payment of physicians, and reflect on the overall system of care. I will also discuss managed care, the training of physicians, both the tension and the collaboration between primary care physicians and rheumatologists, and what these forces mean for the rheumatology work force.
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From page 22... ...
Fifth, gatekeepers will manage patient care, primary care will become primary, specialists will specialize, and consultants will consult. Finally, physicians will redefine their relationships to organizations and third-party payers.
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From page 23... ...
Managed care is not any one of these particular models. When we talk about managed care we should avoid getting trapped in the notion that there is a single model of managed care synonymous with Kaiser Permanente.
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Many believe that there will be both vertical and horizontal integration of medical practice. Vertical integration is coordination, sometimes but not always common ownership, of all the various levels of care from hospitals to specialty care, primary care, nursing home care, and home care.
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From page 25... ...
It tells physicians, "Here is what you get; live within this budget." Short of capitation, four other payment controls are popular. First, under the gatekeeper system, a medical arbiter (usually a primary care physician)
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From page 26... ...
About the same time, that the ABIM task force was studying changes in physician education, I wrote an article in which I addressed the need to train primary care physicians, especially general internists, for their role as gatekeepers. This training should prepare physicians to · Evaluate risks, benefits, and costs of potential treatments; · deal with a wide variety of clinical problems and settings; · maintain strong primary care skills; develop skills in working with consultants; and · teach primary care physicians and specialists how to collaborate.
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From page 27... ...
William Winkenwerder has written that the functions of primary care and specialty physicians clearly differ. Primary care doctors navigate, negotiate, evaluate, educate, and make decisions, he writes.
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From page 28... ...
In emerging systems of care, policies are being instituted not by individual physicians, but by managed care organizations, hospitals, and health care systems. Often these policies are aimed at saving costs, but often they are also aimed at improving clinical outcomes or patient satisfaction.
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From page 29... ...
As medicine and rheumatology enter a new practice era, we need to address these key issues. With careful thought about innovative payment schemes, appropriate numbers of trainees, and responsiveness to the need for outcomes assessment, the future of rheumatology and more fundamentall~the care of patients with chronic disease will be brighter.
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