Does Recent UK Physicians’ Strike Carry an Important Message for the US?

---Anna Shepherd, Health & Personal Finance Professional - Cambria Health Advisory Professionals

For this blog, I generally try to find news that raises prescient questions about healthcare and economics in our current climate. This article (link below) goes a little outside of that but I find it important nonetheless to keep in back of my mind as a guidepost of sorts. It details a recent strike effort by General Practitioner’s in England’s National Health Services (NHS) over a pension dispute with the government. The government has requested that the doctors contribute more to their pension plans as well as raise the retirement age in order to ease the burden on other health care workers such as nurses or porters (patient transporter). The story reports that this strike was small, affecting about 24% of practices, but was still effective due to the tumult the system saw from canceled surgeries, closed clinics and rescheduled appointments. What I find interesting about this article is the insight into NHS functions, and how we’ve experienced similar issues in the US, and what it meant to the patients. http://www.dailymail.co.uk/news/article-2162242/Doctors-strike-affects-10-patients.html

This illustrates a key inefficiency in the NHS: the doctors are not beholden to the consumers. The chairman of the doctor’s union even used the phrase ‘the fight is with the government’, implying that they are not trying to hurt their patients. But who gets hurt when their scheduled surgery, (an appointment that is often difficult to come by in the first place) has to be rescheduled? The power of the purse is in full display in this instance. In the US, we’ve created a society that engenders pride in the success of doctors. We want our doctors to be highly competent, well compensated, and esteemed for their efforts. Bumping them down a peg to the status of ‘cog in the machine’ will certainly not lead to better outcomes. 

We have had similar issues in the US with government employees. You may recall the air traffic controller strike of the 1980’s or rows in individual states over pay and pensions, such as the recent recall election of Scott Walker in Wisconsin. The very idea of public employee unions has been in dispute even going back to the FDR administration. In a letter to a Federal union he wrote,

• “All Government employees should realize that the process of collective bargaining, as usually understood, cannot be transplanted into the public service. It has its distinct and insurmountable limitations when applied to public personnel management. The very nature and purposes of Government make it impossible for administrative officials to represent fully or to bind the employer in mutual discussions with Government employee organizations.”

This seems pertinent still today, given that after the recent Supreme Court decision upholding the ACA, several commentators in the healthcare industry have been predicting the eventual unionization of doctors; if Britain serves as an example, it is not one we should be clamoring to follow. Here’s a link to a very good article on the effects doctors may see in the coming months: (http://news.heartland.org/newspaper-article/obamacare-expected-increase-loss-doctor-owned-practices)

Now to bring the focus back to the most important driver of healthcare: the patient. A problem lingers with the whole premise of having a doctor’s union. I can only ask the question---- because after much thought, I realized that my solutions got very murky, political, emotional, and ultimately led to naught (at least for the purposes of this blog):

What do you do when your doctor is in a union and you no longer trust him/her to put your best interests first? It seems far-fetched for the United States, given the culture I described above, but it’s all too real for thousands of patients in Britain right now.

Read more at the American Presidency Project: Franklin D. Roosevelt: Letter on the Resolution of Federation of Federal Employees Against Strikes in Federal Service   http://www.presidency.ucsb.edu/ws/index.php?pid=15445#ixzz1zbinKpWE

Feds Grant Millions to the “Shared Decisions” Endeavor

----Terri Bernacchi, PharmD, MBA, Cambria Health Advisory Professionals

The proud announcement about more federal funds ($36.1 million in funding, part of a $1 billion “Innovation Grant”) being “won” by a handful of large, integrated health systems exudes optimism as it explains the use of these funds is “primarily to hire and train an estimated 48 patient and family activators over three years to help with shared decision-making (SDM) related to hip, knee or spine surgery, and for patients with diabetes or congestive heart failure.” (By my math, that is $750,000 per “activator” or $250,000 per activator per year, to help what can only amount to a handful of patients.)

While I could comment on the wisdom of bleeding these funds on a speculative project at a time when we are in pretty dire economic circumstances, I won’t indulge that instinct. And those who read my blogs or know me personally know that I am passionately enthused with the concept of “shared decision making” in health care. SDM can be the primary means to improve patient satisfaction and optimize results ----which reaps (only as a by-product) REAL cost-savings based on a reduction in resource waste due to non-compliance or over utilization. http://www.ama-assn.org/amednews/2012/07/02/bisd0703.htm  

My larger concerns in this article and with this approach is described at the end of the article: that a physician can prescribe a “video” for the patient to watch which will result in a “shared decision” for the patient to have (or not have, gasp!) a surgery. SDM is more than “tools”----it is a process that requires time and deliberation. The article quotes Dr. Goldbach, the Chief Medical Officer of HealthDialog as saying, “It can be a matter of a physician “prescribing” a video for a patient deciding whether or not to get knee surgery.”

HealthDialog is a “private, wholly owned subsidiary of Bupa, a global health and care company of more than $12 billion in revenues headquartered in London, England. Health Dialog provides population analytics, interactive decision aids, and healthcare decision programs to over 17 million people around the world. Health Dialog provides population analytics, interactive decision aids, and healthcare decision programs to over 17 million people around the world.” Clearly, this private company is heavily linked to our health care reform initiatives in its relationships with CMS.  http://www.healthdialog.com/Utility/Company

 Shared decision making involves give and take between the clinician and the patient (and sometimes the family). It is as intimate as a confessional and is not something that can be slap-dashed together as part of a “program”.  It occurs in local surroundings and not in corporate offices, conducted by call-center personnel.  Shared decision making happens ONE patient, ONE situation at a time.

Terri is the founder of Cambria Health Advisory Professionals. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders, a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Advisory Professional colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.