Michael Brant-Zawadzki, MD, FACR, serves as Senior Physician Executive at Hoag Hospital; The Ron and Sandi
Simon Endowed Chair, Executive Medical Director for
Pickup Family Neurosciences Institute.
On April 7th, Dr. Brant-Zawadzki will give a presentation on "Creating
a Viable, Community Based Memory and Cognitive Care Program" at Becker's
Hospital Review 11th Annual Meeting. As part of an ongoing series, Becker's
is talking to healthcare leaders who plan to speak at the conference,
which will take place on April 6-9, 2020 in Chicago.
To learn more about the conference and Dr. Brant-Zawadzki's session,
click here.
Question: What, from your perspective, is the biggest challenge about the
future of work for hospitals, and what can they do about it? (i.e. automation,
desire for more flexibility, clinician shortages, etc.)?
Michael Brant-Zawadzki: The biggest challenge facing hospitals in the near future is bridging the
gap between inpatient and post-acute care including at home, SNFF services.
Taking “ownership” of the patient’s journey following
discharge from the hospital, navigating that journey to optimize longer-term
outcomes, prevent unnecessary readmissions, and improve the quality of
life is the Manhattan project for healthcare systems. This is particularly
true for the senior population, as approximately 60% of all health care
expenses occur in that demographic. Costs of a Medicare patient are triple
those of the pre-65 individual. Particularly, seniors with mental conditions
such as cognitive impairment, and mental health disorders, triple the
cost of non-impaired seniors. Therefore, integrating cognitive and mental
health care with chronic medical conditions will be necessary. All of
this is crucial if bundled payments for specific Medicare DRGs will continue
to be enacted.
Q: How can hospitals reconcile the need to maintain inpatient volumes with
the mission to keep people healthier and out of the hospital?
MBZ: The challenge of maintaining inpatient volumes in the face of keeping
patients healthier and out of the hospital should not be a great one.
Given the inexorable demographics of aging, with ten thousand people turning
65 every day in this country and also living longer, inpatient volumes
will be maintained, if not grow. That said, acuity of inpatients, and
lengths of stay will likely increase as the average age of inpatients
increases. Health policy legislators need to understand the transformation
of hospitals into intensive care units is just beginning. This dovetails
with the need to expand hospital services to the post-acute, outpatient
space that will hopefully partially offset the potential unmanageable
growth of the inpatient volume and acuity.
Q: Healthcare has had calls for disruption, innovation and transformation
for years now. Do you feel we are seeing that change? Why or why not?
MBZ: Calls for disruption, innovation, and transformation in health care have
never been as urgent as today. Given the dramatic rise of the senior population,
the need for unsustainable health care cost containment, and at the same
time providing improved experience and quality of life for consumers is
leading to disruptive innovation, if not creative destruction. Transformation
based on Porter’s Value Equation - better health per dollar spent
- is becoming imperative. Evidence-based appropriateness studies are critical.
A good example of the culture change necessary is the recent publication
of the Ischemia trial data showing that many invasive coronary artery
procedures do not prolong life, only produce a better quality of life
in selected patients with the unstable disease. These types of studies
will receive increasing attention and should be incentivized. Many examples
of waste in healthcare delivery exist.
Q: What do you see as the most exciting opportunity in healthcare right now?
MBZ: The most concerning, exciting and overall compelling opportunity in health
care today is the appropriate utilization of the knowledge workers that
represent the means of production in the healthcare industry. Given looming
physician shortages, appropriate utilization of physician extenders, and
the use of primary care physicians for prevention and wellness maintenance
is one example. What we learned from the early ACO projects is the critical
need for integrating specialists into best-practice care delivery care
pathway design, as the “leakage” from accountable organizations
occurred predominantly by patients seeking specialized services.
Peter Drucker famously observed that the best organizations are composed
of well-integrated specialists. Knowledge workers can carry the means
of production out the door with them, especially in a competitive employment
market, thus appropriately incentivizing them through true leadership
partnerships for a sense of common purpose, some degree of autonomy, and
“skin in the game” with accountability will determine which
organizations succeed, and which will fail. Commoditizing knowledge workers
through mechanistic employment will lead to cynicism, and cynicism erodes
professional values.
To view the original
Becker's Hospital Review article, please click
here.