Robert Doherty, BA; Thomas G. Cooney, MD; Ryan D. Mire, MD; Lee S. Engel, MD; Jason M. Goldman, MD; for the Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians *
Acknowledgment: The authors thank Sue S. Bornstein, MD, and Jacqueline W. Fincher, MD, for their contributions as the chairs of ACP's Health and Public Policy Committee and Medical Practice and Quality Committee, respectively, when the Board of Regents in July 2018 asked the committees to develop a new vision for the future of health care policy. They provided initial direction and guidance that led to the vision statements and policies that are in this call to action and the accompanying position papers.
Financial Support: Financial support for the development of this position paper came exclusively from the ACP operating budget.
Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2411.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Robert Doherty, BA, American College of Physicians, 25 Massachusetts Avenue NW, Suite 700, Washington, DC 20001; e-mail, firstname.lastname@example.org.
Current Author Addresses: Mr. Doherty: American College of Physicians, 25 Massachusetts Avenue NW, Suite 700, Washington, DC 20001.
Dr. Cooney: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
Dr. Mire: Heritage Medical Associates, 4230 Harding Pike, Suite 601 East, Nashville, TN 37205.
Dr. Engel: Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112.
Dr. Goldman: 3001 Coral Hills Drive, Suite #340, Coral Springs, FL 33065.
Author Contributions: Conception and design: R. Doherty.
Analysis and interpretation of the data: R. Doherty, T.G. Cooney, R.D. Mire, L.S. Engel, J.M. Goldman.
Drafting of the article: R. Doherty, R.D. Mire, L.S. Engel, J.M. Goldman.
Critical revision for important intellectual content: R. Doherty, T.G. Cooney, R.D. Mire, L.S. Engel, J.M. Goldman.
Final approval of the article: R. Doherty, T.G. Cooney, R.D. Mire, L.S. Engel, J.M. Goldman.
Administrative, technical, or logistic support: R. Doherty.
Collection and assembly of data: R. Doherty.
Michael F. Montijo MD MPH FACP
January 29, 2020
We must clean up our own shop before asking much of others.Where maybe 80% of all hospital admits in the US are avoidable, when the average diagnostic journey has at least 2 flaws, where the therapeutic journey is fraught with wrong therapy, to much therapy, to little AND occurs with little to no patient preference elicitation, no wonder the bill is so high and of dubious value. As someone said, "Every process is perfectly designed to get the results it gets." (Arthur Jones). Incrementalism may, and only may, achieve some of the noted goals 4 generations from now, at best. And, a focus on payment, coverage, etc. component of the effort is important but requires a complete overhaul. The delivery system, in general, is antiquated. Why are activities you want to happen, read prevention, mixed with rare or uncommon events. And, mixed with chronic care that has so many of its own care requirements. No wonder excellence is elusive.And specifically to my ACP colleagues, figure out how to deliver excellent care 99+% of the time.Why not bring the care to the customer versus the customer to the care, especially for care that one wants all to have that should have, no more, no less.The money will follow the improved/transformed value proposition. The goals proposed will not seem as elusive as they do now.Clean our own house, make it impeccable and settle for nothing less.
Doherty R, Cooney TG, Mire RD, et al, for the Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians. Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians. Ann Intern Med. 2020;172:S3–S6. doi: https://doi.org/10.7326/M19-2411
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Published: Ann Intern Med. 2020;172(2_Supplement):S3-S6.
Healthcare Delivery and Policy.
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