David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog. I’m speaking today with Evan Falchuk. He is President and COO of Best Doctors. Evan, nice to speak with you today.
Evan Falchuk: Great to talk to you David.
Williams: It’s a been a couple of years since I had you on the blog and a fair amount has transpired in health care since then. Maybe we should start in with health care reform.
Let me just ask you the big question: is it going to work?
Falchuk: I think it’s going to be a while before we know what works and what doesn’t work and whether it was worth all the trouble.
Williams: Do you think there are some things that we’ll see in the early years? Obviously this may be like some other legislation where the pieces come in over time. Some PPACA provisions will phase in over the next several years but I wonder if you have any sense of the early indicators and where they may lead us.
Falchuk: To the extent that the federal law was based on what we’ve done here in Massachusetts where I am – there will be some effect on the number of people who are uninsured and that will be a good thing. It will reduce the number of people who don’t have coverage. So that will be a positive short term effect.
The negative short-term effect as we saw here in Massachusetts is that there is still the same number of doctors before the law was passed as there are afterward. So there will be increasing problems with access to care.
We have here in Massachusetts wait lists to see doctors, which is something we never had before. When someone gets coverage they are going to use it.
Williams: Under health reform it sounds like it may be harder to get access to providers. Will it at least get easier for patients to identify who they should see in general and to determine who is best for the particular situation that they’re encountering?
Falchuk: I think it’s hard, which is ironic because there is more information available now about medical care for consumers than probably ever in history. You would think that it would be easier for patients to navigate their way through, but I actually think it’s harder.
Doctors don’t have enough time with their patients and patients don’t have the level of expertise that they need to understand all the information that’s at their fingertips. So when you go to the doctor –and the studies show that the average visits are 15 minutes or less of face time with your doctor– it’s very difficult to engage on the issues that are important to you.
Patients say, ‘I’ve been diagnosed with something, I’m not sure what to do, I’ve read all the stuff on the Internet or in some social media and I need help sorting it out.’
Unfortunately your doctor is just not going to be able to do that effectively. I think for patients it’s even more difficult to figure out, “Do I have the right person, am I going down the right path, am I asking the right questions?’
It’s not something that’s obviously addressed by reform in any important way and for consumers that’s increasingly a serious issue.
Williams: If you look at it from the physicians’ side and the focus in ARRA on Meaningful Use of electronic health records, do you think that physicians will be in a better position to have the information and decision support tools that they need at their fingertips at the time of care to help the patient?
Falchuk: Look, it will help. Anything that will make it so that your medical records aren’t stored in handwritten notes in files that are buried in a storage facility someplace or in one of those giant wall units that move around is better, because the doctor will have more access to information.
But there is a real practical issue here, which is that if you’re going to get 15 minutes of face time with the doctor, there is even less time your doctor is going to be able to spend thinking about your case trying to assimilate all that information. So again as a patient if your issue is, ‘I want to make sure my diagnosis is right, I want to make sure my treatment is right, I want to make sure I’m on the right path,’ and you walk into the doctor and you feel like you have to introduce yourself once again to the physician and remind him of the issue that you’re facing, that’s the reality.
I think doctors will tell you the same thing: that it’s hard because you’re the 18th patient I’ve seen today and between the last time I saw you and when I saw you this time I’ve seen 600 other people with similar problems to you, so it’s hard for me to exactly place you.
Williams: Since we last spoke a couple of years ago Facebook has really taken off and there is Twitter and all manner of connecting with people. Other than making for this increased flood of information that’s hard to deal with, does social media improve the doctor/patient relationship or make it easier for patients to navigate their way through?
Falchuk: There is a lot of talk about what connections doctors and patients should have with each other. For example KevinMD has written about whether doctors should be friends with their patients on Facebook and where to draw those sorts of lines. But in general social media is one of those things that’s given patients more access to information.
There are good websites such as PatientsLikeMe where as a patient you can find other people that are facing similar issues to you. That can help you know more and be more educated and also know that as a patient you can be your own advocate and stand up for yourself. You will find that maybe what you think is pushy with your doctor is really what you have to do to get what you need.
What I think is really interesting about social media from a policy standpoint is that a lot of knowledgeable people were absent from the social media landscape during the debate over health reform. I mean people who are really expert in health care policy and the realities of paying for health care and what it means to be an employer who run programs that cover health care expenses.
A lot of people who were advocates for reform were less expert in these issues than the employers were. It was a missed opportunity for a lot of these groups to put their stamp on what reform ended up being, in order to have it be more in line with a lot of the innovation that’s happening in the world. Social media is the place where there is a lot of great stuff happening.
Williams: There has not been a huge explosion in the number of quality rating sites over the past couple of years, but I know it’s a priority for federal and some state governments. What do you make of some of what’s put on the web in terms of quality comparison sites?
Let’s say I wanted to compare two hospitals in the Boston area for a particular diagnosis. Would I be in a good position to do that?
Falchuk: You would not be, and I think it’s really unfortunate. The government came out with its healthcare.gov website, which is meant to be more of an online insurance shopping site. But in the middle of it is a big section that talks about comparing quality providers. There is a tool there for comparing hospitals.
What was really striking about it (and I blogged about this) is that if you tried to compare one of the major teaching hospitals in Boston with a local community hospital in the Boston area, you couldn’t tell the difference between the two hospitals from the quality measures they were using You just couldn’t.
And when you start to drill down, they don’t have any way to compare these providers for diseases like cancer. The tools are really, really weak as far as what they can actually do for you, but they’re promoted in a way that says these are things that you should use.August 20, 2010