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Leadership or survival in the health care revolution: Choices for the vascular surgeon
INVITED COMMENTS From the 1997 E. Stanley Crawford Critical Issues Forum
Leadership or survival in the health care revolution: Choices for the vascular surgeon William M. Abbott, MD, Boston, Mass.
The health care system in the United States is in the midst of dramatic and revolutionary change. To a certain extent, vascular surgery has not been fully exposed to this change. Depending on where they practice, surgeons may have experienced significant change or virtually no change. However, revolutionary changes ultimately will affect all medical practitioners in this country, all surgeons in general, and all vascular surgeons in particular. The Critical Issues Forum for 1997 was designed to acquaint vascular surgeons with these changes, explain how the changes have come about, and relate experts’ recommendations for reacting to and coping with the changes. This information is essential in helping vascular surgeons ensure the survival of their specialty. In the first section, which focuses on the current environment, Dr Jonathan Gertler discusses the health care imperative, with the idea that clinical outcome of treatment, or the perception thereof, may be a real force for change. He identifies the quality factors that are driving the situation. Next, Dr George Andros discusses practicing vascular surgery in Southern California’s managed care environment. Dr Andros’ considerable experience with managed care allows him to give a vivid firsthand description. The second section covers what may happen in the near future. Dr Elizabeth Mort, a primary care physician and expert in health management issues,
discusses management by demand for vascular surgery, identifying both the imperative and the opportunity for change. Next, Dr Jeb Hallett discusses managed care from the perspective of his experience in Minnesota, specifically focusing on capitated programs. He identifies and examines a number of models that are being implemented. Then, Dr Frank Veith addresses turf issues in vascular surgery, identifying ways of resolving them and optimizing the outcome of cases selected for various interventions and overall patient care. This obviously has a great impact on cost. The third section considers the process of change. Dr Richard Bohmer, an expert in health care planning, gives an overview of the use of care paths in vascular surgery patients. Although care paths are well accepted, Dr Bohmer offers an extremely good description for readers who wish to learn more about their use. Dr Jerry Goldstone then discusses the role of quality assurance versus that of total quality management. These concepts, one old and one new, are at the forefront of health care restructuring. Finally, Dr William Abbott describes the operations improvement program at Massachusetts General Hospital. This innovative program was instituted in 1996 to examine both quality and cost issues. Its success in the management of vascular surgery patients has been quite striking, and it is offered as a model to study.
From the Division of Vascular Surgery, Massachusetts General Hospital. Reprint requests: William M. Abbott, MD, Massachusetts General Hospital, 15 Parkman Street, ACC 458, Boston, MA 02114. J Vasc Surg 1998;28:353. Copyright © 1998 by The Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter. 0741-5214/98/$5.00 + 0 24/9/91165
Submitted Sep 9, 1997; accepted Jan 30, 1998.
353
Leadership or survival in the health care revolution: Choices for the vascular surgeon William M. Abbott, MD, Boston, Mass.
The health care system in the United States is in the midst of dramatic and revolutionary change. To a certain extent, vascular surgery has not been fully exposed to this change. Depending on where they practice, surgeons may have experienced significant change or virtually no change. However, revolutionary changes ultimately will affect all medical practitioners in this country, all surgeons in general, and all vascular surgeons in particular. The Critical Issues Forum for 1997 was designed to acquaint vascular surgeons with these changes, explain how the changes have come about, and relate experts’ recommendations for reacting to and coping with the changes. This information is essential in helping vascular surgeons ensure the survival of their specialty. In the first section, which focuses on the current environment, Dr Jonathan Gertler discusses the health care imperative, with the idea that clinical outcome of treatment, or the perception thereof, may be a real force for change. He identifies the quality factors that are driving the situation. Next, Dr George Andros discusses practicing vascular surgery in Southern California’s managed care environment. Dr Andros’ considerable experience with managed care allows him to give a vivid firsthand description. The second section covers what may happen in the near future. Dr Elizabeth Mort, a primary care physician and expert in health management issues,
discusses management by demand for vascular surgery, identifying both the imperative and the opportunity for change. Next, Dr Jeb Hallett discusses managed care from the perspective of his experience in Minnesota, specifically focusing on capitated programs. He identifies and examines a number of models that are being implemented. Then, Dr Frank Veith addresses turf issues in vascular surgery, identifying ways of resolving them and optimizing the outcome of cases selected for various interventions and overall patient care. This obviously has a great impact on cost. The third section considers the process of change. Dr Richard Bohmer, an expert in health care planning, gives an overview of the use of care paths in vascular surgery patients. Although care paths are well accepted, Dr Bohmer offers an extremely good description for readers who wish to learn more about their use. Dr Jerry Goldstone then discusses the role of quality assurance versus that of total quality management. These concepts, one old and one new, are at the forefront of health care restructuring. Finally, Dr William Abbott describes the operations improvement program at Massachusetts General Hospital. This innovative program was instituted in 1996 to examine both quality and cost issues. Its success in the management of vascular surgery patients has been quite striking, and it is offered as a model to study.
From the Division of Vascular Surgery, Massachusetts General Hospital. Reprint requests: William M. Abbott, MD, Massachusetts General Hospital, 15 Parkman Street, ACC 458, Boston, MA 02114. J Vasc Surg 1998;28:353. Copyright © 1998 by The Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter. 0741-5214/98/$5.00 + 0 24/9/91165
Submitted Sep 9, 1997; accepted Jan 30, 1998.
353