The keynote Dotter Lecture at the 2015 SIR conference was delivered by Dr. Robert Kerlan, on the topic of the changing world of healthcare. I must say, I was pleasantly surprised by his refreshingly candid and open take on healthcare restructuration and the need to move away from fee-for-service (FFS) payments.
Dr. Kerlan outlined the unique concept of supply-driven care in the US quite the opposite of supply and demand that we all remember from Econ 101. It's the opposite because the healthcare landscape defies a conventional marketplace physicians are both the consumers AND suppliers of care. This is problematic because it creates an incentive for physicians to increase the number of procedures they perform, sometimes unnecessarily.
In a supply-driven landscape, more physicians = more diagnostic tests, referrals and procedures. BUT, all of this care doesn't necessarily lead to better outcomes. Dr. Kerlan pointed to Medicare data that showed that regions with higher per capita spending did not report better outcomes or patient satisfaction.
Specialists are the most likely to contribute to excessive healthcare consumption under a FFS model because they are motivated to increase their procedure volumes for more reward. Healthcare reform must therefore help stem the supply of specialists by evening out the playing field for primary care physicians and making it less financially advantageous for young doctors to choose to specialize. Dr. Kerlan underscored that part of shifting away from a FFS model must include paying primary physicians for coordination of care.
I thought this was a very interesting topic for Dr. Kerlan to select for his SIR keynote address, given that interventional radiology is a very procedure-driven specialty. IR is technique-based rather than organ or disease state-based, and is largely episodic care in the hospital: interventional radiologists are a prime suspect for overutilization of care. This keynote did not have the self-congratulatory or self-victimization theme of many physician addresses that I have witnessed it was pragmatic and forward-looking. As the healthcare landscape shifts, interventional radiologists will certainly have to adapt. It may be uncomfortable to talk about, but physicians cannot be blind to how these changes will affect their business.
Dr. Kerlan stressed the importance of interventional radiologists involving themselves in longitudinal patient care, which will be key in tomorrow's outcomes-based landscape. He cautioned that while the specialty should be careful to avoid over-treatment, interventional radiologists should not shy away from selective adoption of new treatments and devices. Innovation has long been a hallmark of interventional radiology and should continue to drive the specialty. Dr. Kerlan emphasized that interventional radiologists at the forefront of innovation MUST be diligent in collecting quality data to support their treatments after all, he explained, data is the currency of the future. As a data analyst, I couldn't agree more.