YOU COULD BE
THE THIRD POSSIBLY by Manuel M. Quiñones, Jr., MD
Bexar County Medical Society
President 2008
Many of you have heard me say
that there are only two groups
who embrace change: business
consultants and wet babies.
Change is critical. Think where you’d
be today if you still thought a laparoscopic
cholecystectomy is just a passing
fad. The last 10 years have seen tremendous
changes in medicine, but so have
the last 20, 50, and 80 years. It just so
happens that you have very likely been
here to experience and recall the last 10
and not the last 80. The point here is
that change is constant, change is survivable,
change is often painful, but change
can be good. How you survive change,
how well you adapt, is what determines
success and failure in business — and
medicine is a business.
Our health care delivery system is in
dire need of reform. And change is coming.
We are at the dawn of an election
year, and reform of our health care
industry is unavoidable. How well are
you prepared, and how adaptable will
you be? In a 31-page position paper
published in the Annals of Internal
Medicine, the American College of
Physicians endorsed eight health reform
recommendations, including an option
for a single payer system. Who would
have thought that this organization,
which represents 124,000 physicians in
internal medicine and related sub-specialties,
would take this posture?
Smart move, if you read between the
lines. You can run away from change
and hide your head in the sand, or you
can help to mold policy when the
reform process begins. I think I know
where the ACP will be.
The bottom line is that the current
system of reimbursement for health care
is not working. Just before Christmas,
Congress avoided a 10 percent cut in
Medicare reimbursement; however, that
cut may come anyway, in June. But the
only realistic option would have been to
force doctors to take care of some of the
most medically complex members of
our society and to take a 10 percent cut
in pay. And remember that third-party
payers hide right behind Medicare’s
skirts — they’re next in line to reach into
your pocket.
The reform that is needed is far more
complex than Congress could have handled
quickly. And, as experience has
taught us, quick decisions by Congress
are seldom good ones. The painful
changes that are essential will take years
to develop and implement, and they
will demand your input as well as your
commitment to change. They will not be
easy, they will not be pleasant, and they
will not happen quickly.
There is such a tremendous diversity
in our medical community. Some of us
are engaged in aggressively growing
practices and see new patients every day,
while others are in the late days of their
careers, quite satisfied earning enough to
pay employees and themselves. Some of
us have embraced change, albeit painfully,
and have figured out how to help
patients benefit from Medicare
Advantage plans. Others have chosen to
stay in a fee-for-service system only, and
some have chosen to do both. Some
have had the courage to create their own
hybrid niche.
The long and short of it is that you
can change, your patients can benefit
from that change, and you can, too.
There are thousands of patients here
in San Antonio in Medicare Advantage
plans, and the number grows every
month. Those numbers would not continue
to increase if those patients had
not sought out and embraced change.
As the proportion of medically complex
elderly patients increases in our
country and the cost of taking care of
them increases as well, the only way to
pay for that care is to collect more from
working stiffs like you and me or change
the very basis on which we are reimbursed
for our professional services. See
more, bill more, make more — that system
will not work in the future.
But what will work in the future?
How can I adapt so that I can continue
to practice and someday retire gracefully?
What am I going to have to prepare
for to continue to practice in the future?
I don’t know exactly how the business of
medicine will change over the next six to
eight years, but I do know that we must
all commit to staying involved in the
transformation and be prepared to
evolve in the new era of medicine.
Just to mention a few issues, we have
to be ready to be more accountable for
the care we deliver. We also have to be
more aggressive about preventive care,
structure, and promoting healthy
lifestyles in our patients, rewarding and
encouraging physicians who meet and
exceed evidence-based care standards,
facilitating and encouraging patients to
seek care from their primary care physician
instead of emergency rooms, following
more cost-efficient practice methods,
and encouraging tight chronic disease
management.
There will be many more. Don’t simply
blame Congress for not paying you
more until you embrace the possibility
of change. Only then will society allow
us to dictate what it takes to achieve that
level of health care. You may not like it,
but change is unavoidable. Be the third
possibility. Embrace change.
From the back porch, feet up and sun
going down, I am your President.
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