This article is more than 5 years old. Information may no longer be current.
12 things transforming the world of medicine and how to adapt
Click Here to Manage Email Alerts
AUSTIN, Texas — Tasked with redefining success in today’s changing world of health care, Thomas M. Deas Jr., MD, MMM, FASGE, offered his audience a look back over the changes in health care in the 70 years of his life and a look forward to the future.
“There have been transformative changes and looking back ... makes us very grateful for the technologies and tools that we have. But also by looking back, it gives you a better sense of what you can expect looking forward over your lifetime and your practices,” Deas said during his keynote address at GI Outlook. “The expected doubling time for medical health care information was estimated to be 50 years in 1950. In 1980, that doubling time was 7 years. In 2010, the doubling time for health care info is 3.5 years. Projected in 2020, it’s 73 days. Phenomenal and exponential growth in complexity and information available.”
What to watch
Deas gave 12 areas of medicine that will have an impact on today’s physicians:
1. Artificial intelligence
“Artificial intelligence is real,” Deas said. “It’s going to be a significant supplement to what we do because our electronic medical records will be able to process a lot of information and help us formulate differential diagnoses. ... It will also be useful in endoscopic image assessment ... to supplement what we ultimately have to use our judgment for.”
2. Interoperability of EMRs
“If you create this interoperability, you can exchange information over multiple systems and that will be immensely valuable,” Deas said. In particular, at an administrative level, interoperability would allow analyses to move from claims-based data to clinical information.
“If you can supplement that with clinical diagnoses, clinical findings and lab and other results, it becomes a profoundly effective tool to help physicians perform better, to improve the care delivery and, ultimately, help patients improve as well,” Deas said.
3. Transparent analytics
“That transparency will have a profound impact on your practices in the future. That’s going to become information that’s available to patients, it will be information available to insurers, it’s going to be information available to PCPs who are choosing to whom they’re going to refer their patients when they are being evaluated based on their costs and quality and outcomes,” Deas said.
4. Compensation changes
“We’re moving away from the straight fee-for-service type of compensation and more toward value-based, shared savings, cost efficiency,” Deas said. “You’re going to see more relationships where you have potential down-side risk as well as up-side risks based in those compensation formulas. It’s going to be based on your performance – how cost efficient you are, what the quality outcomes are and what’s your ability to risk adjust your patients.”
“It is just too good for patients. It makes health care accessible in remote areas. It makes it much easier to attain. A lot of what we do in health care doesn’t require a physical presence and it makes a lot of sense,” he said.
6. Colonoscopy screening
“We can pretty much expect some disruption of colonoscopy for screening. It’s almost evident that the procedure will go away for screening, though most of us would agree and argue that whatever test is done will be easier for patients more will be having colon screening, which is good for everyone. GIs will be dealing with positive tests and surveillance and other types of tests. It’s quite possible that there are other technologies that will evolve and eliminate even those subsequent studies,” Deas said.
7. Genetics-based personalized medicine
“We’re going to see more and more of that almost every day,” Deas said. “This will be a pattern that we see with a lot of other disease conditions which then offers the opportunity for genetic-type interventions and therapies. This might be the most profound thing we’re going to be looking at in the future. How it might impact gastroenterology, I couldn’t begin to say, but we need to be prepared for that.”
8. Team-based care coordination of complex disease
With chronic and complex diseases like those in GI, the use of, collaboration with and even employment of extenders, navigators, pharmacists, social workers and a communication exchange are becoming extremely valuable, Deas said.
“These are vitally important ways of managing some of these chronic conditions that significantly reduce cost, patient readmissions, ED visits and improve patient outcomes,” Deas said. “We have to be thinking in terms of those collaborative efforts with a lot of the members of the health care team.”
9. Managing social determinants of health
In today’s world, physicians need to look beyond the physical presentation of disease, Deas said. Instead, they have to consider the impact of social characteristics on the health of their patients.
“During my training, there was not much consideration of these. Now, med students are being more tuned to ethnicity, gender, economics, education level. We all know they have an impact on a patient’s willingness to take medicine, undergo colonoscopy or have people in their home to help manage chronic disease. They become very powerful in the overall care of these global complex medical conditions well beyond GI issues,” Deas said.
10. Narrow specialist panels of high performers
“Within every division of 15, 20, 30 physicians, the difference of cost by physician is three- to fourfold. You can ask if you’re trying to run the most efficient system, why do you continue to use the high cost docs who don’t show any improvement in quality or outcomes? The answer is there isn’t a good reason,” Deas said.
As the compensation and government regulations move toward efficiencies, the allowance for increased costs among high performance will narrow quickly, he said.
“It’s incumbent on you to prepare for that and to know your performance and be able to improve your performance before that time,” Deas said.
11. Social media connection to the patient experience
“The ability to communicate more effectively via social media for education is a major factor,” Deas said.
12. Performance measurement
“We ask physicians to be more cost efficient, deliver a higher value, a better quality of care for the patients, but we don’t really have the tools to give the physicians their performance, to give you transparency into how you do and what needs to be improved,” Deas said. “We have to get to the point to provide you as physicians a good picture of how you compare to your peers on a lot of different measures.”
Attitude, Adaptation
To successfully adapt to each of these aspects of changing medical practice, Deas said it often comes down to individual attitude and understanding of what the most successful practices will have in the future.
“You have to love what you do. ... If you really don’t love it, you’re not going to do well. That’s number one to be successful in an environment where things are changing,” Deas said. “Champion your patient’s best interests. If you put the patient’s best interest as foremost when you’re dealing with change, it becomes a lot easier. Even if the change may have a negative impact to you or your practice, is it something that serves your patients better? If it is, let that be your driver and motivator to change and adopt it into your practice and make it work.”
After that passion, gratitude is the characteristic Deas said is most important.
“One of the reasons I want to look back at the technology changes in medicine through my career is it just makes me grateful for the things that our academicians and other scientists have done that make my life easier and the work we do for patients much more effective,” he said.
And that attitude is key.
“We can have control over our attitude,” Deas said. “If you wake up every day with the idea that it is the one thing you can control, it makes a difference, especially in the long term.”
In that long-term vision, Deas said the successful practices in the future will not all be giant merged practices or tertiary centers. Instead they will do three things well: cultivate strong leadership, assure a secure primary care referral base and deliver value while managing overall costs.
Deas said practices of all sizes will continue to exist and even thrive despite the pressure to merge that seems so prevalent.
“All of them, whether big or small, they’re going to need strong leadership and that’s the focus,” he said.
Part of leadership is treating other physicians, especially PCPs, with respect:
“We need to treat our primary care docs like absolute royalty. Treat them with respect. Communicate effectively with them. Consult them if you’re seeing patients and you think they need to see other specialists work with that primary care doctor and make them happy with the service you’re providing by making their patients happy with the service you’re providing them,” Deas said. “If you don’t remember anything from this session, remember those are the people you need to take care of.”
In the end, physicians need to deliver value to those patients and their PCP referrals, but also to the practice. Additionally, Deas said, incorporating valuable additions like telemedicine and ancillary services will ensure success for future medical practices. – by Katrina Altersitz
Reference: Deas T. The Power of Leadership. Presented at: GI Outlook; Austin, Texas; August 10-12, 2018.