Quarterly News -- Fall 2013
Mark Cullen, MD reports to you the quarterly news for Fall
Mark Cullen, MD
As we head into the new fiscal and academic year, it is my great pleasure to highlight two landmark changes which together augur the advent of a new era for our Division in the history of Stanford Medicine.
The first is the emergence of Stanford’s first Accountable Care Organization—the Stanford HealthCare Alliance—providing the context for a complete re-examination of the role of generalists in the clinical mission of our Academic Health Center. Formerly the focus of clinical development at Stanford has been on those highly technical and specialized aspects of health care in which Stanford could contribute uniquely based on its research and clinical history: Cancer chemo- and radiotherapy; cardiac surgery; solid organ and bone-marrow transplant and the treatment of many rare and hereditary disorders readily come to mind. In this context, generalists were consigned to roles as support caregivers, ancillaries to the main show. To take care of populations, however, requires a full-service, comprehensive system whereby large numbers of patients would receive their total care within the Stanford system—not just a smattering of specialized services. Moreover, for the system to provide the value-added and patient-centered care that the government and payers increasingly demand, that comprehensive care must be coordinated and managed. It’s precisely here that the very unique training and expertise of our various “general medical disciplines” has become so critical and so salient for Stanford. We find ourselves after years on the outside suddenly in the very privileged position of holding the keys to medical-center kingdom—not that we alone could drive a successful, high-functioning health care system, but that such a system cannot even proceed without our strong participation, even leadership. And with the remarkable efforts of Drs Chang and Singh and Morioka-Douglas and Glaseroff and Lindsay—indeed all of our existing and growing primary care faculty-- we have made enormous strides in that direction.
It is in reference to that new reality that the second sea-change—movement from an RVU to salaried based compensation system—must be appreciated and understood. If the old culture of Stanford Medicine is to transform, so too must the system of incentives that motivates our faculty. In a world in which payors reimbursed based on units of service, it made sense that we should reward our clinical efforts based on those units of service. That cognitive services—of which DGMD is far and away the largest generator at Stanford—were reimbursed quite miserably relative to professional fees for tests and procedures was an almost inevitable consequence of a system that rewards “action” over “thought”, resulting in the double whammy of being tied to our minute by minute “unit” generation while still being among the least well compensated. Our new “Mayo Clinic” style system, in which we can offer highly competitive salaries coupled with bonuses reflecting the very things the health care system strives to incent—patient-centeredness, quality and proactive health maintenance—aligns our new stature in the firmament with the deep goals of the health care system for the first time.
To be sure this is only the beginning of a long and likely quite arduous road connecting Stanford medicine past with Stanford Medicine future. But speaking for myself at least, it is great finally be on that train, and—surprise!—to find ourselves for the first time sitting in the engine, not the caboose.