Newtown, CT – February 17, 2012
Following the First World War, the French built the Maginot line to protect themselves from another invasion. The Germans simply went around it – Faced with a potentially disruptive force, incumbents react in one of two ways: they innovate or they protect. We see both happening today at a breathtaking pace. Let's start with the basics, the campaign by the American Board of Internal Medicine to encourage Medical Specialty Societies to voluntarily identify five procedures that are commonly overused. Choosing Wisely is a good attempt at professional self-regulation in an environment in which, up to now, more was better, even if physicians have know for a while that it isn't. The American College of Physicians has responded by identifying diagnostic imaging for low-back pain as an easy first target. While we encourage such moves, perhaps, like the Maginot line, it's simply out of date. Bolder steps are being taken by the real innovators, spurred by new incentives and programs. Last week, the CMMI announced a new program to call attention to a concerning trend in pregnancy and maternity care – the inducement of births prior to term – and attract new thinking on tackling this problem. Such innovation is already taking hold in Minnesota and elsewhere with birth centers, freestanding facilities that specialize in taking care of moms and babies, reduce the volume of inductions and C-sections, and have far lower episode costs. In a similar vein, some surgeons in New Jersey, responding to the bundled payment initiative by Horizon Healthcare Innovations, have moved the site of surgery from the traditional fortress to more innovative….and less expensive settings. They win, the patients win, the fortress dwellers lose.
What this means to you – For how long have we known that excessive imaging for low back pain is unnecessary? For how long have we known that early inductions and elective C-sections are harmful to mom and child? For how long have we known that more efficient and effective ways of delivering healthcare are possible? For far too long. Giving up 5 overused procedures for a medical specialty society is almost an insult to the American people. It's a pretense, not innovation. It's a way to maintain that line, protect the incumbents from real disruption. Some aren't even bothering with pretense. They're overtly building up the fortress walls. The brass-knuckled tactics of some include gag clauses and other non-competitive practices to scare away any who would dare disrupt the comfortable lives built up behind fortress walls. However, there's always a way around the fortress, and we're seeing it happen. The Altarum Institute reports that 2011 had the lowest growth in healthcare spending in 50 years. Our work in the field suggests that can go on for a while. When new birthing centers can deliver babies more safely and efficiently than incumbents, when surgeons can perform operations more effectively and at a lower cost by switching settings, the new dawn is on the horizon. The Maginot line fell, and there's a lesson there for those who would hide behind their fortresses: true disruptive innovation cannot be stopped.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.