Innovation Needed to Quell Health Care "Chaos"

Newswise — A task force of leading internal medicine doctors is recommending significant changes to their profession and the health care industry so they can better serve patients while stemming "chaos" in the current health care system.

The task force, chaired by Eric B. Larson, MD, MPH, director of Group Health Cooperative's Center for Health Studies, will publish a summary of its report in the April 20 issue of the Annals of Internal Medicine. The task force was charged by the Society of General Internal Medicine—a group of physician researchers in the field—to redefine their profession in light of its "uncertain future."

The report points to serious problems in the American health care system—including declining access to primary care, high levels of uninsurance, inefficiency, medical errors, and inconsistent quality control. The group's recommendations include changes in the ways doctors are paid, general internists are trained, and many internal medicine practices are organized.

"Examining the crisis in our nation's current non-system, we became convinced that the time is ripe for innovation," said Larson. "As general internists, we are guided by what's best for patients and the public at large, and we're making these recommendations based on those interests."

The recommendations include steps to:

· Abandon, reform, or restructure current financing of physician services—especially fee-for-service. Changes "must recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality, efficiency, and provide comprehensive, ongoing care," the task force wrote.

· Embrace changes in information systems, "especially those that promise to enhance patient partnership and self-efficacy, reduce costs, and improve care efficiency and outcomes."

· Promote education and training for general internists that include both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership.

· Remain true to general internal medicine's core values and competencies—even though market forces may tempt the field to abandon them.

Larson and other task force members will present the report at the annual session of ACP in New Orleans on April 22-24.

The April 20 issue of Annals also includes commentaries about the recommendations from five physicians, each from different types of medical practice.

Internal medicine doctors, also called "internists," are the nation's largest physician specialty group. Some provide primary care while others sub-specialize in specific areas such as cardiology, oncology, or geriatrics.

In addition to Larson, members of the task force include:

· Stephan D. Fihn, MD, MPH, University of Washington, Harborview Medical Center, Seattle, WA· Lynne M. Kirk, MD, University of Texas, Southwestern, Dallas, TX· Wendy Levinson, MD, University of Toronto, Toronto, Ontario, Canada· Ronald V. Loge, MD, The Southwestern Montana Clinic, Dillon, Montana· Eileen Reynolds, MD, Beth Israel Deaconess Medical Center, Boston, MA· Lewis Sandy MD, MBA, United Health Care, Minneapolis, MN· Steven Schroeder, MD, University of California, San Francisco, CA· Neil Wenger, MD, MPH, UCLA, Medical Center, Los Angeles, CA· Mark Williams, MD, Emory University, Atlanta, GA

About Eric B. Larson, MD, MPHEric B. Larson, MD, MPH, is director of the Center for Health Studies at Group Health Cooperative in Seattle.

On April 22, he will become chair of the Board of Regents of the American College of Physicians, the national organization of doctors of internal medicine. With 115,000 members, ACP is the second largest physician group in the U.S.

Larson is former president of the Society of General Internal Medicine (SGIM), an international organization of physicians and others who combine caring for patients with educating and doing research. On May 15, SGIM will bestow upon Larson its highest honor, the Robert J. Glaser Award, which recognizes outstanding contributions to research and education in generalism in medicine.

Larson is an attending physician, professor of medicine, and adjunct professor of health services at the University of Washington (UW). He was both medical director for the University Medical Center and associate dean for clinical affairs at its School of Medicine from 1989 to 2002.

A commissioner on the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Larson has considerable experience and expertise in quality improvement, patient safety, and risk reduction. His research has included the establishment of an Alzheimer's disease Patient Registry at Group Health in 1987, which was the beginning of an ongoing UW/Group Health research program into dementia and aging. Today that program also involves projects related to promoting "successful aging" and high functioning in seniors.

About Group Health Cooperative and the Center for Health StudiesFounded in 1947, Group Health is a consumer-governed nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and Group Health Options, Inc., serve more than 540,000 members in Washington and Idaho. GroupHealth Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. Funded primarily through government and private research grants, CHS is located in Seattle, Washington.