A new year provides an opportunity to reflect on how we might make a difference in our personal and professional lives. It allows us to learn from past successes and failures and consider better ways to apply ourselves to things that matter for us and those whom we serve.
This year is also an election year, and the results of elections can help frame the context for our personal and professional lives. Physicians and physician leaders are themselves an important segment of the population. In addition, these same physicians and physician leaders, by virtue of their work, are advocates for the health and healthcare needs of broad groups of the electorate.
For this issue, I enlisted the assistance of three members of PLJ’s Editorial Board, Suzanne Kaseta, MD, MMM, CPE, FAAP, FACHE, FAAPL; David F. Lewis, MD, MBA, CPE; and Dilip R. Patel, MBBS, MBA, MPH, FAAP, FACSM, FAACPDM, CPE, to provide some thoughts on what physician leaders might like to learn from candidates to earn our votes. Each Editorial Board member was asked two questions.
What would you hope to learn about a candidate’s proposed health platform that would be encouraging for you as you evaluate their candidacy?
From your perspective, what ought candidates be focused on that could have the greatest impact for the health and healthcare for those you care for?
Their responses are incorporated here and lightly edited for consistency and flow.
Tony Slonim: Suzanne, let’s start with you. What would you hope to learn about a candidate’s proposed health platform that would be encouraging for you as you evaluate their candidacy?
Suzanne Kaseta: Well, Tony, for me, I would like to understand how a candidate plans to address comprehensive mental healthcare for children and adults. Addressing the long-standing and worsening crisis of mental health in this country is an important societal problem. These mental health challenges affect children and families and have grown considerably more difficult since the COVID-19 pandemic. If there were programs aimed at addressing the mental health needs of children and adolescents, these individuals would grow into healthier adults and provide long-term gains in our society’s mental health.
In addition to programming, there needs to be funding, so I would also like to learn how a candidate plans to advocate for appropriate payment reform and parity for both government and commercial payers in mental healthcare.
Slonim: Thank you, Suzanne. David, what are your thoughts?
David Lewis: Tony, there are several areas in which candidates can provide me with some information. First, I would like to learn about their funding philosophy for Medicare and Medicaid. Is the candidate going to continue at current rates or will they be making cuts to these programs?
Second, we have been working on value-based care for a while. When does the candidate think that value-based care will be solidly in place and will this be a priority for them during their term if they are elected?
Third, there is a massive shortage in the financing of healthcare. Hospitals are unable to survive with escalating costs and little change in the reimbursement from third-party payers. What steps will the candidate take to fix the financing gap in healthcare in this country?
Finally, how will the candidate address the issues with pharma? For a long time, pharma has been a benefactor in healthcare and I would like to know what the candidate thinks could be done to address this.
Slonim: Thank you, David. Dilip, can you please share a few thoughts on what you might be looking for in a candidate?
Dilip Patel: Tony, I would like to see how a candidate has contributed to or plans to contribute to reducing the ever-increasing regulatory and administrative burdens on practicing physicians. Although, we talk about the “U.S. health system” compared to other developed countries, it is fair to say that we in this nation do not have “a health system” — rather, [we have] a patchwork of local and regional “health systems,” each with its own operational characteristics.
Given the status of the healthcare delivery models in the United States, it would be interesting to learn how the candidate envisions empowering effective local and regional models of care delivery that best suit the needs of the populations served.
Slonim: Thank you all for your thoughts. I personally have a pretty low bar for candidates. There’s a lot going on in the world today across several fronts in addition to healthcare. And, as physician leaders, we know how complex our work can be.
I would like to know that a candidate has a broad understanding of some of the challenges that people face with accessing healthcare because of the bureaucracy, administrative burden, and personal expense. I believe we need candidates who are sympathetic to these people and can tap into a cadre of respected health and healthcare experts to assist them in identifying and implementing real solutions to help people gain access and live healthier lives.
Okay, let’s move onto the second question: From your perspective, what ought candidates be focused on that could have the greatest impact for the health and healthcare for those you care for? David, what are your thoughts on this?
Lewis: I believe that they should focus on preventive care, maintaining the NIH budget so that healthcare continues to progress, and providing a mechanism for holding the healthcare industry accountable for appropriate outcomes.
Slonim: Thank you, David. Dilip, what are your thoughts?
Patel: Over the past decade or more, the administrative burden on practicing physicians has continued to increase. This has contributed to the increased cost of care delivery.
There is considerable debate regarding the large range of patient surveys and quality measures from different stakeholders, all of whom have their own vested interests in these data, and whether they have a meaningful impact on patient outcomes.
Candidates should focus on reducing the administrative burdens on practitioners so that their time can be reallocated to patient care.
Slonim: Thank you, Dilip. Suzanne, please share your thoughts.
Kaseta: Tony, I think that one key component would be advocating for Medicaid parity with Medicare. As a pediatrician and an administrator working in a pediatric organization, [I believe] providers are not compensated appropriately for the care they provide to Medicaid patients.
Personally and organizationally, it is deep within our mission to provide excellent care to all children, but in pediatrics, where the margins are already so thin, this lack of parity makes it incredibly difficult. This leads to considerable downstream impacts, for both patient care and for organizational functioning, from recruitment to the ability to provide and sustain comprehensive benefits to providers.
In addition, continuing, supporting, and strengthening the Affordable Care Act, Medicaid, and CHIP is vitally important for all patients, but especially pediatric patients.
Also, in pediatrics, vaccination is one of the most important things we do. A presidential candidate who vocally supports evidence-based science and medicine, especially immunizations for children and adults, and works to combat the politicalization of vaccines and the widespread misinformation, would have a significant impact on the health and wellbeing of children and the entire population.
Slonim: Thank you, Suzanne. You have all touched on components of what I believe to be what candidates ought to focus on. Each day, patients and doctors spend an inordinate amount of time simply trying to break into a system that is trying to restrict a patient’s access to services.
We are still practicing medicine in much the same way we did decades ago. However, we are now doing it with computers and considerably more information than we ever could have imagined; yet we practice as though we are still working on paper and the knowledge base is finite.
I would like to democratize services that are evidence-based and of low risk so that people can enjoy maximum access to health services. There have been some improvements in this area. For example, if a patient can no longer hear, they can access a hearing aid without me writing them an order.
There is more we can do. When a woman with a history of recurrent urinary tract infections (UTIs) becomes symptomatic on Saturday night, why should she have to go to the emergency department or urgent care? She knows better than me that she has a UTI and should be equipped to deal with that issue without leaving her home because her physician provided her with the medications she needs in her medicine cabinet.
Patients and doctors alike want this. Patients want improved access to care that they know they need and doctors want to be freed up from these routine demands so they can focus on providing improved and efficient care to complex patients who really need us to think and apply what we have learned in our careers.
Let Your Voice be Heard
A big thank you to Suzanne, David, and Dilip for contributing to our conversation.
This year, candidates across the country will participate in local, state, and national elections that can impact our work and the lives of our patients. We should be asking them about their thoughts regarding how they can better help us care for our patients and communities.
And, a note of appreciation to all of the members of the Editorial Board and our management team of PLJ who work consistently to bring you contemporary and thought-provoking insights that help physician leaders to think differently about the challenges they face each day.