Everyone Wins
There were 117 awards during high school graduation this week, felt sort of like if healthcare had an awards night and honored everyone who showed up wearing scrubs. There were 11 art awards, 16 english, 14 science, and 30 for music. If your instrument made a sound – award. If you sang low and high - award. And if you could write a sentence, run a mile, and make a half decent oral argument why Pluto ought to be a planet, which it obviously should in my opinion, then that was like 3 awards. There was a writing award for best prose, one for best persuasion, and even one for best passion. Even math had a moment, with honors for best parallelogram and best impersonation of Matt Damon’s Will Hunting. Really? Only history seemed to be light on the honors. There was the ancient civilization award, US history, and then one of those awards you love as a parent, but you also feel embarrassed about, the “this kid really showed interest and tried and showed creativity award” given to the student who when asked to name his favorite era, said “Bill Buckner. Because I’m a Mets fan.” Back when I graduated high school there were 5 awards: history, math, English, gym and the arts. Music, band, orchestra and singing were all one award and James McKenzie’s cool solo drum set to the Moody Blues got him the nod. There was no science award, even though green was a Pictionary category. The history, math and English awards all went to Becky Kerstein, our valedictorian. I got the gym award. I feel like healthcare is in a bit of a similar situation these days, doling out more awards in recent years than a suburban high school with mostly average students whose parents think all their kids are above average. We’re giving extra reimbursement just for “sharing data,” enhanced rates for opening up a clinic, and a $1,000 payment just if you offer medication assisted treatment each month. Many major specialists can now get paid a $1000 extra just for doing something outside the 4 walls of a hospital, others negotiate up to a 50% share of savings which adds up to tens of thousands of dollars in bonus payments if you are good at your job. We’ve set a bar and it’s low enough many are hitting it, but we are about 3-4 years out, if I had to venture a guess, from a moment when that bar needs to move or we learn that all those awards and rewards we got were nice, but aren’t coming anymore. Some will keep innovating. Some are like Becky and James, one a college professor, the other a former Julliard teacher. Some may not get bonuses anymore or paid for performance and revert to being average again, not that there’s anything wrong with that. That’s because we need average. Average means access and it helps us know who to reward. Maybe in 3-4 years we can work on helping the mediocre doctors, nurses, therapists, coaches among us to do the work without always needing the extra check. We can adjust by applauding clinicians and front-line workers who diagnose and treat without the sole help of a lab test or imaging but by using clinical judgment and experience. “Not every 70 year old with a 400 calcium score needs to get a cardiac stress test,” my cardiologist friend Dr. Kramer says. It’s just one example of hundreds on what managed care is supposed to mean. How about ‘dem apples….