Page 9 - Delaware Medical Journal - May/June 2018

PRESIDENT’S PAGE
RICHARD W. HENDERSON, MD
MSD President Richard W. Henderson, MD is an Obstetrician and Gynecologist who practices at Saint Francis Healthcare.
Health Care Transformation: The Tip of the Iceberg
Health care has changed dramatically since I graduated from medical school in 1980 and
completed my residency training in obstetrics and gynecology in 1984.
Information and knowledge that was acquired primarily through books at that time is now immediately accessible electronically on almost any mobile platform. I’m also certain that the term “mobile platform” meant something completely different then! Today,
the addition of new information and knowledge is proceeding at a mind- bending pace.
The way health care is paid for has also changed. When I decided to stay in Delaware and establish a practice
in Wilmington, I began to pick the brains of the attending physicians
that I respected about the nonmedical aspects of medicine and running an office. This wasn’t part of my medical education or training during residency! Most were generous with their advice and recommendations, especially regarding the creation of a fee schedule. The fee schedule was very important because it would tell the insurance plans how much I expected to be compensated for the care and services I would provide. This, of course, was under the traditional fee- for-service model for reimbursement. There were no conversations, or at
least none that I can recall, about cost, patient outcomes, or quality.
The first time I really began paying attention to the nonmedical aspects
of health care was during the Clinton administration from 1993 to 2001.
As you will recall, the Clinton health care plan was introduced in 1993 and generated a fire-storm response. This included the now famous or infamous “Harry and Louise” television advertising campaign that ran from September 2013 to September 2014. This was the first time I became aware of the serious discussions about the cost of health care, quality-of-care issues, and reducing or setting fees for physicians who charge per procedure using the fee-for-service system of reimbursement. The Clinton health care plan proposal failed for a number of reasons. However, what we now also know is, what that plan proposed was only the tip of the iceberg of the transformation of health care that would follow.
Not only has transformation continued, but its pace has accelerated at both the national and state levels. The central driving force of this transformation is the rapidly increasing cost associated with health care. How transformation is approached may change from administration to administration and state to state, but the focus remains the
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