Chapter 17: The Physicians Network

Chapter 17: The Physicians Network

Loading...

Media is loading
 

Description

In this chapter, Dr. Goepfert describes his post-retirement work on the Medical Board of the Physicians Network, a subsidiary of MD Anderson that helps physicians offer better patient care. He explains how a service can be connected to the Physicians Network through evaluation according to MD Anderson guidelines for best practices and standards set by other institutions. (Programs pay Physicians Network a fee.) Right now standards for care in breast, lung, prostate, and colo-rectal cancer are in place and standards are in development to evaluate care for more cancer types. Dr. Goepfert explains that there are nine host programs, and that the Physicians Network link –and the MD Anderson name—helps them with their marketing and funding. In response to a question about the expansion of the MD Anderson name, Dr. Goepfert says that the expansion of MD Anderson standards of care is still not well structured, and not much has been learned from past mistakes. He points out the Orlando, Florida remote site as one that is still very “nebulous” and MD Anderson Espana as a “model of what not to do.” He observes that quality of care relies on the participation of faculty to insure quality in both technical and intellectual components of care, but that faculty are still not clear on how to participate and how they will be rewarded. He explains his concern for the peer review program for Madrid oncology. He says that a strong future for the Physicians Network lies in better cooperation, and notes that while physicians see problems with care in remote sites, administration often does not and does not understand the danger of doing nothing.

Identifier

GeopfertH_02_20120828_C17

Publication Date

8-28-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Post-Retirement Activities; Funny Stories; Building/Transforming the Institution; Beyond the Institution; The Administrator; Institutional Processes; Critical Perspectives on MD Anderson; Post Retirement Activities

Transcript

Helmuth Goepfert, MD:

What everybody remembers me for is my answers to their e-mails. You were not here ten years ago?

Tacey Ann Rosolowski, PhD:

No. I just arrived in Texas just a year ago, so I’m all new. You’re telling me news here.

Helmuth Goepfert, MD:

Oh, yeah. There would be some notification come through the Internet from one of the leaders of the institution. I’m a little bit, I would say, big mouthed sometimes. I get a little arrogant, that’s for sure. And I would put down an answer and just send it to everybody. “This is hogwash.” There was the eternal fight over the reallocation of research space. You can imagine that this is a hot potato. It was always a hot potato. So out came communication from one of the offices of vice presidents and it said, “We’re going to reinitiate a program of evaluation of research space allocations. These are going to be the principles.” I was sort of at the thought of making a very short comment to it, like, for example, “This has been tried umpteen times before. What is going to be new this time?” and send it to everybody. (laughs). So, when I retired I went totally away from the institution for about three years, and then PN approached me.

Tacey Ann Rosolowski, PhD:

And that’s Physicians Network?

Helmuth Goepfert, MD:

Physicians Network and the executive vice president of PN, Mr. [William A.] Hyslop, and Dr. Bill Murphy, who is the chairman of the Physicians Network supervising board, met with me for lunch in order to discuss my possibility of being hired. The first thing they said, “You will have to promise us that you are not going to answer more e-mails.” (laughs)

Tacey Ann Rosolowski, PhD:

Well, since we’re on the topic, would you like to tell me about our involvement with Physicians Network without your e-mails?

Helmuth Goepfert, MD:

The reason for Physicians Network involvement is that, as I told you several times, I was always a believer that we needed to help the physicians away from their pink palaces and marble towers—ivory towers—to do better care. The institutional efforts in this regard have been multiple over the years. They started way back then under Dr. [Charles A.] LeMaistre [Oral History Interview]. They were pursued certainly under Dr. Mendelsohn [Oral History Interview]. Right now, this administration is wanting to launch a big program of national strategy. I think they’re a little bit too full of themselves, but okay. But the Physicians Network sort of offered an opportunity to evaluate programs that would qualify as host programs to become part of a network in which we would send in our team to evaluate certain practices, like radiation oncology practices.

Tacey Ann Rosolowski, PhD:

And you say “we” meaning—?

Helmuth Goepfert, MD:

The Physicians Network.

Tacey Ann Rosolowski, PhD:

Okay, so they would have their evaluators go out?

Helmuth Goepfert, MD:

PN is a subsidiary organization from MD Anderson Cancer Center. It exists as a 503c1 or something like that. So, Physician's Network in itself has created programs of best practices. These are concordant studies in which we evaluate how patients are treated based on the principles dictated by guidelines at MD Anderson, concordant studies to see how they proceed with certain fundamental guidelines that come from organizations like ASCO, like NCNN, like the Institute of Medicine and so forth—so to set certain things that— Breast cancer—after hormonal-positive breast cancer needs to be treated with adequate anti-hormonal therapy, was it done or was it not done? So, these types of things that you look into, and we have created certain very targeted protocols by radiation oncology to evaluate these radiation therapy centers of these host programs that want to improve their care. Now, it costs them money. They pay the Physicians Network for doing this. So, I was interested in that, and they sort of felt I could contribute by participating in this effort, and I certainly do participate in the effort as a part-time activity at this time.

Tacey Ann Rosolowski, PhD:

You are on the board as medical director?

Helmuth Goepfert, MD:

I am a medical director. I’m not on the board. I’m just a medical director. There are five medical directors now. There is one chief medical director, Dr. [Richard J.] Babaian, and there are four of us outside of that—or three more—four more. So, we are the physicians that—and all of these physicians are retired. We’re all retired physicians, so we sort of function as the addendum to this activity. Now, mind you, we have programs of evaluation of care for the four big disease sites. This is breast, colorectal, lung, and prostate. These are the four big killers in this country. But we have tools to evaluate the care of head and neck, lymphoma, leukemia, GYN, ovary and so forth, so there are more in development. Now, this movement has gathered nine host programs that are in the southeast of the United States that are basically located—one in the south part of Massachusetts—south coast. There is one in Pensacola, there is one in Spartanburg, there is one in Mobile, there is one here in East Jefferson, which is in Louisiana, there is one in Chicago, and there is one in Missouri. These are programs that basically use our tools for quality improvement. They do a pretty good job, and they sign a contract for three years. They pay a good lump of money for that, but it helps them in their marketing. If they perform satisfactorily according to our principles, they can market that and they can market it with a slogan that says MD Anderson Cancer Network affiliated or whatever.

Tacey Ann Rosolowski, PhD:

Okay. Now, on the other side, how is Physicians Network funded, and what happens to the funds that these programs pay Physicians Network?

Helmuth Goepfert, MD:

They pay Physicians Network. Our budget is based on that, and MD Anderson Cancer Center gets the proceeds. And we exist, too, because MD Anderson Cancer Center cannot hire anybody on the outside, so MD Anderson Physicians Network can hire the physicians that run the regional cancer care centers. All the satellites that exist around there, they are run by physicians that are hired by MD Anderson Physicians Network.

Tacey Ann Rosolowski, PhD:

This goes to an interesting question of the expansion of the institution into remote locations and how MD Anderson is kind of disseminating a particular standard of care into other institutions. What’s your view of that?

Helmuth Goepfert, MD:

That it is still not well structured. That the definition of levels of participation is haphazard. That not much has been learned from the past, including the existence of the Orlando MD Anderson Cancer Center.

Tacey Ann Rosolowski, PhD:

What’s the situation with that?

Helmuth Goepfert, MD:

That has existed for twenty years and is still sort of nebulous, some of the aspects of it. That the whole process of going in there and trying to create an institution that has the MD Anderson name and logo on it, like, for example, Banner, in Phoenix, is fraught with some problems. That there are organizations that I think should not have proceeded the way they did, like MD Anderson Espana.

Tacey Ann Rosolowski, PhD:

What was the lesson to be learned from MD Anderson Espana?

Helmuth Goepfert, MD:

That they have no resemblance of any quality—involvement of quality care—and we have no participation in what they do. They carry our name, they pay us money, but we have no input in the quality of what they do. That’s a shame. Now, they have other arrangements that are sort of business arrangements only. For example, they have now—with Albert Einstein Hospital in Sao Paulo—they have some kind of consultative arrangement, but what is it? And I say that for the quality of what has to be delivered out there at any of these programs that will be in the network—the Cancer Network that MD Anderson wants to create—Dr. DePinho wants to launch—the participation of faculty for the technical and intellectual component is vital, and the faculty itself still is not clear as to how this is going to happen and how it’s going to be rewarded. That is one of the difficult issues to answer. How are they going to be rewarded? If you want to climb the academic ladder, yes, there is the three-legged stool, but now the stool has more legs. How do you evaluate those legs and how you put it in? I mean, it was—

Tacey Ann Rosolowski, PhD:

Well, and what hours of the day do you put it into?

Helmuth Goepfert, MD:

Yeah. When do you find time for that?

Tacey Ann Rosolowski, PhD:

I interrupted you. I’m sorry.

Helmuth Goepfert, MD:

No, that’s correct. You’re absolutely correct. So, I see that that whole effort is not well thought through. And based on the experience I have had in the twenty-five years since Dr. LeMaistre launched it, I have seen multiple versions of the same, and I’m very concerned right now. Particularly I’m very concerned with the particular aspect of one peer review program—or I would say it’s peer review/on-time review of the care that is given out there that we created for medical oncology. It so happens that the parameters were so stringent that we don’t really capture the patients that need to be evaluated.

Tacey Ann Rosolowski, PhD:

I guess I’m not understanding how that works.

Helmuth Goepfert, MD:

It’s hard to understand, but in creating this program for peer review or on-time evaluation of medical oncologists out there, we placed it at the level of initial treatment with chemotherapy. And initial treatment with chemotherapy, although it is important, it’s a relatively simple thing to fill out. What the physicians out there need is a program that allows them to be evaluated in the management of complex cases—patients with recurrent cancer, patients who have failed previous treatment, that type of thing—not what we have. As I say, we barely get one or two patients to be evaluated per week. People out there treat—what? —fifty to sixty patients, and we don’t get it.

Tacey Ann Rosolowski, PhD:

And so the problem is—?

Helmuth Goepfert, MD:

Is to create a program that will allow us to capture the patients that need to be evaluated and give the physician out there a resemblance of the quality that needs to be delivered.

Tacey Ann Rosolowski, PhD:

Now, is Physicians Network addressing that in some way?

Helmuth Goepfert, MD:

Yeah, but we cannot do it because we need the appropriate faculty to help us with that. We may have the IT people and an IT program to launch an educational program, but the intellectual capacity is not there, and we are having difficulty getting the faculty to help us because the faculty is torn. They have not been given the orders from their leaders that this is part of what you have to do, and we’ll remunerate you for that. That has not been given to them. So, there is a disconnect here, and I think it is a very important disconnect because the business part of the house says, oh, we go out there and just charge them money for a program, but what is the content of the program? I’m worried about that. That is something that will have to be addressed. So, there is more to be done, and Physicians Network is basically the tail of the dog, wagging the dog.

Tacey Ann Rosolowski, PhD:

Right. So, there’s stuff that needs to happen on the front end before it can be fully functional.

Helmuth Goepfert, MD:

And the way I see it, they have not really addressed it, and they have not presented this properly to the faculty for their response, input, and participation.

Tacey Ann Rosolowski, PhD:

If I can ask you, I’d like to just pause the recorder for a second. [The recorder is paused.] Is there anything else that you wanted to say about Physicians Network and the future of it is?

Helmuth Goepfert, MD:

The future definitely will have to be forged in a better, cooperative way. At the present time it’s still not a smooth, multiple-input organization where everybody sees us the same way. And we physicians at Physicians Network are very concerned about the quality of what is being offered, and that is not the view that the business side of the house has.

Tacey Ann Rosolowski, PhD:

Interesting.

Helmuth Goepfert, MD:

So that is something that will have to be remedied if we’re going to—because the market right now is full of questions and people are desperate trying to find the best way to solve the problems that sort of come down on everybody not only from the point of view of the best care but the best care, and at the same time, most cost-efficient care, and everybody is trying to do it in a different form. What is going to be the outcome? God knows. Things may change radically if the election produces something else at the end of the year.

Tacey Ann Rosolowski, PhD:

Right. The context is always—

Helmuth Goepfert, MD:

No, the context is— Unfortunately people don’t understand what’s at stake because folks, by and large, only listen to the television and the loudest voice will prevail. (laughs)

Tacey Ann Rosolowski, PhD:

Absolutely.

Helmuth Goepfert, MD:

So it’s very difficult. One of the difficulties in improving our healthcare is the fact that it is murky, it is complex, and people are not really well educated to comprehend the consequences of not doing anything. And I’m not an expert in healthcare, but I can tell you the fact of the matter that we have already almost eighteen percent of national—the NPG—the national whatever it is—used up in healthcare is prohibitive, and people are not happy with their healthcare here, that’s for sure. But that’s not my thing.

Conditions Governing Access

Open

Chapter 17: The Physicians Network

Share

COinS