Chapter 27: Creating a Future Under the Affordable Care Act

Title

Chapter 27: Creating a Future Under the Affordable Care Act

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Dr. Rodriguez explains that MD Anderson’s future will be determined by changes to healthcare under the Affordable Care Act. She first talks about the loss in revenue anticipated, then describes initiatives that the Office of Medical Affairs is setting in place to help address anticipated problems. She talks about the need to document all care processes in the spirit of moving toward more evidence-based care and shifting the mindset of providers away from an expert mentality to a spirit of self-reflection and improvement. She also talks about the importance of examining and optimizing all of MD Anderson’s resources.

Identifier

RodriguezA_04_20150605_C27

Publication Date

6-5-2015

Publisher

The Historical Resources Center, Research Medical Library, The University of Texas Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - MDACC in the Future; Critical Perspectives on MD Anderson; MD Anderson History; MD Anderson Culture; Growth and/or Change; The Business of MD Anderson; MD Anderson in the Future; Institutional Processes

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Tacey A. Rosolowski, PhD:

What’s your prognosis? We’re in year four, coming up on the Moon Shot’s anniversary soon. You know, what—what’s the temperature now, and what do you think is going to happen, what needs to happen to get the Institution onto a track? It’ll be different, obviously, but how to get it on track into a place of where the creativity is recognized, where the culture is--

Alma Rodriguez, MD:

Yeah—

Tacey A. Rosolowski, PhD:

—evolving in a productive way?

Alma Rodriguez, MD:

Well, I’m not trying—I hope this doesn’t sound like I’m evading the question—

Tacey A. Rosolowski, PhD:

No.

Alma Rodriguez, MD:

—but the answer is I truly don’t know in that regard. Because I’m actually much more focused on the real threat, the very real threat, very imminent threat of the changes, speaking of another authoritarian system, of the healthcare system governed by the federal new loss around reimbursement for healthcare, specifically for Medicare, which is a significant portion of our patient population, but that will be across the board, the overwhelming likely population in healthcare another ten years from now. And for us in cancer, the threat is really very imminent because, like I said, probably by 2019, given the number of changes that are coming, we likely will be seeing anywhere from five to ten percent reduction in reimbursement, or at least that’s what the pundits say, or predict. That degree of loss of revenue is certainly going to make certain enterprises in this organization unsustainable.

Tacey A. Rosolowski, PhD:

Which kinds of—what are the categories of activity?

Alma Rodriguez, MD:

Well, I can’t predict entirely, but I can tell you that we would not—I already mentioned that we provide a very substantial support to infrastructure for research. We would not be able to afford that. We will not be able to afford that in the future. Now, so seeing that perspective of the future, I have to say I sincerely hope that Dr. DePinho’s vision comes to pass, that we will be able to generate revenue from the research enterprise of the house, because the clinical side of the house cannot support it.

Tacey A. Rosolowski, PhD:

Can’t do it. Yeah. Yeah. And as I understand it, the burden on clinical providers has a systematic—

Alma Rodriguez, MD:

Is only progressive.

Tacey A. Rosolowski, PhD:

Yeah, it’s been increasing.

Alma Rodriguez, MD:

It’s progressive, and the progressive increase is unsustainable. I mean, there’s a threshold above which really sanity, creativity, productivity, declines.

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

And so for some Physicians, I can tell you that the burnout is imminent, if not already active.

Tacey A. Rosolowski, PhD:

And that’s even—and I’m thinking, too, of, you know—I mean, clinicians come in, obviously, with a presumption that they’ll also be doing research, and that it’s pretty impossible to keep that professional balance.

Alma Rodriguez, MD:

Correct. That’s correct.

Tacey A. Rosolowski, PhD:

Yeah. Yeah. I mean, you know, I’m not sure what question to ask you about, you know, this specter that’s looming. You know, is your office looking ahead towards this moment, 2019? Or at least these other changes—

Alma Rodriguez, MD:

Yes.

Tacey A. Rosolowski, PhD:

What kinds of questions are you entertaining? What kinds of actions are you starting to take?

Alma Rodriguez, MD:

Right. So first of all, we need to educate people, and the message is slowly making its way down the ramps. In fact, this week, there was a symposium in which economic issues of healthcare were discussed. There are some very specific changes that we will need to make; number one, we will need to be much more conscientious about the documentation of what we do and how we do it, because those, in the end, you know, the attorneys say, if it’s not written, it didn’t happen. That’s a lawyerism. But that is a fact. If it’s not somewhere where it can be—that information can be retrieved, then that information cannot be conveyed; it cannot be reported, it cannot be seen. So managing information is going to be one of—it has to be an imperative that we take very seriously. And to that end, I’m hoping that our new Electronic Health Record will be one of the tools to facilitate that for us. But in the end, you know, any system is purely that; it’s just a system, it’s just a method, it’s just tool. It has to—everything hinges on human behavior; so how we do what we do and how we document what we do is going to be imperative. Secondly is that we have to feel comfortable with looking at this information, that we don’t get defensive, that we don’t get angry and that we simply see it as opportunities for change, or opportunities for self-reflection and self-improvement. And that’s a major psychological and cultural shift in medicine, simply because we tend to see everything as—anything that doesn’t align with what we hope or expect of ourselves, we see that as embarrassing, humiliating, deprecating, etc.

Tacey A. Rosolowski, PhD:

And get defensive.

Alma Rodriguez, MD:

Then a defensive attitude is generated. We have to get over that, and we simply have to see it as just information. Information that might require some change, or might not. It may be fabulous. We may surprise and shock ourselves and do extremely well. That’s what I hope for. We happen to be a culture that is very, like I said, performance-driven. I’m hoping that that culture will show in its best light as one that will see this information towards better performance, rather than towards self-flagellation, if you will.

Tacey A. Rosolowski, PhD:

Right. Yeah. Absolutely.

Alma Rodriguez, MD:

So those are very—so information, information, information—

Tacey A. Rosolowski, PhD:

Mm-hmm?

Alma Rodriguez, MD:

—is an important one. The second one is acquiring a totally different set of skills that have to do with—I’m trying to think of the appropriate terms—but it has to do with shifting from the expert-centered mentality that we have lived with, which has been—and that many of us were trained with, as a matter of fact, which is, Dr. So-and-So is the most knowledgeable person, and whatever he or she says, goes, because they are the best. Going from that to saying, what do we know, what has been demonstrated, what is the best data? And it doesn’t have to be our own data; what is the best data from all our peers? And what is the most appropriate, taking all of these factors into consideration? Never mind that I am the Big Kahuna, what do my friends and peers think about this particular situation? So although we talk about evidence-based care, the truth is that culturally, we still have a great deal of the expert mentality. I think we’ll have to overcome that to a greater degree. Most of the young Physicians, actually, are very attuned to the knowledge-based decision-making process versus the expert. It’s also a generational thing.

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

And I think as we move towards a younger workforce, we will, hopefully, also overcome the expert base mentality. That’s another cultural change that we will have to overcome.

Tacey A. Rosolowski, PhD:

Interesting. Yeah.

Alma Rodriguez, MD:

And lastly, that we will have to also think very consciously about the value of all the resources we have; how fortunate we are to have as much as we have, and how at some point, we can’t keep demanding more, that we will have to make do the best with what we’ve got. How can we most optimally utilize resources? That’s the other skillset; resource utilization and consciousness and awareness about resource utilization. So managing information, managing knowledge and managing resources.

Tacey A. Rosolowski, PhD:

And resources, yeah. Yeah. Very interesting. A lot of change demanded. You know, it is a different Institution, in different times.

Alma Rodriguez, MD:

Mm-hmm [affirmative].

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