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benzilGuest Post from Deborah L. Benzil, MD, FACS, FAANS
Vice President, AANS
Chair, AANS/CNS Communications and Public Relations Committee
MKMG
Columbia University Medical Center
Mt Kisco, New York

Recently, Becker’s Spine Review tweeted a story entitled, “13 Healthcare Leaders Named Best Performing CEOs.” The rankings from this piece are from Harvard Business Review and are based on stock market number, total shareholder return and the change in each company’s market capitalization (80 percent). In addition, a measurement of environmental, social and governance performance was included (20 percent).

healthcareaAs a neurosurgeon working hard to provide high quality care to my patients in a practice environment that is ever more challenging, I smiled at the thought that healthcare leaders ranked at the top of the business world. Imagine the shock when I actually read the fine print (a detail I fear too many omit).  Let us consider some of these businesses and what they have contributed to patient care improvement in recent years.

Six of the companies primarily work in the arena of pharmaceuticals. Physicians and their patients rely on the investment of such companies to develop and provide a wide spectrum of medications to treat many acute and chronic medical conditions. Clearly for these companies, that investment has reaped extremely high financial rewards. Three additional companies manufacture equipment or supplies to the healthcare industry, items such as catheters and dialysis equipment. Much like pharmaceuticals, these items are important and in the hands of capable CEOs, can be wildly profitable.

Rounding out the list, however, are four companies that raised considerable ire. First and foremost was the presence of Aetna. Despite regulatory efforts to the contrary, our rapidly escalating insurance premiums are benefiting corporate executives and shareholders, rather than patients! Next on this hit parade is Express Scripts, self-described as the largest pharmacy benefit management organization in the U.S. Much like with Aetna, this company takes premium dollars paid by individuals and then controls the flow of those dollars into required medications. They claim to make the use of prescription drugs safer and more affordable. Certainly that might be true, but they, too, are generous to those treating this strictly as business in a big profit way.

Finally, there are McKesson (imaging platforms) and Cerner (electronic health records), which both provide technological solutions that should make healthcare delivery safer and more efficient. Sadly, as most physicians will attest, these systems (along with their partners in crime such as Epic, NextGen, Carestream, and Fuji) are poorly designed, limited in functionality, and far behind in meeting even the basic interchangeability goals that could mean real benefit to patient care. Is it reasonable to suggest — given the enormous amount of federal support provided for these systems development — that these companies answer to the needs of patients and physicians, not the other way around.

As those in healthcare are struggling hard to meet the important challenge of providing “value” in patient care, there remain those on the business side of this service who are allowed to reap enormous profits and then are honored for the successes of their business acumen.  This highlights the conundrums U.S. healthcare faces:

  • Who deserves investment and reward within the arena of healthcare providers (physicians, nurses, therapists, etc.) or administrators and business people who provide no direct or indirect patient care?
  • Do patients derive benefit from the significant, durable high profits that have been realized by these companies?

We struggle with these complex issues facing healthcare delivery today. The quality of our healthcare system cannot be sustained without honoring and rewarding those who spend years learning the science and art of providing direct patient care. Supplying the support and infrastructure for healthcare providers to ensure optimal quality and value through technology (think EHR) and business acumen is essential and should be both encouraged and acknowledged. Physicians stand ready to work with these companies to bring real benefit to our patients.

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