Five Barriers to Post-Reform Efficiency

Janice Simmons, for HealthLeaders Media , April 15, 2010

"Engineers will tell you that in engineering, fragmentation and variation are the enemies of quality and efficiency. It's as every bit as true in medicine as it is in engineering but we reject it because we're all about our independence—and we guard it jealously."

It lends itself well to a sports metaphor, Murphy said. "We're all about tennis, and well-practice medicine is baseball. And not only are we all about tennis . . . too many doctors in the profession are John McEnroe."

4) No burning platform. "We're a profession that is highly resistant to change," Murphy said. "The problem is it's still credible for us maintain the status quo. And as long as we think that—it doesn't matter whether we are right or wrong—as long as we believe it, we'll act on that belief."

An example is implementation of the sustainable growth rate formula in Medicare that would lead to in effect a reduction in physician payments for services this year. This is not likely to happen because they "keep fixing it and rolling it over," he said. "Right now, we're looking down the barrel of a 21% reduction for physician fee services. Nobody believes it's going to happen, including me. They're going to fix it."

If they didn't fix it, there'd be imperative for people to think about doing something different. "Fixing it enables the status quo, and they'll fix it as sure as I'm standing here," he said.

"It's difficult to get people to drive changes in how they deliver care day in and day out—because the history they've lived with," he said. "Every time they got up to the precipice of needing to make a change, the government always fixes it and made it OK to stay the way it was."

5) Healthcare insurance company resistance. Murphy, who works with many insurance companies, says "they are all over the map." Some are "highly compatible, sympathetic, and consistent in the direction we are trying to move in." Others are "highly resistant."

"But the reason I need health insurers to work with me—to figure out how to practice medicine differently—is that I need their data," he said. "Even if you've got a very effective, very high quality electronic medical record, which we do, we can only have data on stuff that occurs within our confines."

When patients go elsewhere for healthcare, the insurance companies will know about it because there is a bill attached to it—"but we don't know about it," he said. "And, you can't manage what you don't know. The data have to be real time."

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Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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