I was a presenter at the Idaho Industrial Commission’s Annual Workers’ Compensation Seminar in Boise Thursday. While I was very happy to have the opportunity to fly here from Florida and blather on for an hour, just attending the keynote presentation itself would have been worth the trip.

The Keynote presenter was Dr. David Pate, CEO of St. Luke’s Health System, Idaho’s largest health provider. Dr. Pate said some surprising things for a medical professional, but his comments resonated to the problems we face in workers’ compensation. He discussed the cutting edge electronic records systems they use to deliver patient medical information to the people who need it, including the patients themselves, via standard mobile devices. He covered what true “patient centric” medicine should look like, as well as getting comprehensive physician performance data into the hands of St. Luke’s attending physicians. Those were impressive topics. 

The real meat of his presentation, however, was his direct assault on the current philosophy and configuration of hospitals and health care.

Pate spoke of the counter productive financial model of medicine today, where physicians who perform more services and sometimes unneeded procedures are rewarded through a “broken” fee for services model. He stressed how doctors who provide appropriate conservative care simply cannot survive in the current model. Their costs are the same as their more surgically active counterparts, and while their results may indeed be equal or superior, they are not profitable for the physician. He spoke extensively of finding ways to reward physicians based on performance, ultimately paying them for outcome over procedures.

Pate also demonstrated how his organization was looking at the entire patient cycle, and was exploring ways to expand care in a pro-active fashion earlier in the process; providing care and support “where the patient is” – in their home, work and schools. He indicated as a CEO of a major hospital chain, he should be hoping for a huge flu season that would fill their hospital beds with weak and ailing patients, but for the health systems of the very near future, a patient hospital admission will represent a failure in overall care.

Indeed, the entire structure of health care remuneration needs to be “turned on its head” in a complete reversal from how it is fashioned currently. Hospitals, along with post acute care, are profit centers today, but must be viewed in the future as cost centers, with the goal of targeted and quality care being provided in a manner as to ultimately avoid those services.

Of course, this can’t happen if the payment system isn’t modified. There is currently no payment method available for the type of interventional medicine Pate spoke of. 

That has to change. 

And, according to Pate, his colleagues at other hospitals who are trying to survive by simply controlling costs are in for a huge surprise. He believes the wave of obesity in children and young adults will quickly overwhelm these facilities, with Diabetes, heart attacks and strokes afflicting the young at a rate never before seen. His argument for proactive care that emphasizes positive outcomes is a solid one for the future of health care, and an absolute must for the workers’ compensation industry.

There was more, but time simply doesn’t allow me to cover it all. Suffice it to say they are, in theory, well positioned to provide medical care appropriate for the needs of tomorrow. 

I do not know much about the medical scene in this state, except that it is currently embroiled in controversy. St. Luke’s has been engaged in an aggressive growth campaign, buying facilities and private physician practices. This is not uncommon, as a number of hospitals around the nation have been engaged in consolidation, strategic alliances and growth as a hedge against the future changes in medicine. This has not been without cost. Currently engaged in an anti-trust suit over the purchase of a large private physician practice, the health system is aggressively defending its position and strategy. Time will tell if they are successful, but I like what I heard. And if they practice what Dr. Pate preaches, I like where they want to go. 

I would be remiss if I did not mention a second presentation at this seminar, given by Dr. Michael Weiss. Dr. Weiss spoke about “Epidural Steroids: Studies, Experience, and Clinical Guidelines”, but in many ways mirrored Dr. Pate’s emphasis on minimally invasive, outcome oriented care. It was, frankly, refreshing to hear. A needed conversation within the medical community is alive and well here in the Gem state.

It makes me think that when it comes to medicine, Boise definitely has it goin’ on.


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