Dr. Spike Lipschutz – February 20, 2014

Dr. Spike Lipschutz M.D., Senior Vice president and Chief Medical Officer at Greenwich Hospital, spoke on the advancement of healthcare over the last century, his insights from 45 yeas of experience and what we he believes we are likely to see in healthcare in coming years.

Dr. Lipschutz began his talk with caveats – his views represent one person’s perspective and he is not an expert in healthcare. He has, however, been in the field for many years and he has a breadth of experience to draw on. These experiences, Dr. Lipschutz continued, have been limited to the Northeast, and doctors from the Mid-West, for example, may view things differently.

One hundred years ago, Dr. Lipschutz explained, there were few effective drugs; no penicillin and no antibiotics. There was little science to medicine. People became doctors with haphazard training. The Flexner Report, issued after a study of medical schools and training, criticized the frequent shoddiness of medical education and advocated more strict science-based standards, holding up Johns Hopkins as a model.

Fifty years ago, Dr. Lipschutz’s father had a heart attack, spent weeks in a hospital and spent weeks in bed at home recuperating. His Aunt Mae suffered agonies with breast cancer and died in pain. Family life suffered. However, there were more effective drugs available. Immunization programs improved public health. Physicians could feel better about the effectiveness of their treatments. There was no political will for promoting effective medical programs.

Now, if anything, we have too many drugs. We have many drugs of proven effectiveness, but also a huge pharmaceutical industry driven by marketing and profits, generating too many drugs and usage of questionable efficacy. We have non-invasive imaging that allows physicians to gather information without cutting and harming the patient, a development that has greatly improved our ability to deliver good health care. That said, we probably give too many CAT scans, and in 20 years we may well find a problem of over-radiation. We have also seen great advances in minimally invasive surgery and the ability to use robotics and digital connectivity to perform long-distance surgery. Heart attack patients spend less time in the hospital and return to active lives much faster than in the past.  Today, the main public health issue is standardization of treatments to ensure consistent ways of effectively treating problems. Costs have ballooned. 50% of Medicare costs are spent on 5% of Medicare patients, the bulk on treatment in the last weeks of life. There is almost no political will in Washington to deal effectively and in an unbiased manner with health care issues.  We just can’t get politics out of the process, and that is too bad. Dr. Lipschutz feels that Obamacare is really Romney/Gingrich care.

And tomorrow, what will we see? Dr. Lipschutz said that we will be hurting for healthcare professionals – doctors, nurses, technicians and aids. We will see procedures customized to drill to the individual based genetic data, and, at the same time, programs for dealing with the broader population. Funds will be limited. We will see yet more drugs, based on gene mapping and molecular biology. There will be yet more consolidation of hospitals and medical groups through acquisitions and mergers, driven by for-profit strategies. Individual doctors, beset by pressures from all directions, are selling their practices to the large hospital groups and joining them.

Dr. Lipschutz commented on how ballooning costs, pressures by federal and state governments to control medical costs, the efforts of for-profit hospital systems to protect profits, and the efforts of individual doctors to deal with the changes in the industry and a variety of pressures they face are all creating wrenching dislocations. In Connecticut, hospitals such as Greenwich Hospital had to deal with a Connecticut tax that disrupted budgets in mid-year. They have had to curtail programs that serve the community but don’t make money. Federal government pay-for-performance programs have strained the system. Medicare and Medicaid reimburse at or below cost of delivery. Private insurers argue that they too shouldn’t pay more than Medicare. Hospitals ask “How can we be paid for what we do?” Why, Dr. Lipschutz asked should a hospital group executive overseeing a $300 million operation be paid less than comparable private industry executives?

Dr. Lipschutz mentioned potential threats of public resistance to prevention programs, resistance to change by health care providers, and resistance by all to innovation. He commented on the difficulty for a patient to select a proper doctor, hospital or program. Advertising only confuses things with claims of “Best! Bestest! Most Bestest in the World!” Hospital ratings are suspect. Basically, we rely on physicians we trust. He described the Patient Protection and Affordable Care Act as a tremendously complex construct. Insurance companies are the largest industry that doesn’t want the Act to change. Why? Because of their influence in its drafting and their understanding of how to make it work for them.

He described how Greenwich Hospital has instituted procedures to continually and obsessively identify and correct errors and poor practices so as to improve patient safety. He quoted Joseph Campbell, “Dig where you stumble; that’s where the treasure is.”

Dr. Lipschutz concluded by saying this all sounds rather glum; the problems are huge, interests are entrenched and things must change, but he is an optimist. What seems impossible is possible.

In the Q and A, Dr. Lipschutz made the following points:

Further consolidation of hospitals and medical groups is inevitable.

The ACA is here to stay and will have a broad effect on our health care system.

Physicians who refuse to serve Medicare patients will continue to grow in number until laws are passed to stop it. We will also see more concierge practices.

Drug-resistant bugs are a growing problem. We are still “ahead of the curve” because of a concerted effort by hospitals to eliminate hospital-created infections by, for example, enforcing hand washing standards.

We will see greater use of nurse practitioners and physician “extenders.” More universities are developing programs to train such medical professionals.

The country has not yet figured out a way to build effective prevention programs, such as through local clinics and expanded use of EMT personnel.

Several years ago, the government stopped research on the medical benefits of marijuana, which has proven beneficial medical benefits, for example in controlling pain. We will see a continued spread of legalization of medical marijuana.