What Is The Future Of Collaborative Medicine?

David Edward Marcinko, MBA, CMP, and Professor Hope Rachel Hetico, RN, MHA, CPQH, CMP

   1. Patient centered care (demand-driven) versus podiatrist centered care (supply-driven). Patient centered care is the antithesis of command control podiatry, in which patients are engaged collaborators rather than passive followers. This market responsive model has the following characteristics.

• 24/7/365 access versus 9 to 5 banker’s hours
• Early technology adopters versus late technology adopters
• Patient selected caregivers versus practice/MCO selected caregivers
• Patient time sensitive versus patient time insensitive
• Low office overhead versus high office overhead
• Fewer full-time employees (FTEs) versus more FTEs
• Same day open access medical services versus appointment scheduling
• Quality care versus quantity of care
• Preventative culture versus repeated interventions
• Physician-patient satisfaction versus enterprise-wide frustration
• Next generation healthcare versus last generation delivery chain
• Generalists versus surgeons
• Professionalism versus merchantism

   2. The micro-podiatry practice business model. The emerging “micro-practice” model may be an ideal structure for podiatry given its limited body scope. A low overhead, technology driven, labor reduced, electronically connected and often mobile practice allows more doctor control and patient face time. It is ideal for those patients who pay cash, have a high deductible insurance plan or high co-pays. It is also ideal for an aging population and the renaissance of primary podiatric medicine on the horizon, despite some misguided surgical mavens and the Council on Podiatric Medical Education (CPME), which is too surgically oriented, or concierge practices.

   3. Economically guaranteed podiatric care. Primary podiatric medicine is also ideal for the “satisfaction-guaranteed” model. Yet this economic business model may have begun with whole body medicine at the Detroit Medical Center. In 2007, this facility offered patients a credit of up to $100 if they were not satisfied with inpatient services or an overnight visit.7

What The Experts Say About The Changing Healthcare Landscape

In Time magazine, healthcare journalist Bonnie Rochman explored the ramifications of the “empowerment movement” she calls “Patient 2.0.” In her essay, she profiled the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and assists doctors to support patients on this data intensive quest.”8

   As Holstein and Lundberg said, “All medical and health care is intensely personal: one patient, one professional, one moment, one decision. The patient is best served by fully participating. With American health care reform imminent, participation for self-preservation becomes even more important.”9

   Finally, in the New England Journal of Medicine, Hartzband and Groopman claim that nothing in the history of medical innovation “has changed clinical practice more fundamentally than the Internet.”10 The increased access to medical information is “redefining the roles of physician and patient.”

   Donald Berwick, MD, who leads the Center For Medicare and Medicaid Services (CMS), defined patient-centered care in a way that sounds much closer to nursing school models than any medical models. Berwick argues that it is all about asking the patient: “What do you want and need?” “What is your way?” “How am I doing at meeting your needs?” or “How can I help you?”11

   Isn’t that what nurses — and doctors — once asked?

   Although one may surmise that the next generation of Internet savvy doctors are most likely to turn up the volume in Health 2.0 participation, no patient of any age is inclined to go back to the Health 1.0 era, if Rochman, Lundberg, Hartzband, Groopman and Berwick are correct. Welcome to the future of lean and participatory podiatric medicine.

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