Straight Talk - How'd I do with my 2010 prognostications?

December 30, 2010

Dear Friends and Colleagues,

Welcome to the final Straight Talk of 2010. Just in case you're checking, in the very first Straight Talk of this year (, I predicted that we in healthcare would begin to see four trends move to center stage. Next week I'll follow up with predictions for 2011.

How'd I do with my 2010 prognostications? Well, I missed the mark on one of them but scored pretty well on the other three. Here are the four trends we talked about last January:


  1. Physician integration.Bulls eye” on this first prediction. As the year ends, NCH has partnered with 65 physicians, 20 midlevel providers, and about 400 new colleagues. And this is just a start on integration. Our payers—Medicare, Medicaid, and probably the private insurers—will migrate as quickly as possible from quantity to quality and volume to value. Patients, insurers, and caregivers alike should have the same goals of covering most everyone, removing barriers among caregivers, eliminating waste and fraud, creating seamlessness, and focusing on evidenced-based medicine. Whether we evolve to a single payer system depends on how well we can add value with integration. Certainly Medicare and probably soon Medicaid will strongly encourage an integrated system to ameliorate the crippling 6% annual increase on spending for healthcare. If we fail at integration, a single payer system will probably be imposed so we can compete in the global economy.
  1. Technology. Again, the prediction was on point. (Okay, maybe this was a “no-brainer!”) The electronic medical record is thriving, as we partner with many outpatient offices already at an advanced state. Last week, LPN Nancy Gould, longtime colleague of pediatrician Dr. Dulce Dudley, showed me their customized system. Their busy office switched to electronic records about five years ago. Today, they're almost paperless. Meanwhile, we made three significant upgrades to our Cerner inpatient system, to facilitate a new look and friendlier feel. We've started the discussion about integrating the inpatient system with our newly-adapted outpatient system. We're working on simplifying documentation in our ER and ICUs. And the technology beat continues at full speed.
  1. Prevention. This is probably our region's and nation's most important long-term community health goal. Locally, our progress was confirmed when the Robert Wood Johnson Foundation and University of Wisconsin Population Department found that Collier County is the healthiest of 67 counties in Florida. We are 2nd and 3rd respectively, in mortality and morbidity in the state but 11th in health factors, such as teenage pregnancy, access to primary care, percentage of uninsured, unemployment rates, and air pollution-particulate matter days (which translates to smoke from forest fires). So we have much work to do in this area.
  1. Personal healthcare and genomics. This is the one area that experienced slower-than-expected progress. One problem, noted in a Modern Healthcare article (“Not Yet in Sequence”, November 22, 2010) is that the clinical utility of testing has not yet been established. The Government Accountability Office “accused 10 of the 15 companies it investigated of engaging in deceptive marketing, misinformation and questionable practices.” So the jury is still out on genomic medicine.

But as they say, three out of four ain't bad. Next year, I'll stick to areas, like the first three, where we at NCH can make a significant, direct impact. I'll share those predictions with you next week. For now, I hope each of you has a most pleasant and peaceful New Year's celebration. See you in 2011!


Allen S. Weiss, M.D., President and CEO

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