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Saturday, August 07, 2010

Is Boston Getting Serious about Healthcare Reform?

Some time during the early 1970’s I was in a meeting with the clinical chiefs of what is now Brigham and Women’s Hospital in Boston. Mention was made of a particular surgical procedure. Dr. Frances Moore, Chairman of Surgery at the Peter Bent Brigham Hospital, labeled it as experimental. Someone protested, saying that it had been done extensively in some city (St. Louis, as I recall). Dr. Moore’s response was that it had not been done in Boston and that until it was, it was experimental.

Boston medicine generally, and Harvard medicine in particular, has long been known for that sort of arrogance, and not altogether without justification. It is known for its collection of the most renowned minds in medicine.

So perhaps the movement to healthcare reform will not be serious until it is taken up by the medical establishment of Boston.

An early sign in that direction was the creation of the Institute for Healthcare Improvement (IHI) which is based in Boston and its founding executive head, Dr. Don Berwick (now head of Medicare and Medicaid), is a pediatrician with roots in the Harvard Medical School. IHI has had a profound influence in improving the safety and quality of health care.

Then Drs Thomas Lee and James Mongan came out with a book titled Chaos and Organization in Healthcare. Dr. Lee is a senior medical executive at Partners Healthcare – the organization created by the merger of Massachusetts General Hospital and Brigham and Women’s Hospital, both closely affiliated with Harvard Medical School. Dr. Mongan is the recently retied CEO of Partners. The book calls for remedying the lack of organization in health care.

More recently, the Boston Sunday Globe of June 13, 2010, carried an article in which Dr. Gary L. Gottlieb, currently CEO of Partners, said that slowing the rise of health care costs would be an important goal of Partners in the coming year.

So perhaps Boston medicine is beginning to take interest in health care reform. The evidence would be more convincing if it came from the chiefs of Medicine and Surgery in Partners hospitals (who wield the real power in those institutions) or from the Dean of the Harvard Medical School.

But perhaps the expressions of the nominal leaders is a sign that things are moving in that direction and that before too long serious efforts will begin to reform our system of health care.

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