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Fam Pract Manag. 1999;6(9):9

Corporate medicine has become one of those phrases that have no real definition but still make most physicians shudder. It is used to describe everything from a managed care organization to a physician organization to a hospital-run organization. Whatever organizations we include, they all have one thing in common: They view health care as a discipline that encompasses both the clinical and the financial. How these organizations balance the two, though, makes all the difference in the world.

As physicians, we are often at the mercy of corporate medicine. We are the ones left trying to deliver high-quality, patient-focused and family-focused care while the corporate side tries to ratchet down costs. Even I, a medical director for a large physician organization, have days when I just want to run away and hide in a small office someplace far away from today's health care world.

Unfortunately, there are fewer and fewer places to hide. And, I would argue, part of the problem is that we have hidden for too long. We physicians need to admit that there is a reason why corporate medicine in the form of managed care has been so successful: Managed care companies have been able to reduce the cost of care. In fact, managed care has removed a lot of the waste from medicine, and that is a good thing. Until recently, removing waste has been pretty easy. Health care was so inefficient 10 years ago that anyone could have found a way to bring costs down without negatively affecting patient care. But it's not so easy anymore.

And that brings me back to the balancing act between the clinical and the financial. So far, corporate medicine has largely seen physicians as line workers. As family physicians, we have often been the most popular of these line workers; after all, we offer a wide range of relatively inexpensive services to patients of all ages. Our efforts helped make managed care strong. If we are to reclaim our position as the care delivery experts in the health care industry, we need to develop a voice that is as strong as that of the managed care companies. We need to organize ourselves into our own form of corporate medicine, one where the clinical is on equal footing with the financial.

That's one reason I believe physician organizations are so important. Are they corporate medicine? I guess so, since by my own definition corporate medicine involves balancing clinical and financial considerations. However, unlike traditional managed care companies that too often emphasize only the bottom line, physician organizations are learning to strike the right balance between the clinical and the financial. Physicians in these organizations are taking the lead in demonstrating that good financial results are short-term at best without a corresponding improvement in the health of the patients.

It is not up to managed care organizations to tell us what quality is; we should be telling them. While physician organizations and traditional managed care organizations may both use today's catch phrase — providing the appropriate level of care at the appropriate time — we are far more likely to define appropriate care as high-quality care and the appropriate time as being before a problem arises. The key is that physician organizations realize that denying or restricting care merely because it will improve the bottom line is unacceptable.

Physician organizations are also reshaping how care is delivered by offering member physicians the systems and programs that can help them manage the more challenging patients, such as the frail elderly or Medicaid patients with multiple conditions. For example, at MedStar, we provide “personal health coordinators” for our Medicare HMO members. Our health coordinators contact all new Medicare HMO enrollees, help them complete a health risk assessment, and serve as an ongoing resource to them by helping coordinate care and other needed social services. Since most seniors are new to managed care and do not understand the authorizations and referrals that often come with it, the health coordinator also fills an educational role in helping seniors make the transition from Medicare to managed Medicare.

Corporate medicine is here to stay, but we physicians have the power to redefine it, to give back to physicians control over the care their patients receive — but in the context of physician organizations that provide support, maximize efficiency and embody fiscal responsibility.

Editor's note: A slightly different version of this article first appeared in The Maryland Family Doctor, Summer 1998, page 12. © 1999 Barbara Gardner Cook, MD. Adapted with permission.

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