January 26, 2007

elevate: Answering the Tough Questions

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Medical Center leadership answers the tough questions about what the elevate program is and what it means for the people who work at VUMC.

Question: The goal of health care is to prevent medical problems and advocate healthy living. However, as a hospital we're also seeking increased patient volume and revenue. How can we promote both goals at the same time?

Answer: As a physician, nothing could be more pleasing to me than to see the hospitals of the world meet the wrecking ball. Or perhaps be sold off to become hotels and office buildings. When that happens, it presumably will mean that we've won; that hospitals are no longer useful and that we've found better ways to address acute sickness and major injury and the suffering they bring.

I don't think it's quixotic to believe that at VUMC we're working toward that day. But it will take a considerable amount of time to get there.

The incentives under which we physicians have always operated cast us as agents of healing rather than guardians of health — a meaningful distinction. As we gain more of an upper hand over disease, incentives may shift, such that physicians are paid based on the health status of patients in their care instead of services provided to patients.

Meanwhile, we're left working both sides of the street. And for good reason. Insight into good health furnishes insight into illness, and vice versa. The knowledge and expertise needed to help people stay healthy is of a piece with the knowledge and expertise needed to help people regain health in the face of acute sickness or major injury.

— Harry Jacobson, M.D., vice chancellor for Health Affairs