ANNUAL REPORT 2007: Thoughts on Health Care Reform
By Kyle Kim, MD, neurosurgery chief
Everyone talks about what's wrong with American health care. It seems to me we've created an unworkable system. I've been fortunate to see the workings of our health care landscape from both sides — first from many years in private practice at a major hospital in Pittsburgh, and now from inside a system of integrated care at Group Health. If I needed medical care, I'd much prefer to receive it from doctors in a system like Group Health.
Ten years ago I never would have said that, but my experience here has changed my view.
I had a great private practice. It was tough to leave. At the same time, my practice was run more and more based on business decisions. That's especially true in large metropolitan areas because of the intense competition.
I love it here because we're not paid per widget. Or per craniotomy. We're paid to see patients. We're not expected to do a big, expensive operation when it doesn't make good sense for a particular patient. At Group Health, our practice is driven by evidence of what works. As a patient — and as a purchaser — you want your doctor absolutely committed to evidence-based medicine; it saves lives as well as dollars.
This model increasingly appeals to the most highly regarded practitioners. Our department recently hired Rajiv Sethi, an extraordinary spine surgeon. James Wang is a top expert in movement disorders and functional neurosurgery. Rick Rapport has decades of experience doing intricate epilepsy surgeries. J.C. Leveque, whose focus is minimally invasive spine surgery, joins us in July. Combine this expertise with the incentive to do only what needs doing and you get the best care. I don't think the people outside of Group Health know this. At least not yet.
Our electronic clinical information system helps us as physicians connect with each other and promotes collaboration. We can examine an emergency room CAT scan from our home computers — in the middle of the night if necessary. It also enabled patient Kathleen Turner to e-mail me whenever she had questions about her upcoming surgery.
Technologically, we have the tools we need: MRI, CAT scan, angiography, and focus-beam radiation — which allows us to direct radiation into a space of a few millimeters instead of the entire head. We recently updated our neuro-navigation system that marries real-time pictures in the operating room with previous MRI images, so I can compare what's happening at that moment with what was known before the operation.
When people ask what I'd do with the mishmash of insurance providers, doctors, drug companies, and technology firms contributing to or struggling with our health care crisis, I can't give a perfect answer. But I can explain why a system such as ours — where the only incentive is to do what's best and no more — must be a key part of the solution.
"Each of Group Health's neurosurgeons handles about 200 major cases a year. That keeps us busy," says Dr. Kyle Kim. "But you have to do a lot more surgeries in private practice to pay for all of your expenses."
Kyle Kim, MD, PhD, is board certified in neurosurgery and serves as Group Health's Neurosurgery Chief. He joined the organization in 2005 after years of private practice in Pittsburgh. Dr. Kim received his MD and PhD from the University of Chicago. He underwent neurosurgical training at the University of Washington.
