Mohlenbrock W C
Iameter, San Mateo, CA, USA.
Physician Exec. 1998 Jan-Feb;24(1):26-9.
Clinical decision-making was once the sole purview of physicians, but no longer. Medical judgment has been usurped by third parties in the name of cost control. To reestablish this rightful authority, physicians must organize to assume the financial risks for their patients' health, using objective, clinical information to deliver superior quality outcomes. To successfully manage their patients' clinical and financial risks, physicians need to: (1) establish a structure independent of the hospital medical staff for outpatient contracting; (2) secure a capital partner that supports their independent, clinical decision-making; and (3) be leaders in acquiring and effectively using clinical information that accurately risk-adjusts and integrates both inpatient and outpatient data for all episodes of care. Physicians who acquire these skills will secure premium contracts from purchasers who are demanding value-based health care delivery.
临床决策曾经是医生的专属职责，但如今已不再如此。医疗判断已被第三方以成本控制的名义篡夺。为了重新确立这一正当的权威，医生们必须组织起来，为患者的健康承担财务风险，利用客观的临床信息提供卓越的治疗效果。为了成功管理患者的临床和财务风险，医生需要：（1）建立一个独立于医院医务人员的门诊签约结构；（2）获得一个支持其独立临床决策的资本合作伙伴；（3）成为获取并有效利用临床信息的领导者，这些信息要能准确地进行风险调整，并整合所有治疗阶段的住院和门诊数据。掌握这些技能的医生将从要求基于价值的医疗服务的购买者那里获得优质合同。
