you [Music]
[Music]
[Music] so the next time you drive down a major
so the next time you drive down a major
so the next time you drive down a major roadway or highway simply look you
roadway or highway simply look you
roadway or highway simply look you likely see signs or billboards
likely see signs or billboards
likely see signs or billboards advertising the services of a health
advertising the services of a health
advertising the services of a health system or hospital or increasingly
system or hospital or increasingly
system or hospital or increasingly emergency services pointing out things
emergency services pointing out things
emergency services pointing out things like efficiency and quicker care and
like efficiency and quicker care and
like efficiency and quicker care and faster care all obviously an attempt to
faster care all obviously an attempt to
faster care all obviously an attempt to actually track paying patients but
actually track paying patients but
actually track paying patients but there’s a story behind this and I think
there’s a story behind this and I think
there’s a story behind this and I think it’s important for you to understand the
it’s important for you to understand the
it’s important for you to understand the dimensions in the emergency care has not
dimensions in the emergency care has not
dimensions in the emergency care has not just become an integral part of modern
just become an integral part of modern
just become an integral part of modern health care but it’s become truly the
health care but it’s become truly the
health care but it’s become truly the safety net for health system that’s a
safety net for health system that’s a
safety net for health system that’s a need of repair with emergency department
need of repair with emergency department
need of repair with emergency department visits actually growing to over 140
visits actually growing to over 140
visits actually growing to over 140 million visits a year hospitals
million visits a year hospitals
million visits a year hospitals especially our safety net hospitals are
especially our safety net hospitals are
especially our safety net hospitals are at a breaking point and costs are
at a breaking point and costs are
at a breaking point and costs are mounting so one may ask the question how
mounting so one may ask the question how
mounting so one may ask the question how do we get here how did our safety net
do we get here how did our safety net
do we get here how did our safety net system actually evolve to this point
system actually evolve to this point
system actually evolve to this point well we have to go back to more than 50
well we have to go back to more than 50
well we have to go back to more than 50 years ago to understand what happened
years ago to understand what happened
years ago to understand what happened and this is the birth of emergency
and this is the birth of emergency
and this is the birth of emergency medicine as a specialty so you see in
medicine as a specialty so you see in
medicine as a specialty so you see in 1961 a group of physicians family
1961 a group of physicians family
1961 a group of physicians family physicians to be exact
physicians to be exact
physicians to be exact decided that they were going to leave
decided that they were going to leave
decided that they were going to leave their practices their well-developed
their practices their well-developed
their practices their well-developed primary care practices the Philibert all
primary care practices the Philibert all
primary care practices the Philibert all we need in the health care system at the
we need in the health care system at the
we need in the health care system at the time and that was to fulfill the need to
time and that was to fulfill the need to
time and that was to fulfill the need to provide after-hours care reliably during
provide after-hours care reliably during
provide after-hours care reliably during that period of time so in the basement
that period of time so in the basement
that period of time so in the basement of a hospital in Alexandria Virginia
of a hospital in Alexandria Virginia
of a hospital in Alexandria Virginia they opened up a one-room to bad
they opened up a one-room to bad
they opened up a one-room to bad emergency air practice and this was
emergency air practice and this was
emergency air practice and this was called the Alexandria plan and this plan
called the Alexandria plan and this plan
called the Alexandria plan and this plan actually served as one of the blueprints
actually served as one of the blueprints
actually served as one of the blueprints for what emergency medicine has become
for what emergency medicine has become
for what emergency medicine has become today a phenomenon that’s actually grown
today a phenomenon that’s actually grown
today a phenomenon that’s actually grown from a neglected mission in the basement
from a neglected mission in the basement
from a neglected mission in the basement of a hospital to one of the most
of a hospital to one of the most
of a hospital to one of the most sophisticated and essential offerings in
sophisticated and essential offerings in
sophisticated and essential offerings in healthcare today but a very costly
healthcare today but a very costly
healthcare today but a very costly safety net for health systems failures
safety net for health systems failures
safety net for health systems failures now pivotal to the growth of emergency
now pivotal to the growth of emergency
now pivotal to the growth of emergency medicine
medicine
medicine was the law that was passed in 1986
was the law that was passed in 1986
was the law that was passed in 1986 called EMTALA emergency medicine
called EMTALA emergency medicine
called EMTALA emergency medicine treatment and active Labor Act now
treatment and active Labor Act now
treatment and active Labor Act now believe it or not before 1986 there were
believe it or not before 1986 there were
believe it or not before 1986 there were problems in the health care system big
problems in the health care system big
problems in the health care system big problems because you see in parts of our
problems because you see in parts of our
problems because you see in parts of our country patients critically ill patients
country patients critically ill patients
country patients critically ill patients even patients who were dying were being
even patients who were dying were being
even patients who were dying were being turned away from hospital after hospital
turned away from hospital after hospital
turned away from hospital after hospital because of one problem they could afford
because of one problem they could afford
because of one problem they could afford to pay and what was really interesting
to pay and what was really interesting
to pay and what was really interesting about this was that this law
about this was that this law
about this was that this law EMTALA essentially focused on ensuring
EMTALA essentially focused on ensuring
EMTALA essentially focused on ensuring that these hospitals did not pursue the
that these hospitals did not pursue the
that these hospitals did not pursue the discriminatory practice of not caring
discriminatory practice of not caring
discriminatory practice of not caring for patients who could not afford the
for patients who could not afford the
for patients who could not afford the high cost of health care of emergency
high cost of health care of emergency
high cost of health care of emergency care of treating and managed those
care of treating and managed those
care of treating and managed those conditions now what’s interesting about
conditions now what’s interesting about
conditions now what’s interesting about this is hospitals before 1986 actually
this is hospitals before 1986 actually
this is hospitals before 1986 actually did not have the legal obligation to
did not have the legal obligation to
did not have the legal obligation to care for patients and so what happened
care for patients and so what happened
care for patients and so what happened was that this law EMTALA essentially
was that this law EMTALA essentially
was that this law EMTALA essentially also served as a safety net for patients
also served as a safety net for patients
also served as a safety net for patients who were on Medicaid or patients who are
who were on Medicaid or patients who are
who were on Medicaid or patients who are in government insurance but in fact what
in government insurance but in fact what
in government insurance but in fact what it did was it protected everyone and
it did was it protected everyone and
it did was it protected everyone and anyone who wanted to enter the emergency
anyone who wanted to enter the emergency
anyone who wanted to enter the emergency care system for care EMTALA this law
care system for care EMTALA this law
care system for care EMTALA this law essentially became national healthcare
essentially became national healthcare
essentially became national healthcare policy for those who were uninsured and
policy for those who were uninsured and
policy for those who were uninsured and underinsured this was a mandate it was a
underinsured this was a mandate it was a
underinsured this was a mandate it was a mandate this lasted for more than 30
mandate this lasted for more than 30
mandate this lasted for more than 30 years this was a mandate essentially did
years this was a mandate essentially did
years this was a mandate essentially did one thing it diminished access barriers
one thing it diminished access barriers
one thing it diminished access barriers to health care through emergency
to health care through emergency
to health care through emergency medicine more than in any other part of
medicine more than in any other part of
medicine more than in any other part of the healthcare system so as a result of
the healthcare system so as a result of
the healthcare system so as a result of this emergency departments today serve
this emergency departments today serve
this emergency departments today serve as a safety net for society’s most
as a safety net for society’s most
as a safety net for society’s most vulnerable including minority
vulnerable including minority
vulnerable including minority communities and the poor but there were
communities and the poor but there were
communities and the poor but there were challenges that actually lay ahead
challenges that actually lay ahead
challenges that actually lay ahead significant ones because after 1986
significant ones because after 1986
significant ones because after 1986 emergency department visits continue to
emergency department visits continue to
emergency department visits continue to escalate
escalate
escalate perhaps because access to other parts of
perhaps because access to other parts of
perhaps because access to other parts of the healthcare system
the healthcare system
the healthcare system could not keep pace and were virtually
could not keep pace and were virtually
could not keep pace and were virtually closed or inaccessible to those most
closed or inaccessible to those most
closed or inaccessible to those most vulnerable matter of fact the emergency
vulnerable matter of fact the emergency
vulnerable matter of fact the emergency department visits grew faster than the
department visits grew faster than the
department visits grew faster than the u.s. population
u.s. population
u.s. population fact between 1997 and 2009 US population
fact between 1997 and 2009 US population
fact between 1997 and 2009 US population grew by 12% but during that period of
grew by 12% but during that period of
grew by 12% but during that period of time emergency department visit group by
time emergency department visit group by
time emergency department visit group by 43% so make no mistake that emergency
43% so make no mistake that emergency
43% so make no mistake that emergency departments especially their safety net
departments especially their safety net
departments especially their safety net hospitals are crowded and the specter of
hospitals are crowded and the specter of
hospitals are crowded and the specter of more uninsured or underinsured entering
more uninsured or underinsured entering
more uninsured or underinsured entering our system in addition to the aging
our system in addition to the aging
our system in addition to the aging population is a prescription for
population is a prescription for
population is a prescription for emergency department visits increasing
emergency department visits increasing
emergency department visits increasing throughout the United States but is this
throughout the United States but is this
throughout the United States but is this really the direction we want to go an
really the direction we want to go an
really the direction we want to go an ever expanding safety net system of
ever expanding safety net system of
ever expanding safety net system of uncoordinated care complicated by
uncoordinated care complicated by
uncoordinated care complicated by inconsistent information sharing
inconsistent information sharing
inconsistent information sharing duplication of services and escalating
duplication of services and escalating
duplication of services and escalating costs in truth this law EMTALA was a
costs in truth this law EMTALA was a
costs in truth this law EMTALA was a victory for patients it was a victory
victory for patients it was a victory
victory for patients it was a victory for some form of access to care but the
for some form of access to care but the
for some form of access to care but the question is was this access truly
question is was this access truly
question is was this access truly sufficient perhaps we needed to pay
sufficient perhaps we needed to pay
sufficient perhaps we needed to pay attention to the fact that preventive
attention to the fact that preventive
attention to the fact that preventive care or long term care or care based
care or long term care or care based
care or long term care or care based upon relationships was important perhaps
upon relationships was important perhaps
upon relationships was important perhaps some emergency department visits could
some emergency department visits could
some emergency department visits could be prevented in this way because you see
be prevented in this way because you see
be prevented in this way because you see it is wrong to force patients to enter
it is wrong to force patients to enter
it is wrong to force patients to enter the emergency department system for care
the emergency department system for care
the emergency department system for care when that care could have been avoided
when that care could have been avoided
when that care could have been avoided or could have been perhaps provided and
or could have been perhaps provided and
or could have been perhaps provided and the less resource intense more connected
the less resource intense more connected
the less resource intense more connected less costly environment so you see in
less costly environment so you see in
less costly environment so you see in emergency medicine you have to get it
emergency medicine you have to get it
emergency medicine you have to get it right the first time and you have to get
right the first time and you have to get
right the first time and you have to get it quickly oftentimes with insufficient
it quickly oftentimes with insufficient
it quickly oftentimes with insufficient information and most of the time without
information and most of the time without
information and most of the time without the benefit of a relationship with a
the benefit of a relationship with a
the benefit of a relationship with a patient so this is precisely why in this
patient so this is precisely why in this
patient so this is precisely why in this fragmented system of care that I have to
fragmented system of care that I have to
fragmented system of care that I have to look very carefully at my practice
look very carefully at my practice
look very carefully at my practice knowing that I may actually have to
knowing that I may actually have to
knowing that I may actually have to order one more test or perhaps admit to
order one more test or perhaps admit to
order one more test or perhaps admit to the hospital one more time simply
the hospital one more time simply
the hospital one more time simply because I may not have a choice when our
because I may not have a choice when our
because I may not have a choice when our health system fails and you may not see
health system fails and you may not see
health system fails and you may not see that but I see that in the emergency
that but I see that in the emergency
that but I see that in the emergency department with increasing cascades of
department with increasing cascades of
department with increasing cascades of patients entering the safety net health
patients entering the safety net health
patients entering the safety net health system for the care
system for the care
system for the care cannot receive elsewhere so while our
cannot receive elsewhere so while our
cannot receive elsewhere so while our health care system truly bristles with
health care system truly bristles with
health care system truly bristles with the best of technology and gleaming
the best of technology and gleaming
the best of technology and gleaming infrastructure and leads the world in
infrastructure and leads the world in
infrastructure and leads the world in advancement in science and discovery and
advancement in science and discovery and
advancement in science and discovery and medicine you need only look under the
medicine you need only look under the
medicine you need only look under the hood to find that we’re failing to meet
hood to find that we’re failing to meet
hood to find that we’re failing to meet the basic needs of society and what do I
the basic needs of society and what do I
the basic needs of society and what do I mean by that well let me explain of the
mean by that well let me explain of the
mean by that well let me explain of the thirteen most developed countries in the
thirteen most developed countries in the
thirteen most developed countries in the world the u.s. ranks the lowest in life
world the u.s. ranks the lowest in life
world the u.s. ranks the lowest in life expectancy the highest and infant
expectancy the highest and infant
expectancy the highest and infant mortality and the highest and obesity
mortality and the highest and obesity
mortality and the highest and obesity rates when you control for the size of
rates when you control for the size of
rates when you control for the size of the economy comparatively speaking the
the economy comparatively speaking the
the economy comparatively speaking the u.s. actually spends a V most in health
u.s. actually spends a V most in health
u.s. actually spends a V most in health care and the least in social spending
care and the least in social spending
care and the least in social spending and these are just but a few indicators
and these are just but a few indicators
and these are just but a few indicators that point that our health system may be
that point that our health system may be
that point that our health system may be in jeopardy here are some more facts 1/2
in jeopardy here are some more facts 1/2
in jeopardy here are some more facts 1/2 of patients that actually enter the
of patients that actually enter the
of patients that actually enter the emergency department system for care are
emergency department system for care are
emergency department system for care are either completely uninsured or maybe
either completely uninsured or maybe
either completely uninsured or maybe underinsured under Medicaid one quarter
underinsured under Medicaid one quarter
underinsured under Medicaid one quarter of acute care visits in this entire
of acute care visits in this entire
of acute care visits in this entire country and virtually all such visits
country and virtually all such visits
country and virtually all such visits that are after-hours or on weekends are
that are after-hours or on weekends are
that are after-hours or on weekends are seen in emergency departments of all of
seen in emergency departments of all of
seen in emergency departments of all of the uninsured visits for acute care in
the uninsured visits for acute care in
the uninsured visits for acute care in this country 1/2 are seen in emergency
this country 1/2 are seen in emergency
this country 1/2 are seen in emergency departments by physicians like me but
departments by physicians like me but
departments by physicians like me but the emergency department is not just a
the emergency department is not just a
the emergency department is not just a place for the uninsured or underinsured
place for the uninsured or underinsured
place for the uninsured or underinsured because studies have shown that even
because studies have shown that even
because studies have shown that even those with insurance one-third of them
those with insurance one-third of them
those with insurance one-third of them actually access the emergency department
actually access the emergency department
actually access the emergency department for care because they could not actually
for care because they could not actually
for care because they could not actually get care elsewhere because elsewhere was
get care elsewhere because elsewhere was
get care elsewhere because elsewhere was not available
not available
not available so you see access to care to the
so you see access to care to the
so you see access to care to the emergency care system is virtually
emergency care system is virtually
emergency care system is virtually without any barriers compared to the
without any barriers compared to the
without any barriers compared to the rest of the healthcare system and we
rest of the healthcare system and we
rest of the healthcare system and we need to understand that we need to
need to understand that we need to
need to understand that we need to debate this we need to discuss this we
debate this we need to discuss this we
debate this we need to discuss this we need to repair this broken part of a
need to repair this broken part of a
need to repair this broken part of a health care system people access
health care system people access
health care system people access the health care system through the only
the health care system through the only
the health care system through the only avenues that are available to them and
avenues that are available to them and
avenues that are available to them and so in our society 9/11 millions of
so in our society 9/11 millions of
so in our society 9/11 millions of people have essentially become access to
people have essentially become access to
people have essentially become access to care so we have to think about this a
care so we have to think about this a
care so we have to think about this a little bit the rate of rise of emergency
little bit the rate of rise of emergency
little bit the rate of rise of emergency department visits and the increasing
department visits and the increasing
department visits and the increasing burden our safety net system is going to
burden our safety net system is going to
burden our safety net system is going to happen and we have to think about
happen and we have to think about
happen and we have to think about whether or not this is truly sustainable
whether or not this is truly sustainable
whether or not this is truly sustainable so how can we actually slow the cycle of
so how can we actually slow the cycle of
so how can we actually slow the cycle of flawed and vicious fragmented care and
flawed and vicious fragmented care and
flawed and vicious fragmented care and reliance on our burden healthcare system
reliance on our burden healthcare system
reliance on our burden healthcare system well a colleague of mine actually wrote
well a colleague of mine actually wrote
well a colleague of mine actually wrote in a recent paper that fear and
in a recent paper that fear and
in a recent paper that fear and uncertainty is what most often drives
uncertainty is what most often drives
uncertainty is what most often drives patients to seek care fear of the course
patients to seek care fear of the course
patients to seek care fear of the course and the consequence of disease and the
and the consequence of disease and the
and the consequence of disease and the need for insurance and the need for
need for insurance and the need for
need for insurance and the need for information so what’s happening in our
information so what’s happening in our
information so what’s happening in our healthcare system is actually exciting
healthcare system is actually exciting
healthcare system is actually exciting because people are beginning to really
because people are beginning to really
because people are beginning to really innovate around this one of the things
innovate around this one of the things
innovate around this one of the things you’re probably seeing today is a
you’re probably seeing today is a
you’re probably seeing today is a proliferation of free-standing emergency
proliferation of free-standing emergency
proliferation of free-standing emergency departments and urgent care centers and
departments and urgent care centers and
departments and urgent care centers and you know clinics in retail pharmacies
you know clinics in retail pharmacies
you know clinics in retail pharmacies and even department stores trying to
and even department stores trying to
and even department stores trying to meet this need but here’s what’s
meet this need but here’s what’s
meet this need but here’s what’s happening in innovation and access to
happening in innovation and access to
happening in innovation and access to care hospitals and organizations for
care hospitals and organizations for
care hospitals and organizations for instance they’re looking at things like
instance they’re looking at things like
instance they’re looking at things like extending primary care or hours or even
extending primary care or hours or even
extending primary care or hours or even extending specialty care clinic hours or
extending specialty care clinic hours or
extending specialty care clinic hours or how about telehealth where cellular
how about telehealth where cellular
how about telehealth where cellular technology and Wi-Fi technology can be
technology and Wi-Fi technology can be
technology and Wi-Fi technology can be used to connect a patient to a provider
used to connect a patient to a provider
used to connect a patient to a provider and a healthcare transaction can
and a healthcare transaction can
and a healthcare transaction can actually occur without an in-person
actually occur without an in-person
actually occur without an in-person visit now here at UF we actually have an
visit now here at UF we actually have an
visit now here at UF we actually have an example of an After Hours clinic that
example of an After Hours clinic that
example of an After Hours clinic that you have orthopedics and sports medicine
you have orthopedics and sports medicine
you have orthopedics and sports medicine Institute which a couple of years ago
Institute which a couple of years ago
Institute which a couple of years ago began to offer extended hours both
began to offer extended hours both
began to offer extended hours both during the week and also the weekends
during the week and also the weekends
during the week and also the weekends and the impact that has had is that
and the impact that has had is that
and the impact that has had is that emergency department visits for simple
emergency department visits for simple
emergency department visits for simple uncomplicated orthopedic complaints and
uncomplicated orthopedic complaints and
uncomplicated orthopedic complaints and injuries dramatically decreased what
injuries dramatically decreased what
injuries dramatically decreased what about health information technology what
about health information technology what
about health information technology what we must decrease the barriers to meaning
we must decrease the barriers to meaning
we must decrease the barriers to meaning we share health information across
we share health information across
we share health information across hospitals and across health systems in
hospitals and across health systems in
hospitals and across health systems in our region while maintaining the safety
our region while maintaining the safety
our region while maintaining the safety of patient information but why should we
of patient information but why should we
of patient information but why should we be doing this so we can actually reduce
be doing this so we can actually reduce
be doing this so we can actually reduce duplication of services so you could
duplication of services so you could
duplication of services so you could reduce costs reduce unnecessary testing
reduce costs reduce unnecessary testing
reduce costs reduce unnecessary testing and perhaps even reduce harm perhaps we
and perhaps even reduce harm perhaps we
and perhaps even reduce harm perhaps we should develop systems that allow
should develop systems that allow
should develop systems that allow patients to actually own their own
patients to actually own their own
patients to actually own their own health records so they could actually
health records so they could actually
health records so they could actually freely distribute it when necessary
hospitals and organizations need to look
hospitals and organizations need to look at their own neighborhoods their own
at their own neighborhoods their own
at their own neighborhoods their own populations to really look at unmet
populations to really look at unmet
populations to really look at unmet needs so we’re doing some of this in
needs so we’re doing some of this in
needs so we’re doing some of this in emergency medicine for instance and
emergency medicine for instance and
emergency medicine for instance and we’ve done research that actually is
we’ve done research that actually is
we’ve done research that actually is focus in public transportation policy
focus in public transportation policy
focus in public transportation policy and finding that even that can impact
and finding that even that can impact
and finding that even that can impact the numbers of patients who actually go
the numbers of patients who actually go
the numbers of patients who actually go to the emergency department with
to the emergency department with
to the emergency department with potentially avoidable visits and even
potentially avoidable visits and even
potentially avoidable visits and even potentially avoidable hospital
potentially avoidable hospital
potentially avoidable hospital admissions primary care redesign is
admissions primary care redesign is
admissions primary care redesign is actually happening everywhere so instead
actually happening everywhere so instead
actually happening everywhere so instead of fixed appointments during weekdays
of fixed appointments during weekdays
of fixed appointments during weekdays you actually have open access there is
you actually have open access there is
you actually have open access there is experimentation with what’s called
experimentation with what’s called
experimentation with what’s called direct care where folks are actually
direct care where folks are actually
direct care where folks are actually bypassing insurance companies and paying
bypassing insurance companies and paying
bypassing insurance companies and paying physicians a very small fee like a gym
physicians a very small fee like a gym
physicians a very small fee like a gym membership to receive basic health care
membership to receive basic health care
membership to receive basic health care what about home visits by the primary
what about home visits by the primary
what about home visits by the primary care workforce but used to happen
care workforce but used to happen
care workforce but used to happen decades ago how about power medicine
decades ago how about power medicine
decades ago how about power medicine where paramedics are actually visiting
where paramedics are actually visiting
where paramedics are actually visiting the homes of patients who have just been
the homes of patients who have just been
the homes of patients who have just been discharged from the hospital to ensure
discharged from the hospital to ensure
discharged from the hospital to ensure that they’re safe and they understand
that they’re safe and they understand
that they’re safe and they understand their healthcare needs you see we have
their healthcare needs you see we have
their healthcare needs you see we have to innovate around primary care it’s not
to innovate around primary care it’s not
to innovate around primary care it’s not just about expanding the primary care
just about expanding the primary care
just about expanding the primary care workforce we must innovate and these
workforce we must innovate and these
workforce we must innovate and these innovations I think become the future of
innovations I think become the future of
innovations I think become the future of improving health care in this country
improving health care in this country
improving health care in this country but I want to return to one particular
but I want to return to one particular
but I want to return to one particular issue I mentioned and that was EMTALA
issue I mentioned and that was EMTALA
issue I mentioned and that was EMTALA this mandate that was signed into law
this mandate that was signed into law
this mandate that was signed into law more than 30 years ago
more than 30 years ago
more than 30 years ago this was a mandate that we really could
this was a mandate that we really could
this was a mandate that we really could learn from the mandate in health care it
learn from the mandate in health care it
learn from the mandate in health care it had an unintended consequence obviously
had an unintended consequence obviously
had an unintended consequence obviously because it helped to fuel the rise of
because it helped to fuel the rise of
because it helped to fuel the rise of emergency department visits across the
emergency department visits across the
emergency department visits across the country but this is a mandate that
country but this is a mandate that
country but this is a mandate that actually worked quietly in the
actually worked quietly in the
actually worked quietly in the background ensuring access to care for
background ensuring access to care for
background ensuring access to care for those most vulnerable but also ensuring
those most vulnerable but also ensuring
those most vulnerable but also ensuring access for those who have insurance who
access for those who have insurance who
access for those who have insurance who could not find timely care elsewhere
could not find timely care elsewhere
could not find timely care elsewhere EMTALA is an example of a mandate that
EMTALA is an example of a mandate that
EMTALA is an example of a mandate that is demonstrated that mandates actually
is demonstrated that mandates actually
is demonstrated that mandates actually can work in our health care system even
can work in our health care system even
can work in our health care system even though in this particular case it wasn’t
though in this particular case it wasn’t
though in this particular case it wasn’t perfect because it created one-way
perfect because it created one-way
perfect because it created one-way street and health systems safety net but
street and health systems safety net but
street and health systems safety net but maybe we should rethink this maybe it
maybe we should rethink this maybe it
maybe we should rethink this maybe it shouldn’t be just assuring access to the
shouldn’t be just assuring access to the
shouldn’t be just assuring access to the emergency care and high-cost care maybe
emergency care and high-cost care maybe
emergency care and high-cost care maybe access to the very basic of health needs
access to the very basic of health needs
access to the very basic of health needs should be assured regardless of your
should be assured regardless of your
should be assured regardless of your ability to pay regardless of your social
ability to pay regardless of your social
ability to pay regardless of your social or economic background regardless of
or economic background regardless of
or economic background regardless of your cultural origins regardless of your
your cultural origins regardless of your
your cultural origins regardless of your zip code perhaps we need to invest in
zip code perhaps we need to invest in
zip code perhaps we need to invest in rather than abandon the idea that
rather than abandon the idea that
rather than abandon the idea that long-term and trusting relationships
long-term and trusting relationships
long-term and trusting relationships between patients and physicians should
between patients and physicians should
between patients and physicians should be the cornerstone of good health policy
be the cornerstone of good health policy
be the cornerstone of good health policy empowering patients advancing patient
empowering patients advancing patient
empowering patients advancing patient centered care and yes improving outcomes
centered care and yes improving outcomes
centered care and yes improving outcomes perhaps we need to rethink the fact that
perhaps we need to rethink the fact that
perhaps we need to rethink the fact that our health system safety net only has a
our health system safety net only has a
our health system safety net only has a one-way street
one-way street
one-way street so this in this most developed country
so this in this most developed country
so this in this most developed country in the world I have seen example after
in the world I have seen example after
in the world I have seen example after example of failures in our health care
example of failures in our health care
example of failures in our health care system I took care of that middle aged
system I took care of that middle aged
system I took care of that middle aged man who would not have had that
man who would not have had that
man who would not have had that devastating stroke if he actually had
devastating stroke if he actually had
devastating stroke if he actually had timely and effective access to care and
timely and effective access to care and
timely and effective access to care and could afford the medicines that would
could afford the medicines that would
could afford the medicines that would have controlled his blood pressure
have controlled his blood pressure
have controlled his blood pressure I personally grieve with that family of
I personally grieve with that family of
I personally grieve with that family of that woman that wife that mother who I
that woman that wife that mother who I
that woman that wife that mother who I tried to resuscitate and I couldn’t
tried to resuscitate and I couldn’t
tried to resuscitate and I couldn’t because she actually died on the way to
because she actually died on the way to
because she actually died on the way to the hospital
the hospital
the hospital from asthma a completely preventable
from asthma a completely preventable
from asthma a completely preventable disease why because she didn’t have
disease why because she didn’t have
disease why because she didn’t have access to primary care or access to men
access to primary care or access to men
access to primary care or access to men that could have saved her life I’ve seen
that could have saved her life I’ve seen
that could have saved her life I’ve seen like my colleagues across the rest of
like my colleagues across the rest of
like my colleagues across the rest of the country example after example of
the country example after example of
the country example after example of failures in a health care system but
failures in a health care system but
failures in a health care system but there is good news and the good news is
there is good news and the good news is
there is good news and the good news is that we are seeing innovations in our
that we are seeing innovations in our
that we are seeing innovations in our health care system people are thinking
health care system people are thinking
health care system people are thinking about access to care people are thinking
about access to care people are thinking
about access to care people are thinking about how we can truly improve care in
about how we can truly improve care in
about how we can truly improve care in America and so we have to grab this
America and so we have to grab this
America and so we have to grab this opportunity and truly rethink how we
opportunity and truly rethink how we
opportunity and truly rethink how we approach health care in America thank
approach health care in America thank
approach health care in America thank you
you
you [Applause]
”
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