Talk:The Phoenix Project

Rough Sketch of Ideas, Not Yet Fully Coherent...

The key/radical shift in concept for this project came from an intense study of how physicians are paid for providing inpatient care (in my capacity of chair of the section on hospitalist medicine at the OMA, charged with preparing the proposal for a new funding model for MRP care).

What struck me was the need for a universal productivity measure for patient-physician interaction. This was nearly impossible, with the literature well established that patients only retain 10% of what is communicated to them and are often "non-compliant" with medications.

This, to me, translates to waste of everyones time.

Imagine if we were paid only based on the patient's perceived "benefit" from the encounter. Then I realized, some encounters might take longer because they are covering several issues at once. Then I realized that there was a wealth of information being "lost" in the day-to-day trials and errors that occur in the provision of real health care (i.e. not randomized controlled trials), but n of 1 "will this work for me".

Then it struck me. If the patient was the lead investigator of their own health encounter and the physician's job to "empower" them with the appropriate use of system resources to address their personal health goals, then we could "code" each problem in the form of an experiment. The patient would have their field journal, the provider/team would have their field journal, and the EMR would be relegated to supporting/bit player in adding objective test data (20% of diagnosis) to the much more important (80% of diagnosis) human story.

Overall, the concept would be this: Patient has secure "wiki" space where they can arrange their health issues/goals in the manner that suits them best.

This would have typical sections such as user:Laith Bustani/Medications, user:Laith Bustani:Past History, user:Laith Bustani: Active Health Issues, etc. The patient could create a "space" for new symptoms and "journal" the development/progression of the symptoms. This could be then sent to an appropriate care provider ahead of an appointment, perhaps with secure two-way communication to clarify symptoms ahead of the appointment/interaction.

The provider would be able to participate in the patient's "journal"/"wiki", but the overall control of the content would ultimately rest in the hands of the patient.

So, how does a doctor get paid in this new system? 1) Base salary = mean salary of supporting tax base. In this case just under $40,000. 2) Productivity bonus: For patient encounters where the patient perceives a "positive" experience, points can be accumulated for each "experiment" (in the format of individual S.O.A.P notes for each issue) that is formatted as a formal research question: Perhaps there is a "subjective grading scale" that the patient can apply in addition. Finally, when system inefficiencies are perceived and reported (just as though the ailing health care system was the patient) 10% of the savings accrued from the "removed" inefficiency would be distributed, up to a fixed cap. Above that cap, the money would perhaps be pooled in a "Venture Capital" fund to allow providers to "Invest" in other projects taking place that are perceived to have potential to improve patient's experiences.

The system wins (return of 90% of cost savings from identified inefficiency). The patient wins (doctor only gets paid for what patient "takes away" from encounter, incentivizing them to efficiently use their time. Society wins by having physician's salary reflective of the mean income.