Dr. Delos M. Cosgrove spoke at Georgia Regents University as part of the inaugural Robert and Lois Ellison Lecture, named for the late pioneering cardiothoracic surgeon and his wife, who now serves as provost emeritus and historian for GRU. Heart surgeons today are “standing on the shoulders of giants like the Ellisons,” said Cosgrove, who is also a cardiothoracic surgeon.
As health care has changed, the Cleveland Clinic, with its salaried physicians and physician leadership, is often upheld as a model for future hospital design and was cited by President Obama and Republican challenger Mitt Romney during the campaign last year, Cosgrove said.
The health system is considered a leader in quality and the search for efficiency, having eliminated 12,000 unnecessary lab tests and instituted protocols for care in the treatment of stroke, congestive heart failure and obstetrics.
It seeks to be more patient-friendly in all of its care, offering them access to their electronic medical records, putting sleeper sofas in patient rooms and eliminating visiting hours.
“We even changed the parking lot,” Cosgrove said. It did away with the physician parking at the front. “Patients park closest to the hospital.”
With shrinking reimbursement, the pressure to change and consolidate will only increase. The health system’s $6 billion budget will need to shed $600 million to $800 million in costs during the next five years, Cosgrove said.
Others will have to make similar moves, which means large-scale consolidations, he said.
“I think you’re going to see consolidation simply to take the costs out of the back office,” Cosgrove said, referring to such areas as billing and information technology.
“You’re going to see
nationwide networks of hospitals.”
His health system, for instance, is in talks with health systems from New York to Chicago to California, and others are adopting more of his health system’s approach.
“What we’re looking at is hospitals becoming increasingly to look like Cleveland Clinic,” Cosgrove said. About 60 percent of physicians are now on salary and employed, and that figure will rise to 75 percent in 10 years, he said.
Where people access care is changing and increasingly is done outside a hospital and perhaps soon outside a doctor’s office. For instance, there is under development a booth with a two-way interactive video feed and instruments to take basic measurements that would allow a patient to connect with a caregiver.
“I think you are going to see that,” Cosgrove said. “You are going to see it in factories, I think you are going to see it in drugstores. I think it is going to be a major change in where primary care is delivered, because we don’t have enough primary care physicians.”
Half of the 90,000-doctor shortage is primary care, he said. That means more pressure on other caregivers, such as nurses and physician assistants, to do more and for physicians to collaborate more, Cosgrove said.
“Health care has gone from a single sport to a team sport,” he said. What is helping Cleveland Clinic is its ability to react rapidly to those changes, Cosgrove said.
“At the end of the day, speed is the only continuous competitive advantage,” he said.