Emery A. Rovenstine Lecture

SPE14 Rovenstine Lecture: Health Care at the Crossroads: The Imperative for Change
Monday, October 13, 2014, 10:20 - 11:35 a.m.
Karen B. Domino, M.D., M.P.H.


The current health care model in the United States is unsustainable. Health care expenditures per capita have increased every year since 1960, when spending was $147 per citizen. In 2010, $8,402 was spent per capita. At almost $2.2 trillion, health care spending in the U.S. is 2.5 times higher than the wealthy nation average. Health care spending has grown faster than the Gross Domestic Product (GDP). It is estimated that health care as a percentage of GDP will sit at 20 percent in 2017.

By 2037, health care spending is estimated to rise to more than 30 percent, a level which will crowd out funding of other important societal necessities, including education of our children, transportation, defense, and research funding. The massive health care spending has not improved outcomes. A recent Institute of Medicine report ranked the U.S. 17th out of 17 peer nations in life expectancy, and a JAMA study indicated that the U.S. ranks 27th out of 34 advanced nations in life expectancy. “Business as usual” is clearly a bad business policy.

The funders of health care (e.g., federal and state governments, businesses, and consumers) are responding to skyrocketing health care costs by focusing on quality, cost-containment, transparency, and performance incentives. These include no payment for preventable events; no payment for certain hospital readmissions; payments with positive/negative incentives based on quality; value-based purchasing; value-based physician payments; reference pricing; and alternative payment models. The health care industry is responding with greater consolidation and potential loss of jobs. Anesthesiologists and other health care leaders must respond with a greater emphasis on wellness, prevention, standardization of care, and coordination of care by physician-led teams. Anesthesiologists are uniquely suited as perioperative leaders. Future training must emphasize the tenets of the Perioperative Surgical Home (better health, better delivery of care, reduced costs), physician-led team-based care, technological advancements (e.g., SedasysR, target controlled infusion devices, robotic anesthesia, decision support systems), and health policy and regulation changes.

Significant transformations will need to be made to the residency curricula to meet the demands of future practice. Anesthesiologists are poised to take leadership positions across the continuum of perioperative care. The health care system of the future will embrace perioperative care that is organized, physician-led, team-based, and driven by quality and cost-containment. We must commit ourselves to new avenues of education and training. The future is ours to lead.