Top heart doctor: 'The system is broken'

By Mary Carter
CNN

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(CNN) -- Research breakthroughs and successful new treatments make headlines, but the president of the American Heart Association says the real story is the need for fundamental change in the way care is delivered in America.

Doctors "don't have enough time to educate their patients and to stop and think about what measures the patient really needs," said Dr. Raymond Gibbons, Gray Professor of Medicine at Mayo Clinic College of Medicine in Rochester, Minnesota.

Incentives in today's health-care system encourage procedures over doctor-patient face time, according to Gibbons. Many serious illnesses are preventable, but their numbers continue to rise in part because doctors "don't have enough time for preventive health measures," he said.

Insurance companies do reimburse at higher rates for procedures. For example, Medicare pays a doctor $55.22 for a 15-minute office visit with an established patient. For a 30-minute visit, the reimbursement is $101.22. But a relatively straightforward procedure like the puncture and aspiration of a cyst pays $117.90. Removal of a foreign body requiring an incision nets $141.06.

"As a result, we spend a lot of money on the expensive things and don't pay enough attention to the little things," Gibbons said. "It doesn't mean that doctors are bad people. It simply means that, like everyone else, they respond to the structure of the system and the incentives of the system."

So in his address in November to the heart association's scientific session, Gibbons plans to talk not about science, but about how to change that system. He'll share a few specific ideas, but energizing public conversation is his chief goal. The first steps toward real change can't come, he says, until the stakeholder groups -- health-care providers, insurance companies, labor unions, employers, the government, and patients -- suspend their fear of short-term pain.

"Every time somebody initiates the discussion, the media asks them, 'What is your solution?' And then there's severe criticism immediately from every group, who feel that they're better off with the status quo than with the proposed change. And because everybody knows that's going to happen, then they don't want to talk about it," he said.

"It's daunting," he acknowledged. "And because it's daunting and because the potential changes that would have to occur are so painful, we shy away from the discussion."

But with the number of American 65-year-olds projected to double by 2030, the country needs to take the first steps toward change now. Drastic demands on the nation's health-care system, unseen up to this point, are "imminent," said Gibbons. Meaningful change will take time, so he hopes to help start the process.

"We can't start with the solution," he said. "We have to start with the discussion."

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