Thomas H. Jones, MD
Neurosurgeon and
Medical Director
Santa Barbara
Neuroscience Institute


Dear Colleagues,


One of the core initiatives of Santa Barbara Neuroscience Institute at Cottage Health System, as previously mentioned in this column, is that of improving measured quality of healthcare delivery, and at a lower total "cycle of care" cost.


Controlling cost is a particularly formidable goal when one is familiar with our healthcare economics; they reveal 20 percent of a given population of patients account for 80 percent of the expenditures and 5 percent for almost half of total expenditures.


The U.S. healthcare system seems to be a perfect incubator for unfettered healthcare consumption by these patients, especially those with chronic illnesses. The ingredients for this excessive consumption include the perfect storm of dominance of small group practices, fee-for-service medicine and an unlimited availability of high-technology diagnostic and treatment options. The almost-Brownian motion of patients through our system is the epitome of chaos, and this chaos leads to inefficient and needlessly expensive health care. For example, in one study published in The New England Journal of Medicine in 2007, Pham et al. found that the average Medicare patient saw seven different doctors in a year: two different primary care doctors and five different specialists who collectively worked in four different practices. Sicker patients saw far more physicians per year. Most of these physician offices still used paper charts that are relatively inaccessible to other physicians.



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In their book Chaos and Organization in Health Care, Thomas Lee, MD, and James Mongan, MD, document the current malaise of U.S. health care, examine the reasons and propose changes. They refer to numerous examples of certain provider groups joining together to implement changes in care using a "chronic care model and disease management." They have both encouraged such changes in their Harvard-affiliated Partners HealthCare System. In the closing pages of their book, they make the statement that "if providers are not part of an organization that can implement systems to improve quality and efficiency, they should join one. If none exists around them, they should form one." They end the book by stating, "Physicians are not just providers of services to individual patients, but they also should be stewards of the healthcare system itself. As such, physicians have obligations to use resources efficiently, participate in efforts to make health care financially viable, and play their role on teams that coordinate and improve care."


The SBNI hopes to foster such a system.




Tom Jones, MD