COMMENTARY Nutrition Support and Health Care Reform—The Work to Be Done
like to share them with you.
A keynote address is intended to be a thoughtprovoking speech presented by a notable person. We have been fortunate that the planners of our Clinical Congresses have selected speakers and topics that have been both timely and stimulating. We have had the privilege of publishing the last two of these addresses in Nutrition in Clinical Practice and plan to continue to do so as a regular feature of this publica-
1. A basic level of health care should be defined that is readily available to every citizen without regard to wealth or social status. 2. Payment for health care services should be structured in a way that removes incentive for cost shifting. 3. Health care decisions should be as decentral-
tion. In Orlando, Dr. Marc Roberts delivered a &dquo;powerful and immensely interesting presentation,&dquo; in the words of one of our associate editors, titled &dquo;Setting Priorities for Health Care: Your Money or Your Life&dquo; (pp 246-251). When we reviewed it, the editors were excited about publishing it. We felt, however, that it deserved comment. A reaction from someone in our field-a rebuttal perhaps. I offered to prepare some thoughts. It is probably good, but nonetheless difficult, to see ourselves through someone else’s eyes. Perhaps, like me, you cringe a little bit when you hear a recording of yourself or see yourself on videotape. Dr. Roberts’ remarks call up some of those feelings. And, like Dr. Roberts, I too view problems as opportunities. But sometimes I feel like &dquo;I’m dancing as fast as I can!&dquo; How, then should we react to this keynote address? Most clinicians have a justifiable perception that they practice in an environment over which they really have very little control. Patients continue to come to our care with legitimate and necessary health care needs. I doubt that many of us see patients and provide care that is not medically necessary. We are also given tools that enable us to do great things for patients. Unfortunately, they are usually expensive. Most of us try to make responsible use of this new technology. For the average clinician, Dr. Roberts’ presentation reminds us of problems we often try to forget, not because we don’t care or out of ignorance, but because we are so busy taking care of patients and feel powerless to effect change. Perhaps we should spend a little more time thinking about our environment and about ways to take a more active role in shaping it. A friend, colleague, and fellow editor has reflected on these issues and offered the following thoughts about health care reform as a public policy issue. I’d
ized and 4.
as free from bureaucracy as possible. Congress and its retinue of advisers should admit that they do not know with certainty
what the best solution is to the health care crisis. 5. Much greater national priority should be given to disease prevention and health promotion. 6. Greater effort should be devoted to solving deep-seated social problems that strain health care resources.
7. Health
greater
should be imbued with of mission and idealism.
professionals sense
a
Practitioners involved in the care of patients who receiving specialized nutrition support practice in a system that is a model of the total health care delivery system. It is multidisciplinary, uses new (and expensive) technology, is perceived as costly, and is specialized. The treatments we manage are usually necessary, life sustaining, risky, and often associated with ethical decisions. Perhaps we are in as good a position as anyone to participate in the debate over health care reform. Whether this is done at the bedside with patients, in the education of students in our field, or in the public arena, there is an opportunity for practitioners to be heard in the discussion. Don’t you think we should? I offer the following suggestions to concerned practitioners. are
practice should be exemplary so that the services we render are perceived by the public to be of value. This should include assurance of medical necessity, treatment effectiveness, safety, and cost consciousness. Of specific con-
1. Our
252 Downloaded from ncp.sagepub.com at UNIV ARIZONA LIBRARY on April 20, 2015
253 cern are
patients who are not getting nutrition
support when they need it and patients who are getting nutrition support when they do not
port services are in a unique position to develop cost control strategies for of treatment.
this expensive form
need it.
place concern about the patient personal gain. We are a primary advocate for the patient in an environment of restricted resources where politicians and administrators are struggling for answers, often at the expense of the patient. We should perform research to answer questions about effectiveness, safety, and cost. Much of the current uncertainty about public policy decisions relates to a lack of factual
2. We should over
3.
information about the treatments we manage. We need to add objectivity to the debate over the allocation of health care resources. 4. We should be conscious of the limitations in resources available for health care and use
responsibly. Patients should not be overfed, laboratory tests should be used responsibly to monitor patients, and patients should be cared for in the home when possible and fed enterally when feasible. Nutrition sup-
Organizations like A.S.P.E.N. can serve as the voice for those with a common interest. There may be those called to speak for these issues individually or as leaders in this association. But whoever is chosen to speak on our behalf must have a message to carry-a &dquo;substrate,&dquo; if you will. Our public policy initiative will need to begin at the bedside, therefore, with our practice. Each of us can share in that responsibility and produce the message. As you read, or reread, Dr. Roberts’ keynote address, consider that challenge in helping with the task of &dquo;setting priorities in health care.&dquo; Obviously, we still have some work to do.
Philip J. Schneider, MS, RPh Editor-in-Chief Nutrition in Clinical Practice
them
REFERENCE 1. Zellmer WA. Goals for Health Care Reform. Am J Hosp Pharm
1991;48:2133.
Downloaded from ncp.sagepub.com at UNIV ARIZONA LIBRARY on April 20, 2015
like to share them with you.
A keynote address is intended to be a thoughtprovoking speech presented by a notable person. We have been fortunate that the planners of our Clinical Congresses have selected speakers and topics that have been both timely and stimulating. We have had the privilege of publishing the last two of these addresses in Nutrition in Clinical Practice and plan to continue to do so as a regular feature of this publica-
1. A basic level of health care should be defined that is readily available to every citizen without regard to wealth or social status. 2. Payment for health care services should be structured in a way that removes incentive for cost shifting. 3. Health care decisions should be as decentral-
tion. In Orlando, Dr. Marc Roberts delivered a &dquo;powerful and immensely interesting presentation,&dquo; in the words of one of our associate editors, titled &dquo;Setting Priorities for Health Care: Your Money or Your Life&dquo; (pp 246-251). When we reviewed it, the editors were excited about publishing it. We felt, however, that it deserved comment. A reaction from someone in our field-a rebuttal perhaps. I offered to prepare some thoughts. It is probably good, but nonetheless difficult, to see ourselves through someone else’s eyes. Perhaps, like me, you cringe a little bit when you hear a recording of yourself or see yourself on videotape. Dr. Roberts’ remarks call up some of those feelings. And, like Dr. Roberts, I too view problems as opportunities. But sometimes I feel like &dquo;I’m dancing as fast as I can!&dquo; How, then should we react to this keynote address? Most clinicians have a justifiable perception that they practice in an environment over which they really have very little control. Patients continue to come to our care with legitimate and necessary health care needs. I doubt that many of us see patients and provide care that is not medically necessary. We are also given tools that enable us to do great things for patients. Unfortunately, they are usually expensive. Most of us try to make responsible use of this new technology. For the average clinician, Dr. Roberts’ presentation reminds us of problems we often try to forget, not because we don’t care or out of ignorance, but because we are so busy taking care of patients and feel powerless to effect change. Perhaps we should spend a little more time thinking about our environment and about ways to take a more active role in shaping it. A friend, colleague, and fellow editor has reflected on these issues and offered the following thoughts about health care reform as a public policy issue. I’d
ized and 4.
as free from bureaucracy as possible. Congress and its retinue of advisers should admit that they do not know with certainty
what the best solution is to the health care crisis. 5. Much greater national priority should be given to disease prevention and health promotion. 6. Greater effort should be devoted to solving deep-seated social problems that strain health care resources.
7. Health
greater
should be imbued with of mission and idealism.
professionals sense
a
Practitioners involved in the care of patients who receiving specialized nutrition support practice in a system that is a model of the total health care delivery system. It is multidisciplinary, uses new (and expensive) technology, is perceived as costly, and is specialized. The treatments we manage are usually necessary, life sustaining, risky, and often associated with ethical decisions. Perhaps we are in as good a position as anyone to participate in the debate over health care reform. Whether this is done at the bedside with patients, in the education of students in our field, or in the public arena, there is an opportunity for practitioners to be heard in the discussion. Don’t you think we should? I offer the following suggestions to concerned practitioners. are
practice should be exemplary so that the services we render are perceived by the public to be of value. This should include assurance of medical necessity, treatment effectiveness, safety, and cost consciousness. Of specific con-
1. Our
252 Downloaded from ncp.sagepub.com at UNIV ARIZONA LIBRARY on April 20, 2015
253 cern are
patients who are not getting nutrition
support when they need it and patients who are getting nutrition support when they do not
port services are in a unique position to develop cost control strategies for of treatment.
this expensive form
need it.
place concern about the patient personal gain. We are a primary advocate for the patient in an environment of restricted resources where politicians and administrators are struggling for answers, often at the expense of the patient. We should perform research to answer questions about effectiveness, safety, and cost. Much of the current uncertainty about public policy decisions relates to a lack of factual
2. We should over
3.
information about the treatments we manage. We need to add objectivity to the debate over the allocation of health care resources. 4. We should be conscious of the limitations in resources available for health care and use
responsibly. Patients should not be overfed, laboratory tests should be used responsibly to monitor patients, and patients should be cared for in the home when possible and fed enterally when feasible. Nutrition sup-
Organizations like A.S.P.E.N. can serve as the voice for those with a common interest. There may be those called to speak for these issues individually or as leaders in this association. But whoever is chosen to speak on our behalf must have a message to carry-a &dquo;substrate,&dquo; if you will. Our public policy initiative will need to begin at the bedside, therefore, with our practice. Each of us can share in that responsibility and produce the message. As you read, or reread, Dr. Roberts’ keynote address, consider that challenge in helping with the task of &dquo;setting priorities in health care.&dquo; Obviously, we still have some work to do.
Philip J. Schneider, MS, RPh Editor-in-Chief Nutrition in Clinical Practice
them
REFERENCE 1. Zellmer WA. Goals for Health Care Reform. Am J Hosp Pharm
1991;48:2133.
Downloaded from ncp.sagepub.com at UNIV ARIZONA LIBRARY on April 20, 2015
