Healthcare Economic Reform: How and Why Physicians Must Lead Change Within Our Evolving Healthcare Economy

By Ellis “Mac” Knight MD, MBA

Although the healthcare delivery system is as full of committed idealists as it ever was, the difference now is that the current healthcare system operates within an economically and politically driven milieu that prevents it from delivering what it is designed to provide: high-value healthcare services for the patients it serves.

The healthcare economy creates major problems with the dominant fee-for-service payment system, enables the treatment of physicians as commodities, and stifles them from realizing their original motivations for choosing a career in medicine. In order to change this broken system, it is up to physician leaders to identify, treat and ultimately reform problems inherent in the current model.

Healthcare Economic Reform serves as both an educational overview of how the healthcare economy operates, and a step-by-step guide for physicians to follow in pursuit of making the delivery of healthcare more satisfying. This book will address industry-wide problems and shift the focus from reform of the delivery system to reform of the healthcare economy.

How does this book give you an advantage?

Knight shares key lessons gleaned from his long career to not only provide a review of how the healthcare system operates, but also to arm physician leaders with actionable information to reform the healthcare economy and satisfy their own motivations for entering the field of medicine.

Here are just some of the topics the author discusses in detail:

• The Unique Aspects of the Healthcare Economy
• Business Models in Healthcare
• The Payment System
• Distortions in the Process of Exchange
• The Perverse Nature of the FFS Model
• Clinically Integrated Networks
• Shifting Risk
• Pricing in the Healthcare Economy
• Market Forces in the Healthcare Economy
• For-Profit vs. Not-for-Profit
• From Volume to Value
• Bundled Payments
• Accountable Care Organizations
• Correcting Defects in the Healthcare Economy Revealed by the COVID-19 Pandemic
• Care Process Design
• Clinical Practice
• Specific Recommended Actions

If you’re a physician leader, Healthcare Economic Reform: How and Why Physicians Must Lead Change Within Our Evolving Healthcare Economy will give you deeper understanding of the current healthcare economy, and the tools, wherewithal, and confidence to go about reforming it.

Table of Contents

MODULE 1

• Introduction: The Basic Sciences
• Chapter 1 Definitions and Core Principles
• Chapter 2 The Unique Aspects of the Healthcare Economy
• Chapter 3 Business Models in Healthcare
• Chapter 4 The Payment System

MODULE 2

• Introduction: Pathophysiology
• Chapter 1 Distortions in the Process of Exchange
• Chapter 2 Invalid Assumptions About the Distorted Exchange Process
• Chapter 3 The Perverse Nature of the FFS Model
• Chapter 4 Clinically Integrated Networks
• Chapter 5 Shifting Risk
• Chapter 6 Waste
• Chapter 7 Pricing in the Healthcare Economy
• Chapter 8 Health “Insurance”
• Chapter 9 Market Forces in the Healthcare Economy
• Chapter 10 For-Profit vs. Not-for-Profit
• Chapter 11 Physician Employment
• Chapter 12 Monopolies
• Chapter 13 Inequality

MODULE 3

• Introduction: Therapeutics
• Chapter 1 From Volume to Value
• Chapter 2 Bundled Payments
• Chapter 3 Accountable Care Organizations
• Chapter 4 Correcting Defects in the Healthcare Economy Revealed by the COVID-19 Pandemic
• Chapter 5 Cost Accounting
• Chapter 6 Care Process Design

MODULE 4

• Introduction: Clinical Practice
• Chapter 1 General Activities
• Chapter 2 Specific Recommended Actions

EPILOGUE

About Ellis “Mac” Knight MD, MBA

Ellis “Mac” Knight MD, MBA has over 40 years of experience in the healthcare arena as a practicing physician, physician executive, healthcare consultant, industry thought leader, and advocate for change. Dr. Knight has a particular interest in value-based care process design, healthcare economics, cost accounting, clinical integration, and physician/clinician leadership skill development.

Dr. Knight graduated from Stanford University with a Bachelor of Arts degree in Human Biology and received his doctor of medicine degree from the University of Oregon Health Science Center’s School of Medicine. He earned a Master of Business Administration from the University of Massachusetts at Amherst. He is a board-certified internist and has achieved fellowship status in the American College of Physicians, the Society of Hospital Medicine, and the American College of Healthcare Executives.

While now retired from clinical practice, Mac has continued to advocate for positive, physician-led, change in the healthcare economy. He and his wife live in Atlanta, Georgia, taking advantage of the opportunities they now have to spend more time with their nearby children and grandchildren.