Not What the Doctor Ordered: Liberating Caregivers and Empowering Consumers for Successful Health Reform

169 Pages·2019·2.992 MB·\169

by  Jeffrey C. Bauer (Author)

Contents Contents
Not What the
Doctor Ordered
Third Edition

Not What the
Doctor Ordered
Liberating Caregivers and Empowering
Consumers for Successful Health Reform
Third Edition
Jeffrey C. Bauer
Cover art by Jeff Bauer. Detail from “Pierre BOULEZ #4,” acrylic on board, copyright 2018, Jeffrey C. Bauer.
All rights reserved by the artist.
Third edition published in 2020
by Routledge/Productivity Press
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Library of Congress Cataloging‑in‑Publication Data
Names: Bauer, Jeffrey C., author.
Title: Not what the doctor ordered : liberating caregivers and empowering
consumers for successful health reform / Jeffrey C. Bauer.
Description: 3rd [edition], 25th Anniversary edition. | Boca Raton : Taylor &
Francis, 2020. | “A Routledge title, part of the Taylor & Francis imprint,
a member of the Taylor & Francis Group, the academic division of T&F
Informa plc.” | Includes bibliographical references and index.
Identifiers: LCCN 2019010656 (print) | LCCN 2019012918 (ebook) | ISBN
9781315168647 (e-Book) | ISBN 9781138050808 (hardback : alk. paper)
Subjects: LCSH: Medical care--United States. | Medical economics--United
States. | Managed care plans (Medical care)--United States.
Classification: LCC RA395.A3 (ebook) | LCC RA395.A3 B295 2020 (print) | DDC
338.4/736210973--dc23
LC record available at https://lccn.loc.gov/2019010656
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
This edition is dedicated to Dr. Loretta C. (Lee) Ford

Contents
About the Author ...............................................................................................ix
Acknowledgments ..............................................................................................xi
1 Introduction and Background: 25 Years Later .......................................1
Key Issue: Regulation vs. Competition in Health Reform ...........................2
The Making of a Contrarian Health Economist ..........................................3
Doctors and Substitution in Consumption ..................................................7
Differences 25 Years Have Made ..................................................................9
And the Winner Is … Advanced Practitioners ..........................................10
What This Book Is Not ..............................................................................11
2 Medical Monopoly: What the Doctor Ordered ....................................17
Medical Monopoly and Prices for Health Care ..........................................20
Advanced Practitioners and the Costs of Care ...........................................24
Background: What’s Wrong with Monopoly? ............................................27
Economic Perspectives on the Medical Marketplace ..................................30
The Changing Measure of the Medical Monopoly .....................................33
3 The Medical Marketplace: Learning Lessons of History ......................37
Ancient Roots: Religion and Medicine.......................................................38
The American Way of Medical Care ..........................................................41
The Physicians: Allopaths and Osteopaths ................................................44
The Golden Age of American Medicine: The 1920s to the 1960s ..............46
Drawing the Fein Line ...............................................................................49
Beyond the Doctor Shortage ......................................................................57
The Mirage of Managed Care ....................................................................60
Transition to the Twenty-First Century .....................................................63
4 Captain of the Ship: Legal Foundations of Independent Practice ........65
Professionalism and Autonomous Authority ..............................................70
Seven Foundations of Professional Authority and Autonomy .....................71
1. Advanced Education.........................................................................72
2. Ongoing Certification ......................................................................76
3. Scientific Base ..................................................................................78
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4. C oherent Clinical Model ..................................................................81
5. Professional Liability ........................................................................82
6. Professional Ethics ...........................................................................86
7. Quality Assurance ............................................................................88
Building on Today’s Foundations ..............................................................91
5 Advanced Practitioners: Health Professionals Whose
Time Has Come ....................................................................................93
Nurse Practitioners (NPs) ..........................................................................96
Certified Registered Nurse Anesthetists (CRNAs) ...................................100
Certified Nurse Midwives (CNMs)..........................................................103
Clinical Pharmacists (PharmDs) ..............................................................106
Doctors of Physical Therapy (DPTs) ........................................................108
Doctors of Clinical Psychology (PsyDs) ...................................................111
Advanced Practitioners and Workforce Planning .....................................114
6 Case Studies........................................................................................117
CHI St. Alexius Minot Medical Plaza, Minot, North Dakota .................117
Allcare Health, Grants Pass, Oregon........................................................119
CHI Franciscan Birth Center at St. Joseph, Tacoma, Washington ...........122
Emergency Department, Ellenville Regional Hospital, Ellenville,
New York .................................................................................................125
Partnership for Removing Barriers to Full Practice, West Virginia ..........126
Emergency Department, UC Health Hospital,
Aurora, Colorado .....................................................................................129
Cherokee Health Systems, Knoxville, Tennessee ......................................131
Conclusions .............................................................................................134
Additional Reading .....................................................................................137
Index ...........................................................................................................151
About the Author
Dr. Bauer is an internationally recognized health futurist and medical economist.
As an independent industry thought leader, he forecasts the evolution of health care
and develops practical approaches to improving the medical sector of the American
economy. He is widely known for his specific proposals to create efficient, effective
health care through multi-stakeholder partnerships and other initiatives focused in
the private sector.
Dr. Bauer has more than 275 publications on health care delivery. His most
recent books, prior to this edition of Not What the Doctor Ordered, are Paradox
and Imperatives in Health Care: Redirecting Reform for Efficiency and Effectiveness
(2015) and Upgrading Leadership’s Crystal Ball: Five Reasons Why Forecasting Must
Replace Predicting and How to Make the Strategic Change in Business and Public
Policy (2014). Previous books include Statistical Analysis for Health Care Decision-
Makers (CRC Press, 2009), and Telemedicine and the Reinvention of Health Care:
The Seventh Revolution in Medicine (McGraw-Hill, 1999).
As a consultant, he has assisted hundreds of provider, purchaser, and payer
organizations with strategic planning and performance improvement initiatives.
He served as Vice President for Health Care Forecasting and Strategy for ACS, a
Xerox Company, from 1999 to 2010. His own consulting firm, The Bauer Group,
specialized in consumer-focused strategic planning and clinical affiliation agree-
ments for multi-hospital networks from 1984 to 1992.
In addition, Dr. Bauer was a full-time teacher and administrator at the University
of Colorado Health Sciences Center in Denver from 1973 to 1984, where he held
appointments as Associate Professor and Assistant Chancellor for Planning and
Program Development. He also served for four years as Health Policy Adviser to
Colorado Governor Richard D. Lamm. From 1992 to 1999, Dr. Bauer was a visit-
ing professor in Administrative Medicine at the Medical School of the University
of Wisconsin-Madison.
He received his PhD in economics from the University of Colorado-Boulder.
He graduated from Colorado College in Colorado Springs with a BA in economics
and completed a certificate in political studies at the University of Paris (France).
During his academic career, he was a Boettcher Scholar, a Ford Foundation
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