Dr. Jeffrey Weisz Has Big Plans for Kaiser Permanente
February 22, 2012 – Dr. Jeffrey Weisz is a man on a mission. As the newly appointed president and executive medical director for the Northwest Permanente Medical Group, he’s setting his sights high.
“I believe Kaiser is the answer to healthcare in America, and I’m going to prove it,” he said in a candid interview with The Lund Report. “We’re going to save more lives, and out perform everyone with better service and access, and have the best price and the best quality. Insurance companies that have the best rates win the market. But, I want the best rate and the best quality.”
Competitors such as Providence want Kaiser’s 500,000 members, he said. “But they’re not getting them. We have a better chance they’ll lose them to us because I’m very laser focused on what needs to be done. I want to take over the market and make Kaiser as big as I can, and would like to add 20-25,000 new members every year.”
Weisz intends to partner with private employers interested in lowering their healthcare costs and having a healthier work force.
“We can run a report that no one else can, and tell employers how many of their employees smoke, how many are overweight, how many of people with diabetes have their blood sugar out of control,” he said. “No one else can do this. Everyone’s looking for an answer on how to lower healthcare costs that are escalating every year. If you prevent illness and have higher quality, you’re going to lower your costs and save lives. That’s what I believe in and what I’ll help bring to the northwest region.”
Weisz has other changes in mind as well since joining Kaiser on January 1.
Reducing Outside Medical Costs
Up until now Kaiser members have also been able to see physicians at Oregon Health & Science University. But that’s about to change. Unless OHSU can provide care not available at Kaiser such as heart transplants and complicated pediatric treatments, its members will have to pay the bill if they decide to be seen at OHSU.
“OHSU has a great training program and 60 percent of our doctors are trained there, and we’re spending millions of dollars in care at OHSU,” he said. “Up until now, it’s been a fairly easy path to go over there. I believe we have the same quality care.
Once its new hospital opens in western Washington County next year, Kaiser will have a robot in place, at a cost of several million dollars, and will no longer need to hospitalize patients at Providence St. Vincent Medical Center. Currently, it uses 30 of its beds nearly every day.
“We believe we can do better with our own patients at our own hospital,” he said. “When the robot was introduced, virtually every hospital – other than Kaiser Sunnyside – bought a robot immediately because they wanted to put more patients in their beds.”
Urologists believe the robot gives them better surgical techniques and fewer adverse complications with nerve injuries so people having surgery for prostate cancer can still have normal sexual function and fewer continence problems.
“Most young urologists doing prostate cancer surgery are trained on the robot, and if you don’t have one, they don’t want to join your organization,” he said. “Medicine has become big business and there’s a subset of patients and everyone is competing for the same group. When any new technology comes in, we do an evidence based analysis to make sure we should buy this new technology. If there’s no evidence we won’t buy it. We didn’t buy the robot earlier because were waiting for more literature and more data to see that it was evidence based. We want to be careful because we’re spending our members’ money.”
Niche Care for Nurse Practitioners and Physician Assistants
On a philosophical level, Weisz believes nurse practitioners and physician assistants are better at niche care – becoming an expert in one or several diseases. “Don’t forget I went to medical school, and it’s complicated to take care of patients,” he said.
Nurse practitioners could manage a panel of diabetics, chronic congestive heart failure or well baby visits. Now they usually take care of everything a patient may need.
“I’m going to try and focus them more on niche care,” he said. And, if nurse practitioners and physician assistants need more training diabetes, physicians can teach them.
Weisz realizes everyone might not appreciate this new focus and developed a similar approach while working in southern California. “Anytime you change anything in healthcare people are always upset. But, you have to do what’s right for the patient. It’s very hard for a doctor to assess a patient and they went to medical school for four years. If someone comes in with acute abdominal pain, it’s a complicated thing. Can they feel the spleen, feel the liver, do they know what tests to order? It’s hard for doctors to figure out and even harder for people who haven’t gone to medical school.”
When asked to clarify this statement, Richard Odell, director of communications and assistant to the president, provided the following response to The Lund Report:
“Dr. Weisz is not talking about creating a separate structure for these professionals. In fact, just the opposite embedding them in a specific area of practice where they would work along side physicians.
“For example, there is significant value in using highly skilled NP's and PA's (rather than have them managing a panel of primary care patients) and having them focus on a very specific area of practice.
“These areas of practice could include case and disease management in coordinating care across multiple areas of the care delivery system. It could also include placing them into certain high volume specialized procedural based care settings; for example in a gastroenterology practice performing colonoscopies; or in a head/neck surgery practice to perform myringotomies (placing tubes in children's ears for middle ear infections). There are many other examples.
“Finally, under the current way in which Kaiser Permanente care delivery operates, NWP is responsible for the practice of NPs, PAs and mental health therapists; but they report to the Health Plan and not NWP.
“I don't believe that Dr. Weisz was talking about creating a separate structure for the work that nurses and other clinicians do. He was talking about how an RN often becomes quite adept in a certain area of care, that might be called a 'niche.' A good example of that would be the case managers for congestive heart failure patients. Much of that care is coordinated and delivered by non physicians, in a team care or medical home type of model, but the physicians is still the leader of that team when it comes to making key clinical decisions. “
Weisz’ Has a Track Record in Southern California
Before joining Kaiser Northwest, Weisz, was executive medical director and chairman of the board of the Southern California Permanente Medical Group, a position he held since 2004.
Early on, he decided Kaiser would become number one in prevention in America. Shortly after joining Kaiser, he had attended a national Kaiser meeting in Oakland on breast cancer quality screening and learned that Kaiser’s rate was in the 70th percentile.
“I got up and said those rates aren’t high enough, and I don’t want to go to a meeting where the rates are mediocre,” he said. “In just one year we got all 12 medical centers over 80 percent.”
Two years later, Kaiser became number one in America, having screened more than 90 percent of women between the ages of 50-65 for breast cancer.
“The reason that’s important is because breast cancer is the number one issue women think about and if pick up breast cancer in the early stage, you can do minimal surgery and don’t have to do radiation and chemotherapy or reconstructive surgery, and you have a better chance of saving lives.”
Soon the success in breast screening caught fire in southern California and Weisz realized similar spikes in other healthy measures – from 2004 through 2010, cholesterol control rose by 22.5 percent; blood pressure control, 41.8 percent, smoking cessation decreased by 17 percent; cervical cancer screening went up 5.8 percent and colon cancer screening, by 29.8 percent.
“By picking up the disease early, you prevent less advanced disease and spend less money on chemotherapy and you can put that money back in your system so you can have lower healthcare rates,” said Weisz who intends to create similar screening goals for the Pacific Northwest.
There’s no reason, he said, anyone over age 50, should die of colon cancer if polyps can be identified earlier by investing in colonoscopies. “We’re spending millions of dollars on chemo for advanced disease – why not pick it up early?” he said.
With Kaiser’s sophisticated electronic healthcare system, specialists and primary care doctors can determine whether a patient has undergone screening for colon or breast cancer, for example.
“Anytime one of our patient’s goes to a doctor – be it an allergist or dermatologist, they’ll take your blood pressure and start you on screening tools. That’s how you improve quality and increase prevention,” he said,