• Increased competition. Some of the most exciting
innovations in cost-effective care are occurring in
outpatient ORs, according to Dr. Makary. "I'm
encouraged to see areas of health care becoming
more competitive," he says. "Same-day joint
replacements are a perfect example. They're
being done in highly competitive markets where
facilities are being rewarded for providing value-
based care."
Dr. Makary believes surgical innovations will help ensure technolo-
gies that contribute to high-quality, affordable care will come to mar-
ket more quickly than ever before.
• Frontline feedback. The big thinkers in health care are approach-
ing the nurses and surgeons who work in the trenches, the ones with
the hands-on experience and real-world insights needed to come up
with the ideas that gradually evolve into game-changing evolutions.
"How can we redesign patient care? How can we increase competi-
tion?" says Dr. Makary. "Providers are being asked the key questions
that will ultimately help drive down the costs of care."
• Remember what matters. Some health systems and insurers are
using predatory billing practices that are saddling patients with
mountains of debt and ruining their lives, according to Dr. Makary.
"It would disgust any healthcare provider," he adds. "It violates our
oath and mission."
Moral outrage at unfair billing practices has inspired numerous
physicians, nurses and facilities to spearhead the movement
toward honest billing and price transparency.
"Health care is a business, but we've seen in competitive markets
that businesses run with high ethical standards can thrive and inno-
vate," says Dr. Makary. "There will always be plenty of patients to care
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