Impacting Healthcare Reform at the National and Local level

When I first started my blog I had good intentions of writing at least weekly if not more, I apologize for not keeping up. In the future, I will try and do better.

It has been a month since my last blog and certainly there has been much to write about. Before I dive into one of my favorite topics these days, Reform of our Health System, I'd like to mention that this was a very good week for me personally. I just returned to work after the wedding of my daughter Amy to Eric. While I was away, I had five phone messages from customers; four were compliments and the fifth was a very good suggestion on how we could improve services. I want to send Compliments to our Community Care and Rehabilitation Center, Imaging, Physical Therapy, and ER departments, each of which was mentioned favorably in the complimentary calls.

Now, onto the issue of Health System Reform. If you go to Forbes.com website and type “ Solutions: Health Care” into its search engine, you will see some great commentary from political leaders, professors, government employees , physicians and many others calling for reform of our national healthcare system. If we would just take some of their inspired, mutually-agreed upon suggestions and start implementing change, it would be wonderful. The payment system is archaic and cumbersome and the barriers to real price information are thwarted by it complexities and the confidentiality agreements between payers and providers.

At the local level, we are continuing with our efforts to collect meaningful price information from customers in the marketplace. We will reach out to service organizations and others to collect information from individual E.O.B.s(explanation of benefits). From this information, we hope to be able to explain to our marketplace that Alliance Community Hospital and the Independent Hospital Network (Aultman, Dunlap, Joel Pomeren and Union Hospitals) are one of the best consumer values for acquiring health services in the USA. Another advantage we hope to garner from compiling this information, is to determine whether or not we are being fairly compensated.

Internally, we will be studying the design of our health benefits package. We want to do more to foster accountability for changes in health habits of Colleagues. An example might be: Colleagues who smoke may pay more in the future for their health insurance. Our Pharmacy department is exploring a better way to manage chronic ailments and illnesses that are a major part of our colleague expense budget. In addition, we are examining better use of our internal data to be help shape better prescription drug purchases.

We will keep you informed about our progress in these areas. In my next blog, I hope to touch upon the issue of Community benefit and our not-for-profit status.

Stan

Competition, but on a level or even playing field…please talk with your local legislators regarding house bill SB120

Competition is a very good thing. If you have read some of my past blogs relating to transparency, our hospital and doctors feel we can compete with anybody in providing great services at a valued price.

Why am I so concerned about this legislation and the expansion of niche or specialty hospitals? More services and choices mean more competition, right? WRONG!

These specialty hospitals usually target the most profitable services that are typically part of a Community-not-for profit hospital, like ACH. Yes, we too (like the for profit hospitals) need to make money otherwise we wouldn’t be here. However, the profits we make get plowed back into all the services that aren’t self supporting and sometimes lose a great deal of money; services that are vital to our Community like having an Emergency Department available 24 hours a day, seven days a week that never closes; or OB Services or Cardiac Rehabilitation.

At our facility our not for profit status entitles us to tax advantages to the tune of about 2.3 million dollars a year. We still make a profit but, we provide just under $8 million of Community benefit dollars to support services that otherwise would not be provided or scaled back greatly.

One of two things should occur if specialty hospitals are allowed to proliferate in Ohio. The first, which is addressed in the proposed legislation, is that these hospitals should also provide emergency support to the Communities that they are in. This levels the playing field and shares the burden of providing much of the Community’s uncompensated care. The other is unlikely to occur. Without inclusion of this type of provision how services are paid for must change. Insurance companies and the government must shift some of the payment away from the profitable services and pay more for services like OB, ER, and Cardiac Rehab. If that doesn’t occur we will have more competition, more fragmentation and most likely higher costs. That is my opinion, what’s yours?

Health Consumers We Need Your Help

At Alliance Community Hospital we are trying to learn how to be better shoppers of health care. How can you help? By sending me your comments and questions as they relate to shopping for health care services. Hospitals, doctor offices, and free standing centers are not very well prepared to answer many of your questions. Probably the most frustrating is not knowing in advance how much you will pay for a service, the amount of your co-pay or out of pocket expense. So, what information do you need to become better shoppers of health care services?
Looking forward to hearing from you.
Stan

Is the Customer/Guest Always Right? And Kudos Again

Kudos Again

Being a backwards thinker sometimes gets you where you want to be faster. So I will begin with the end of this blog first…I have been getting more and more compliments about Colleagues who work here. Here are two, one from the end of the summer that missed being passed on and the other from last week:

Sharon writes “…In E.R. Susan was the shining star. She was patient, kind, caring and quite knowledgeable…she more than goes the extra mile. She is a great asset…And in same day surgery, Dotty went the extra mile as well…she was kind and had a wonderful sense of humor. She puts the patient at ease and has a wonderful smile. Please let both individuals know how much they are appreciated.

Debra called to recognize Dawn and Tricia part of our therapy team. They were both so kind and professional. I will always recommend Alliance Community as the place to go.

The above comments are wonderful. I look forward to the calls regarding staff because I usually can get more of what our colleagues exactly did to make such an impression.

Is the Customer/Guest Always Right?

So is the customer or guest always right? I guess it is a matter of perspective. When a customer takes the time, or initiative, to share a comment you can either receive it as free consulting/advice or you can view it as a complaint. Most people usually don’t express their dissatisfaction because they don’t want to get anybody in trouble; at least those are the words I hear most often as it relates to healthcare. Many of our customers and guests at Alliance Community Hospital listen for the following words, “Is there anything else I or a fellow Colleague can do for you?” as their cue to let us know if we haven’t met their expectations; and they can do so without getting anyone in trouble. During a patient's stay or visit with us a Colleague may offer a business card. On the bottom of their card is the leader of the department in which they work. If the Colleague can’t respond to the request directly their boss is available to help. If for any reason they are unable to respond, the patient is free to turn the card over and contact me directly. My business, cell and email are listed. In the past when I would be responding to what customers would say is a "complaint" and went to follow up with a Colleague or department manager often the first words I would hear were, “You have to hear my (our) side of it." This doesn’t happen too much anymore. Most times it goes, “Let’s look at what happened and see if there was a way to meet the customer’s expectations.” It isn’t a right or wrong issue anymore.

Last week a patient’s wife called in to express concern over the discharge process related to her husband’s care. Although she was very concerned about her husband, she wanted to make sure if there was anything that could have been done better that we investigate, and if so help avoid some of the things they went through.

We will be getting back to her and her husband and we were very thankful for her call. Certainly when things go well we love to hear from you; however we care just as much when they don’t or we haven’t met your expectations so please let us know how we are doing.

Thanks. Stan

P.S. (Just recieved this comment!) Virginia writes regarding our transport services sponsored by local physicians and the hospital: “I want you to know how important your transport service is to me….I ….and most of my friends are in our eighties and don’t like to drive…It is a wonderful service”

Hillary, Rudy, Ted in Ohio et al….please help!

In a recent meeting with several physicians, we were discussing all the changes that health care providers must deal with that are non-clinical in nature. As frustrating as it might seem to patients, it has been increasingly so to doctors as well.

More than half their time seems to be spent on non-clinical matters, helping their patients navigate the health care system maze or on billing activities trying to get paid by insurance companies. This last Friday on 20:20, the final segment showed a primary care physician who dropped all insurances and would only accept cash. He lowered his overheads, seemed to have more time for his patients and his income stayed the same. In a recent seminar that I attended material was presented on a RAND study done in Ohio several decades ago. This study found that when patients paid a greater percentage of their health care costs they used 31% less care with no significant outcome differences.

So, let’s design a system of caring and health that lets doctors practice and doesn’t require them to get another degree in accounting or information systems to get paid for their work. Next, make sure patients have enough incentives to learn to be good buyers of health care services.

So what’s next? Transparency. Health consumers need information on actual out of pocket expenses in advance of service. Sorting out value will be a bit more complicated; however, the quality information that hospitals, doctors and insurance companies possess needs to be shared in ways that help patients purchase health services. We also need to get this information into the hands of doctors and other health professionals who can assist their patients in determining the best value.

Now here is where we could use help from our legislators. Last time Hillary tried to get more information out there the insurance industry had a lot of lobbying money, and the Republicans turned her plan into waste material. Of course I am on dangerous ground here because I too didn’t like the plan. My point here is that the governor of Ohio has a task force working on these issues and I am not sure that any doctors or hospitals are on it. I hope Ohio can take the lead in developing something that both Ohio Democrats and Republicans can get behind because, the big picture for Ohio and the U.S. is for us to be a lot more competitive, after all our health care costs are killing us. Being too idealistic? It never hurts to dream big.

With all these pressures it was refreshing to hear comments from local doctors last week as they were discussing their own frustrations in running their practices; whatever they do they agreed the bottom line was to do whatever it takes to care for their patients. After that they would focus on running their practice or how to work better with a hospital.

Not there yet but we are getting closer…building our dream of becoming the best Community Hospital for the State of Ohio

Last Friday, several hospitals from the Cleveland Clinic network visited us and I had a chance to reminisce about changing the culture at our hospital. To borrow a line from W. Edwards Deming, “America has the greatest and most productive workforce in the world, all it needs is leadership who believes in them."

The culture of an organization certainly is a leadership issue. Well at ACH/Planetree I have gotten a lot of credit for many of the wonderful things we have achieved and do everyday, but I will be the first to admit we just have a great team of talented individuals who get to practice their professions in an environment that they helped create. What we have done as an organization is create an atmosphere of shared beliefs and values that makes us feel good and is appreciated by our patients and guests. What was wonderful to hear was how our guests perceived our colleagues and their level of genuine engagement.

Postscript to my very first blog. I was saddened to learn that the physician practice decided to discharge Susie’s mom from their practice. Even in the movie, Miracle on 34th Street, Santa sent a customer to Gimbels for the one item they were searching for because Santa cared about the value to the customer. There is an old expression, "let the buyer beware.” Well the new expression will be “let the seller beware.” The end result for Macy’s, they are still around today. Hospitals and doctors, the world is changing quicker than ever; let’s help educate our customers and serve them well. What has always made us special in the eyes of our patients is their trust. There are rough times ahead and as long as we continue to keep that trust of “patients first” we will all be better off.

What do you get when you mix transparency, with support from the government, hospitals, and doctors?

Answer, a possible cure for managed care, a boost for an ailing economy and more knowledgeable healthcare consumers.

In an article by Robert Pear that was published in the New York Times January 9, 2004:

• Health spending was 15 percent of the nation’s economy
  
• 1.55 Trillion
  
• Projections put health spending at 17.7 percent of GDP by 2012
  
• Spending for hospitals and prescription drugs seemed to be tapering off
  

On August 12, 2007 in the Huckabee Roundup summarizing some of the presidential candidate’s views:

• The health care system in this country is irrevocably broken, in part because it is on a health care system, not a health system
• Health care spending is close to 17% of our gross domestic product
• Our health system is making our businesses non-competitive in the global economy
  

Well, it is only three years since the earlier prediction of 17% of GDP. Gosh we are five years ahead of schedule. Unfortunately, I expect that there will be lots of good ideas bantered about throughout the next 15 months and little change until 2009 or beyond.

In Media Beat there was an article by Kip Sullivan (8/14/2007):

• The call for rationing became audible in the late 1980s It got louder in the early 1990s as universal health insurance rose to the top of the nation’s agenda
• Five years even louder as it has dawned on pundits that HMOs are incapable of reining in health care inflation The U.S. system may be wasting up to 300 to 400 billion dollars a year It would cost 40 billion to cover the uninsured with insurance
• A conservative estimate of the cost of excessive administration spending and excessive prices alone comes to 15 percent of total health care spending
• Excessive administrative spending refers both to the administrative spending of insurers and medical providers
• The issue is whether we could spend less than a fourth of our health care dollar on clerks, HMO police, ad writers, lobbyists, merger specialists, and a host, of other functions who do not provide health care to patients
• Administrative spending grew rapidly as managed care spread. Because HMOs hire people to supervise doctors and hospitals and because doctors and hospitals hire people to deal with HMOs
• If you give a dollar in premiums to an insurance company it will keep 15 to 30 cents for overhead and pay out 70 to 85 cents for medical services
• The GAO found that U.S. providers would enjoy administrative savings equal to 4.5 % of total health care spending primarily because billing for physicians is so much easier when they have to bill just one insurer

Where do we start?

Since the health care system is sick we, who work in the system, should start the process. Modern Healthcare’s August 27, 2007 issue recently ran the article, “Religious Experience” by Cindy Becker in which she quoted Sister Carol Keehan. Sister Keehan is leading us in the right direction. She says, “A good (healthcare) system is not necessarily only one way…On the balance we are not looking for the perfect system…So we’re say as opposed to advocating your plan vs. my plan, we have been working to develop principles so we can say any healthcare reform plan should be measured by these principles.”

Let us begin with the transparency on the information we have; we need to figure out how to share it. We get quality data on how we compare to other hospitals from the insurers. It is only for internal use. Let’s agree to share it. If we are low and it is shared maybe we will work harder to change it. Let’s ask our customers for their EOBs (explanations of benefits paid) so we can see how others are being paid for the services they provided. Let’s share our pricing with our consumers. They need to know before their service what their co pays will be, not after. If we are not efficient, competitive or can’t explain the value difference in price or service then maybe we don’t deserve the business; isn’t that what today’s free market is all about?

For those who don’t take care of their own health insurance when they are capable of doing so, they should bear greater out of pocket expenses. I’m usually not in favor of more government control, but I can vote on tax increases (force those of us in healthcare to reallocate what we do) so why not a single payer system, with true transparency on how hospitals and doctors are actually performing and let knowledgeable consumers decide for themselves.

As bureaucratic as it may be, the fragmented system of managed care is far more difficult a course to navigate. It is a shame with all the wonders of medicine available to us that we don’t have a better system. Sister Carolyn is right. “Until we have that critical mass of American people saying, ‘WE WANT IT,’ things won’t change.” Let’s keep educating those we serve.

-Stan
Writen: August 28, 2007