The predictable failure of Maine's effort at universal care will be the same for ObamaCare if it fails to inspire the health care delivery system. We know from history that Medicare purchasing power is more apt to expire a hospital or medical practice than inspire health care professionals. The following article addressed the fate of Maine's failing Dirigo Health program
Dirigo Health: 'dead program spending'
04/22/2005 By R Daniel King, Times Record Contributor
Dirigo Health is sadly a "dead program spending." The executive director of the Governor's Office of Health Policy and Finance recently reminded us that the "Legislature enacted Dirigo Health to reduce our health care costs, improve quality and increase access to coverage." Yet none of the strategies the office has chosen has any remarkable history achieving these goals.
The office does not acknowledge it rewards failure in quality and efficiency, so quality and cost will continue to deteriorate. DirigoChoice enrollment increases are offset by mandated decreases in MaineCare enrollment, adding to bad debt and charity. The office failed to inspire the hospital industry with old control and fear tactics and now will attempt to transform the entire industry from Augusta, the ultimate strategy of hope, regardless of "time and diligence."
Rewarding failure by paying for operational inefficiencies and preventable clinical errors is the root cause of the organized chaos we call a health care delivery system. This reimbursement methodology contradicts the volumes of scripted quality and costs regulations and penalties the government hopes will control and instill fear in providers to avoid inefficiencies and preventable errors. Paying for failure is why growth in health care costs outpaces inflation. What incentive does a provider have to focus on eliminating inefficiencies and preventable clinical errors when they pay? Government's commitment to these contradictory tactics has made providers as much the victim as they are the culprit.
It is like watching the dysfunctional families on the TV shows Nanny 911 and SuperNanny. The parents (government) believe they are good parents and are doing all the right things but the kids (providers) just don't respond with the appropriate behavior. After some trail and error, a heart to heart with the Nanny and some tears, the parents become committed to new strategies. The parents transform first, and then the children improve their behavior. It is the same for health care. Government, insurers and the governor's office will have to transform its reimbursement methodology and attitude towards providers before providers will have an incentive to change behavior.
The National Committee for Quality Assurance labeled the current systems of reimbursement as "neutral on the issues of bad quality, which actually - often inadvertently - pays more for it." The Juran Institute Inc. has projected that rewarding failure, which could have been prevented, represents 30 percent of the nation's total health care costs. In 2003, that represented $1,389 per Mainer or more than $12,000 per uninsured Mainer!
What are 21 st century win/win strategies a health care Nanny might suggest?
- Stop paying for failure. Create a reimbursement methodology that gives providers the incentive to be in the constant pursuit of excellence and the financial means to avoid failure.
- Stop the need to cross-subsidize where one underpaid service needs a financial lifeline from an overpaid service.
- Stop Medicare and Medicaid from recouping payments for failure with 15 percent and 30 percent discounts respectively, which are added on top of the cost of failure the rest of us pay.
- Stop refusing physicians and hospitals certificates of need if they can demonstrate new heights in quality at lower costs. And the list of "stops" and "create" is endless if we have the courage to think outside the box.
Sounds scary because conventional thinking views the world of health care as flat; and without regulatory barriers of fear and control, providers would fall. But the opposite is true. We see it every day in every industry except health care, government and education, the only three industries controlled by government and universally rewarded for failure.
If we created a reimbursement methodology that instills accountability, freedom and the financial resources to explore new frontiers in quality outcomes and costs, then the health care industry, not government, will create an organizational culture that will support affordable universal health care. Until the Governor's Office of Health Policy and Finance develops 21st century strategies that effectively will challenge the status quo, Dirigo Health and DirgoChoice will remain just two "dead programs spending."
R. Daniel King of Topsham was the president/chairman of MEDQIC Inc., a large medical group in St. Louis, Mo. He periodically was contracted to do crisis management for health care institutions with very serious patient care problems and/or financial issues. He says that during this period he learned that inspired employees can make extraordinary transformations in patient care when they know leadership cares through words and actions.
Thursday, May 14, 2009
Thursday, May 7, 2009
Pursuing Excellence In Efficiencies Trumps Medicare-Purchasing Power
Universal access to affordable care starts with operational efficiencies the rails quality travels to achieve excellence in patient and financial outcomes. Without operational efficiencies, quality outcomes are a crap shoot which is why the US has the best and worst health care.
The constant pursuit of efficiencies forces leadership to be engaged in patient care and financial processes and the rewards are what they value: money. Only a few find value in patient outcomes, otherwise the industry would not be quality challenged. The cultural impact of inspiring excellence in efficiencies transfers to patient outcomes like a contagious disease. This is why this blog advocates paying for excellence and not failure which gives providers the financial resources to pursue efficiencies which will have a direct impact in lowering preventable medical errors IMMEDIATELY.
You can not achieve excellence in efficiencies without leadership inspiring employees and supporting each with continuous education, effective communication, and the most current information timely delivered so each can effectively focus on the needs of the patient in an environment driven by accountability and innovation. Two that approach this strategy are Intermountain Healthcare and Mayo Clinic.
Research by Dartmouth Medical School suggested that if all Americans accessed care from Intermountain and Mayo, the nation’s $2.7 trillion health care bill would be cut 33 and 25 percent with NO rationing while saving $890 billion and $675 billion respectively. It only takes $215 billion in savings to pay for an individual private insurance policy for every uninsured American leaving billions in savings and an unbelievable boost to US businesses.
Presently, Medicare and Medicaid utilize purchasing power to underpay excellence which hospitals and physicians recoup through inflated charges paid by private insurers. These subsidies according to two studies inflate premiums 11 to 13 percent, maybe more, giving the perception Medicare efficient; private insurers inefficient. It is this myth that makes many Americans think a Medicare-like program for the masses is a solution. But, Mayo’s chief executive has stated that a universal Medicare-like program would eliminate these subsidies and, “your very best providers will go out of business.” Health care reform should be focused on increasing “best providers,” not exterminating them.
It is interesting how government advocates that health care professionals learn from best practices, but government does not seem inclined to learn how “best providers” achieve quality outcomes at 25-33 percent savings and no rationing. It is this kind of inconsistency that consistently defines the Obama Administration's attempt to nationalize industries that government manipulation has perverted: health care, education and mortgage banking.
The constant pursuit of efficiencies forces leadership to be engaged in patient care and financial processes and the rewards are what they value: money. Only a few find value in patient outcomes, otherwise the industry would not be quality challenged. The cultural impact of inspiring excellence in efficiencies transfers to patient outcomes like a contagious disease. This is why this blog advocates paying for excellence and not failure which gives providers the financial resources to pursue efficiencies which will have a direct impact in lowering preventable medical errors IMMEDIATELY.
You can not achieve excellence in efficiencies without leadership inspiring employees and supporting each with continuous education, effective communication, and the most current information timely delivered so each can effectively focus on the needs of the patient in an environment driven by accountability and innovation. Two that approach this strategy are Intermountain Healthcare and Mayo Clinic.
Research by Dartmouth Medical School suggested that if all Americans accessed care from Intermountain and Mayo, the nation’s $2.7 trillion health care bill would be cut 33 and 25 percent with NO rationing while saving $890 billion and $675 billion respectively. It only takes $215 billion in savings to pay for an individual private insurance policy for every uninsured American leaving billions in savings and an unbelievable boost to US businesses.
Presently, Medicare and Medicaid utilize purchasing power to underpay excellence which hospitals and physicians recoup through inflated charges paid by private insurers. These subsidies according to two studies inflate premiums 11 to 13 percent, maybe more, giving the perception Medicare efficient; private insurers inefficient. It is this myth that makes many Americans think a Medicare-like program for the masses is a solution. But, Mayo’s chief executive has stated that a universal Medicare-like program would eliminate these subsidies and, “your very best providers will go out of business.” Health care reform should be focused on increasing “best providers,” not exterminating them.
It is interesting how government advocates that health care professionals learn from best practices, but government does not seem inclined to learn how “best providers” achieve quality outcomes at 25-33 percent savings and no rationing. It is this kind of inconsistency that consistently defines the Obama Administration's attempt to nationalize industries that government manipulation has perverted: health care, education and mortgage banking.
Wednesday, May 6, 2009
President Obama Moving US Towards YugoCare
In April, lawmakers and experts focused on sweeping changes to Medicare declaring it should become the “test lab for making the entire health care system less wasteful.” Sen. Max Baucus, D-Mont, the Finance Committee chairmen heading this share your feelings meeting declared, “Medicare is going to be the driver to achieve quality reforms.” Health care is wasteful and quality challenged because of Medicare purchasing power and win/lose strategies. Sen. Bauscus's committee is delusional if it thinks larger injections of the virus, Medicare, is the cure. As this blog has argued previously, if Medicare rewards operation inefficiencies and preventable medical errors, then expect growth in wastefulness and deterioration in quality.
Historically, Medicare focuses on price controls and shifting costs to private insurers at the sacrifice of patient outcomes. Remember the 1999 Institute of Medicine report that declared the nation’s hospitals kill 98,000 patients annually due to preventable errors. The same data reviewed by HealthGrades upped the estimate to 200,000 preventable deaths. It took ten years and two million preventable deaths before Medicare on October 1, 2008 took action against preventable medical errors. That is if you call Medicare’s policy to not pay for one hundredth of one percent of the cost of preventable medical errors action.
When Congress talks of wasteful spending, it does not mean operational inefficiencies. It means paying less for more which is exactly what the proposed (FY) 2010 Inpatient Prospective Payment System (IPPS) plans to do for hospitals. IPPS gives advocates of a government single payer system an insight to how Medicare gives an increase of 2.1% to hospitals then takes 1.9% back through a phased-in documentation and coding adjustment (DCA) with no regard whether revenue cuts will impact patient outcomes.
It is my anticipation that this anti-free market Congress thinks that more price controls inflicted on all health care suppliers and physicians who happen to be in politically incorrect specialties or products will be the strategy for eliminating “waste.” This strategy brought the world the Yugo automobile which was a socialistic government's attempt to set prices so Yugoslavia could achieve universal automobile ownership. Sound familiar. The Yugo’s use of price controls failed because it was cheap to buy but unaffordable to maintain. Meanwhile, Toyota was pursuing a strategy to inspire employees to be in the constant pursuit of excellence giving it world dominance in affordable, reliable automobiles. Inspired humans will always trump command/control governments.
The disdain the Obama administration has for free markets drives it to pursue the Yugo strategy of price control pain moving the US health care system to YugoCare. This will result in great costs and human suffering. It will take extraordinary failure before the country will adopt the cheaper, quicker, self-sustaining strategy of paying for excellence and never failure in a manner that inspires health care professionals to be in the constant pursuit of excellence. Remember, Adam Smith's free market concept grew from government controlled economies that caused massive famine.
Historically, Medicare focuses on price controls and shifting costs to private insurers at the sacrifice of patient outcomes. Remember the 1999 Institute of Medicine report that declared the nation’s hospitals kill 98,000 patients annually due to preventable errors. The same data reviewed by HealthGrades upped the estimate to 200,000 preventable deaths. It took ten years and two million preventable deaths before Medicare on October 1, 2008 took action against preventable medical errors. That is if you call Medicare’s policy to not pay for one hundredth of one percent of the cost of preventable medical errors action.
When Congress talks of wasteful spending, it does not mean operational inefficiencies. It means paying less for more which is exactly what the proposed (FY) 2010 Inpatient Prospective Payment System (IPPS) plans to do for hospitals. IPPS gives advocates of a government single payer system an insight to how Medicare gives an increase of 2.1% to hospitals then takes 1.9% back through a phased-in documentation and coding adjustment (DCA) with no regard whether revenue cuts will impact patient outcomes.
It is my anticipation that this anti-free market Congress thinks that more price controls inflicted on all health care suppliers and physicians who happen to be in politically incorrect specialties or products will be the strategy for eliminating “waste.” This strategy brought the world the Yugo automobile which was a socialistic government's attempt to set prices so Yugoslavia could achieve universal automobile ownership. Sound familiar. The Yugo’s use of price controls failed because it was cheap to buy but unaffordable to maintain. Meanwhile, Toyota was pursuing a strategy to inspire employees to be in the constant pursuit of excellence giving it world dominance in affordable, reliable automobiles. Inspired humans will always trump command/control governments.
The disdain the Obama administration has for free markets drives it to pursue the Yugo strategy of price control pain moving the US health care system to YugoCare. This will result in great costs and human suffering. It will take extraordinary failure before the country will adopt the cheaper, quicker, self-sustaining strategy of paying for excellence and never failure in a manner that inspires health care professionals to be in the constant pursuit of excellence. Remember, Adam Smith's free market concept grew from government controlled economies that caused massive famine.
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