2005 Prediction That Maine's Dirigo Health Would Fail

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.