Robert FrombergEditor in Chief, HFMA
In any public policy discussion, the hardest role to play is the one in which you find yourself saying, "Yes, but it's not that simple." Take the Bush administration's recent statements about hospitals needing to publish their prices or legislation will be forthcoming to mandate it. Consider this response: "Yes, but it's not that simple; price transparency is a complex thing that requires collaboration among many parties, not just a mandate." Such a response puts providers in the uncomfortable position of seeming to argue against something that they generally believe in--the importance of price transparency. The same situation exists when a state government attempts to mandate a certain level of charity care. Hospitals are not against charity care, but again can find themselves in a position of having to say, "Yes, but it's not that simple."
In HFMA News this week is a story involving pending legislation in Massachusetts that would give government a role in determining appropriate RN-patient ratios. As in the examples above, it's a tough situation rhetorically, not to mention in terms of policy. Of course Massachusetts hospitals are in favor of providing high-quality care, and of course they realize that sufficient staffing is an important part of high-quality care. Yet, they are in the position of needing to say, in essence, Yes, but the best way to make such determinations is by individual teams of care providers in individual hospitals based on individual patients.
I wouldn't dream of suggesting that I have an answer to such situations, but I have two observations. One, it's always a shame when a common goal is not achieved because of differing views about how to reach it. Two, the next time I make a statement and someone responds, "Yes, but it's not that simple," I'm going to be sure to listen hard to the reason why "it's not that simple."
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