The Commonwealth Fund has posted a page on its web site with revealing reactions to the organization's recent study showing a rise in the proportion of middle-income Americans without health insurance. Here are a few excerpts.
Most respondents showed a distinct lack of surprise and identified rising healthcare costs as a key culprit:
"To learn that a growing number of people in moderate- and middle-income households are going without health coverage is disheartening, but not surprising. As the head of a large hospital system serving a major metropolitan area, I see the impact of more and more families going without medical care due to the combination of eroding health insurance coverage and rapidly rising health care costs."--James Mongan, M.D., President and CEO, Partners HealthCare, and Chair, Commonwealth Fund Commission on a High Performance Health System
"As the director of a large metropolitan area public health department and a practicing pediatrician, I witness the impact that the high cost of health care has on families and communities. Every day, I see working families that are struggling to pay for food, housing, clothing, and transportation, and that don't seek care until an illness has progressed to the point where hospitalization, surgery, and expensive medicines are required to treat it."--Fernando Guerra, M.D., Director, City of San Antonio Metropolitan Health District and Member, Commonwealth Fund Commission on a High Performance Health System
"Often, the problems of the uninsured and underinsured are attributed to the difficulty small firms have in subsidizing health benefits for their workers. While this is undoubtedly true, given the unsustainable cost of health insurance today, it obscures the coverage problem in large corporations. This report documents the extent to which coverage problems exist in large businesses that reject a shared responsibility approach, where the company provides significant funding for health care and workers contribute as well."--Gerald Shea, Assistant to the President for Government Affairs, AFL-CIO
Solutions posed include collaborative work to control costs, build on programs already in place, and enhance preventive care:
"No economy can support the current rate of growth in health care costs. Business owners both large and small work hard to offer coverage to their employees but in order for them to remain effective and competitive, health care costs must be brought under control."--Helen Darling, President, National Business Group on Health
"If we are going to make true progress for the hardworking uninsured families in our communities, we must put a higher priority on the importance of a medical home; begin to value the relationship between health care professionals and their patients; make routine health care affordable for working families; and ensure that essential preventative care is accessible."--Fernando Guerra, M.D., Director, City of San Antonio Metropolitan Health District and Member, Commonwealth Fund Commission on a High Performance Health System
"Real solutions that build on group forms of coverage already in place, including employer plans, Medicare, Medicaid, the State Children's Health Insurance Program, and state and federal employee benefits programs, can help to fill insurance gaps with meaningful, affordable coverage that helps link families and providers."--James Mongan, M.D., President and CEO, Partners HealthCare, and Chair, Commonwealth Fund Commission on a High Performance Health System
Scott MacStravic, Ph.D.
I recently read another of the countless, invariably laudatory articles about Herb Kelleher, founder of Southwest Airlines. [K. Sutherland “Plane Smart!” Cincom Expert Access Apr 11, 2006] It described the corporate culture he created and the ways it has played out in customer service and company success.
Lots of elements of his strategy and culture are perhaps not wholly applicable to health care and hospitals. His principle and practice of “hiring for attitude, everything else can be trained” is only partially adoptable in health care, where professional training and credentials are the sine qua non in most hiring decisions. But this principle is not wholly applicable to airlines, either, since pilots, at least, must be highly trained as well as licensed. And attitude is clearly a major element in serving “customers,” along with training in treating patients.
Other elements are directly adoptable:
Southwest’s dedication to its employees is equally strong – it clearly and consistently recognizes its employees as individual human beings, not just workers. Every employee who becomes a parent gets a letter from the corporate office. So does every one who has a death in the family. Anyone out sick for a length of time gets regular contacts asking how they’re coming along.
And Southwest’s customer service notoriously extends to both non-customers and well past when passengers get on or off the plane. Southwest flew into New York City, for example, where it has no routes, just to remind people there that there is another option besides JetBlue. It celebrates examples such as the employee who helped a non-passenger fix a flat tire in the parking garage, and another who drove employees from an airport hotel in his own car when the hotel van broke down to be sure they made their morning flight, then came back and drove the employees of a rival airline as well.
But perhaps the principle and motto most clearly transferable to health care is Southwest’s “Herbocratic Oath,” which reads the reverse of the Hippocratic Oath that has so long served the medical profession. Herb calls for all to “First, do Good!” rather then primum non nocere – first, do no harm.
Hospitals and physicians have always been, and are particularly now focused on reducing medical errors, ensuring patient safety, i.e. doing less harm than the estimated 100,000 or so patients being killed each year, and countless others with nosocomial infections, medication errors and other harm short of death. All such efforts are essential, to reduce malpractice insurance costs, bad PR, and patient dissatisfaction, as well as fulfill the do no harm oath.
But the essential mission of hospitals and physicians is to first do good. And they do so much good, not just in annual “community benefit” expenditures that have failed to persuade communities that there is any significant difference between for-profit and not-for-profit institutions. They have enormous positive impacts on the lives of individual patients and their families.
I recently had an article I wrote edited for publication, with the editor sending it to me for review, with repeated questions about what I meant when I cited the “health and life quality impacts” that health care providers deliver. If an editor of a health care publication isn’t sure what I meant, can the American public be more familiar with the concept?
In general, providers, especially physicians, have been loath to accept accountability for the good that they do. One justified this reluctance as follows: “…you can hold a physician accountable for doing the right thing, but you can’t really hold him (sic) accountable for whether it works or not. That’s really in God’s purview.” [A. Robeznieks “Tennesee Doctors to Get Paid for ‘Doing the Right Thing'” American Medical News Feb 2, 2004]
Hospitals and physicians tend to be measured by outsiders based on how little harm they do – how low their mortality, complication and infection rates are, for example. They rarely even know what the total positive impact, the total “good” they have done for patients, simply because they don’t follow up to find out how they’ve done months or more after discharge. Instead, they get their patient satisfaction surveys done as soon as possible, before patients get the bill.
Why don’t hospitals and physician practices identify and celebrate their successes, along with minimizing their failures? Why don’t they report on the employees who have gone out of their way to serve patients, even after discharge, for example? Why don’t they remind employees of the patients whose lives have been dramatically improved or restored by services each had a role in delivering? Why don’t they remind patients, themselves, by asking about them, and offering them opportunities to contribute case examples, testimonials, or serve as “references” to other patient prospects?
If providers spend too much time on doing no harm, they will have something to be proud of as they reduce the harm they do and remind patients, employees and the public of that fact. But how much more impact can they have if they spend roughly equal effort focusing on the good that they do, and reminding everyone in sight of that fact? Otherwise, their reports of doing less harm merely reminds people that they are still doing some harm, and omit mentioning how much good they are doing all the while.
Robert FrombergEditor in Chief, HFMA
The Commonwealth Fund just released a new study showing that a significant number of working, middle-income Americans lack health insurance and that the uninsured receive "inefficient" health care.
What this reminds us about how the uninsured affect hospitals. This study vividly shows that hospitals are challenged not just by needing to provide uncompensated care, but by the fact that patients without insurance tend to be sicker because of their lack of routine health care, and that getting information about their health and health care is difficult.
Haven't I read this study before? We're faced with so many studies about the uninsured. As an experiment, I just did a Google search on the words "changing face uninsured" and sure enough the first hit was a 1996 study by the state of Connecticut that said the number of working families without health insurance was rising.
When do we reach the point when action is politically palatable? I saw David Gergen on TV last night talking about the history of the nation's efforts to enact energy reform. (By the way, Gergen is speaking at HFMA's annual conference this year.) He said when he was in the Nixon administration he was writing position papers about energy independence. He said maybe, just maybe, the confluence of a terror threat, high gas prices, and environmental concerns could bring us to the point at which the political will will be present to bring about energy reform. This study makes me wonder when we will reach that point with healthcare reform. The Nixon administration--during the height of Watergate--proposed healthcare reform that in many ways resembled the Clinton administration's proposals. (I once said that to Dick Clarke, who replied, "Nixon? How about Truman?") This problem has been with us for years, and reform proposals have been floated for years. What factors will make action inevitable? This study suggests that the middle class is more than ever affected by problems with health insurance coverage. We would like to think that the nation's concerns would be triggered if any group--lower class, middle class, or upper class--is afflicted by a serious and systemic problem such as this, but perhaps a rising awareness of the middle class's involvement will trigger political action.
Breakfast is over--time to head to the office and find out what wiser minds than mine think about all this.
Tony ChenDirector, Product Innovation, HFMA I've been somewhat impressed by the recent coverage of what appears to be the transformation of the CFO role in Corporate America. For example, Booz Allen Hamilton released a report (PDF) a few years ago on the new CFO Agenda. Booz contends that the days of pure cost control are over, CFOs are now charged with value generation. No longer just focused on finance, no longer just "an advisor," CFOs are becoming the primary business partners of their CEOs. The folks over at IBM just wrote an article arguing that CFO should truly stand for "Chief Focus Officer" whereby the CFO is the CEO's right-hand man in defining the organization's core competencies and developing its unique strengths. A Strategy+Business Article, titled "Not Your Father's CFO," reported on some extensive Fortune 500 interviews and noted that more and more CFOs were taking on operations, planning, and business development roles. Based on this research on corporate CFOs, more and more CFOs seem to be: - Wearing more hats - Thinking about their department less as a function, and more as a organizational discipline - Hiring people into the finance department with significant operations, planning, and other nontraditional backgrounds - Spending more time communicating. Externally, to lenders, ratings agencies, shareholders. Internally, to more cross-functional and varied groups across the entire enterprise. - Spending more time on the "growth agenda" - More closely engaged than ever in designing, adapting, and implementing their organizations’ business models - Being asked to be change agents How much of this carries over into our hospital setting?
“There are a number of studies--from the government, from the Center for Studying Health System Change, from PricewaterhouseCoopers--that outline factors behind rising healthcare costs, and lack of competition among health insurers is not one of those factors. Competition is vigorous within our industry by any measure you use. If you just look at the number of competitors per market in major metropolitan statistical areas, there are at least eight, and those companies have multiple product offerings.”
Susan PisanoVice President of CommunicationsAmerica's Health Insurance Plans
Following is reaction noted to the recent AMA study that found a near monopoly among health insurers in many markets.
"Health care premiums are up because the underlying costs of health care are up dramatically. The causality is not consolidation," said Christopher Ohman, chief executive of the California Association of Health Plans.--quoted in The San Francisco Chronicle …Gary Claxton, vice president at the Kaiser Family Foundation, contends fewer insurers mean the need for underwriting cycles has diminished, and it's likely that carriers will settle on the high side when it comes to premium increases. "They won't get down to cost," he said. "They see it as their collective right not to cut prices too much."--quoted in Associated Press story David Colby, chief financial officer for WellPoint Inc., the nation's largest carrier…said medical cost increases have forced his company to hike premiums. He added that the percentage his company spends on actual medical care has remained constant in recent years. "Our premiums are pretty much tracking what medical costs are doing," he said.--quoted in Associated Press story
"Health care premiums are up because the underlying costs of health care are up dramatically. The causality is not consolidation," said Christopher Ohman, chief executive of the California Association of Health Plans.--quoted in The San Francisco Chronicle
…Gary Claxton, vice president at the Kaiser Family Foundation, contends fewer insurers mean the need for underwriting cycles has diminished, and it's likely that carriers will settle on the high side when it comes to premium increases. "They won't get down to cost," he said. "They see it as their collective right not to cut prices too much."--quoted in Associated Press story
David Colby, chief financial officer for WellPoint Inc., the nation's largest carrier…said medical cost increases have forced his company to hike premiums. He added that the percentage his company spends on actual medical care has remained constant in recent years. "Our premiums are pretty much tracking what medical costs are doing," he said.--quoted in Associated Press story
Kevin C. (Casey) NolanManaging Director, Navigant Consulting, Inc.
As I travel around the country working with healthcare organizations, it has become readily apparent to me that there is a “sea change” taking place in the United States with respect to physician recruitment. Virtually every healthcare provider organization has as a key component of its strategy a major focus on medical staff recruitment/physician relationship development. Most of these organizations have carefully analyzed the marketplace and identified those specialties needed in the community and developed a set of recruiting goals and objectives related to those needs—all the while being mindful of Stark and multitudinous other regulations. And most of those organizations—regardless of whether they are in highly attractive places to live/practice or significantly “challenged” places to live/practice—are having an incredibly difficult time in recruiting physicians. The reasons for these difficulties are numerous and range from the limited supply of many specialties to the different expectations of the “gen X” and “gen Y” physicians to the changes in the demographic composition of the newly trained physicians (in terms of gender and ethnicity).
While it is imperative for healthcare organizations to understand and respond to this “sea change,” it seems to me that many healthcare organizations continue to conduct their physician recruitment/medical staff development initiatives pretty much the way they have historically done. Which in today’s shifted paradigm, is essentially a recipe for disaster. Recruiting physicians today—ANY physician—needs to be conducted and orchestrated much the way a college sports team recruits high school athletes. These candidates are identified early in their development; relationships with the athlete and those close to her/him (including families, high school coaches, etc.) are developed and nurtured; the progress of the athlete is monitored and tracked on a regular basis; the athlete is made aware of the school’s interest and is made to feel wanted; and when it comes time for a visit to campus, virtually every minute is planned, as is the follow-up communication.
Most healthcare organizations defer physician recruitment initiatives to their physician practices, most of which are relatively small and while well-intentioned, have to fit physician recruiting in after the physicians are done with their office hours and hospital rounds. In addition, most physicians are not trained to perform this increasingly important function. As a result, it is imperative that healthcare organizations work with their physicians and provide them with the infrastructure and support required to successfully identify, attract, and retain physician recruits.
A recent survey we conducted of a medical staff associated with a well-regarded medical center revealed that virtually none of the practices had a formal recruitment plan. While they had identified a need, they didn’t have a formal plan (with action steps, timeframes, and assigned responsibilities) that outlined HOW they were going to go about meeting their need. And NONE of them had a plan for retaining the physicians they did (in some cases miraculously) recruit. Most of the physician practices assumed that the whole recruitment process basically ended when they got someone to agree to come. Which is clearly one of the contributing factors to the tremendously high “churn” rate in physician practices (e.g., more than 50% of physicians recruited to a practice leave within two years).
The recruitment process extends well beyond the “signing.” It is imperative to put together a plan to ensure the physician and her/his spouse/family are not only IN the community, but fully integrated INTO the community. Which entails a formally structured follow-up plan that covers at least the first 18-36 months of the recruit’s presence in your fair city.
I believe that success in physician recruitment and medical staff development going forward will require a totally different, more comprehensive set of skills and competencies than in previous decades. And while physicians need to be involved in the recruitment process, the process should not be completely delegated to them. Healthcare organizations can and should provide appropriate assistance and support in the process when requested, or drive the process if its physicians are unwilling or uninterested in recruiting needed physicians.
I also believe we can learn a lesson (or two) from those colleges that have proven their ability to recruit and retain high quality athletes (i.e., who graduate and who are the kind of “kids” you would welcome at your dinner table during a holiday) and build highly successful programs while adhering to the spirit and the letter of the law.
While there are strong arguments for preferring a customer vs. service-line focus in managing and marketing reactive sickness care, the arguments in proactive health care are even stronger. Patients seeking proactive health services hope to:
As with reactive sickness care, patients are likely to have different goals, expectations and hopes for proactive health care, so knowing the idiosyncratic differences across patients is likely to be more important than their uniformities. People who seek weight loss for one special reason, for improving their appearance, increasing their energy levels, protecting their longevity, reducing risks of diabetes, improving their performance and productivity, etc are likely to want a somewhat different service experience than those who have another special reason.
Moreover, in proactive health, the one competitive distinction providers are likely to enjoy over the often free services and programs offered by employers, insurers and vendors they employ – is the willingness and ability of providers to customize the proactive experience to each patient. Providers have and usually have permission to use individual patient information, where HIPAA rules tend to strictly limit employer, insurer and vendor ability to do so.
And patients are far more likely to expect, indeed demand that providers treat them as individuals, while grudgingly accepting the “one-size-fits-all” approaches that characterize most payer-sponsored programs. Since payers are focused almost entirely on saving themselves money, they naturally prefer the less expensive option of standardizing proactive health services to customizing them. And in contrast to payers, whose intent is to save money, the wide variety of intents among patients will necessitate more of an individual customer focus.
And in contrast to reactive sickness care, patients experience with proactive health services is likely to be far more continuous. It should involve far more frequent repetitions of contacts with providers than do almost all reactive care experiences, often weekly or monthly coaching sessions, follow-up visits, online communications, etc. focused on engaging and enlisting patients’ enthusiastic cooperation. And this collaboration may last for months in a relatively short “project” involving smoking cessation or diet improvement, while for years, even decades with chronic and risk conditions, or behaviors that are subject to relapse, such as weight management.
Moreover, patients--even those with no lifelong chronic condition or intractable risk--may wish a continuous relationship with their provider. They may have multiple chronic diseases, for example, which is the rule, not the exception, among patients with at least one. Even when patients have no chronic disease or risk, they may choose a series of projects, each addressing a different goal.
Perhaps the biggest contrast between the service line vs. customer focus in proactive vs. proactive care is that the customer focus calls for identifying, tracking, and monitoring, as well as reminding each patient of the individual success each achieves. This should include the individual “life meaning” goal each pursues.
The action steps each patient takes individually, the success with behavior change each achieves, the progress toward health goals, and toward life quality, should all be individually monitored. Moreover, patients should be regularly reminded of their progress while pursuing goals, to reinforce their commitment, as well as their relationship with the provider who is equally committed to their success.
While some elements of proactive health projects and continuous partnerships may be standardized, in pursuit of efficiency, each should be customized to the degree that this enhances the probability of success. And such customization clearly calls for a customer, rather than service-line focus by providers.
Richard L. Gundling, FHFMAVice President, Product Development, HFMA
CMS's proposal to rebase DRG payments using cost versus charges, and adjusting for patient severity, will have far-reaching implications for providers. Everyone agrees that the Medicare DRG payments are distorted, which results in Medicare paying much more for some types of patients (notably surgical patients) and too little for others (namely medical patients). These payment distortions and the resulting gains and losses reward or penalize individual hospitals more on the mix of patients rather hospitals' efficiency and quality of treatment. The impetus behind this proposed rule is the controversy over physician-owned specialty hospitals and CMS' efforts to close incentives to "cherry pick" less medically-complicated patients. All hospital finance managers should analyze the impact based on your own patient mix and then submit comments to CMS on the proposed rule.
Almost everyone seems to be convinced that we are in the midst of a “health care crisis”, that the unsystematic health care system is broken and needs fixing. And almost everyone seems to have a good idea as to who is to blame for this mess, though opinions vary widely. Many blame consumers for lifetimes of unhealthy living and their sense of entitlement to expensive fixes when they’re sick. Others blame doctors and hospitals, pharmaceutical firms and lawyers for their greed being placed ahead of consumers’ best interests. Still others criticize payers, from employers to insurers to governments for only reacting to problems, never either preventing or totally fixing them.
Clearly there is plenty of blame to go around. Consumers have reached unprecedented levels of health risks, thanks to their appetites for too much of the wrong kinds of food and drink, as well as their too comfortable physical and mental indolence. But entire industries depend on and promote such unhealthy habits, and employ all the tricks of the marketer’s trade to persuade consumers in unhealthy directions.
Providers can claim that insurers have forced them toward the far more remunerative reactive sickness care, making proactive health management largely unaffordable to either patients or providers. Pharmaceutical firms and medical device manufacturers depend on encouraging as much dependence as possible among patients for the profits their shareholders and Wall Street demand, where prevention rarely pays off big.
But one thing seems clear—if we are to be able to afford to insure or otherwise ensure that everyone has access to the sickness care they need, we have to reduce the amount that they need. The current game of shifting costs and blame to different constituents may make everyone feel better, but holds little promise for actually reducing the incidence and prevalence of diseases, risk conditions and behaviors, while promoting health, all of which will help and are probably needed to make total health care, reactive and proactive, anything close to affordable in both present and future.The answer is likely to lie in getting as many parties who have contributed to this mess to sit on the same side of the table, as in any successful negotiations. “Getting to Yes” [R. Fisher & S. Brown Getting Together: Building Relationships as We Negotiate New York, NY, Houghton Mifflin 1988] We need to recognize that we are all to blame, but more important, that the solution to the problem lies not in assigning blame at all, but identifying and exploiting the most promising avenues for change.
Governments may help by shifting regulatory emphasis and incentives toward commercial avenues of promoting health, perhaps taxing unhealthy products and services, for example tohelp make it as profitable for providers and manufacturers to promote and protect health as it is to threaten and cure it today. CMS’ offers to “gainshare” 80% of expenditure reductions achieved beyond a 2% minimum with the providers responsible may be a good way to get providers and payers on the same side of the table, for example. [“Physician Group Practice Demonstration Bonus Methodology Specifications” Centers for Medicare & Medicaid Services Dec 20, 2004]
By contrast, the many suggestions for making consumers more “responsible” for their own health and care by shifting more of the costs of care to them is sure to have huge “collateral damage”. HSAs are fine for young, healthy consumers, but penalize those already sick. Moreover, if they fail to make proactive health investments affordable for consumers, they will do little to reduce future sickness care needs, while failing to pay enough to make currently essential sickness care affordable to the sick, leaving them and the providers who serve them to hold the bag.
We truly have no idea how much proactive health management, combining the efforts of all health system constituents, might reduce the need for reactive sickness care. Only indiscriminate studies of disease management, for example, have been done, concluding predictably that DM hasn’t been proven, because they lump all DM together, regardless of how promising the disease or how good the managers. And most have reached this conclusion while considering only health care expenditures, with no regard for labor costs savings, which often double or tripe the amount of sickness care cost savings.
Having one set of interests blame another set of interests is both futile and inaccurate. We truly have a health care “system”, at least in the systems dynamics sense that anything done in one part of it affects what happens in other parts. So all parts have to voluntarily get together to solve it, rather than choosing whom to blame. As Pogo so eloquently put it many years ago: “We have met the enemy and it is us!” But we are also the only possible solution.
It is clear that we have a crisis—one we are already in, and can do nothing but get dramatically worse with the aging of the population, and the decline in the number paying into compared to drawing benefits from government insurance. Rather than wasting time on blame, we should be joining in a “war” on disease and injury, with everyone possible enlisted, since virtually everyone will benefit. That way, by making sure everyone does benefit, as well as pay, with equitable balance, we might have a chance to actually achieve the kind of system we both will need and can afford.
Keith T. Pryor Director, Leadership Advisory ServicesHealth Strategies & Solutions
You have to hand it to Massachusetts. The state really keeps trying. Twice in the last 20 years the state’s favorite sons have run for President against a man named Bush—and each lost in different, but equally frustrating ways.
And now twice in that same period the Commonwealth has passed comprehensive healthcare coverage. The first was in 1988; its champions included one Michael Dukakis, and as Eileen McNamara pointed out in her April 5, 2006 piece in The Boston Globe, the nationally trumpeted plan was not implemented because it was never funded.
But the bill passed this past week—this looks pretty good. Frankly, from this angle it looks politically brilliant. The funding is somewhat complex, in that many parties share the costs. And that may be a major difference between 2006 and 1988. And why this looks like it just might work.
Companies will need to either offer health insurance, or pay a charge per employee. The poorest will not pay for insurance. Low income citizens will pay on a sliding scale. Those individuals who can afford insurance but don’t buy it will be fined. It is a financing plan that should appeal to the liberal members of this most liberal state as well as those of the “let them pull themselves up by their bootstraps” conservative lot.
A brilliant compromise. Whoever designed this ought to be leased out to the geniuses working diligently on tearing the country apart on immigration legislation.
Undoubtedly there is a long way to go here. Lots of things will go wrong. Without question the original funding estimates will be too low. The legislation will clearly be seen as treating some communities unfairly. We know the legislation has not been exhaustively studied. These broad scale economic initiatives always seem to have unintended consequences.
But it certainly looks better than Medicare Part D.
Opinion pages and blogs over the past few days have featured plenty of opinions about the Massachusetts plan for near-universal health insurance coverage. Here is a sample:
A Boston Globe editorial titled “Healthcare Heroes” begins with this laudatory paragraph:
“Approval of a bill to provide just about everyone in Massachusetts with health insurance has attracted national attention, and justifiably so. The Legislature devised an innovative, comprehensive approach to a hitherto intractable problem. The plan ventures into uncharted policy territory and will require adjustments and probably more money, but it is a proud statement that government can improve the lives of its people.”
However, a Washington Post editorial titled “Universal Health Care: Massachusetts points the way--sort of” is a little more cautious:
“The state's Republican governor, Mitt Romney, lauds the plan as a way of achieving universal coverage without new taxes or a government takeover of the health system. Mr. Romney deserves credit for working with a Democratic legislature to come up with a promising plan, but not for his rhetoric. Though there may be no new taxes, there are new business ‘fees’--and most experts predict that these will have to go up to make the plan work. Meanwhile, the bill envisages the creation of a government agency to decide which health plans are ‘affordable,’ which ones offer sufficient quality, which, if any, are deviously trying to cherry-pick healthy customers, and so on.”
An op-ed piece in The Boston Globe by Edwin Amenta, professor of sociology at University of California, Irvine, and New York University, suggests that history has taught us how such proposals can become palatable at a national level:
“Social Security also provided language that shielded politicians from an American public that can become hostile to government, even when public opinion is in favor of action…. The Massachusetts legislation provides similar political cover. By requiring individuals who can afford health insurance to buy it, the proposal emphasizes individual responsibility. By placing fees on businesses that fail to cover their workers, the proposal sanctions those not carrying their weight. A Massachusetts proposal writ large can be favorably contrasted to the highly complicated and much maligned Clinton health security plan of the 1990s.”
Finally, blog posters presented a variety of sharply worded opinions. Here are a few excerpts from comments made on The Huffington Post:
“Well, it's a start. Something certainly has to be done because the system as it stands right now is nothing short of broken.”
“Instead of addressing the issues of the medical care crisis in this country and the staggering profits the insurance and pharmaceutical companies are raking in, our politicians once again put more of a financial burden on their citizens.”
“I suspect that most supporters of universal health care have never experienced it themselves. I grew up in a country with a national health scheme, and although treatment is ‘free’ it comes with a 17% national sales tax and $5/gallon gasoline. It also comes with rationing, quotas, and after waiting (sometimes for years) second rate treatment.”
Read opinions from some healthcare leaders here.
And click on the word "comments" below to add your thoughts.
And now for something completely different...
A robot that sees, hears, and smells may be Japan’s answer to caring for the country’s burgeoning elderly population.
The robot, known as “RI-MAN,” was created by a government-funded Japanese research institute as an alternative provider of care for the nation’s elderly. The 5-foot, 2-inch robot, whose soft, pale-green body sits atop a wheeled base, is capable of distinguishing eight kinds of smells, can tell which direction sounds are coming from, and can “see” a human face.
RI-MAN also can carry a 26-pound doll, and researchers hope that within five years, he’ll be able to carry a 70-pound human. Underneath its silicone skin are more than 300 sensors that allow RI-MAN to detect both the weight and position of the human body.
“In the future, we would like to develop a capacity to detect a human's health condition through his breath,” researcher Toshiharu Mukai told the AFP news agency.
In Japan, long lifespans and a declining birthrate have pushed care for the elderly at the top of the nation’s concerns.
Following are reactions to the Massachusetts legislation mandating near-universal health insurance coverage. We welcome your comments as well!
"The state government in Massachusetts accomplished what Washington too often only talks about--providing insurance for a bulk of the uninsured in that state. They did it by bringing together key leaders from government, business, advocacy groups, payers and providers to agree on a proposition that smooths out the burden among these groups. What a refreshing example of government leading."--Richard L. Clarke, DHA, FHFMA, president and CEO, HFMA
"Two things stand out for me in this legislation. One is the political accomplishment of getting this compromise among different stakeholders with different ideologies. The other is the very important and somewhat untested approach of requiring individuals to have health insurance coverage. At a time when government resources are stretched thin, this is likely to be a critical component in getting substantial coverage. This approach allows government coverage to go further."--Paul B. Ginsburg, PhD, president, Center for Studying Health System Change
“If the Governor signs this bill, it would place Massachusetts at or near the top of the class in providing affordable coverage for the uninsured. Today’s compromise sets a number of important precedents for Massachusetts residents that are truly historic from a national perspective. In the end, this bill offers a laudable mixture of public and private solutions to achieve the goal of affordable health care coverage for workers and small businesses."--Ron Pollack, executive director, Families USA
"This bill is good for our economy, good for the uninsured, and good for our health care system. Covering the uninsured eliminates hidden costs in everyone's insurance premium. The provisions to improve the quality of care will save costs and improve health."--Phil Edmundson, president and CEO, William Gallagher Associates, and Chairman, Affordable Care Today
"It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan. It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces."--Stuart H. Altman, PhD, professor of health policy, Brandeis University, quoted in The New York Times.
"I don't think we've seen any other state where virtually every Democrat and Republican voted for a measure of this sort." --Richard Cauchi, health analyst, National Conference of State Legislatures in Denver, quoted on Bloomberg.com.
Updated Thursday, April 6
Throughout my career in healthcare strategy and marketing, I have had to deal with the traditional and unavoidable realities of financial accounting. Marketing should be a revenue center, delivering continuous and additional revenue attributable to its research and advertising efforts, plus the operational insights and suggestions it offers based on research and insights into customers.
When I was a marketing executive at “corporate”, in a widely separated system of hospitals, I and half a secretary were the only costs the corporation had to bear, but I was never considered a source of revenue. I mainly offered advice and insights into the administrators and marketing professionals at the hospitals, and was as welcome as most corporate office meddlers, I suspect. But though the costs of supporting my generous salary and expenses didn’t amount to much, when spread across the revenue-generating hospitals, they were an easy target, and eventually, cost-cutting won out.
At my next marketing executive position, I had the joyful experience of changing the perception and treatment of marketing from being a cost center to being a revenue center. Thanks to an opportunity to demonstrate the power of marketing research, advertising and insights in a new program, we eventually were able to show that our efforts yielded multi-millions in additional revenue and margin contributions. We became a profitable revenue center, and enjoyed significant benefits as a result of the switch.
Cost centers have always been the first preferred targets for attention, since cost reductions gravitate immediately, directly, and completely to the bottom line. By contrast, revenue enhancement efforts gravitate more slowly--rarely are the returns on marketing investments achieved, or at least recognized in the same year as they are made. And revenue has to be “adjusted” by the costs of producing it and of handling the added patient volume involved before it adds to the bottom line.
No wonder cost savings have long been the dominant preference in hospitals’ and other healthcare organizations’ strategies.
Pat Williams is senior vice president of the NBA's Orlando Magic and an author and speaker on leadership. He will be speaking at HFMA's forthcoming Annual National Institute. Recently, we asked Pat some questions about leadership. Here is part of what he told us:
Q. In your writing, you talk about leading from the middle. What is one successful technique that healthcare financial managers can use to lead from the middle?
A. Reach out to people. When you’re a leader, and not the top guy, but you’re leading in divisions and departments, you have to have people skills in abundance, and a wide range of them. You’ve got to be able to relate to the men or women who own the company or are running the company. On the other hand, you’ve got to be able to relate to the janitors and the hourly wage earners. When you’re leading from the middle, the most vital leadership skill is the ability to relate to a wide range of people.
In sports, the successful coaches and general managers have to relate to the person who owns the team. They also have to be able to relate to the equipment manager and the ball boys, on the other end of the spectrum, in addition to the assistant coaches and the scouts and all the other people they’re working with. So leading from the middle is the ultimate test of people skills.
Extended Business Office Perot Systems Extended Business Office solutions can help you achieve a high-performing revenue cycle through strategic collaboration with your team. 800-659-8883 revenue cycle solutions www.perotsystems.com/revenuecycle
Perot Systems Extended Business Office solutions can help you achieve a high-performing revenue cycle through strategic collaboration with your team.
800-659-8883
revenue cycle solutions
www.perotsystems.com/revenuecycle
