A number of stories in the news this week focused attention on the human factor in health care, specifically the role of nurses in improving patient satisfaction and the difficulties a healthcare organization can face in recruiting and retaining a talented nursing staff if it does not make accommodations than enable nurses to achieve a desired work-life balance.
These stories remind us that in a world increasingly dominated by technology, the human factor remains an essential component in our daily lives and in the business of health care. Technology cannot address the concerns of an anxious patient, nor can it satisfy a dissatisfied staff member who is seeking flexibility in a work schedule. These situations require conversation, negotiation, and compromise--distinctly human capabilities.
The human factor in health care is also explored in Reflections on Doctors: Nurses’ Stories About Physicians and Surgeons, a new book that was reviewed in the Health section of The New York Times on October 28. Abigail Zuger, a doctor who wrote the review, noted that “in our transparency-seeking, report-card-issuing, memoir-happy climate, not much about medicine goes unexamined these days.” An exception is the relationship between doctors and nurses, “an aspect that used to be at the center of attention.” Among other observations, Zuger comments that “nursing is intensely reality-based; medicine, often, not so much.”
As this week’s study of nurses’ impact on patient satisfaction suggests, attention to the reality of what people are experiencing within our healthcare system can go a long way toward improving their experience of it.
The Kaiser Family Foundation’s final election poll, featured in HFMA’s “In the News” earlier this week, finds the cost of health care at the top of the list of economic concerns for many Americans. But as Election Day draws near, the candidates’ proposals on healthcare reform--and the feasibility of either candidate’s plan--have come under increasing scrutiny.
Kevin Sack, a reporter for The New York Times, wrote this week that despite the fact that both Barack Obama and John McCain are “filling their speeches, advertisements and debating points with authoritative-sounding statistics about the money they would save and the millions of Americans they would cover,” those statistics are at best “the roughest of estimates” and have “become so disparate and contradictory as to be almost meaningless.”
Meanwhile, a post on the The Wall Street Journal’s Health Blog noted that although both candidates are proposing big changes to the health insurance system, “nobody knows exactly how those changes would play out in the real world.”
Complicating matters further, of course, is the vast amount of federal funds that have been committed to the economic bailout effort. But as the Kaiser election poll suggests, health care too is a looming crisis for the nation, and the political pressures for change are likely only to intensify as economic conditions deteriorate.
Despite the fuzzy math that has characterized cost and saving projections of the two candidates’ plans during the campaign, there are significant and concrete differences in their approaches to healthcare reform. The Commonwealth Fund has provided a useful interactive chart that allows point-by-point comparison of these plans across a range of issues.
What are your views on the candidates’ healthcare plans? Weigh in by posting a comment below. Just click on the “Comments” link and let us know your thoughts.
Deepening economic troubles have exposed a few myths about the healthcare industry, while bringing to the fore the line many providers must straddle between functioning as a business and serving their communities.
A feature in this week’s HFMA “In the News” summarizes a New York Times article in which HFMA president and CEO Richard L. Clarke and Chairman-Elect Catherine A. Jacobson are cited on the effects of disappearing credit on hospitals. A significant point made in the article is that hospitals are subject to the same pressures as any other business in difficult economic times, belying “the stereotypical notion of health care as recession-proof.”
Just how vulnerable healthcare providers might be to recession was illustrated by another article in The Washington Post describing measures people across the country are taking to postpone medical care as budgets tighten. The article also refutes the notion of health care as a recession-proof industry. It notes that in past recessions, “healthcare spending briefly spiked--as people raced to doctors before their insurance ran out--and then fell sharply.” This time around, “even those who have coverage are feeling the pinch as employers shift higher deductibles and co-payments onto employees.”
Yet, as an article (subscription required) in The Wall Street Journal demonstrated, healthcare providers are still subject to criticism for making decisions that make good business sense if a community might suffer as a result. That’s because, the article asserts, “nonprofit hospital systems aren’t ordinary businesses. They’re required to provide benefits to their communities, such as free care for the indigent, in exchange for the billions of dollars in annual tax exemptions they receive.”
Business decisions such as the one that came under fire in The Wall Street Journal--closing a hospital in the economically distressed city of Detroit that was losing a reported $16 million annually--may become more frequent if the economy continues to worsen. In a message posted on HFMA’s special economic crisis resources page, Richard Clarke notes that such decisions “must be tempered with the realities of capital access and effective service delivery, but they also must be focused on what best serves community needs.” This is the difficult balance that all providers engaged in the “business of caring” must try to maintain.
Next Thursday (October 23, 2008), HFMA leaders will be offering a special audio webcast, provided exclusively to HFMA members as a free benefit, on the implications of the economic crisis for healthcare finance. To register, click here.
We wrote last week about efforts to promote use of electronic health records (EHRs), but a report by the State Alliance for e-Health featured this week in HFMA’s “In the News” pointed out barriers to widespread EHR adoption beyond skewed financial incentives. Among the more interesting, and in some ways uniquely American, are concerns about consumer privacy.
Privacy concerns over EHRs are distinctly American for several reasons. First, privacy concerns are deeply rooted in America’s culture and laws, stretching back to the Bill of Rights and the Fourth Amendment’s prohibitions on “unreasonable searches and seizures.” Second, America’s federalist system of government, in which power is divided between national and state governments, can lead to a confusing network of regulations protecting consumer privacy. And third, if Americans feel that their rights have been violated, they are typically not shy about pursuing their claims in the courts or in the media.
The privacy values embedded in the Fourth Amendment may not provide much actual protection to consumer EHRs. The Supreme Court has held, for example, that individuals lose any constitutionally protected privacy interests in financial information that they “voluntarily” hand over to a third party. Thus, when you give a credit card to a store clerk, you are giving up any constitutional claim to the privacy of that information.
There is a significant difference, of course, between financial information and the highly personal information that may be contained in an EHR. A court could determine that providing a blood sample to a lab technician is a less “voluntary” act--and one that raises more intense privacy concerns--than providing financial information to a bank. But courts have so far been unwilling to accept a Fourth Amendment challenge to EHRs.
Where the Constitution stops, legislators are free to step in. While state legislators cannot pass a law that contradicts a federal law, they are free to require protections that exceed what federal law requires. As the State Alliance for e-Health’s report notes, “When state and federal laws are layered together at the practice-level, providers may find variable privacy requirements daunting. Rather than risk non-compliance, they most often seem to take an extremely conservative approach to sharing health information.” Given the bad publicity that companies have received over stolen laptops, and the potential liability they face, who can blame hospitals for dragging their feet?
The digital age is putting longstanding notions of privacy under pressure. There is clearly a generational divide on where the line between “private” and “public” falls, but Americans of all ages have proved willing to sacrifice a little privacy for the convenience of credit card purchases, online bill paying, etc. Still, resistance to EHRs remains, and will probably require a legislative solution that aligns state and federal laws, as well as a coordinated effort to convince the public that their health information is being treated in a way that both respects their privacy and improves the quality of the care they receive.
Given all the talk of the $700 billion bailout/rescue plan efforts in Washington this week, readers of HFMA’s “In the News” may have done a double take when they saw the headline about $700 million in funding for health IT.
The story offered some good news in a week of economic gloom. The Certification Commission for Healthcare Information Technology reports that it has identified 90 initiatives in the public and private sectors that together represent at least $700 million in potential funding for electronic health record (EHR) software and implementation costs.
The programs in the Certification Commission’s report include the biggest federal initiative to date—a $150 million Medicare demonstration project that will provide incentive payments to 1,200 physician practices that use certified EHRs to improve the quality of patient care.
It seems apparent that more of these initiatives will be needed to spur widespread adoption of EHRs, and Ezra Klein’s blog for The American Prospect suggests why (“Where Are My Health Records?”, October 1, 2008). Citing evidence from The New England Journal of Medicine, Klein notes that doctors receive only 11 percent of the savings from EHRs. Most of the rest goes to health insurance companies or the government. “In other words,” Klein argues, “it’s something of a collective action problem. We’d all be better off with wide adoption of electronic medical records. But it’s not in the direct interest of any of the relevant agents to actually pay the money to implement the systems.”
That’s what makes the news that both private and public sources are providing incentives for EHRs even better. HFMA’s healthcare payment reform initiative has pointed out the perverse incentives that run through our current healthcare system. In this case, physicians are being asked to assume an expense that will largely benefit other stakeholders in the system. Financial incentives that mitigate initial EHR costs would likely go a long way to encourage adoption of a technology that stands to benefit many stakeholders, most importantly the patients who would benefit from the reductions in medical errors and improved preventive care that EHRs can facilitate.
The recognition of EHRs’ value is apparently spreading. Also this week, an article in Information Week reported that Wal-Mart is offering EHRs as a voluntary benefit to 1.4 million employees and their dependents during this fall’s open enrollment season (“Wal-Mart Rolls Out E-Health Records to All Employees,” Oct. 1, 2008).
Where Wal-Mart leads, can the rest of us be far behind?
