Paul O'Neill: Reform O'Neill-Style
Former U.S. Secretary of the Treasury Paul H. O'Neill says healthcare leaders should strive for nothing less than perfect safety and clinical outcomes.
By Lola Butcher
For someone who does not have experience with health care, reforming it may look easy. That is why Paul H. O'Neill, a former member of President Bush's Cabinet, gives short shrift to the proposals offered by the current presidential hopefuls. “I don't think any of them have spent a week in a hospital studying what really goes on and have the authority of knowledge”, he says. “So they all tend to be advocates of abstract reforms without much reference to what life is really like out there.”
O'Neill, who served as U.S. Secretary of the Treasury in 2001 and 2002, does not hold out much hope for transformative healthcare policy. “I think it's highly unlikely we're going to pass anything because I don't see anyone running for the presidency who I believe is a leader”, he says. “They all seem to me to be in the tradition of panderers. They will say whatever they think they need to say to get elected.”
O'Neill, the former chairman and CEO of Alcoa, co-chairs an Institute of Medicine forum devoted to both healthcare quality research and the implementation of findings. And he serves on the policy advisory committee of RAND Health's Comprehensive Assessment of Reform Efforts (COMPARE) Initiative. He is not running for office, so he says what he thinks. And he thinks hospital leaders should be doing a better job. An awful lot of the improvement potential exists in spite of the policy framework that [hospital leaders] have to work in, he says.
His favorite example: The Pittsburgh Regional Healthcare Initiative, which O'Neill co-founded in 1997, led an infection control project that reduced one type of bloodstream infection by 63 percent across the region.
That's not good enough to suit him. Indeed, O'Neill advocates that the federal government should expect perfect safety and clinical outcomes—and insists that healthcare providers strive for nothing less. As non-executive chairman of Value Capture LLC, O'Neill is working with healthcare executives and policymakers who share his belief that improvements can increase the value of healthcare operations by at least 50 percent.
O'Neill's style of healthcare reform would include:
- A mandate that every American purchase a base level of coverage, with financial support for those who cannot fully pay on their own.
- A “total value opportunity study” of five outstanding hospitals, which would detail how all operations compare to a perfect scenario and identifying process problems that create the gap between the actual and the ideal.
- A national commission on healthcare payment assigned to recommend a replacement of today's dysfunctional billing and reimbursement system.
- A reworked incentive system that rewards primary and preventive care and puts more pay in the government's pay-for-performance programs. Real-time transparency—which would require tracking when a person is harmed or nearly harmed, the circumstances, a root cause analysis of the problem, and identification of process changes to avoid the problem in the future—is posted on the Internet within 24 hours of the incident. “Everyone in the practice of medical care can get up every morning and look at their computer screens and learn about things that they need to improve in their own institution, without having the same thing going wrong in their place,” O'Neill says.