More about Money
Yes! Cost is the numerator in the efficiency equation. It it the factor that will pay for all the other needed improvements in healthcare. If 30 to 50% of healthcare costs are "waste," think of the money we could have to invest in improvement! Several initiatives aim to reward providers for efficiency. Remember to include time in your cost equation--both provider time AND patient time. Advice for those with Healthcare Savings Accounts (HSA) or Flexible Spending Accounts: Third parties (HMOs, insurance companies, Medicare, etc.) reimburse at roughly 50% of charges and do so only after at least 90 days. Thus, if you go to a practitioner and put green money on the table, expect at least a 20% discount from charges. You are NOT powerless! If you don't get that, go elsewhere. My daughter told her pediatrician (who was 60 min late seeing her kids), "You're going to be less busy in the future, because I'm taking my business elsewhere!" Vote with your feet. There are too many doctors to put up with inefficient care or steep prices. Expect good serivce at a reasonable price, and you will get it. Tolerate poor service, and you will get that too. Efficient healthcare provides the best of both worlds--the patient gets good value, and the provider is more efficient. I once wrote that healthcare could be improved if Medicare cut their reimbursements in half. Most hospitals would go bankrupt, but those that remained would be VERY efficient. Note: we're talking about micro-efficiency here--the cost for an individual patient visit. (The Medicare drug benefit is pure politics and has nothing to do with efficiency.)
Comments
It is very easy to say that money is the numerator, but is it really? It is certainly a driving force behind all the changes in healthcare, both good and bad, but is it the efficiency equation or the quality equation that we want to measure when it comes to our own healthcare? And then what numerator will we use?
The past two decades have seen more changes in the healthcare system in the US than any other time in history. Unfortunately, many of those changes have been profit-driven and not quality-driven. We must make (and keep) healthcare accessible to everyone while keeping the quality at a level that we have come to (and should continue to) expect. The true value of the community hospital of 1985 was derived in great part from the contributions and hard work of the community ? equipment purchased with money raised at a bake sale, or with a contribution from local businesses, etc. That value was assigned a monetary tag and sold to the highest bidder when profit became the motive. With all the shuffling of assets and closure of hospitals, that value is lost to the community that created it, and we and our communities are left with a system that has been effectively raped and left with what is fast becoming sub-optimal care.
Doctors and hospitals alike are continuing to provide services to patients while seeing a continually shrinking profit margin due to insurance and Medicare reimbursements based on artificial numbers. When you say that those reimbursements are at 50%, you are being generous. So where does the money come from to continue to provide services? How does your doctor update his equipment to continue to provide diagnostic services within his office ? or are you happy to have your x-rays and blood work done elsewhere and wait an extended period of time for the results? Okay for routine care, but what about when your son or daughter is in pain and needs immediate attention?
Healthcare workers are being asked to continually find new and better ways to do their jobs ? on the surface that sounds fine, but what they are really being asked to do is to provide less care with less personnel and equipment and to maintain the quality of their care at the same time. Again, that may work for many situations, but are you willing to be short-changed when it?s your baby who needs intensive care, or your wife who needs an emergency c-section? How far away will the specialists be to treat your baby and assure a positive outcome? How far away will the anesthesiologist be, and can he arrive in time to save your wife and baby? When minutes count, we all want our care immediately. So whose care are we willing to defer to a more convenient time? Your neighbor?s? Your mother?s? Mine? Keeping people available 24/7 to provide those services costs money! Having the right equipment available and functioning properly costs money!
Certainly, we hold our doctors and nurses to a high standard, and we should expect courteous as well as excellent care. Where in that equation is there room to pay the board of directors of the insurance company, or its stockholders? What about the for-profit hospitals? They moan about the costs of everything, but still manage to pay stockholders and executives money that should be going back into the care of more patients. It?s time we started returning the value to the community clinics and hospitals. Can we streamline things? Of course! Can we make healthcare more efficient? Undoubtedly! But if we do it at the expense of quality care, or the safety of our communities, we need to label it something new, for it will certainly no longer be Health Care. Perhaps it should be labeled Sick Care, and we should come up with a plan to heal it.
What is efficient about holding the hand of a dying patient?
What is efficient about spending hours helping a new mother succeed at breastfeeding?
What is efficient about a tender touch or a kind word?
When you were hospitalized, what impressed you? The efficiency of the nurse in your room, or the sense you received that you were important and your care was important?
Yet, there are studies that will prove that these very things may get you well faster ? but we are no longer seeing the big picture; we are too focused on the small print of the bottom line!
Posted by: Nancy Benner | December 2, 2005 07:33 AM