Bridging Business & Healthcare : Healthcare Management Consultants for Dispute Resolution, Valuation & Clinical Compliance

This week Modern Healthcare released its annual list of the top 100 most powerful people in healthcare. It’s populated with many people who most would agree are quite powerful –Barack Obama, Nancy Pelosi, Bill Gates, and the list goes on.  Perhaps more interestingly, however, are the people who topped the 2008 list of healthcare’s power brokers – Steve Case (founder of AOL and Revolution Health), Eric Schmidt (CEO of Google) and Hillary Rodham Clinton – who have dropped off of the list entirely. If they had such enormous power two years ago, why are they seemingly no longer even in the equation?

Webster’s dictionary defines power as “the possession of control or command over others; authority; ascendancy.”  Power is fleeting. Exerting power may allow you to achieve your short-term goal, but it has a downside – it gets used up. If your only approach is to exert or impose your will to achieve your ends, there will always be another waiting to take your place.

Influence is another thing entirely. It is the capacity or power of persons to be a compelling force, to produce effects on the actions, behaviors or opinions of others. In short, to influence is to cause long-term, meaningful change.

For better or worse, we now have an outline for change to our healthcare system, but we have yet to see the type of long-term influential leadership needed to sustain and implement meaningful change. There are some new and creative ideas out there; some of which just might work, but unless we can identify consistent, passionate, and effective leadership in healthcare at the highest levels, the door will continue to spin.

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"It would be so nice if something made sense for a change.”

Alice in Wonderland

One of the primary challenges of living in the new healthcare world is embracing the concept of value. Value in the world of healthcare means mastering the balance between improving the quality of care while simultaneously decreasing its cost. I frequently am privy to debates on what constitutes “real” quality and how is it going to be defined and by whom, but I am rarely questioned about cost. Cost would seem to be rather straight forward. Not so fast. A recent study published in the Journal of Hospital Medicine showed that only one tenth of hospitalists were within a 10% accuracy rate when surveyed about the actual cost of commonly used inpatient services, tests and procedures. Some were off by thousands of dollars. A recent article on healthleadersmedia.com referred to this phenomenon as “price opacity”. The article goes on to say that It would be almost unheard of for you, the individual patient, to be able get a clear price on a menu before the service is delivered”

One of the key tenants of healthcare reform has been the promotion of transparency, mostly focused on quality. I do agree that transparency is necessary and will ultimately lead to improved care, but if we are ever to get to truly improved value – not just improved quality – we are going to need to find a way to clear the smoke from the costs of care for physicians and patients alike.

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Approximately 4 years ago, a family friend who was a practicing attorney in his early 60's had a moderately complex valve surgery performed at a reputable hospital. He was told he would eventually need the surgery, but it was not critical to have immediately. He decided to proceed with the surgery.  He was in relatively decent health. He survived the surgery and recovered well, getting moved from CCU to private room within a couple of days. Then he acquired an infection (sepsis). He never returned home, leaving a widow and many loved ones.
 
Risks are inherent in any invasive procedure. But the incidence of hospital-acquired sepsis and pneumonia are preventable and manageable. Without doing so, the costs are extraordinary. For example, Healthcare Financial Management Magazine recently reported that in 2006 alone there were 48,000 people "killed" due to these two hospital-acquired infections. The cost of these infections totaled 8.1 billion dollars....and this does not include the cost associated with the loss of a productive life, as in the case of my friend.
 
The ultimate face of real healthcare reform will likely include more accountability for these types of results as, indeed, government payers such as Medicare have already begun to reduce payments for such infections. Clinical outcomes must be the centerpiece of real reform. Time will tell if PPACA will accomplish this or not. But rest assured that a central tenet  of any health system strategic plan we are privileged to lead will include a focus on improving clinical outcomes. Consumers cannot easily discern quality in healthcare (see Michael Millenson's post about misunderstood Joint Commission data.), but numerous efforts are under way to provide real direction for consumers. This will, of course, eventually impact market share, as it should.
 
We are interested to learn more from our clients and friends about how they discern quality. Are there websites you utilize? Reports you read? Let us know. We will of course keep you posted on all things Quality, Strategy, and Finance related to healthcare, so check our healthcare blog often for updates.

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