Tuesday, March 20, 2007

It's about the Physician

Who has patients.....doctors or hospitals?

Somewhere along the way to the informed healthcare consumer and all that hospital advertising about how good they are, the newest piece of technology and the latest greatest renovation as well as how much we care about you as a person (or your spirit, whatever that means), we have may have forgotten about the role of the doctor.... and that is not a good thing.....

Hospitals and health systems talk about "their patients". Healthcare organizations troll for consumers and employers through a variety of marketing techniques. Some have even entered into agreements with insurance companies under capitation arrangements for "covered lives" where they are paid a certain dollar amount per month per life to provide complete care. (After learning that it's not as easy as it sounds and losing millions of dollars, most hospitals and health systems have exited the insurance business. Good move.)

Physician referral programs, RN staffed call centers, community health and wellness programs, service lines in cardiology, neurology, orthopaedics and others, quarterly magazines and newsletter mailings, advertisements and public relations aimed at creating that awareness, usually center around the hospital, clinic or health system. Sometimes, just sometimes, it does center around the primary care doctor, specialist or physician group. Those hospitals and systems that do center their efforts around the doc get it.

Its about the physician......

A contrary view no doubt. But think about this for a minute. When to go to the clinic or hospital and you need a test what do you need? A doctors order. You can't walk into the Emergency Room at any healthcare facility and just go... "My shoulder hurts, give me an MRI". You need a doctors order. Want an aspirin to treat a headache in a healthcare setting, you need a doctors order. Want an antibiotic for an infection filled at your local pharmacy (unless you live in Mexico), you need a doctors order. If the hospital wants to bill for inpatient or outpatient services, managed care aside, they need the doc to put the patient in the bed or send them to the outpatient clinic. No order, no physician involvement, no bill. No bill, no revenue. It all starts and ends with the physician.

But to hear healthcare providers tell it, I belong to them. I don't belong to anyone, but have a relationship with my physician whom I trust and will go where she directs me. It does still happen to be that way for most people. Informed consumers exist and lots of available data is there for all of us to see, but the exception to the rule is the consumer who at the end of the day, will disagree about where their personal physician will send them for care.

What can hospitals learn from this....

Its about a partnership. That partnership is a three way- you, me and my doc. Stop spending so much time figuring out joint ventures, employment options and all the rest. Yes, I do admit some of it needs to be done, any organization worth its salt will look at service enhancements. That is the natural evolution of a business. But focus on the doc. Each year dozens of seminars, books and articles appear about improving medical staff relations, partnering with physicians, strategies for working together and on and on and on. Maybe its about time we learned from that and began to practice it more.

It means putting egos aside and listening. Doesn't mean you are going to do everything the physician wants, but if you listen very closely you might find some simple ways to help the physician practice medicine more efficiently, improve their satisfaction and at the end of the day increase admissions and procedures.

Want a sure fire way to improve admissions, focus some of your improvement efforts on making it easier for the physician to practice medicine in your institution. When the nurse pages the attending physician, make sure they are there when the doctor calls back. If a physicians wants a faxed copy of their ER report, send it. If the doctors office calls Admissions, have caller ID available so the admission representative can ID the doc and respond appropriately. And improve your patient satisfaction. Patients complain to their doctor about your service and care. Docs don't want to hear it. Physicians will send their patient to those facilities where it is easier to practice medicine, where they have their needs meet and their patients are satisfied.

Don't believe me. Take a look at market share data of any provider over time. Seeing only a one or two point market share swing among competing facilities? Guess what, it is not through any great marketing, its about the docs moving patients around to different facilities.

The healthcare organization that can improve physician satisfaction and make it easier for them to practice medicine in the halls of the hospital will gain admissions and outpatient business, which in turn will generate revenue, which, well you get the idea.

I admit it is not so simple with competing medical staff, the movement of services and procedures to different settings and other providers raiding medical staffs. But at the end of the day, if you can understand that it is about the doc, you will be better, the physician will be happier and patients will hold you in a new light.

Not that much different from billing the 1960s is it?

Friday, March 2, 2007

Learning from Europe - Universal Healthcare

The debate heats up.......Again......

Much is beginning to be written about healthcare as it continues to consume an ever increasing portion of the GNP; as the medical care component of the CPI continues its rise outpacing the general CPI; as employers find operational costs increasing due to health insurance expenditures; the 2008 campaign...... Well, you get the picture.

Intense focus will be coming over the next year as the presidential campaign for 2008 heats up, with the Democrats and Republicans putting forth their proposals on fixing healthcare. State initiatives will also force the issue, cobbling together a patchwork quilt of suggestions, programs and hidden taxes to pay for the "universal" coverage. There will be some new proposals, but I for one expect much of the same. Looking at past history, nothing will really be solved until both parities engage in a discussion of two very basic questions: Is healthcare a right or a benefit and how/who pays? These are the two unspoken issues and questions which both parities skirt.

One could make the argument, that the Democrats view healthcare as a right by their proposals and the Republicans view healthcare as a benefit by theirs. Still, who pays and how? My bet is that in the end universal healthcare under a one payer system here won't happen. Too many interest groups, too much politics, and with billions of dollars at stake on all sides (forget the quality argument for a while) a universal system just won't fly. I would expect to see some kind of hybrid between universal and private, similar to what is found in Europe. That is...... if we are willing to learn from other parts of the world and not have to reinvent the wheel every time the subject comes up for debate.

European Healthcare

Having worked for a European medical device manufacturer and traveling Europe seeing healthcare in action in some hospitals, there are some true misconceptions in the American healthcare community about what is considered healthcare delivery and payment in Europe.

Not all but most senior executives don't have a clue about what is going on in Europe regarding care or payment. I doubt that the politicos do either. Not bombastic or self serving are those statements. I come from hospital senior management and am guilty of the "if its not invented here, its not worth anything" syndrome. And that attitude considering the seriousness of the topic is just not acceptable any longer. Take away the signage in different languages in a European hospital and you would never know you were not in an American hospital.

So, lets look at a couple of myths.

OK first myth... healthcare is paid solely by the government

It is not a universal one size fits all healthcare payment system in Europe. They leave that to the Canadians. There are government programs, private insurance programs, employer sponsored health insurance programs. Consumers have much higher deductibles than what we pay and a greater emphasis on personal responsibility in maintaining health and wellness. Payment is a combination of various healthcare mechanisms that we too have here in the US. It is a complicated payment maze. But everyone gets care, everyone gets primary care and everyone gets quality care at the right time, in the right amount, in the right setting.

Now in Europe they have some very real misconceptions about us as well. The most important was understanding the difference between 45 million uninsured and 45 million Americans not getting care. They equate uninsured with no care. After many long sessions, people I worked with began to understand that in America, being uninsured doesn't mean that you don't get care. Yes, the care may be inappropriate utilization of healthcare resources by individuals and families over utilizing emergency rooms, which when treated earlier in a primary care setting would have been the preferred option, but people do get care, they do get surgery, they the do get the drugs they need.

Second myth......The hospitals and health systems in Europe don't face the same operational issues we do

Sorry to disappoint everyone, but they do. Declining reimbursement, IT consuming ever greater portions of capital budgets, the need to reduce medical errors, lack of qualified medical professionals, increasing productivity and efficiency, decreasing costs, improving quality, the shift to outpatient from inpatient care, etc, etc, etc. Matter of fact, it may even be more difficult in Europe as each country has its own language, culture, regulations, payment systems, etc. One size does not fit all. On the HIT side, many countries are farther advanced on the implementation of the Electronic Medical Record that we are. Germany and France are good examples.

Third myth.....What happens in Europe or the rest of the world for that matter doesn't effect me

Yes it does. Nothing is new in healthcare. It has been done already somewhere in the world. Its more of a question of discovering the issue, what they have done, how the solution is working and what parts of their solution will work for us. Sorry to say but we are not best in breed. If we were, then why do so many American companies have difficulty in selling their HIT and other solutions oversees. Lots of issues there besides the inability to customize their solutions for different markets, but that's another Blog for another time. We could learn a bit from how Europeans have approached the healthcare coverage issue, the provision of medical care and how it all works together.

Europeans have answered those two basic questions, is healthcare a right or a benefit and who pays and how.

What this all could mean

Clearly we are at a crossroads. We already have a tiered healthcare system that is neither reasonable from a care perspective or socially acceptable. Its easy to medicalize social problems (which is what has been done) and blame the medical community for the indecisiveness of state and national leadership in addressing this issue. Our medical care system today is based on those that can pay, those can can pay some and those that can't pay anything at all.

Individuals, government, employers and healthcare providers must all come together to reach a common understanding. I for one believe that universal coverage is a possibility, but I do not for one minute believe that it is the sole responsibility of the government. It is a partnership. A solution to a societal crisis that can be based on what has happened successfully in other parts of the world.

For the future

This isn't the last writing on this topic. It's complex. Holds many unknowns,. And as the presidential campaigns become more vibrant with proposals coming forth, much more will be written on this topic.

But life would sure be a lot easier if we could learn from others like the Europeans and not make the same mistakes.