Saturday, March 29, 2008
Let me set the stage. A new hospital opens in Bolingbrook, Illinois. It has been under construction for two years and is the first new greenfield hospital in 25 years. Looks like a major PR opportunity but no. The marketing consisted of some billboards without any mention of location, one full page advertisement, and one direct mail piece. Most of which happened during that two years before the hospital opens. Now that's useful.
So what do they do, open the hospital, a couple of newspaper stories and a billboard way off the expressway and a radio commercial. Build it and they will come mentality. Guess what? People are not coming. So for the last couple of weeks high on top of the hospital, the Adventist's and yes its Adventist Bolingbrook Hospital puts a giant black sign with white letters saying "NOW OPEN". Oh, I bet that will draw the patients. What were they thinking? Hey it works in retail, it will work for us? What is next a grand re-opening? Me thinks they are having trouble attracting docs to admit patients.
There I go again thinking that docs hold the patient admittance keys.
Thankfully, the sign finally came down.
Just another great example of what people in the hospital industry don't know about brand, marketing or even common sense.
A word of advice to the Adventist Health System in Winter Park, FL. You all have $2 billion in cash in the bank, the Midwest region pulls down nearly $500 million annually after expenses, spend some of that cash and do it right. But its going to cost you a whole lot more now because you have already lost the market opportunity.
I should have taken a picture and posted it. On second thought, I am sure they finally became embarrassed enough.
Sunday, March 23, 2008
An under-current of thought at the Congress was the sense that healthcare is undergoing some fundamental restructuring. No, not the kind that really addresses the underlying systemic process and care issues, not the "medicalized" social issues like the estimated 47 million men, women and children without health insurance, nor the crisis in Medicare solvency. The kind of change that over a generation will have a basic and fundamental shift based on the transparency of quality and data reporting.
Where we were
Healthcare in general for far too long, has been mired in secrecy and arrogance. No data releases, no voluntary reporting of adverse events, little effort to report how well a hospital does what it does. It is what is is, but that is really beginning to change. And I call the change the Age of Quality Transparency. An evolution of sorts.
Real Change is Generational in Nature
Looking at the past, it appears that healthcare in every generation has gone through a fundamental change. In the sixties, it was the age of insurance - employer and based private, the introduction of Medicare and Medicaid which had profound effects little understood or anticipated. Hill-Burton grants for construction and modern healthcare as we know it was born. Explosive growth little control and we will do things to you and take care of you. You take this pill, have this surgery, do this rehab.
Like parents talking to children, the industry took care of us.
In the 80s and 90s, the introduction of DRGs, managed competition, managed care, HMOs, PPOs, POS and the list goes on. Control of rising costs by attempts to limit utilization and place more burden of cost on the patient. A big change was the introduction of the concept of personal responsibility for your health. Wellness programs became an effort to change lifestyle. A change that is generational in nature for which we are all finally starting to see it pay-off.
Most cost control efforts are still in place today, but have done little in restricting choice and limiting payment having no effect on the continued unabated rise in the cost of healthcare. A failed attempt at meaningful reform and a single government payer system as proposed by the Clinton's in the 90s only added to the dilemma.
Today, HSAs, MSA, higher co-pays, employers dropping coverage and reports that healthcare will top the $4 trillion mark in a few short years. A new call for national health insurance. What we never had until the past few years is the spoken realization that quality pays, individuals have the right to know and that informed decision making based on measured performance against a peer group or nationally recognized care standards is fundamental to controlling utilization and cost.
Medicare will no longer pay for what they consider to be never events. Amazing when you think about it that we as an industry were paid for preventable errors.
Where are we headed?
To the brave new world of price and quality performance data reporting. Informed decision making based on information that is available, free and transparent. Dashboards, report cards, comparisons, call them what you will but it is data reporting none-the-less. This is not a fad, only the beginning of change. Consumers, government and employers being able to make informed choices. Asking a hospital or other provider what there prices are and getting a clean and understandable answer.
Will there be excesses, yes. Its happening already with healthcare organizations using Thompson, Healthgrades, Press Ganey, PRC reports and other reporting companies as evidence that they are better than the competition. Run an advertisement! Yep, that will sure do it. Unfortunately, the use of that medium to report data is not creative in the least and does a disservice to consumers and others, leaving it to the hyperbole of advertising claims.
I do think a clearing house is needed for all of us to sort through the claims, unless of course hospitals and other providers can shift to a more meaningful approach to transparency and quality data reporting than what we are now seeing. It's not about the ad. It's not about the newsletters. It's about doing the right thing this time before other tell the industry how to do it.
Sunday, March 2, 2008
A couple of weeks ago, Health Affairs reported that healthcare spending increased by $750 billion to $1.5 trillion. It was also predicted that by 2017 healthcare spending would increase to $4 trillion. Okay, can anybody without giggling too hard really admit that they can comprehend and understand exactly what $4 trillion means? Monopoly money... it has no meaning except for those that can figure out how to be part of that spending. Hospitals, health systems, medical device manufacturers, pharma, physicians, associations etc., all looking at what piece of the pie is theirs. The economist's know what that means. So what else are we to spend our money on?
Well, that kind of spending is unsustainable and will force concrete action to fix a broken healthcare system. Just what that will look like is any ones guess at this time. Don't fix it and we will have rationing, long waits and a national healthcare system where no one is cared for. And a dollar that so far south of the Euro that it will never come back. Government has enough trouble running Medicare and Medicaid now, what in good gosh almighty makes anyone think they can run a national healthcare system.
A bet and forecast for my money..... Like Chicago politics, once everyone figures out how they get theirs, healthcare reform will happen. Everybody wins except for the consumer......
Medicare Rates Are Cut!
Scream the headlines and the hospital administrators, national leaders decry the action. OK, what does it really mean. First, Medicare is not being cut. Second, it is still growing. Third,what was cut was the rate at which Medicare is growing. And fourth, it is just not the rate healthcare people want. How about instead of crying for what we don't have find ways to be more efficient and productive, reduce medical errors, promote standards of care and become more self sufficient and less whinny.
Having been outside of the hospital part of the healthcare industry now for a couple of years and reading and watching, I never realized how whinny hospital execs are. We are expecting someone else to fix our problems. Maybe its time as healthcare executives we stepped up to plate, reached consensus on a strategy and drove some real national policy agenda and change. Instead we are reactive and acting surprised when someone steps with a solution on issues that we should be leading and then we react with the why it will not work, not the why it will. Oh wait, if we did that we couldn't complain much anymore. No wonder no one takes the healthcare industry seriously. I am sure this really endures me to the industry.
Expensive... needed.... and the right thing to do. EMR, e-prescribng, RHOIs (which may be dead anyway) and a whole host of issues besides the technical ones. Seems to me to be the cost of doing business. We all agree that government wants IT, doctors and hospitals want IT, employers want IT from providers and national healthcare leadership want IT and the AHA wants government to pay for IT. Sorry, there I go again not being part of the solution but adding to the let someone else pay for what I need to do for my organization from a cost of doing business perspective.
My simple question is, so why is the government expected to provide the cash to hospitals, health systems and others to move to computerization? Money for IT might just be available if every hospital in the US didn't have to provide every service, piece of new technology, improved efficiency and productivity, reduced medical errors and improved customer satisfaction.
In the end....
These are not simple problems and do not have simple answers. I have made light and poked fun, and I am sure irritated a bunch of people along the way. But at the end of the day, unless we can come together, use a little common sense and ask what is right for all instead of what's in it for me, we could solve these problems. Maybe that's what Senator Obama has figured out, the American people have figured out and we are just waiting for everybody else to catch up.