Posts Tagged cost

A Real Reform Idea from the Joint Commission

Earlier today, the Joint Commission announced the launch of the Center for Transforming Healthcare. The full details can be found here, but the idea is to team up with top hospitals and health systems across the country to use new methods to find the causes of and put a stop to dangerous and potentially deadly breakdowns in patient care.   The first initiative is to “improve hand washing failures that contribute to health care-associated infections that kill nearly 100,000 Americans each year and cost U.S. hospitals $4 billion to $29 billion annually to combat.”

As referenced in David Goldhill’s article in the September issue of The Atlantic, what is troubling is that just obeying what your mother told you 3,684 times can generate as much as $30B in savings (or 37.5% of what the entire pharmaceutical industry wants to “contribute” to healthcare reform). Fundamentally, that suggests a simple lack of discipline throughout hospitals, and it is hard to pin the blame for that on the executive suite. As we have previously suggested, personal responsibility is a key, though forgotten, element in healthcare reform. If we need to start with the basics, so be it – let’s go.

What is exciting from a value perspective is that the first initiative is common-sense, low cost, and clearly proven to reduce infections. I am not sure whether success in this area requires organizational process improvement (Six Sigma, Lean) or just cultural change through inspired leadership. 

I am also not sure why these initiatives always start with the “name” hospitals, though I applaud them for acknowledging their need for improvement. With the Hospital Value Index™, we are constantly reminded that the highest value healthcare in America is often delivered at hospitals that don’t make the U.S. News and World Report list. Let’s hope that the Joint Commission broadly embraces the hospitals that nobody talks about in the near future, where most of us receive our care.

I am sure that this initiative does not cost much money, and it will clearly save lives and dollars. If the White House is serious about the path to reform, it is the everyday blocking and tackling that will get us there. Kudos to Mark Chassin for demonstrating leadership in this area, and let’s hope that others follow quickly and forcefully.

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Healthcare Value and Tax Policy

An article published (ironically) July 4 in The Boston Globe reveals the crux of the problem of healthcare in America, which is the tax-exemption on employer-sponsored healthcare benefits. The article entitled Healthcare overhaul could limit tax breaks on benefits reports that New Hampshire state employees pay $720 per year for $20,400 of coverage. As part of the coverage, “surgery is free, even at Boston’s top teaching hospitals if it’s necessary. So are MRIs, CT scans, and X-rays.” Hmmm….

Diana Lacey, the chair of collective bargaining for the union, thinks that healthcare reform should “bring people up to the standard we have – healthcare that is responsible and affordable and you don’t have to go bankrupt to get the treatment you need”. Query as to where those dollars come from…

Fittingly, from the Left Coast comes the following report from the Los Angeles Times. In an article entitled Paying for healthcare overhaul may fall unevenly on states, the author notes that “blue states”, like California, New York and, wait for it…, New Hampshire and Massachusetts, may pay more for healthcare reform than “red states” that voted for John McCain.

We’ll say it again – there is simply no credible way to pay for healthcare reform without taxing employer-sponsored health benefits. Why some, but not all, of us should be taxed brings to mind a gathering of certain individuals in Boston Harbor some 235 years ago. Healthcare reform is certain to bring a number of unintended consequences, but the one that is most likely to lead to real reform and to reflect the American ideal is taxation of healthcare benefits for all. As long as surgery is “free”, we will not solve the problems before us.

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