Posts Tagged John Morrow

Dear Mr. President,

As all good statisticians and pollsters know, the best stories are found in the outliers of an analysis, but often have an N of 1. In other words, the best stories are usually the exception and not the rule.

Not surprisingly, healthcare is no exception. Neither McAllen, Texas nor the “Clinic” model (Mayo, Cleveland, Scott & White, Geisinger, Sayre, etc.) are the rules. None of them, as even they acknowledge, are replicable models for healthcare reform. It appears that your advisors have selected models of reform based upon a mixture of historical reputation and old (non-severity adjusted) data as examples about what looks to be wrong or right about healthcare. It doesn’t make any sense, and besides, my pick-up truck won’t get there from here!

Mr. President, I offer you an alternative model. I would like to draw your attention to a formidable group of 747 unrelated hospitals that serve communities in nearly every state, in all CMS regions and across all hospital types. These hospitals are urban and rural, religious and secular, for-profit and not-for-profit, teaching and non-teaching community organizations that spend their days and nights doing the right thing, time after time. These hospitals are the leaders who persevere irrespective of patients’ ability to pay and who provide billions in community benefit beyond their primary functions. These hospitals employ 3.33 million professionals, and spend over $130 Billion on delivering services to make safer, happier, healthier lives for their taxpaying communities. These hospitals are typically the largest employer in their town, providing essential emergency services and serving as the first responders and last line of defense. And they do this without any official mandate to do so.

These hospitals are the Hospital Value Index™: Best in Value™ Award winners, and they will succeed under Value-Based Purchasing better than the other hospitals in America. They are the unsung heroes because they deliver quality, access, affordability, safety and outcomes better than the rest, while doing so in an efficient and affordable way that makes patients and taxpayers highly satisfied. Furthermore, they have been selected based upon an objective and comprehensive set of criteria.

Who are these hospitals?

What drives their leadership?

How do they do it?

How do you inspire an industry to seek their counsel?

Mr. President, it seems to me that holding up 747 hospitals as examples of models of success would be a far more effective way of understanding the culture of healthcare than embracing the anecdotes of a magazine most famous for its cartoons. The folks in Hidalgo County, Texas are burdened with immigrant and indigent populations with chronic conditions. To suggest that the “Clinic” model would “fix” what is wrong in Hidalgo County is, at best, naïve. Sure, the “Clinic” model is a worthy contributor to the U.S. healthcare system, and their lobbyists in Washington are effective at keeping their names in the media and in front of your advisors. But these microcosms of care won’t get replicated because they are outliers. Each of the aforementioned clinics provides a level of healthcare value that is above the national median. They are, however, isolated by either geography or access or both, putting them out of the reach of the typical American. The “Clinic” models have unique cultures especially with respect to physician leadership (which apparently is OK if “Clinic” is in the name but not if the physicians are the owners). I applaud them for their innovation, but I worry about the bigger picture. Medicare covers over 10 million people and there are 5,000 hospitals…I see a little bit of a bottleneck in your message.

Healthcare, like politics, is local, with the populations and health status that is endemic to each market. Hospitals have no choice but to care for their taxpaying, health care utilizing citizens regardless of their work permit status, educational levels, or ignorance about wellness and healthy living.

If these exemplary 747 hospitals have already accepted the challenge with Value-Based Purchasing, make them your poster child. Use the social media to endorse one in every major town, and create incentives for them to lead and others to follow.

Use the carrot and not the stick to recognize and reward those hospitals that meet the value definition. Help these hospitals with what they are good at and support where they want to improve.

Some hospitals may not make the change needed to survive in a value-oriented environment, That will be unfortunate, but it happens in every industry, and it might even be healthy for the industry.

If Stanford, Harvard, Princeton and Yale were your models for education where would that take us? Heck! My pick-up truck doesn’t even know where Princeton is!

If you want leadership, invite the 747 hospitals that are doing the right thing to a summit, introduce them to the country, and let them tell the world their success stories. There are some common threads among this special group of 747 – analyze those things that work in most markets and reward those hospitals that implement those practices.

These 747 hospitals are the bread and butter of our healthcare system. Please, please don’t disenfranchise them with talk of a new and better model…they are your models, statistically relevant and a force to collaborate with.

I still have “hope” that “change” will be good. So, Mr. President, let’s dispense with the sound bites and move on to the serious business ahead of us.

Respectfully,

 John Morrow