Thursday, October 13, 2005

Individual vs. Corporate Responsibility

The October 12, 2005 issue of The Boston Globe carried a follow-up piece on the heart surgery shut-down at the UMass Memorial Medical Center in Worcester due to an excessive mortality rate. It summarized the report of a review team of four heart surgeons and an anesthesiologist that had been appointed by the Massachusetts Department of Health to look into the situation.

The group said that “the underlying problem has been a lack of leadership.” Later in the article, Paul Dreyer, head of the state’s Division of Health Care Quality was quoted as saying “To me what stood out is that the problem seemed to be a hospital problem, as opposed to a problem with individual surgeons.”

Dreyer may have made a bigger statement than he knew. The concept of individual responsibility (as contrasted with corporate responsibility) lies at the very foundation of our system of health care. It is a concept that served well for many years, but is now out of date.

If Dreyer is right (as I believe he is), then the management and governance of the hospital – not individual professionals - should be held publicly accountable for the quality of clinical performance. But it seems that we are not yet ready to do that. The story quotes Dr. Walter Ettinger, Jr., executive head of the hospital, as saying that the hospital had implemented some staffing cuts several years ago in response to financial problems and “Probably the combination of financial strain and lack of clear-minded and strong leadership led to this happening.”

One may ask whose leadership he is talking about. Apparently not his, considering that he had been in charge of the place for over a year and a half at the time the Department of Health blew the whistle on its heart surgery program.

Once we get past this reluctance to hold institutional leadership accountable we will begin to see significant progress in the reform of our health care system.

Thursday, October 06, 2005

On Universal Coverage

Yesterday morning’s Boston Globe carried a column by Eileen McNamara about the movement in Massachusetts to declare quality medical care to be a basic human right and to guarantee coverage to the uninsured.

It stimulated me to send the following e-mail to McNamara:

Four factors stand in the way of achieving universal health insurance coverage:

- The uninsured are neither visibly suffering nor politically active in the cause.

- The health care delivery system is financially healthy despite providing large amounts of unreimbursed care.

- Covering the uninsured would require a substantial increase in taxes.

- Covering the uninsured would also infuse large amounts of additional money into a health care delivery system that is undisciplined, unaccountable, and grossly inefficient.

Reforming the health care delivery system is the place to start. A disciplined and accountable system will be able to provide high quality care for everybody with less money than it is spending now.

Bringing the cost of health care (and, therefore, of health insurance) under control will soften the political opposition to employer mandates and will allow the new taxes required for universal coverage to be offset by reductions in the cost of health insurance.

But reform will not happen until the public, including people like you, insist upon it.

Sunday, October 02, 2005

Community Benefit and the Town Square

The Alliance for Advancing Nonprofit Health Care, a Washington-based advocacy organization, has recently issued a report entitled Advancing the Public Accountability of Nonprofit Health Plans. The stated purpose of the report is to provide “a tool to motivate and enable nonprofit health plans to improve their community benefit practices.”

A laudable goal, without doubt. But in reading the report, one gets the impression that community benefit is something that a nonprofit health plan would do in addition to its ordinary business. The report goes so far as to suggest that nonprofit health plans should have a “community benefit ‘infrastructure’ consisting at a minimum of a designated lead executive for organization-wide coordination of effort.”

I always thought that community benefit was the purpose of everything a nonprofit organization did. If making a healthy profit and paying its executives hefty salaries strengthens the ability of the organization to achieve its purposes, then the community benefits.

Modern Healthcare’s story about this report (September 26, 2005 issue) related the case of Blue Cross and Blue Shield of North Carolina, which spent nearly a half million dollars on the U.S. Open golf tournament. When a coalition of doctors, pharmacists and consumers published a report revealing the expenditure, the organization sued them for illegally obtaining and publishing confidential business information.

John Russell, long-time executive head of the Pennsylvania Hospital Association, once said something about this sort of thing that stuck in my mind. He said that if a nonprofit organization was doing something that wouldn’t stand the light of day, it should fix it or quit doing it.

I used to put it in different words. I said that the test of any executive decision in a nonprofit organization was whether the person who made it would be willing to stand in the town square at high noon and defend it.

Both still seem like a good rules to me.
Whipkey on Getting IT

Neil Whipkey, Florida-based hospital CEO, has the following response to my posting titled Health Care Still Doesn’t Get IT – IT standing for information technology:

We get IT - we just have no idea what to do with IT.

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