Wednesday, November 30, 2011

At Last!!!

Early in my career, I observed that if any other form of organization had a service as popular as the hospital emergency room, it would be promoting it vigorously instead of fighting it, as hospitals were doing then and continued to do for years thereafter.

Now I note that the Boston Globe Magazine of Sunday, November 27 carries an ad by suburban Newton-Wellesley Hospital headed “No time for waiting?  Our Emergency Room wait times are now available online – and on your phone.”

A common complaint about emergency rooms is their hours-long waiting times.  The Newton-Wellesley ad was not so bold as to urge one to use the service, but the clear implication was that if you needed to do so, or were so inclined, you would find the waiting time acceptable.  The sample shown in the ad was 34 minutes.

The reluctance of hospitals to promote their emergency room services most likely arises out of the influence of the private medical practitioners on their staffs who have seen those services as competition – attracting paying patients who, in their view, ought to be seen in their private offices.   This concern has given rise to the unsubstantiated claim that providing episodic care in the emergency room leads to lower quality by interfering with continuity.  An even more prevalent myth is that emergency care is more costly than that provided in doctors’ offices – an assertion that ignores the fixed cost associated with the 24/7 nature of emergency room operation.  Since the doctors and nurses have to be there around the clock anyway, the non-emergency cases allow the cost of such coverage to be spread over a larger number of patients, thus reducing the cost per case.

Perhaps we are in the process of getting beyond all that.  At least the Newton-Wellesley ad would make it seem so.

Monday, November 28, 2011

Part D as a Model?

Wife Marilyn and I have received word that the monthly premium for our Medicare Part D Prescription Drug policies will be reduced next year from the present $45.80 to $38.90.  One drug that Marilyn has been taking will no longer be covered, but a generic substitute is being offered.  She has yet to decide about that.

Adoption of the Part D program during the Bush II administration was a fiscally irresponsible thing to do since it was financed by adding to a budget deficit that was already too large.  But from what we can tell, the program otherwise has to be considered a success.  We get our coverage from Humana.  The service has been excellent, including that of its mail order pharmacy RightSource.  The Part D approach, with its competitive volume purchasing, seems to have had a needed restraining effect on drug prices.

It poses the question of whether the Part D program – aside from its financing method - might serve as a model for traditional health insurance; i.e., whether a Humana might cover hospital, physician and other health services in the same general way that it provides drugs, shopping around for the best deals and then offering to subscribers a package of services to be obtained from the providers with which it has chosen to do business.

The difference, of course, is that we are not particularly interested in the sources from which Humana gets its drugs but we would care very much about who it would select to provide general health services.

In order to make judgments about that, it would be necessary for providers to be organized into entities large enough to be readily recognized and well enough established to have reputations.  If in the Boston area my insurance company offered me services from the Leahy Clinic and its hospital, I might well be satisfied with that.  But if it offered a lesser-known hospital and a list of independent physicians I knew nothing about, I most likely would not feel so comfortable.

It is another reason for developing organizations that integrate hospital and physician services into a single entity, like the Leahy Clinic or what is being visualized by the concept of Accountable Care Organizations.

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