Friday, August 28, 2015
Urgent Care
There are 168 hours in a week and illness or injury can
strike during any one of them – not only in the 40-plus hours that physician
offices are open for business.
There being no practical way for individual physicians to
plan efficiently for the unplanned needs of their patients, they tend to fill
their schedules ahead of time.
One result of scientific and technological advances is that
a large and increasing portion of medical care can be adequately provided by
people who are not physicians.
In light of all that, one might expect that the health care
establishment would have some time ago made convenient provision for patients
seeking out-of-hours care, much of which falls short of emergency status. But physicians in private practice would have
seen that as competition and so it didn’t happen.
There being no alternative, patients got their out-of-hours
care from hospital emergency rooms. The specter
of competition prevented hospitals from making the service attractive. Hours of waiting for service became common
but patients in droves sought it anyway.
As the health care economy grew, investors saw an
opportunity and urgent care chains were developed and drug store chains began
to offer health care services that could properly be offered by nurses.
Hospitals are finally beginning to become interested. Partners Health Care, the Boston Hospital
behemoth, has announced that it will begin opening urgent care centers
throughout the Boston area.
When Partners moves, everyone pays attention. So it seems that hospitals are finally
responding to a need that they should have filled a long time ago.
Sunday, August 23, 2015
Doctors or Systems?
We used to think that the best way to be assured of good
medical care was to put ourselves in the hands of the right physician.
It appears not to be that simple any more.
The July issue of H&HN, the journal of the American
Hospital Association, included an article entitled When Stroke Care is a Statewide Effort. The article began by reciting the story of a
stroke victim in Illinois who was taken to a 25-bed hospital in Taylorville
rather than to a larger hospital in Springfield. The patient’s wife questioned that decision
and was assured by the local doctor that it was the right thing to do. The patient got a quick CAT scan, followed by
a dose of tPA, the clot-busting drug, and was then shipped off to the larger
Memorial Medical Center in Springfield. By the time the
patient arrived there, his previously paralyzed left side was working again.
The rest of the article discussed the Paul Coverdell
National Acute Stroke Program. Coverdell
was a U.S. Senator from Georgia who died of a stroke. The program named for him is operated by the
Atlanta-based Centers for Disease Control and Prevention and sponsors stroke
systems of care. These programs involve
coordinating the activities of Emergency Medical Technicians and hospitals so
that stroke victims receive appropriate treatment promptly – time being of the
essence in this case.
So it seems that if, God forbid, you should suffer a stroke,
the quality of the care you receive may depend more on the system that provides
it than on the identity of the doctors who staff it.
Thursday, August 20, 2015
Exorbitant Compensation
According to the August 10 issue of Modern Healthcare, the
top ten compensation amounts for healthcare executives in 2013 ranged from 3.6
million to 8.4 million. Then the August
18 issue of The Boston Globe included an article about CEO salaries in
Massachusetts teaching hospitals, all of which were well into seven figures,
the highest quoted for the full year of 2013 being 2.6 million.
Spokespersons quoted attributed these salary levels to
competition and market forces.
I don’t believe that.
I have yet to read of a healthcare CEO being paid in the millions being
attracted to another job by more pay.
I think what we are seeing is a social mechanism that has
gone off the rails. I think what has
happened is that compensation committees of boards of trustees started using
consultants and that those consultants found that the way to become popular was
to find ways to justify high compensation levels. Boards are populated in large part by CEOs of
other organizations who are typically overpaid themselves and find it easy to
adopt those consultants’ recommendations.
The thing has gotten out of hand and nobody as yet has found
a way to bring it back under control.
There are some indications of popular discontent over these exorbitant
salary levels, but so far it doesn’t seem to be having much effect.
