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.

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