It’s too hard….
By Shelley Burns
I listened today to Janie Wilson’s outstanding presentation about reducing elective inductions and the concomitant positive impact on outcomes and cost. (Wilson is operations director for W&N Clinical Programs at Intermountain Healthcare.) She made a point on changing behavior and culture that made me think. She said: “We try to make it easy to do the right thing.”
The implication of that comment – namely, “It’s too hard to do the right thing” – is a pretty good categorization of the current healthcare system in the United States, isn’t it?
It’s too hard …
· for the oncologist to view images or lab work performed by a different hospital, so they perform all the diagnostics again, increasing utilization and cost.
· for some families to get insurance so they use the Emergency Room as their primary care, using expensive resources to treat a sore throat.
· to get all the orthopedic surgeons to agree on a standard supplies and clinical criteria for specialty products, therefore the hospital inventory is bloated with high-priced, non-standard implants.
· for patients to be followed across the continuum of care, so no one does, resulting in unnecessary re-admissions. No one really knows if discharge instructions and suggested follow-up care actually occur, even for chronic diseases such as asthma, congestive heart failure, COPD, and diabetes.
· for the nurses to communicate easily with far-flung and multiple family members, so they answer random phone calls at impromptu times, increasing the likelihood for errors.
· for the primary care physicians to communicate with patients via e-mail because they don’t get paid for their time and are nervous about getting sued. Instead, physicians require an appointment, unnecessarily wasting their time and the patient’s.
· for patients to understand the tsunami of paper they receive from hospitals, physicians, clinics, and insurance companies. Therefore, they can’t uncover the true cost of healthcare and abdicate their decisions about healthcare value.
· for the obstetrician to counsel watchful waiting as opposed to performing a C-section because the financial, malpractice, and social incentives are completely out-of-synch with less-invasive (and often safer) vaginal deliveries.
· for the hospital to drop a clean bill or claim (no payment denials or partial denials). Instead, they hire nearly as many coders, utilization reviewers, case managers, and insurance verification/authorization/denial management coordinators as they hire physicians, increasing costs for everyone.
There’s really no excuse for these things to be “too hard” A great healthcare system requires that we align the incentives to make it easy for everyone to do the right thing.
Shelley Burns is head of knowledge of management at HMC.
