tag:blogger.com,1999:blog-32053362.post5972791343934909777..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: The ad I would buyPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-32053362.post-43498124287347482112008-12-02T16:36:00.000-05:002008-12-02T16:36:00.000-05:00Interesting point regarding the role of boards and...Interesting point regarding the role of boards and senior management in adoption of business plans. Most hospitals have embedded in their mission statements "the alleviating of human suffering." What do striving toward monopolistic tendencies, ruthlessly crushing "competitors", and negotiating for bulk premiums from insurance companies have to do with alleviating human suffering? The answer, I believe resides in the DNA of Boards, which are dominated by Type A hypercapitalists who believe that success can only be measured by P&L's, balance sheets, and throughput of their production systems, eg, OR's, ER's, ACC's etc.<BR/>Perhaps if we began to populate some of these BOD's with a more diverse range of interests, we would see a change in corporate behavior.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-79727544846611789602008-12-01T18:18:00.000-05:002008-12-01T18:18:00.000-05:00Why lay policing of such behavior solely at the fe...Why lay policing of such behavior solely at the feet of the state or federal government? What responsibility does the board and senior management of these "not for profit" hospitals (including yours) have in executing such a business plan. I think they have quite a bit. Just because it is legal does not mean it is right. Blaming it solely on the government seem to be a bit of a cop out. Most boards and senior management of any large not for profit hospital or health system that I know of lost site of its mission and reason for tax emempt status a long time ago.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-56621026692341717272008-11-30T15:23:00.000-05:002008-11-30T15:23:00.000-05:00I am a physician who works at a non-Partners terti...I am a physician who works at a non-Partners tertiary care teaching hospital in the city, but and I heard a lot of complaining about this issue at work. <BR/><BR/>But it seems to me that the only crime Partners has committed is being better negotiators and better businesspeople than everyone else. And yes, they did this by executing the only well-conceived hospital 'merger' in this city (at least in recent memory) and amassing marketshare. Businesses do this all the time to get better pricing power. And their marketshare is only meaningful because it is associated with a strong brand. <BR/><BR/>Similarly, Children's has built such an impressive brand for its services that it can leverage its brand for higher prices. Again, a good way to build a successful business. <BR/><BR/>I understand all the ethical/moral overtones of medical care (universal coverage, quality, etc), but instead of burying Partners, we should praise them and try to emulate them. Remember, the insurance companies are businesses too, and they try to gather as many subscribers as possible to get better prices from providers.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-65291960759345467702008-11-27T10:22:00.000-05:002008-11-27T10:22:00.000-05:00Yes, Partners did a great job of executing an busi...Yes, Partners did a great job of executing an business plan. <BR/><BR/>Unfortunately it is one of the many reasons hospitals throughout Massachusetts are in such poor financial condition. <BR/><BR/>Some hospitals are better than others, but this does not explain the reimbursment discrepancy between Partners and hospitals like yours along with Tufts.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-47628786393018618182008-11-25T19:25:00.000-05:002008-11-25T19:25:00.000-05:00The way in which the insurance companies have fram...The way in which the insurance companies have framed this debate in front of a credulous amazes me. Basically what they are saying is that typically insurers can slash reimbursements however much they want and hospitals have to eat it. But there's one hospital where the hospital has leverage instead of the insurer. And this is an atrocity that must be corrected, while in all other cases it's the proper order of things?<BR/><BR/>Criticism should be focused at the way reimbursement contracts are "negotiated", not the fact that Partners has successfully turned the insurers game against them and they're unhappy about it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-36861915813193036022008-11-25T17:57:00.000-05:002008-11-25T17:57:00.000-05:00Paul-You are spot on. I wonder what our MA Secreta...Paul-<BR/>You are spot on. I wonder what our MA Secretary of Health and Human Services (and former BWH internist) <A HREF="http://www.mass.gov/?pageID=eohhs2utilities&L=1&sid=Eeohhs2&U=bio" REL="nofollow">Judy Ann Bigby</A> thinks. Somebody send this to her!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-43085171354391467252008-11-25T15:55:00.000-05:002008-11-25T15:55:00.000-05:00An interesting article from a prestigious economic...An interesting article from a prestigious economics journal, the Journal of Economic Perspectives, frames the discussion from a national perspective. The last sentence in the abstract is particularly apt:<BR/><BR/>Is American Health Care Uniquely Inefficient? <BR/>Authors: Garber, Alan M.; Skinner, Jonathan<BR/><BR/>The U.S. health system has been described as the most competitive, heterogeneous, inefficient, fragmented, and advanced system of care in the world. In this paper, we consider two questions: First, is the U.S. healthcare system productively efficient relative to other wealthy countries, in the sense of producing better health for a given bundle of hospital beds, physicians, nurses, and other factor inputs? Second, is the United States allocatively efficient relative to other countries, in the sense of providing highly valued care to consumers? <BR/><BR/>For both questions, the answer is most likely no. Although no country can claim to have eliminated inefficiency, the United States has high administrative costs, fragmented care, and stands out with regard to heterogeneity in treatment because of race, income, and geography. The U.S. healthcare system is also more likely to pay for diagnostic tests, treatments, and other forms of care before effectiveness is established and with little consideration of the value they provide.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-83785185960286266462008-11-25T13:07:00.000-05:002008-11-25T13:07:00.000-05:00Partners will probably throw out the prospect of "...Partners will probably throw out the prospect of "job cuts" in a tough economy if they feel any state regulators breathing down their backs over their inflated rates and enormous profits.... despite, of course, being a "non profit" that does not pay any taxes.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-19196050446660242022008-11-25T12:01:00.002-05:002008-11-25T12:01:00.002-05:001) Sorry, I don't do pediatrics!2) Please read w...1) Sorry, I don't do pediatrics!<BR/><BR/>2) Please read what I wrote again, as I think you missed my point. The point was not to put Partners (or Children's) under the spotlight for their successful implementation of a business plan.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-66448426075185664152008-11-25T12:01:00.000-05:002008-11-25T12:01:00.000-05:00Paul, every time I read your blog I get so excited...Paul, every time I read your blog I get so excited. I love what you're doing. Keep it up.Geewhizhttps://www.blogger.com/profile/07267823098094566514noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-224237135034396662008-11-25T12:00:00.000-05:002008-11-25T12:00:00.000-05:00For the majority of the readers on this blog, I wo...For the majority of the readers on this blog, I would bet that they have health insurance. They will not care that much if one hospital costs that much more or less than another. We all realize that our premiums are skyrocketing, but when someone is having chest pains, they do not generally start calling around for the best price.<BR/><BR/>This is a consumer issue where the consumer has zero power to affect the problem or solution. Maybe the state insurance commissioner needs to step in and look into the issue along with the help of the local hospital administrator.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-61264359682559005042008-11-25T11:18:00.000-05:002008-11-25T11:18:00.000-05:00Paul - Anytime you write about this subject make s...Paul - Anytime you write about this subject make sure to include Children's Hospital and their associated physicians along with Partners. Children's has also pressured the local non-profit insurers (especially Blue Cross and Blue Shield of MA) for rates FAR above anyone else for largely community level of care. Sure they do some stuff no one else does but a vast majority of their care is for asthma, dehydration and croup. Children's uses these higher fees and rates to actively recruit more community PCPs into their Physician Organization, driving up costs even further without any demonstration of better quality outcomes. Partners and Children's both need to be put under the spotlight as "non profits" that are making millions of dollars more than anyone else for largely the same level of care with largely the same level of quality.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-34158799181003487842008-11-25T09:59:00.000-05:002008-11-25T09:59:00.000-05:00I found it interesting that I (the public) have n...I found it interesting that I (the public) have no way of comparing prices and then deciding what is worth it or not. For instance, if I need a cardiac cath done and I do not have insurance, can I decide that I will "take a chance" at Hospital A since it is $2,000 less expensive than Hospital B?<BR/><BR/>Right now it is virtually impossible to figure that out especially if you are having chest pains!<BR/><BR/>I wonder if knowing prices would have an impact on Hospital costs...<BR/><BR/>How naive of me....Anonymousnoreply@blogger.com