tag:blogger.com,1999:blog-32053362.post8624631669285375070..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: The downside of competitionPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-32053362.post-42950738671352378542008-11-02T18:29:00.000-05:002008-11-02T18:29:00.000-05:00Our payment system is screwed up. Isn't is all ab...Our payment system is screwed up. Isn't is all about having the high dollar specialties? Since EDs and maternity are money losers aren't those solid organ transplants, cardiac surgeries and highly specialized services where the $$ is?<BR/>I thought they were always profitable with the pull through business too. <BR/><BR/> I agree that having enough volume to demonstrate quality and efficiency is where we should be. Every hospital duplicating the same services and competing for the surgeons and technical peoople is no way to run health care.Toni Brayer, MDhttps://www.blogger.com/profile/15258759363309666629noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-55286738003349219352008-10-31T18:45:00.000-04:002008-10-31T18:45:00.000-04:00Well, to make my umpteenth reference to Porter and...Well, to make my umpteenth reference to Porter and ___'s book (I always forget the second author), their suggestion of competition based on value (outcome per dollar spent) among bundled providers (e.g. hospitals plus physicians) seems a good model for transplant surgery. I do think the payors need to start thinking in this direction instead of just cost, cost, cost. They need to start requiring the providers to keep such data to inform decisions.<BR/>I think much of their proposed scheme would be impossible to implement, but I think this idea is a good model at least.<BR/><BR/>nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-28103370712195321112008-10-31T16:22:00.000-04:002008-10-31T16:22:00.000-04:00Good points, Lee. Monopolies tend to be unrespons...Good points, Lee. Monopolies tend to be unresponsive over time and also slow to innovate, so you don't want to go that far. Perhaps having somewhere between 10 transplant centers in NE and 1 center could get us to a happy compromise.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-33204161637742741192008-10-31T11:04:00.000-04:002008-10-31T11:04:00.000-04:00I think part of the issue is with referral groups....I think part of the issue is with referral groups. If I need a specialist, my PCP will refer me first to someone within her practice group. If there is no resource in the group that meets my needs, she will refer me to someone in her affiliated hospital. In order for me to see a physician in a different hospital, she would have to demonstrate that my needs could not be met in the first two categories. It is not a restriction from my insurance plan, but from my PCP's contract.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-90191513051984731802008-10-31T10:58:00.000-04:002008-10-31T10:58:00.000-04:00Are there models of academic hospitals that have c...Are there models of academic hospitals that have chosen to invest in only those service lines in which they can provide the highest quality (measurable outcomes) as a business strategy - attracting patients from around the world for procedures that they develop from bench to bedside, so to speak? Can it work in Boston?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-41139815541810899142008-10-31T08:25:00.000-04:002008-10-31T08:25:00.000-04:00I'm amazed that there are so few transplants happe...I'm amazed that there are so few transplants happening. I would have guessed thousands.<BR/><BR/>Is there any precedent for hospital specialization directed by government or insurance?<BR/><BR/>I'm reminded of the intense process banks had to go through to set up a branch.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-46762803657560146572008-10-31T07:52:00.000-04:002008-10-31T07:52:00.000-04:00The flip side to your argument is if you consolida...The flip side to your argument is if you consolidate functions (Eg: Cardiology surgery is done at only one hospital) you suffer other effects such as:<BR/>- Long wait times<BR/>- Not enough staff for sudden surges of need<BR/>- Bureaucratic nonsense (Eg: hiring/firing/nepotism/etc because you're the only game in town)<BR/>- Loss of the ability for different doctors to innovate<BR/><BR/>There are advantages and disadvantages to each model. Presenting one side without adequately presenting the other side seems a bit disengenuous, doesn't it?<BR/><BR/>You also seem greatly fixed on the "central control" model for health care. Some day you should explain why you are, what you don't like about other models, and why your model is better.Unknownhttps://www.blogger.com/profile/11228992629065531924noreply@blogger.com