Health Care Solutions: Hospitals

Hospitals are in the toughest position of all in the health care debate.  Anyone showing up in their emergency rooms are required to get health care, whether they have insurance or not.  Many people without insurance coverage use the emergency room for all of their health care needs, which strains the ability of the hospitals to provide a high level of service to their paying customers.

In addition, hospitals are at sharp end of the stick when it comes to dealing with insurance companies.  Even if a patient has insurance, if the insurance company denies authorization for a treatment or procedure, the hospital must jump through hoops to try to reverse the denial. A friend of mine manages a group of 6 people who work for a company that is contracted by a single hospital chain just to reverse these denials.  They make a very good living just adjudicating the differences of opinion between the insurance companies and the hospitals.

Hospitals do not do themselves any favors, however, when it comes to managing their own businesses.  Because most of their funding comes from insurance companies and Medicare/Medicaid, they negotiate with these companies for standard reimbursment rates, which in many cases have no basis in the actual costs to provide the service or procedure.  They do not post the prices of their services, so that the average consumer can make informed decisions.  And of course, if you are uninsured, you will pay the highest price.

Hospitals are always looking to grow, to take market share away from the other guy.  There is a strong sense that they need to buy the flashiest newest technology, the multi-slice MRI or the gamma knife.  And I think that we need to have access to these technologies as they can significantly improve the quality of diagnosis and treatment provided.  But I don’t think that every hospital in the county or state needs to have the same technology.  Heck, run the MRI 24/7.  If my doctor requires that I need to get an MRI to diagnose a serious condition, I would go in at 2am to get it done.

The technology that will make the hospital work better and provide significant patient care overall is EMR – Electronic Medical Records.  It is not flashy, but it provides the framework to allow doctors to work together and have a unified view of the patient’s status from anywhere.  This is not being implemented at anywhere near the pace that it needs to be.  President Obama is wise to have included significant incentives to its implementation.

Hospitals are in the crosshairs.  They need to maintain good relationships with physicians, insurance companies and big pharma.  They are mandated to serve the public, whether they can pay or not.  They have significant unfunded mandates from the government, accreditation organizations and insurance companies. Now is the time for hospitals to take the initiative to step out from the “Woe is me” persona and propose needed reforms to the entire health care  debate.

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