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Friend or foe: eliminating healthcare waste through an autonomous board

Posted Mar 19 2009 3:49pm

By Mike Daly

There’s an awful lot of talk about waste in the healthcare system these days. I’ve seen it firsthand. Look at the redundancies in regulatory requirements for hospitals. I would bet that if we could have government regulatory agencies and insurance companies review these requirements and standardize processes, we could likely remove 20 percent to 30 percent of excess without eliminating a single nurse or piece of equipment. There are plenty of similar examples, whether in the 50 different ways to credential physicians, the myriad reimbursement documents that vary from payer to payer, or even the very specific documents required by state insurance companies.


However, with the current healthcare system structured as it is, eliminating these wastes and working together is unlikely, and true reform will continue to elude us. Everyone is nibbling around the edges. Yes, we need to improve quality and reduce costs, but with the players currently involved, that’s not going to happen unless there’s a big shift in perception and approach. 


Ed mentioned that a semiautonomous board, akin to Sen. Tom Daschle’s Health Care Reserve Board, could work to balance government and industry players. I agree, if we’re sure to include the right people with the power necessary to truly govern. Otherwise, it would just turn into yet another layer of unneeded bureaucracy. Such a board would have to take on the lobbyists (as surely Big Pharma will disagree with many cost-cutting changes) and private insurance companies, while standing strong on behalf of quality public care. 


Why haven’t we been able to create such a board as yet? I believe it’s because the players involved neither respect nor trust each other. (Not to mention that there’d be a major loss of jobs at the state and federal levels were everything to be standardized, but let’s just table that for now…) The uphill battle is to get these rivals to become collaborators.  


Dramatically altering views seems to be a trend nowadays, though. An article a couple of weeks ago in The Washington Post on President Obama’s healthcare summit provides examples of former opponents to the Clinton healthcare plan who are now in full support of Obama and his reform. During the summit, Rep. Joe L. Barton (R-Tex.) reminded the crowd that he was “instrumental in killing ‘Hillarycare’ in the 1990s.” “Words of support came from lobbyists for physicians, drug makers and the corporate sector.” Now, perhaps I’m a bit cynical, but I wonder if these former foes just wanted to be at the table to see which cards were dealt or whether they really do embrace the new plans. After all, it can be difficult to completely change one’s view.


Take, for example, when competing hospitals collaborate for mutually beneficial outcomes. In my own Baystate, we worked with other organizations throughout western Massachusetts to share radiologists. When another organization has historically been viewed as an enemy and is now an ally, there are surely growing pains. It’s worked, as I’ve seen, provided that there are successful joint activities and time is given to build up requisite trust. Once everyone is on the same page, I am certain that this type of collaboration yields long-term benefits.


Maybe that’s what we need in healthcare reform. Perhaps we need a joint activity with all players currently involved – regulatory, insurance, pharmaceutical, etc. – to break down the walls of disrespect and build the foundation of trust and collaboration. Their first assignment? Review hospital regulatory requirements and eliminate the waste. Everything after that would be a cake walk.

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