Tuesday, January 29, 2013

Squeeze on Hospitals and Physicians
The tighter you squeeze, the less you have.
Thomas Merton (1915-1968), American Trappist Monk

Managing is like having a dove in your hand.  Squeeze it too hard and you kill it, not hard enough and it flies away.
Tommy Lasorda (born 1927), baseball manager

January 29, 2013 -  The Affordable Care Act has put the squeeze on hospitals and doctors by systematically cutting what doctors and hospitals  will be paid from Medicare and Medicaid over the next 10 years.  
The government’s  reasoning  is obvious.  Hospital and doctors account for 50% to 55% of total health costs.   To reduce total health costs,  you therefore have to squeeze payments for hospitals and doctors.
Consequently,  the health care hills are full of talk about how to best achieve hospital- doctor “alignment”  for mutual survival.  The government figures if you can bundle hospitals and doctors into the same organization,  known as an Accountable Care Organization, you can then more conveniently squeeze  out high cost juices   and reduce the size of the organizational lemon.
Don’t  squeeze  hard enough to close hospitals or drive  doctors out of practice.     The ensuing hospital bed and physician shortages might reduce access enough to cause the public to revolt – and to fly away from Obamacare.
Don’t  squeeze physicians out of traditional practice into concierge or cash-only medical practices outside the reach of government. Squeeze just hard enough to make hospitals and doctors squeak but not squeal – to make changes that save government money.  As you’re squeezing,   divert the public’s attention with euphemisms  that the squeeze will “enhance, integrate care, and coordinate care,” “reduce duplications,” and “increase efficiencies.”   Avoid talk about the bitter juices that may emerge from the squeezing,  like independent doctor complaints, public grousing, higher costs,  fewer choices,  lesser access,  tighter restrictions that limit referrals to hospital-based specialists.
Tweet:  Obamacare is  squeezing hospitals and doctors by reducing their federal pay,   forcing them to join together and to “align”  to survive.

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