Tuesday, April 30, 2013

The Last Three Health Reform  “Cs” – Cost, Coordination, and Connectivity
Sailing the Seven “Cs” of Hospital-Physician Relationships – Competence, Convenience, Clarity, Continuity, Competition, Control, Cash
Title of Book, by James Hawkins, MBA, and Richard L. Reece, MD, PSR Publications, 2006
Seven years ago, James Hawkins, a hospital administrator, and I wrote on a book listing the seven Cs we considered essential for a harmonious hospital-physician relationship – competence, convenience, clarity, continuity, competition, control, and cash.
Today, as Obamacare undergoes its  implementation travails,  I would like to add "cost", "coordination", and c"onnectivity" to the orginal seven "Cs."

·         Cost - It is now clear Obamacare is going to cost at least twice, perhaps even three times, its original $900 billion estimate over the next decade – and the cost will come in human, access, and economic terms.   According to Daniel P. Kessler, professor of business and law at Stanford and fellow at the Hoover Institute,

In total, it appears that there will be 30 to 40 million people damaged in some fashion by the Affordable by the Affordable Care Act with  more than one in 10 Americans. .. We’ll hear more about innocent victims who saw their premiums skyrocket, who were barred from seeing their usual doctors, who had their hours cuts or lost their insurance – all thanks to the faceless bureaucracy administering a federal law.” ("The Coming ObamaCare Shock," Wall Street Journal, April 30, 2013)

·         Coordination -  It’s hard to turn your head these days when reading about health reform without hearing cries for more “coordination.”  What is proposed for coordintion  solutions are more primary care physicians,    more medical homes,   more hospitalists, more accountable care organizations,   and more large integrated care organizations with more doctors, nurses, other health professionals, and managers working together seamlessly  in teams.  The  article concludes
´Some medical centers have taken steps to improve communication, assigning color-coded ID tags or scrubs to staff members so patients know who's a nurse and who's a doctor, and installing white boards in patient rooms, where a nurse starting a shift can jot down his or her name. At some facilities, hospitalists write their names on those boards, and hand patients and their relatives business cards or sticky notes with their photos."
“A few hospitals have gone further. At the Mayo Clinic in Rochester, Minn., patients having surgery attend a pre-admission education class so they know "almost to the hour, let alone to the day, what's going to happen," said Chief Medical Officer Michael Rock.”
“In Pennsylvania, Geisinger Health System has developed a checklist on laminated cards that fit in caregivers' pockets. It includes questions that doctors and nurses need to keep uppermost when reviewing cases, such as: "Is the patient taking high-risk medications? When is the patient going home? Does the patient have any catheters or lines that should come out?"
“Virginia Mason Health System in Seattle completely overhauled how they did things after sending representatives to Japan to learn from Toyota. Now nurses spend 90 percent of their time near the patient “so the shift handoffs don’t happen at the nurses’ station anymore,” said Dr. Gary Kaplan, Virginia Mason’s chairman and CEO. “Patients don’t have to use the call button.”
“Consumer advocacy organizations, meanwhile, advise patients entering the hospital to have a relative or close friend, or even a hired hand, who can communicate on their behalf and be at their side through the hospitalization. “
·         Connectivity -  These days computer "connectivity"  as a universal solution for coordinating care is a huge and sprawling subject; The logic goes:  Once everybody is connected to everybody else via handheld mobile devices, smart phones,  embedded tracking implants,  the social media,  big data, and electronic health records that can communicate with one another, everything can be coordinated with nothing and nobody failing through the cracks. 

I suppose this may happen if one interprets  the current  IBM ad as gospel, “Few human technologies have transformed human behavior as quickly as mobile.  Two of three people in the world  keep mobile devices within reach as all times.  A typical user  reaches for the  device 150 times every day- sending messages, researching, collaborating.  There are four times as many mobile phones, in use as there or personal computers, and as many as there are TVs."

Or If you read  The Digital Age: Reshaping the Future of People, Nations, and Business,  by Eric Schmidt,  former Google CEO, and Jared Cohen, author, researcher, and top global thinker. 
I see only one problem with these lines of thinking –fear of loss of personal privacy and security, identity theft, and misuse and abuse of personal information, particularly that dealing with personal health.

Tweet: Higher costs, lack of coordination, and loss or privacy and economic security, are fears shaping the fate of the health reform law.

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