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Healthcare – Time to Recognize and Confront the ‘Elephant in the Room’

Have you ever been involved with an obvious situation, either personally or professionally, that was largely ignored and going unaddressed? Perhaps a work scenario in which a manager who wields considerable organizational power was impacting the workplace culture in an extremely uncomfortable and unhealthy direction. Speaking up may cause one to lose his/her job or suffer long-term upward job mobility opportunities. Self-preservation is a natural powerful reaction when confronting a seemingly formidable opponent – we simply choose not to act at all.

The fear of speaking up is a metaphor for an ‘Elephant in the room.’

This is happening today in our healthcare delivery and payment environment. We frequently see or experience unacceptable situations that clearly require action to prevent it from happening in the future. As a reader of my blogs, you are keenly aware of the egregious nature of the medical establishment hiding their preventable medical error ‘indiscretions’ in the proverbial litterbox – covering up preventable mistakes that are not meant for public viewing. Yet, without being held accountable for their actions, the medical community will continue to repeat what should be un-repeatable.

The elephant exists in healthcare in a number of ways. Below are just a few prime examples.

Employers are Reluctant

Employers serve as the real payers of healthcare, yet oddly sit on the sidelines exhaustively complaining about the high cost of health insurance and how it adversely impacts their competitiveness in the markets they serve. Unfortunately, most employers are reluctant to bring up the inherent dysfunctional problems because hospitals and medical practices are considered to be ‘other’ large, recognizable community members that are off-limits to public correction. In fact, many business owners are board members at the local hospital, making it difficult to publicly speak up while serving in a ‘distinguished’ role. As real payers, employers can clearly climb into the driver’s seat to collectively initiate sorely-needed changes in how the healthcare establishment behaves. But to do so, they must firmly take hold of the steering wheel to begin the journey. Instead, the employers have historically farmed out this responsibility to the insurance companies.

Insurance Companies Lack Initiative

One can be equally mystified by insurance companies’ lack of initiative when it comes to medical errors. By default, these ‘third-party payers’ assume the purchasing role as an intermediary between the real payers and health providers. More often than not, employers assume that insurance companies are adequately vetting the quality-of-care their network providers are giving to their employees and family members. This is largely not happening. As a paid intermediary, insurers can play a vital role in determining whether their subscribers are receiving the best possible outcomes from the care being purchased through the insurers’ networks.

Because the medical community will not admit their playful litterbox games, an appropriate opportunity for safety-conscious insurers would be to randomly survey their members after they have been discharged from a hospital to learn about their experiences – specifically as it relates to preventable medical errors. Doing so could be a great branding opportunity for innovative, forward-thinking insurance carriers. Over time, when enough patient feedback has been collected and analyzed, insurers can then become a more engaged advocate for employers and their employees when vetting network providers. Why are insurers not performing this difficult but necessary work on behalf of their members? Great question. They should.

Medical Community Touts Economic Strength

The medical community, specifically hospitals, spend a good deal of our[1] money to help perpetuate their economic value in the communities they serve. Recently, the Iowa Hospital Association purchased airtime on at least one local television station to help educate Iowans about the “economic impact” hospitals have in Iowa, including:

  • Number of hospital workers employed in Iowa
  • Benefits hospitals provide to the communities
  • Number of additional jobs created by hospitals

Similar to a certain species of cicadas, which are insects that remain underground from 2-to-17 years before emerging to be seen and heard, the hospital community will annually reveal themselves to promote their substantial workforce and economic growth – but remain curiously silent on the indiscretions buried deep inside the litterbox. Apparently, this marketing scheme successfully elevates their status as the elephant in any room, whether it be in Iowa or some other state. This diversional tactic makes it difficult for others to honestly speak out about the associated problems the elephant causes within our communities. After all, who doesn’t want jobs? No one wants to be ridiculed as a ‘naysayer.’ Unfortunately, honesty may come at a great expense.

Joe Gardyasz of the Des Moines Business Record recently wrote an insightful piece (subscription required) about healthcare jobs in Iowa. Even though jobs in the healthcare sector have surpassed U.S. manufacturing and retail sectors for the first time in 2017, Iowa’s manufacturing sector – at least for now – still outpaces healthcare jobs in our state.

Why healthcare has become the most dominant sector in our country

Other than rising demographic trends of an older population requiring more healthcare services, the most plausible reason for more healthcare jobs is likely due to gross inefficiencies in an inordinately complex environment. As mentioned in my previous blog, “Healthcare Billing Process – The Cost of Doing Business,” non-healthcare industries might typically employ 100 full-time equivalents to collect payment for $1 billion in services, but healthcare employs 770 full-time equivalents per $1 billion of physician services. Keep in mind, healthcare is now a $3+ trillion-dollar industry – which primarily explains why healthcare jobs are soaring past other more-efficient sectors.

Put another way, if non-healthcare sectors wish to tout their economic dominance in their respective communities or state, they would need to become bloated with inefficiencies that would inflate costs, revenue and increase employment opportunities. Thankfully, largely due to powerful market forces that are embedded with price and quality transparencies, those sectors are forced to act efficiently by offering reasonably-priced products and services that are of the highest value. The healthcare industry, it seems, is oddly immune from having to play by these transparency rules. According to Warren Buffett, “Healthcare is the tapeworm of the American economy.”

Through our entrenched relationships (e.g. family, work, business and community), we are too often reticent about changing the status quo when it might possibly ‘threaten’ the comforts of doing nothing. Employers, insurance companies and the medical establishment are each capable of making the necessary changes, but at times, must be ‘nudged’ to do so. The late Stephen Hawking made a great point by writing, “I have noticed even people who claim everything is predestined, and that we can do nothing to change it, look before they cross the road.”

What IS the Elephant?

Regarding healthcare, if each of us fails to recognize, acknowledge and confront the elephant in the room, we too become complicit in this persistent, serious and increasingly costly and harmful problem. If we continue to sit on our hands and do nothing, we eventually enable the elephant to become even larger and more undisciplined.

So what is this elephant in our collective “healthcare room?” John Atkinson of Wrong Hands developed a ‘chartoon‘ about this metaphor, whether the elephant appears in healthcare or elsewhere.

Isn’t it time to begin “eating” this elephant one bite at a time? It starts by recognizing and acknowledging the elephant in the room, and then crossing that road to initiate necessary improvement.

To learn more, we invite you to subscribe to our blog.

[1] For the services they provide, hospitals are predominantly recipients of our tax dollars, government-related grants, philanthropic donations, insurance premiums and personal out-of-pocket payments.

The Medical Error Problem – Do Employers Have Solutions?

Medical errors do not discriminate. In fact, preventable medical errors occur on an ‘equal-opportunity’ basis to patients, regardless of age, gender, race, political ideology and the type of medical plan you may (or may not) have. This means that employer-sponsored health plans are not exempt from medical mishaps and the associated costs that come with this problem.

Although the cost to employers can be massive – it is opaque and mostly hidden. Leah Binder, president of The Leapfrog Group, a national nonprofit organization whose mission is to address the quality, safety and affordability of American healthcare, has stated the cost associated with this unintended harm that silently creeps into the premiums that employers and employees pay – is a “hidden surcharge.”

This ‘surcharge’ not only includes additional costs to fix the medical problem resulting from the error, but the lost productivity of absenteeism and presenteeism – when employees lose time away from work and the emotional toll it takes when they do show up for work.

Simply put, employers own this problem, whether they know it or not. Relying on your insurance company or vendor to apply leverage on healthcare providers is most likely a delusional strategy in trying to improve this problem.

A 2013 Leapfrog Group white paper calculates that hospitals with a grade of “A” on their Hospital Safety Grade (hospitals who participate in Leapfrog surveys that rate patient safety efforts), will have a hidden surcharge for medical errors of $6,962, while a hospital with a grade of “C” or lower will command a hidden surcharge of $958 higher ($7,920 total). It is quite evident, especially when it comes to safety of medical care, not all hospitals are created equal. This is a fact that both patients and payers alike must acknowledge – and address.

Recently, Leapfrog announced that five states showed the most improvement over the five-year period since the Hospital Safety Grade’s inception. The states are Oregon, Rhode Island, Hawaii, Wisconsin and Idaho. Just as politics is considered to be local, so too is the healthcare that is delivered to patients. Though patient safety is a national problem, the solutions must begin locally, within each of our communities and within state borders. See how Iowa ranks in the most recent Leapfrog rankings.

With this in mind, what can Iowa employers do about patient safety issues? Actually, quite a bit.

What can Iowa Employers do about Patient Safety Issues?

Heartland Health Research Institute recently wrote a fact sheet, “What Employers Can Do About Medical Errors,” that addresses at least six approaches Iowa employers can consider taking to reduce the incidence of medical errors. The approaches include:

  1. Make insurance contracting decision-making process part of the medical error strategy.
  2. Develop a coalition with other like-minded employers and purchasers in your community.
  3. Meet with local hospital(s) and clinic(s) to convey the importance of safety and quality – require they demonstrate ‘cultures of safety’ within their respective organizations.
  4. Actively communicate the importance of safety issues to employees.
  5. Encourage employees to report medical errors when they occur.
  6. Visit with both state and federally-elected officials, trade association groups in which your organization participates, and other local commerce organizations.

It is tough sledding to make policy recommendations that would have a chance of becoming law. Instead, to disrupt healthcare into being delivered more safely, it really must begin with those who actually pay the healthcare bills – the employers and their employees, and yes, the taxpayers who ultimately fund Medicare and Medicaid and other state healthcare programs. In the past, this applied-pressure usually started (and ended) with only the largest of employers. But for this new movement to gain local traction, employers of all sizes and industries must embrace the approach that there is zero-tolerance for preventable medical errors.

Just remember, when we don’t demand safety in our healthcare, they don’t supply it. There’s no better time than now to begin taking action.

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New Survey: Nearly One-in-Five Iowa Patients Experience Medical Errors

Clive, Iowa – January 8, 2018 – Although a vast majority of Iowans have positive experiences with the healthcare system in Iowa, nearly one-in-five Iowa adults (18.8 percent) report having experienced a medical error either personally or with someone close to them where they were very familiar with the care that person received, during the past five years.

This finding comes from a new Iowa survey released today by Heartland Health Research Institute of Clive, Iowa. The first of its kind in Iowa, this statewide survey… (learn more).