A Postmortum of the Healthcare Reform Summit

Well the waiting is over. Yesterday's much touted bipartisan Healthcare Reform Summit is in the books. As expected, there was no coming together between Democrats and Republicans. The Republicans generally stated that it was all a show with no real interest by the Democrats to hear what they had to say. Meanwhile the Democrats stated that the Republicans are against any kind of reform and have not offered any meaningful plan of their own. So where do we go from here?

President Obama wanted the summit to have full national exposure so discussions would be transparent to the American people. This is in stark contrast to his original approach of pushing through bills in the House and Senate that were so detailed and complex that most members of Congress did not really know what they were voting on, much less the public. Maybe yesterday was the beginning of real bipartisan discussion on the issues. If so, it is evident that we have a very long way to go.

I had the opportunity yesterday to hear Tom Dolan who is President and CEO of the American College of Healthcare Executives speak on this subject. He made two interesting points. First, the bills being presented by the Democrats are not really about true health reform but more about health insurance reform. He stated that in this country we do a great job (and spend lots of money) on fixing people who are broken. But our health statistics don't stack up to the money we spend per capita because we are not addressing many other more important issues affecting overall health. Obesity, diabetes, smoking, alcohol abuse and stressful lifestyles do a whole lot more to impact our health than a great acute care system. The Obama Healthcare Reform Plan does little to address these issues but at least its a start.

Second, Mr. Dolan makes the assumption that healthcare reform in now dead until at least some time next year. Based on the complete lack of agreement between the political parties, certainly a compromise measure is over a year away. But what about the President's threat that if no meaningful dialogue happens very soon that he will push through a modified version of the Senate bill using the budget reconciliation procedure? Most people assume this is a viable option since aspects of the Senate bill could be passed through with a simple majority and without filibusters which is now the Republican threat having 41 Senators. When I asked Tom about this, he made a keen observation. The Republicans may not be able to filibuster on aspects of the current bill going through, but they can add amendments and debate them forever thus stopping passage of the rest of the bill.

So once again we see politics at work while Medicare followed by the rest of our healthcare system head speeding toward bankruptcy. There are many issues that need to be included in the debate including expanded coverage, insurance reform, tort reform, health education (with incentives) and many others. But if we are to stop the runaway train we need to start somewhere, anywhere, and soon. Let's stop all the political posturing and get to the business of fixing our broken healthcare system.

More on this later.

Mark Brodeur

A New Call For Tort Reform

While we are all waiting for some meaningful outcome to President Obama's bipartisan summit on healthcare reform today, another old issue has resurfaced- the staggering cost of defensive medicine. A new Gallup poll released this week by Jackson Healthcare and the Center for Health Transformation now estimates that 25% of our healthcare costs are spent on unnecessary tests and treatments. The sole reason for these procedures is physicians' fears of being sued for possibly missing something no matter how unlikely.

So based on the Centers for Medicare and Medicaid Services (CMS) estimate that we are spending $2.5 trillion annually on healthcare in this country, the cost of defensive medicine is roughly $650 billion each year. Think what these saving would do as part of a real healthcare reform package. We could expand coverage like the President is trying to do while removing the giant sword that is currently hanging over the outstretched necks of hospitals and physicians. If cuts in reimbursement to the healthcare providers could be matched with a real reduction in the services they provide, this may work for everyone.

But before this could ever happen, there are a couple of things to consider. First, even with real meaningful tort reform that allows physician practices to be guided by their judgement and not by fear of lawsuits, some questionable testing will remain. Less experienced physicians order more than their veteran counterparts. Also for inpatients, there is the overriding push to reduce length of stay. If one test at a time is ordered to rule out multiple possibilities, this lengthens the costly hospital stay. So sharp physicians that are dealing with a complex issue use the shotgun approach for testing to get the answer quickly and get the patient discharged. Therefore the real reduction of unnecessary testing would certainly not be 25%, but it ought to be well over half of that amount.

Secondly, and more realistically, there are the political issues blocking meaningful tort reform. The trial lawyers have done a much better job of banding together and spending their money to protect this issue than physicians and hospitals have done to change it. Particularly with a Democratic Administration, House and Senate, the chances for meaningful tort reform are remote.

Still, the current study released this week presents a fresh face and staggering numbers to a longstanding issue at a time when both parties are desperately looking to reduce healthcare costs. Lets hope something meaningful comes out of today's summit. Whether it does or not, here is another healthcare cost reduction idea to put under consideration.

More on this later.

Mark Brodeur

Healthcare Reform Wars: Obama Strikes Back

In our last episode it appeared that forces from the Republican Senate had put an end to President Obama's chances to pass meaningful healthcare reform this year. Many called the House and Senate bills DOA for further consideration. We all watched President Obama demote healthcare reform as his top domestic priority and relegate it to a position well under jobs and the economy.

But those closest to this insisted all along that the issue was not dead but rather dormant while the strategy for passage was being reworked. Many of us were hopeful that there would still be meaningful healthcare reform, but that it would be a slower, more inclusive process to allow for more input. The major concern was to not allow input to paralyze the process and leave us with nothing. After all, despite personal beliefs and political leanings, everyone must admit that the current economics of rising healthcare costs are heading us toward disaster.

Now it appears that the President's conciliatory tone of the last two weeks may again be taking a back seat to his threat to force a bill through. This in my opinion is the mistake he made the first time and it appears that he is making it again. As I mentioned in an earlier post, the House has the option to essentially pass the current version of the Senate bill to make a law without any further Republican input. The President is using an option very similar to this. He is slightly modifying the current Senate bill to remove some of the more controversial features. This process is called reconciliation and means that the revised bill only needs a simple majority in the Senate and not the 60 vote supermajority needed to block filibuster.

Although the new plan sticks very close to the original Senate bill, the good news is that it has addressed some of the negative issues. The sweetheart deal for Nebraska that drew so much ire is gone. The new plan also delays enactment of his tax on high-cost employer-sponsored insurance plans. It also does away with the unpopular "doughnut hole" in the Medicare prescription drug program.

So the president is again threatening the Republicans to work with him for a meaningful plan or he will once again shove through a plan with no Republican support. This is the context under which both sides will be meeting tomorrow to work out a bipartisan compromise. Good luck!

Here is a message to both sides: We need healthcare reform ASAP but more importantly we need it to be done right.

More on this later

Mark Brodeur

The Unmeasured Lost Revenue of Patients Who Leave Your ED

All hospitals keep close track on the number of patients who leave without treatment from their Emergency Department. I have discussed this in past posts and stated that this number should be well below 1%. If you are in excess of 4%, adding up the lost revenue from these patients over a year's time can be a sizable number. But there are even greater revenue losses occurring that you may not be completely familiar with.

In addition to the patients who come in your ED, register and then walk out frustrated by the wait. There is another group of potential patients who never get that far. I am talking about the patients who come to your emergency department with a relatively minor or perhaps chronic condition and see the backlog that exists in your waiting room. Many of these people will not even bother to sign in. They walk in the door and out again without registering. If you have a relatively large number of left without treatment (LWOT) patients, the number that don't even register is estimated to be another 50% of those you do know about. Now we are talking about some significant lost revenue.

But the numbers don't stop here. Those that walk out of your doors mad because they were not seen in a timely basis (both registered and unregistered) will tell everybody. And you seldom get a second chance. Although I know of one patient who came to our ED, saw the wait and decided to take the 20 mile trip to the next ED. That wait was so much longer that they drove back and got in line at our ED again. This is the exception, not the rule. You must have a system and staffing in place to deal with the surge of patients that you will get from time to time.

Ironically, the patients who leave may not have really not needed your services in the first place. But that does not dampen their enthusiasm to bash your lack of response to their perceived needs. Their disdain for your hospital's clinical abilities will extend well beyond the ED into services that have nothing to do with their condition. Their perception is,"If they couldn't take take care of my minor condition, imagine if I had gone in there with something really serious".

No one has an accurate assessment of the magnitude of lost revenue caused by this type of negative word of mouth campaign. But at Compirion we have experience with the growth in new business that occurs almost automatically when we fix the bottlenecks and improve patient throughput in the ED. One hospital saw a 20% increase in ED patients that were treated and discharged. They also saw a 50% increase in patients who were admitted to the hospital through the ED. This type of increase is unusual, but the potential is there.

How much revenue are you losing by patients walking out of your ED without treatment? Don't be fooled by just focusing on the LWOT numbers. The impact is significantly larger than that.

More on this later.

Mark Brodeur

The Economic Imperative for Healthcare Reform

I spent the last several days at the Annual Leadership Meeting for the Texas Hospital Association. They are a vibrant group of hospital leaders who have some success stories to share during these challenging times. Their Keynote speaker leading off the conference was Len Nichols. Len is a very respected healthcare economist and directs the health policy program at New America Foundation in Washington DC. He has been a frequent commentator on news shows recently in discussions about President Obama's healthcare reform initiative.

Over a number of posts I have discussed the political forces either driving or blocking the passage of a sweeping healthcare reform bill. But Mr. Nichols addressed the economic forces driving this initiative. Basically he is saying that from an economic perspective, we either pass healthcare reform that gets cost increases under control or we will end up with some worse alternative such as price controls. He presented some startling economic indicators that support his concerns.

1) The percentage of a median family's income that is used to purchase health insurance grew from 7% in 1987 to 17% in 2006. At this rate it will be between 35-45% by 2016. That's just six years from now.
2) The percentage of our Gross Domestic Product spent on Medicare was 3.2% in 2008 and will grow to 4.5% by 2020 and 7.3% by 2035
3) The biggest issue affecting our national debt is Medicare cost growth
4) Overall healthcare costs are growing at a rate faster than our productivity and income

We need to change this trend by bending down the cost curve, but that can only happen if we expand coverage to the uninsured. This is a key economic driver behind the President's plan. When you consider that today 2/3 of the hospitals in this country already lose money on Medicare and we are looking to make cuts, they can't survive unless there is expanded coverage.

So from an economic perspective,there are two needed changes in healthcare reform:
1) Changing the risk selection. Current private health providers are incentivised to only insure healthy people. We need to change that to include the sick but include incentives for individuals to maintain a healthier life style.
2) Change fee for service medicine. Everyone agrees that this system is fraught with problems and conflicting incentives. We need to quit paying for volume and start paying for value.

Simply put, we can no longer afford the healthcare delivery and payment system that we currently have. It is only a matter of time, which we are running out of. Maybe it is good that the complex and clandestine plans being run through the House and Senate were slowed down giving us a chance for discussion. But let's stop the political chest thumping and start that discussion. The problem will not go away by ignoring it.

Mark Brodeur

The Art of Making Sustainable Change in Your Hospital Part II

In the last post I discussed the steps involved in identifying problems and breaking them down into their component steps. Today I want to focus on what to do with that information and how to track your progress.


The key to sustainable change is to get as many of the players as you can involved in finding the solution but most importantly, listening to what they have to say when they have a suggestion. So once you have identified the problem area you want to address and you have broken it into components assigning teams to each one. The next step is to get these teams together on a weekly basis to report in front of each other the progress they are making. This does two things. First it gets all aspects of the problem area discussed with everyone to get input from all and facilitate a ordinated solution. Secondly, it provides a sense of friendly competition among teams which improves overall morale and builds a sense of buy in to the change process.

Once you have your teams reporting to each other you need to make sure that they have accurate information to report on. I will say it again; if you can't measure it you can't manage it. Before you start the process you must ensure that you have an accurate baseline from which to measure any improvement, such as ED Customer Service scores at the 6th Percentile. Next you need to set a realistic goal and time frame to get there. Your goal could be to be at the 75th Percentile within 6 months. Now comes the important step of providing timely accurate feedback to the team to measure their progress. Monthly reports from Press-Ganey are not sufficient. In this case you need to set up an in house Customer Service survey that can be given to as many ED patients as possible every day with daily tabulations. Believe me, teams will not want to stand up in front of their peers reporting bad information.

Putting all of these steps together over a prolonged period will indeed produce sustained results.



Mark Brodeur

The Art of Making Sustainable Change in Your Hospital Part I

I have discussed specific ways to improve the performance of your Emergency Department by providing specific action steps to take and the key areas to look at first. But once you start this process, how do you go about making changes in your organization that will last? How do you go about changing the culture of an organization?

The guiding principle is that the approach must be comprehensive, inclusive and implemented consistently over an extended period of time. There is no overnight or quick fix that will be worth anything to your organization in the long run. You must commit to actively working to address the particular problem daily for a period of six months to a year. After that you must continue to monitor it daily to ensure that there is no backsliding or returning to the previous culture that created the problem.

The first step in the process is to identify the particular problem being addressed; such as lowering the number of patients leaving the ED without treatment or increasing the number of inpatients discharged before Noon. You must also collect baseline data on the current performance in each area; such as LWOT of 4.5% or 12% of patients discharged before Noon. If you don't currently have in place an accurate measurement system you must initiate one. If you can't measure it you can't manage it.

The next step is to break the particular problem into the individual components that take you from the beginning to the end of a process. For example if you are decreasing the time to get an MI patient diagnosed in the ED to the Cath Lab with balloon inflation, there are multiple departments and multiple steps that can be the source of bottlenecks and delays. Analyze the entire process and create separate teams to look at each area and improve it. Is the primary care physician contacted and do you wait for his response before calling the cardiologist? How long do you wait for the cardiologist response before calling in the Cath Lab team? Are the Cath Lab team members called individually in sequence or do you have a broadcast page alert? If you get the people in each of these areas involved in helping address the issue, not only will you get much better information about the problems but you will also get much stronger support for the solution.

In the next post I will discuss how to integrate this input and the all important process of establishing an effective measurement and feedback system.

More on this later.

Mark Brodeur

Building New Business in Your Emergency Department

Earlier we have discussed Improving Patient Throughput and Staff Productivity in your ED. I want to finish the week by discussing Building New Business. After all this is the real goal for all hospitals struggling with cost increases and declining reimbursement. If you are not growing you are actually shrinking.

Building new business certainly means bringing new patients in the door, but it also refers to adding new revenue. There are things that hospital's can do to increase the revenue from their current business. One area we usually see overlooked is collecting CoPays from patients at the time they come in for service. When I mention this people tend to imagine the mercenary hospital refusing to treat the dying patient until they get the payment issues settled. This is not the typical scenario. Obviously all EDs are committed to treating first and asking the questions later for critical patients. But what about the other great majority of patients whose conditions are not life threatening? Having a system in place to collect CoPays up front, just like at the doctor's office, can have a big impact on revenue. We recently saw a hospital increase its overall CoPay collection by 65% simply by asking for the payment upfront.

Next I want to discuss building the number of "treat and street" ED patients. Those patients less severely ill who can be discharged to home. The quickest way to grow this number is to simply follow the steps from my previous posts on patient throughput along with a strong emphasis on customer service. The ED lives or dies by the word of mouth marketing done by its former patients. If a patient has issues, they tell everybody. If a patient gets exactly what was expected, they may not market for you but they will come back. If you exceed expectations, or effectively deal with a problem they had, they become your ambassadors in the community. A recent hospital we worked with increased their non admitted ED volume by 20% by following this formula.

The formula for building volume of the admitted ED patients is essentially the same except you need to also involve inpatient throughput to ensure that there are no bottlenecks that result in waits in the ED. It sounds simple but once you fix the processes in you ED and provide world class customer service, the growth in business is almost automatic. One hospital client actually saw a 50% increase in patients admitted from the ED, generating $20 Million in new revenue to the operating statement.

This is a great example of Quality First and Finances Follow.

Have a good weekend.

Mark Brodeur

Improving Staff Productivity in Your Emergency Department

For the last two posts I have discussed patient throughput in the ED, now I want to move on to staff productivity. This is key to your overall success and is actually easier to address than you might think.

The traditional way to approach this is to look at consolidating activities. Bring in a team of time and motion engineers who look at wasted motions and staff you can exist without. Although this approach has merit, it is not where we find the greatest opportunity for saving in EDs. After all, most EDs have already thoroughly addressed this issue. But it is the right place to start. Are there staff in your ED who are not being fully utilized or doing functions that are no longer key to the functioning of the department today? If there are, they need to be reassigned somewhere they can be of real utility to the organization. Layoffs should only be used as a last resort. This sends a terribly negative message to the entire organization and certainly must be considered a failure by management to keep up with changes in the work flow and patient volume.

The real opportunity for increasing productivity in your ED is to focus on decreasing patient throughput using the steps I have discussed in the previous posts. If you do that effectively your productivity will automatically increase. To prove this to yourself, take a look at the number of rooms occupied in your ED during peak times. This number or something close to it is the basis of setting staffing levels for this shift. Now imagine that 30% is cut off the average time currently spent in the ED for all patients and look at the impact this will have on the total number of rooms operating during the peak period. The number of rooms to be staffed at peak volume drops substantially. By the way this will also delay the need to expand beds in your ED if you are running tight. One ED I have worked with had recently expanded beds to better meet the growing demand. They found that after implementing throughput improvements, they didn't need all the new beds they built.

So to effectively manage the process of improving staff productivity, you need to measure a baseline and tack progress. Paid Hours per Patient is the most effective measure for the ED and high performing EDs are keeping this number under 2.5. The hospital mentioned above had started at 4.2 paid hours per patient and lowered it to 2.5 largely by reducing throughput times.

We also find that by taking these measures, certainly the patients are much happier to get through the ED process faster, but staff are also happier. Dedicated staff will be happier not wasting as much time and focusing on delivering efficient, quality care to patients who are now more appreciative.

Tomorrow we will discuss building new business.

Mark Brodeur

Improving Patient Throughput In Your Emergency Department, Part II

Yesterday I began presenting action steps that you can take in your ED to improve patient throughput. Today I would like to finish that list. Certainly this list is not intended to be exhaustive of all the areas you can address, but it does provide key indicators that can make a significant difference in your overall ED function.

4) Decrease Door to Balloon Inflation Time for Acute MI patients needing angioplasty. Although this is a very specific measure, it is one of the most important indicators used to assess the quality of your hospital's cardiac program. It is one of the Core Measures that CMS tracks and publishes on their website. High performing hospitals are now performing this within 60 minutes. I have found that this is a needlessly complex process for many hospitals and the time is increased due to the many approvals needed before the cath lab team is actually activated. A multidisciplinary task force can be very effective to change this.
5) Increase the number of inpatient discharges before Noon. High performing hospitals have 50% of their discharges out by Noon. You may ask what this has to do with ED throughput. The answer for most hospitals is; everything. We used to do consulting engagements for ED throughput just focusing on the ED itself. We quickly learned that ED throughput is directly tied to inpatient throughput as well. Often the ED is backed up with patients who need to be admitted. Often these patients are waiting on a bed to free up on the unit. So getting those inpatients who can go home out of the hospital earlier is key. This may require not allowing patients to take up a bed all day waiting on a ride home. Find an alternative for them. It may also require getting discharges set up for the next day by those late rounding physicians, since you will not get them to change their rounding schedule to accommodate you.
6) Decrease Inpatient Length of Stay. This is related to the previous point and again addresses the issue of freeing up inpatient beds so they are available for ED admits. Most hospitals have thoroughly addressed this issue and feel good about their LOS. Our experience is that by applying the same comprehensive task force methodology, there are always additional opportunities in this area. We usually see at least an additional 15% decrease in overall LOS by addressing this.

This completes my list of the action steps to address ED patient throughput. In upcoming posts I will discuss staff productivity and building new business.

More on this later.

Mark Brodeur

Improving Patient Throughput In Your Emergency Department, Part I

To improve the overall performance of your Emergency Department you must start by breaking up this complex department into individual areas and focusing on each area. As I stated in yesterday's post, I want to look at three areas and give some specific action steps that can be taken in each of these areas. Again these areas are:
-Patient throughput
-Staff Productivity
-Building New Business

Today let's look at Patient Throughput. This is a key area of dissatisfaction among patients and ranks as the number one concern from most ED Patient Satisfaction surveys. Getting patients through faster is easy to talk about but complex to actually achieve. In order for most EDs to achieve this they will have to undo a lot of existing steps and processes that over the years have become ingrained in the culture of that institution. What I am suggesting is drastically changing that culture which can only occur with a comprehensive effort that is constantly measured and kept in place for an extended period of time.

The following Action Steps will help you navigate through this process.
1) Decrease the number of patients who leave without treatment (LWOT). You should already be tracking this number, if not you need to start. High performing EDs have this under 1%. Keep in mind that in addition to those patients who register and leave, there is another group that you never count. These are the patients who come in, see the wait and walk out without registering. Set up a task force to look at this area specifically and provide a mechanism to track and report this on a daily basis for the team.
2)Decrease Door to Discharge time for the "treat and street" patients. All hospitals have a great triage system in place to make sure critical patients are taken care of right away. But what happens to the walkie talkies. High performing hospitals average under 2 hours door to door for these patients. Again, get your task force in place armed with the tools they need to make change and measure their progress.
3) Decrease Door to Admit Time for the critical patients. Most hospitals have the treatment part of this down pat. Where many drop the ball is actually discharging the patient from the ED and transferring them to a unit in the main hospital. Once they are in an acute bed is your real discharge time. High performing hospitals average under 3 hours for this group of patients. This is usually held up for two reasons; there are no acute beds available, or there are too many steps and disincentives for staff to make this timely process. Again its time for an action team.

More on this tomorrow

Mark Brodeur

Processes of a Highly Functioning Emergency Department

Continuing on with the theme of improving operations in your emergency department, I want to spend the next few posts discussing specific areas you can look at to move patients through your ED faster, with great outcomes and ultimately grow your business.

Most people will tell you that design of your ED is critical, and that the adage "form follows function" is especially applicable to the ED. While there is no argument that a well laid out ED is a great asset, good design alone will not ensure great quality outcomes. I was involved with an ED that was undersized and poorly laid out. This led to issues of overcrowding, lack of confidentiality and safety, and general inefficiency. Their logical answer was to build a new, larger, well designed department. Six months after opening, the problem of patient waits and low customer service scores persisted.

So if you have a well laid out and properly sized ED, that's a great start but not a complete answer. If you don't have the luxury of a well laid out department, there are still things you can do to improve operations. This is what I will discuss throughout the week.



The key is to have proper processes in place and to motivate the staff to follow them. This is not always easy to accomplish, but if you take a comprehensive and well laid out approach you can achieve substantial and sustainable results.

This week I will discuss specific areas you should be addressing, focusing on:
-Patient Throughput
-Staff Productivity
-Building New Business
As we go through these I will give actions steps and benchmarks that your ED should be achieving.

More on this later.

Mark Brodeur

How to Operate a Highly Functioning Emergency Department While Growing Revenue

Quality First and Finances Follow

Your Emergency Department is your hospital's true front door to the community accounting for roughly 1/3 of hospital admissions. Opinions formed in the ED make lifelong impressions about the quality and convenience of ALL hospital services. 

This Webinar looks at areas hospitals can address to improve their EDs performance such as patient throughput, staff productivity and building new business; as well as developing specific action steps to operating a highly functioning ED. Mark presents a comprehensive and coordinated approach that gradually changes hospital culture and allows for sustainable results. 

Mark demonstrates how the principle of "Quality First and Finances Follow" applies to all facets of healthcare, particularly the ED. "If you provide a high level of service, as measured by quality and customer service indicators, your ED will be more cost effective and business will grow," said Brodeur. 

Register

Is Healthcare Reform Dead? Not So Fast Part III

On the heels of major setbacks for President Obama's Healthcare Reform initiative comes some bad news that might actually be a shot in the arm for renewed discussions about our current system and needed changes. The Government announced yesterday that healthcare consumed a record 17.3% of all domestic spending last year. This translates to approximately $2.5 trillion and represents the single largest one year jump in helathcare spending ever recorded. Further, according to CMS (Centers for Medicare and Medicaid Services), the government's share of this amount has grown to almost 50%.


Why is this potentially good news for the President's Healthcare Reform initiative? Because it clearly shows that the current system of delivery and payment is broken and only getting worse. While there is severe doubt among many that the two bills currently passed by the House and Senate respectively will really curb these out of control costs, it points out that something must be done soon. Meanwhile the only something being discussed right now is President Obama's initiative.


As I said in earlier posts, if a bill is passed it will only be after long and deliberate discussions. But the news yesterday will certainly renew interest to change the status quo for healthcare delivery in this country.

Is Healthcare Reform dead? I don't think so, at least not yet.

Mark Brodeur

Is Healthcare Reform Dead? Not So Fast Part II

In my last post I talked about the current political situation that has forced President Obama to rethink his position on healthcare reform and take a much more bipartisan approach. The recent election in Massachusetts sent a clear message that he will not have a mandate of support on this issue from the country until unemployment and the economy are addressed. So the healthcare reform train is slowed down but it has certainly not stopped. My hope is that this time we will have a chance to really shape it and address key issues before it is thrust upon us.



I had the opportunity last week to attend a meeting of the Massachusetts Hospital Association. I figure that these folks should really be in the know about what is happening with healthcare reform. After all for years their Senator, Ted Kennedy, has been the champion for sweeping changes in the healthcare delivery and payment system. More recently this state served as the bell weather for the country making it clear to President Obama that our domestic priorities were different than his. So I think the hospital leaders in this state should certainly have a handle on what is next for healthcare reform.



Ellen Zane, CEO of Tufts Medical Center and Chair of the MHA Board, opened the meeting reminding every one that even with current events, healthcare reform is not dead. It is still coming and still needed. There must be a move from the current fee for service medicine model that has so many conflicting incentives built in to it. The good news is that recent events have slowed down the process to allow more dialogue and input.

No one was comfortable with the speed at which this complex issue was being addressed. Both Houses of Congress were passing legislation that they honestly did not understand. We now have the opportunity to make sure that the 1000 page bill being discussed can be understood and as appropriate as possible. The only caveat here is to make sure that we do not waste this opportunity. Many in both Houses of Congress would like to see this issue just go away. We must make sure that this does not happen. Maybe the bills being thrown at us four weeks ago were too clandestine and comprehensive. But change is needed in the healthcare delivery and reimbursement system. We need to seize this opportunity to make well thought out, positive reform to a broken system.

Healthcare reform is not dead. It has just slowed down enough for us to make it more meaningful.

Mark Brodeur

Is Healthcare Reform Dead? Not So Fast Part I

There have recently been two significant and somewhat surprising developments that have many people now saying that healthcare reform is dead. The first of these was the Republican upset in Massachusetts for the Senate seat long held by Senator Ted Kennedy who for years was the country's strongest champion for healthcare reform. Most political experts did not see this one coming, particularly in light of President Obama's strong push for this initiative as a testament to Senator Kennedy's long career of service.



The second event was President Obama's backing off of healthcare reform as his number one domestic agenda item. Four weeks ago, with a solid Senate majority of 60 votes, the president was calling for a healthcare reform bill to be passed prior to his State of the Union address. As it turned out, healthcare reform wasn't even mentioned until 40 minutes into his speech. When he did bring it up, it was in a much more conciliatory tone asking the Republicans to at least consider some type of compromise measure.

The president made two key mistakes in trying to push through healthcare reform. The first was thinking that he could get unilateral party support on a complex issue such as this in such a short time. The bill itself is over 1000 pages long meaning that most of his supporters had not even read it.

The second mistake was thinking that the American people were settled down enough on the job issue and the economy that they were ready to move on and support his priority. He got the message loud and clear from Massachusetts that any time spent on healthcare reform is time that wasn't being spent dealing with unemployment and the economy. That is the country's priority.

With this being the current situation, how can I say that healthcare reform is not dead? The answer is that healthcare and access to it are still very much key issues in this country. Furthermore, the cost of healthcare continues to grow exponentially each year, not only in gross dollars but it also grows its share of the gross domestic product. So it must be addressed and soon, just not in the slam dunk way that President Obama originally intended.

More on this later.

Mark Brodeur