August 7, 2009

how to cure sick hospitals

Question: How can we use the lessons from the private sector to improve care for everyone?

An answer from an article in the Wall Street Journal today says that it may be more straightforward than we think. Dr. Abraham Verghese, a physician and professor at Standford Medical School, reflects on a recent trip back to a public hospital in El Paso, Texas, now called University Medical Center,where he worked after medical school. Then, the hospital was backed by a falling tax base, had a huge population of people who were not necessarily legal immigrants (El Paso is right next to Mexico) and therefore did not qualify for any medicaid, and was largely unable to handle the myriad problems of its patient population. Now, after the arrival of a new CEO in 2004 (James Valenti) the hospital is thriving, the atmosphere is positive, and they've actually cut costs. Mr. Valenti says he did it by imposing a private model on the public hospital. He created a physician advisory panel, so the physicians feel more involved in decision-making, he has renegotiated contracts with insurance companies, and streamlined costs (e.g. instead of ten different knee prosthetics, the hospital offers one at a very reduced price). The Dean of Texas Tech Medical School, the medical school affiliated with the hospital, said of the changes Mr. Valenti has made, "care was not rationed so much as a rational approach made to giving care."

Dr. Verghese ends the article with a prescription for improving care given in hospitals without raising costs: "Just as much of the funding gap for Medicare could be plugged by cutting out waste and fraud, sick public hospitals —and so many of them are sick-- do not always need infusions of money to be fixed. Instead they need discipline, accountability, and progressive politicians and hospital boards whose actions are made very public and who are held accountable."

I like the sound of it.

"I want to stand as close to the edge as I can without going over.
Out on the edge you see all kinds of things you can't see from the center."
-Kurt Vonnegut

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