Why Isn’t Your Employer Choosing Your Hospital?

by Kathleen Bartholomew

Revolutions that change the course of history do not begin in thunderous explosions of action covered by the media.

Revolutions that changed governments, that gave women the right to vote, that spurred the civil rights movement, that changed the belief system of a nation … these revolutions began as seeds of conversations between like-minded individuals who said, “Something must be done. We must do it ourselves.”

So it was that in 2012, Wal-Mart announced it would foot the entire bill for certain bundled treatments–heart, spine, and transplant surgeries–if its 1.2 million employees would go to one of six designated health care organizations for that treatment.

Now, other Fortune 500 companies have signed on as well, and the list is growing by thousands every day (Emerick).

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Why?

• Because quality varies so greatly between hospitals and healthcare providers that outcomes are significantly different and corporations are tired of footing the bill.
• Because many hospitals remain oblivious to the fact that they even perform unnecessary operations
• Because error is profitable for hospitals, but not for the people paying the bill. The average surgical complication generates an additional $39,000 for hospitals (April 2012 JAMA)

Another foreshadowing example is Maine, where state employees have their $250 inpatient copay waived if they use high-performing hospitals–a simple move that has driven significant quality improvement there.

As Buckminster Fuller once said, “If a system isn’t working … you create a new system that makes the old one outdated.” And that’s just what benefit managers are doing.

Benefits managers of huge corporations are taking their hospital business elsewhere as they arm themselves with knowledge and exert their purchasing power. They are realizing they can tweak benefits packages and inform employees of individual hospital performance with a revolutionary energy. “As hospital services consume a growing percentage of healthcare spending, these strategies will become increasingly more critical” (Emerick).

Last month I received a call from a large urban hospital saying, “Why didn’t they choose our hospital?” I recited key points provided by Dr. Mary Bourland, director of Clinical Integration for Mercy Clinics.

Do you …

• Utilize a team approach to care? Interdisciplinary evaluation of the patient is the cornerstone. Involving all subspecialties of the treatment team allows for unbiased recommendations and well-rounded disease management. 

  An example would be with a patient referred to the spine center for possible fusion. He would be seen by an orthopedic spine surgeon, a neurosurgery spine surgeon, pain management and physiatry–and a psychologist if indicated.This team would then come together and decide the best treatment plan for that patient.

• Appropriately select patient treatment? Ethical care over utilization of surgery has led to skepticism in the employer market. The team must be able to show they select patients based on evidence-based recommendations and that conservative measures are considered with as much weight as surgical options. Using the team approach helps drive this.
• Have above average quality metrics? Track the quality of healthcare services through national databanks (Leapfrog, etc.) demonstrating low infection rates, reduced mortality or high patient satisfaction.
• Hold physician leadership accountable? Physician leaders should possess the moral characteristics, believe in the mission and have the fortitude to make the difficult decisions surrounding physician behavior and accountability.
• Align incentives? For quality incentive plans that work, align the resources and leadership of physicians, hospitals, clinics and health plans and deliver excellent outcomes with best utilization of resources.
• Value transparency? Maximize transparency around patient records, cost, quality outcomes and behavior.

The answer to most of these questions was “No.”

“We’re not there yet,” the administrator replied reluctantly. “Our physician referral for surgery is still set up from the primary physicians, and the surgeon still independently decides.  We need to change our structure and funnel our patients through the physiatrist. And most of our surgeons are fantastic, but we still have a few cut happy docs.”

“It’s too late,” I replied. “The other hospital already has a team approach and can document how many times surgery was not chosen as the first option for treatment.”

The creation of a true healthcare system in the United States will not be done by our totally dysfunctional Congress, nor government at any level.  As it turns out, the greatest influence for change may well be American corporations.

There is a revolution in health care. Some leaders see it coming–and some don’t.

Kathleen Bartholomew, RN, MN (www.kathleenbartholomew.com ) is an author, international speaker and national expert on healthcare culture.