Health Care Health Care Reform

On quality of care as a strategy for success…

Taking care of heart attacks is about speed, the “door to balloon time” is the primary metric used to determine a hospital’s worthiness.  So congratulations to the Santa Rosa Memorial’s staff for being the fastest in the country, but they should not delude themselves with the notion that high quality care is all that is needed.

For heart attack care, my hospital (Baptist East) is presently, and historically been the fastest in our community.  Providing outstanding care is one strategy for holding a competitive advantage in a capitalistic milieu.  It seems obvious that in the delivery of health care, either by the doctor or hospital, “quality” should be the primary determinant of success -like having the best food and service in the restaurant industry.

However, the health care delivery paradigm is much different than a “regular” business.  The quality of care provided is regrettably way down the priority list of reasons for getting referrals.  How could this be you may ask?   There are many reasons for this injustice, but the latest one, especially here in Louisville, is the buying of doctors by hospitals. The lower reimbursement to individual doctors provides a strong incentive to “associate” or to be owned by a hospital.

Recently, I was speaking with a high quality cancer doctor who is in a high quality practice which deservedly is extremely busy.  With a sweep of a pen and a “pot of gold” promised, a large competing hospital bought huge portions of the primary care doctors and employed a new group of cancer doctors across the street.  So, despite their present high quality and years of good service, this group’s business is diminished greatly.  The referring doctors owned by the competing hospital are “encouraged” to send their patients to their owner’s specialists.  She told me, “the recently bought referring doctors will send their mom to me, but their patients to the other group of cancer doctors, as they are owned by the same corporation.”

This referral bias is one of many frustrating business practices of medicine. Consumers  should know this.   I see this everyday and after 15 years it is still depressing.   Here we have the fastest heart attack care in the area and chest pain patients often go across the street to the two competitors, one is an ER without a hospital and the other is a hospital without angioplasty -for heart attacks, both scenarios delay care immensely.  Why is this?   A consumers (patients) lack of knowing, or believing billboards and ownership of their primary care doctor are the main reasons.

A wish list…

That the quality of care delivered be the primary driver of referrals.

That patients had the means to know the best best quality doctors and hospitals.

If they could know the best care, that they would choose it over a possibly lower priced or more convenient service elsewhere.