The Milwaukee Journal Sentinal:

What’s the cost of surgery for a spinal fusion of the lower back in southeastern Wisconsin?

It can range from $25,000 to more than $50,000.

The price depends on the hospital and the doctors. And that’s just for patients covered by one insurer — Anthem Blue Cross and Blue Shield. It would differ for other health insurers.

The wide disparity in prices explains why businesses and consumers contend that more information on what hospitals and doctors charge is needed to lower costs and make the health care system work better.

Seconded.  But there’s a problem:

Yet the effort to provide consumers with meaningful information on prices is proving to be a lot slower and more complicated than expected.

Transparent pricing is an important bit of information patients could use in selecting providers and choosing where to seek medical care.  But as the article states, it’s not always an easy task for a patient to find such information.  Hospitals have an opportunity to make that easier.

Two health systems in Sioux Falls, South Dakota, post prices.  Sanford Health posts price averages for the top 25 diagnoses at its main hospital prominently on its website.  The table displays information in four categories: minimum, median, average, and maximum charges along with specifics about charge, length of stay, out of pocket cost with coverage, and out of pocket cost without coverage.

Competitor Avera also posts price information, although it is more difficult to find and doesn’t provide as much information.

Here’s a comparison on strokes: Sanford, Avera.

There’s obviously still room for improvement.  But it’s a great start.  Price transparency helps us toward what really matters: competition on value.

As covered previously, at least one health system is working hard on making prices transparent amongst a group of competitors.

USA Today has an article about online second opinion services. One would think it to be a booming market, however the largest three providers of said services only offer about 3,000 opinions annually.  Here’s the service explanation:

Online second-opinion services offer patients consultations from specialists based on the medical records that they fax, mail or send via the Internet. The average cost, payable upfront via credit card, is $500 to $1,500, depending on the number of radiology or pathology interpretations required. Patients then receive online access to a second opinion in about two weeks.

The problem: “A limiting factor is that most insurance companies do not cover remote second opinions.”

However, the Cleveland Clinic and Cigna recently inked a deal to provide (the former) and cover (the latter) online second opinions for insured individuals.  As more insurance companies begin to reimburse for the service, utilization is likely to rise.

That feeling of less time to do more is real.

It seems calendars are getting fuller every day.  The red light on the telephone blinks daring one to enter the voicemail queue.  Hundreds of emails await a return to the computer. In fact, for some tech companies the information overload has affected productivity so negatively that they have formed a partnership to research solutions.

The responsibilities of this modern world are intense.

In this Wall Street Journal article, Novartis AG CEO Daniel Vasella comments:

“I’m locked in,” he says. He is booked nearly solid until September, with back-to-back meetings and trips that were scheduled months ago. “Due to the constraints, I have to put down in priority things I like to do and that would be very interesting. I can’t spend as much time as I’d like to at hospitals, talking with doctors and patients who use our products. This is where I hear and see so much and get so many ideas.”

Requirements of constant connectivity are impacting management…in a bad way (from the same article):

“They [CEOs] complain about a lack of spontaneity in their workdays and little time to mull over problems that crop up. They often have to make do with phone calls and emails when a face-to-face meeting might be more effective.”

Limited management visibility is noticed by employees and negatively impacts the culture of an organization.

At our own system, limited desk time for managers will be “strongly encouraged.” The kind of strong encouragement that borders on requirement.  Managing people means interacting with them. Management By Walking Around (MBWA) is the philosophy we will live by.

Annie Stevens, managing partner at ClearRock, highlights the issue in an article at Management-Issues:

“There has been a greater tendency to try to manage employees by e-mail, memos or in meetings, rather than managers and executives getting out of their offices, walking among the employees they manage and talking with them. Many companies are missing out on the benefits they can get from this.”

Here’s the kicker—actual human to human interaction is required:

Key to an effective MBWA approach is to prepare yourself for hearing feedback and insights that you may not agree with.

“If the purpose of conducting MBWA is only to reinforce your current beliefs, you should save everyone’s time and don’t do it. The goal should be to uncover honest and objective contributions from people you manage without them feeling they need to tell you only what you want to hear,” said Stevens.

Here’s the message: do it.

Principle #23: Human interaction is vitally important.  Talk to employees.  Talk to patients.  Talk to providers.  Ask them how things are going.  Ask them if their needs are being met.  Ask them for their ideas.  Ask them anything!  Build relationships.  Full calendars, voicemails, and inboxes are no excuse.  Clear some time.  Get out of the office.  Get to know employees.  Besides, sitting in an office all day is awful.

The individual voices of physician discontent are becoming louder.

The easy response is no response.  There are plenty of capable students who are turned away from medical schools on an annual basis that would be more than happy to receive a spot in the class of 2012.  Don’t like your job? Find something else…

But that argument is simplistic and elementary.  There is obviously something very wrong with the environment that many physicians are currently operating in.  And that should concern all of us.

A very wise health care administrator once told me, “There are two types of people in a hospital: those who care for patients and those who don’t.  If you’re a person that doesn’t care for a patient, you damn well better be working hard to make the jobs easier for those who do.”

What’s going wrong?

It’s a combination of many issues.  Reimbursement rates are constantly pushed downward.  Risk of malpractice lawsuits is rising.  Scopes of practice are under fire.  The days are long.  The list could go on.

This essay in The New York Times highlights the real reason for physician frustration: “There are serious consequences to this discontent, the most worrisome of which is that it is difficult for doctors who are so unhappy to provide good care.”

It need not be like this.

By no means am I advocating that administrators bow down to every physician command.  The physician’s frame of mind versus the administrator’s frame of mind is what keeps health care organizations open.  But it is time that a concerted effort be made to make the practice conditions for physicians favorable once again.

Conditions that allow providers to do what they do best: care for patients.

(links courtesy of Kevin M.D.)

Lots of cool stuff going on at SSM St. Clare Health Center.

Namely, question asking:

Building from the ground up, SSM officials sought to streamline the health care delivery process through a facility that maximizes patient and practitioner efficiency. They started by turning inward, scrutinizing processes like outpatient admissions and emergency department procedures and soliciting opinions from staff, physicians and patients.

“It’s asking each one of us who deliver health care in today’s current state to really broaden our horizons, challenge the way we do things, ask ‘why’ a million times and then figure out what’s the right way,” said Brobst, a clinical director at St. Joseph.

YES!

And a commitment to delivery innovation:

Brobst oversees a unique 22-bed medical and surgical pilot unit that mimics conditions at the soon-to-open St. Clare. Housed in a medical office building connected to St. Joseph, the pilot unit allows nurses and physicians to implement new procedures and processes in real-world conditions.

The health system also spent more than $110,000 on a full-scale mock-up of a patient’s room at the new hospital. More than 150 St. Joseph employees have walked through the prototype in the last two years, providing feedback that resulted in changes ranging from the creation of individual nurse alcoves outside each room to wall-length safety bars leading from the bed to the bathroom.

YES!

Forward thinking hospitals. It’s cool to see good ideas in action.

Frankly, I couldn’t have said it better.

The good thing about articles like this is that it makes the public aware of something we have known in health care for some time. Transparency improves accountability.

Comarow on Quality has a post titled “What Medicine Can Learn from Business.” Waiting rooms (in which patients incur long waits) have long been a part of what we do.  But new perspecitives bring new insight. Mr. Comarow shares a story of Virginia Mason’s implementation of the Toyota Production System:

During the visit, a team led by Virginia Mason’s chief of medicine met with a Toyota guru, a sensei who had absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus.

“Who waits there?” the sensei asked.

“Patients,” said the chief of medicine.

“What are they waiting for?”

“The doctor.”

The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average.

“You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?” He paused and let the question hang in the air. “Aren’t you ashamed?”

In Boston they fight the spread of the retail clinic (from The Boston Globe):

The mayor has argued that retail clinics providing episodic care will fracture the medical system, ultimately hurting patients.

But in St. Petersburg, Fla., traditional care providers are going retail (from St. Petersburg Times):

“A lot of hospitals are getting into more retail medicine” to boost their bottom line, said Donna St. Louis, vice president of outpatient services for BayCare.

So basically hospitals want to be able to operate in retail environments—and have no new competitors in that arena.

Hmm.  “Have your cake and eat it too?”

In Washington D.C., Senator Grassley is up to his old tricks (from the Health Blog):

Sen. Chuck Grassley took another swipe at lucrative tax breaks of nonprofit hospitals yesterday–-at a hearing that wasn’t even about hospitals.

But again, in Florida, this (from St. Petersburg Times):

Bayfront Medical Center operates Bayfront Rejuvenations at one of its convenient care walk-in clinics at 7000 Fourth St. N. And BayCare Health System, which runs several nonprofit hospitals in the Tampa Bay area, plans to open a medical spa at its St. Anthony’s Carillon Outpatient Center in late August.

Tell me how to go about defending the important nonprofit tax benefit hospitals receive when they are offering cosmetic procedures like Botox injections.  Can anyone rationalize how these medical spas are providing enough community benefit (i.e., free care) to make up for that tax free benefit?  I’m sure there are plenty of self-pay patients utilizing the services—but definitely not the traditional self-pay (i.e., no-pay) patients hospitals have become accustomed (averse?) to in recent years.

Here is an attempt:

“We do not have a medical spa. We have an aesthetic medical practice,” said Waldrep, medical director of the new practice and of Bayfront’s convenient care clinics.

OK, we’ll call it AMP for short.

Throw us a bone…

Here is another attempt:

As medical spas have multiplied, so have concerns about the quality of services they offer and the level of medical supervision present. The hospitals see themselves as a natural alternative. They hope people will automatically associate their names with higher-quality medicine.

OK, better.  But need we be reminded that traditional health care organizations have quality concerns of their own?

Finally, the real reason for the service expansion:

Just as primary care doctors have found spas a way to bolster their bottom line, medical spas are a way for hospitals to bring in dollars to balance out other services that communities need, but lose money for the hospital, such as trauma and indigent care.

Misplaced incentives make for mislaid business plans.  But building barriers around hospital fiefdoms isn’t the answer.  And dabbleing in borderline health care services isn’t either.

The answer comes from concentrated efforts to improve what we were created to do: care for patients who truly need our help.  Competition helps us get there.  Focusing on what we do best helps us do it.

Health care services marketing is beginning to respond the to the needs of the patient. Marketers in Minnesota are moving away from traditional advertising to a model trumpeting convenience and personalized care, the Minneapolis Star Tribune reports.

Finally.

It could be the early stages of competition on quality of service. Not quality that we in health care are finding it difficult to define. Quality perceived by the consumer. Things like: can I get an appointment when I need one? Are providers responsive to my needs? Do I receive information in a timely manner? etc.

Mark Hansberry of Fairview says:

People “are becoming much more savvy and more informed about their health-care decisionmaking,” he said. “They want to have health care on their terms, whether it’s evening appointments or same-day test results.”

Service matters. The take away for the rest of us:

All three clinics said their market research had shown patients are becoming more demanding as they take on a bigger share of the medical bill.

Good to hear they are listening to patients (and their dollars). However, this might be a stretch:

The latest HealthPartners campaign, launched last month, includes life-sized mascots Petey the Pee Cup and Pokey the Syringe and promotes an updated patient services website.