Beth Israel Deaconess CEO Paul Levy is delighted we mentioned his blog here the other day. He also wrote regrets that comments on his site have been too non-critical. So let’s give him his wish for some non-adulatory comments. Here’s Paul’s recent post about what some consider a hot issue: should we create a Canadian-style single-payer health system (US or Massachusetts): http://runningahospital.blogspot.com/2006/08/single-payer.html
“…a government-controlled single payer system would inevitably face budgetary pressures and would shift costs to providers, suppliers, and patients, and would ultimately lead to rationing of services and a slowing down of innovation. I’m not saying the current US system is ideal, but at least it offers the possibility of competition among insurance companies and gives my hospital a chance to negotiate better reimbursement rates in return for offering higher quality and better value to consumers than my competitors provide.”
Lots of single payer fans advance the idea that opposition to single payer only comes from the big bad health insurance industry and that’s why we don’t have it. Paul’s post bursts this balloon and makes clear something important – it’s not just insurers, it’s hospitals, physicians and other providers. Why? Because health care providers do better under our messed up, deregulated, market-based multi-payer and fractured system when they can play payers off each other, and make up losses from one by jacking up prices from others. Their worst nightmare – a single payer with real power to create financial accountability and budget discipline. Even more than the power of the insurance industry, that’s a key reason single payer is not on the horizon.
A one payer or regulated multi-payer system – regardless of administrative savings – is anathema to providers. It’s refreshing to see Paul put it into words – more than a few hospital CEOs pay convenient and disingenuous lip service to single payer and they would run quickly in the other direction if faced with a real single payer plan and it’s budget constraints.
Here’s the real reservation. Paul’s field of vision seems to end at Longwood and Brookline Aves. Yes it’s undoubtedly great for Beth Israel Deaconess and other hospitals that their revenues can grow at 2/3/4 times the rate of inflation. How sustainable is this? Is this good for society? Are we getting real value for these massive infusions of money?
Back in the 1960s, Nixon’s economic advisor Herb Stein said unsustainable trends can’t go on forever. What other societal needs get pushed aside to pay the tab for our extra heavy dose of hospital services? Has Paul seen the latest report from the Commonwealth Fund on how astoundingly and embarrassingly mediocre our US medical care system is?
Paul’s a former regulator and MWRA head, so he understands government vs. private in a highly sophisticated way. It would be great to see him apply those keen insights to health and medical care beyond the economic self-interest of Beth Israel.
I was recently rushed to the BID for an Asthma attach. As for the attention I received in the ER was “Outstanding” – when I was transferred to the room that looked like it was in need of upgrading… I was ignored from 11:00am until 7:30pm I rang more than once for help to the bathroom and when no one came I had to shut off the alarm on the bed and drag myself over to the bathroom. When coming out I was noticed by a nurse who said you should have rang for help. I was very dissatisfied with the way I was treated! I never got properly discharged and “no one even called to follow-up” I will go back to the Baptist where “Quality Care” means something!
Dear Dr. Levy: A BIDMC employee suggested you might want to hear about an ER experience I had about a month ago. First, I felt uncared for and a test object for the teaching of Residents. Second, noone listened to my set of symptoms so I left with no answers, a total waste of my time. They were focused on my heart; however, if it were my heart, I would have languished in that ER room without any real help. I won’t go into needless detail, but I was there for many hours and never saw the same doctor or nurse twice. I needed to use the facilities but I couldn’t keep anyone’s attention long enough to get me off a heart monitor so I could go down the hall. I deliberately flatlined by holding my breath to get someone in the room – nothing. Then I found out the next day that there is not even a record of that heart monitor reading in my record. What was the point then? Was it all just a teaching experience for interns and residents, and I was the CPR dummy?? I signed out AMA and ran!
I spent as many hours at St. Elizabeth’s Hospital two weeks later for the same problem. The experience was nowhere near as stressful AND the Attending came in and TALKED to me – I actually found a cause and a cure for my problem at St. Elizabeth’s ER, gastrophageal reflux (GERD) – so painful yet so simple to alleviate. A patient is still a person there, unlike how I felt at BIDMC. THIS Attending and Resident took the time to realize the symptoms and I am on the proper medication, and I am now moving back to normal.
I have been in the BIDMC system for quite a few years. In the last three years or so I have felt a great difference. I do not feel cared for or about. I will add that I am hoping to move my care out of BIDMC and into the St. Elizabeth’s system as I understand they have excellent primary care doctors who actually work with the patient. That does not seem to be the case with BIDMC any longer.
Dear Paul, You asked for criticism. Why are BID patients not offered the shingles vaccine? Staff says not set up to administer or bill for vaccine.
Also, I suggest a system be set up to complain about a doctor, without it be handled by her direct superior who seems biased. It may help to improve BID overall delivery of health services.
thanks for your comments.
Encouraged by CEO Levy’s Boston Globe’s published view on infectious disease, I recently visited his hospital’ ER, where it seemed as if my arrival were anticipated. Few people in waiting room nor patients in ER. I sought treatment for a skin infection, perhaps symptomatic of an infectious disease. The ER nursing staff quickly registered me, although frequently departed for seemingly long periods of time. The ER doctors seemed ill equipped to deal with a skin infection, never even examining my skin but repeatedly asking me questions such as “How often do you clean it?” “Do you pick your face?” And totally irrevalant questions such as “Do you have a psychiatrist? “Are you hearing voices?” Oh yes — I heard voices — the voices were the perpetual questions, repeated four or five times by the 2 doctors attending me (Epstein and an Asian whose name I can’t recall), as to where I was previously treated (I refused repeatedly to respond),was I hearing voices, etc. — no relevance to the skin infection whatsoever. When advised it would take 3 to 4 hours to be referred to a doctor perhaps capable of diagnosing/treating a skin infection, I left.
What a fanciful ego trip CEO Levy has on his blog with total lack of credibility in his posturing for infectious disease tracking …
Treatment obviously will be pursued elsewhere
Well, I asked for criticism and am pleased to have it, but I think the commenter has it wrong. The current system is not great for BIDMC, by any means. We are lucky to make any operating margin at all in the current system, and we are intensely involved in looking for ways to make our hospital more efficient and deliver higher quality care. If you think that we don’t need budget discipline and financial accountability in the current environment, you are way off base. Further, part of our approach is to encourage low acuity patients, those who do not need high-level tertiary care, to be seen in community hospitals.
Yes, when Medicare rates go up only 2%, well short of the inflationary pressures we face in supplies, pharamaceuticals, and salaries of nurses and rad techs, we try capture the shortfall from other insurers. And, it is a good thing they are there, or else we could never deliver the quality of care to Medicare recipients that they deserve and expect.
That being said, the increase in healthcare costs is not, for the most part, a result of growth in hospital costs. It comes from the large increase in drug-related costs and from the greater utilization of out-patient procedures that didn’t exist years ago.
As far as value delivered, please recall that the major advances in diagnosis and treatment of disease originate at academic medical centers like Beth Israel Deaconess. Payments for clinical care generally do not support that important research. It is supported by federal grants from the NIH and by philanthropy from generous people.