Paul Levy has another interesting post:
In it he recounts the the practices of
Heartland Regional Medical Center, of St. Joseph, Missouri.
Basically, Heartland is the Scrooge of healthcare. They pursue debts
with a fervor and an unfairness that is hard to fathom. Someone gets
sick and comes to the hospital, fails to sign up for the hardship
program that would reduce charges, and thus becomes ineligible to
sign up when the program is eventually discovered, because they
didn't start out as members of that program. Because there is a cap on
how much they can recover from one paycheck, Heartland sues both wife and
husband to get a part of each paycheck. Etc.
It's bad enough when corporations in
other fields pull this. But in healthcare? Yes, healthcare needs
better business methods. But when you think about it, "businesslike" seems
to have two separate lines of thought, even two different meanings.
On the one hand, good business is knowing your costs and recovering
them, producing a better product, increasing efficiencies, etc. On
the other hand, business practices can be rapacious, grab the money,
go for the gold, do whatever it takes, etc. When people say that
healthcare should be “run like a business,” mostly they mean #1,
not #2. But if you confronted Heartland, odds are they would say “we
need to run it like a business,” and mean #2, not #1.
Reading this reminded me of the dinner
I had last Wednesday with two healthcare consultants and my long time
close friend, Steven Wright, who is at once idealistic and ethical,
and a practical and effective healthcare manager. Steven has run
many programs in the mental health and alcohol and drug areas, and
inevitably takes a failing program to effectiveness and
profitability. He most recently did this with Thunder Road, an
Oakland program for troubled youth. He brought this program to
effectiveness and profitability, although a program in this field
will never be a big winner – just breaking even is an achievement.
Unfortunately, bringing the program to profitability was soon met
with the declaration from Sutter Health, the owners who inherited the
program, that Thunder Road had to be sold, because it didn't fit in
with what they were trying to do, maybe didn't fit with their “core
competencies.” The health consultants we were dining with nodded
with sad and knowing assent. They know healthcare corporations like
that.
(It reminded me also of the new owner
of The New Republic, a magazine that had never run a profit and was
never intended to. Let's go vertical, let's go digital, let's go
Silicon Valley, said the billionaire owner who had been the roommate
of Mark Zuckerberg at Harvard. Let's make money. Ambitious,
arrogant, steeped in the modern digital culture that produces greedy
young jerks. But I digress. Let him be a jerk, and I never liked
The New Republic that much anyway. Maybe he'll learn something.)
But you just have to think, is profit
an objective, or a constraint? If your objective is to help people
one way or another, then profit can be a constraint – you can serve
people, but only with the constraint that you can't lose too much
money doing it, or you will go out of business and help nobody. If,
however, it's the reverse, you then want to make as much money as
possible, with the constraint that you do have to help some people
along the way. Or at least not hurt them too much. Or at least not
get caught hurting them too much, which would then start hurting
profits.
So, if I look at a healthcare program,
I have to think: OK, run it in a businesslike fashion, but is it
businesslike #1, or businesslike #2? Are they doing well by doing
good, or just doing well? The difference is pretty important.
Budd Shenkin