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Could Segmented Health Care Be Part of the Solution?

Could Segmented Health Care Be Part of the Solution?

It is clear to all associated with healthcare that the redesign of the industry is high on the national strategic agenda. We all know that many parts of the health delivery system in the US are broken: overall consistent quality is mediocre; service metrics reported through HCAHPS are poor; business literacy is in jeopardy as evidenced by predictions that over 1000 hospitals will be bankrupt by the end of 2013, and community value as represented by the amount of charity care provided by non-profit hospitals and health systems is under scrutiny by the Federal Government.

Redesign of American health care will most likely be evolutionary rather than revolutionary. In this case, it is imperative that all of us who are privileged to work in this industry spend significant time looking at the pieces of the puzzle that could be put together to create a new delivery process which would significantly improve the performance areas outlined above.

Based on some clinical experiences, both past and present, I am proposing that one piece of the puzzle may be for providers to get increasingly comfortable with segmented healthcare as part of the solution. What specifically am I suggesting?

I define segmented health care, which I experienced many years ago in my internship and residency, and more recently in Mexico, as the provision of healthcare in different settings with different amenities according to the patient’s ability to pay for such amenities. I know that many people initially will react to this idea by asking, “Are you proposing different levels of healthcare for the poor and the rich?” Absolutely not! Rather my proposal is to provide equitable health care for all from the clinical, safety, and service perspectives, but not providing equal amenities to all.

I am convinced that some of our struggle to control our healthcare costs in the US is due to the fact that we are providing private rooms with flat screen TVs, free telephone access, free internet connections, and menu selections to many who cannot afford them. If patients wanted such while hospitalized 25 years ago, charges for these additional, non-crtitical items would be added to the bill. In addition, today we allocate large spaces in our lobbies, waiting areas, and other non clinical locations to environmental pleasantries such as fountains, trees, artwork and even, chandeliers. Yes, it all creates a great impression but, in the long term, these amenities add to overall costs, none of which is off-set by revenue.

In order to consider this transformational strategy we will need to undertake a re-educational process with our patients and their families, informing them that we are committed to equal quality and service for all, regardless of their ability to pay, and that we can provide certain, non-critical amenities only if they wish to pay extra for them. We need to remind those who enter our doors, often for only a short time in our hospitals, clinics or other outpatients programs, that many amenities add no value to their care, and in fact, will probably not be missed.

An example of this concept in another industry is demonstrated when we go to buy a car. Adequate transportation is the expected outcome, but, some of us can only afford a used car, while others can buy a luxury model. Yet we all reach our goal! If you transfer this analogy to healthcare, I think you might agree we are giving sunroofs and high-class stereo systems to everyone, even those who can only afford the cheaper models. This practice is adding to a cost structure that is not sustainable. Again, we must remind people over and over again that we are not sacrificing quality or service, but in fact only wrapping the package differently based on the patient’s desire and ability to pay.

I know there are many reading this blog asking, “Can we safely go back to wards with two and four bed rooms with the infectious disease issues facing us today and the critical illnesses we are seeing in our hospitals? The answer is clear. If a patient’s severity of illness is significant, they are moved to special care units whose physical layouts need not be changed. In ICUs, CCUs, Isolation Rooms, and the like, the “amenities” are mainly focused on the high technology required by their providers.

I readily admit that this proposal, as one piece of the puzzle for the redesign of healthcare, may seem radical and interpreted by many as a step backward rather than forward. Yet based on our experience, the Partners at Royer-Maddox-Herron Advisors are convinced that a segmented health care system is at least worth putting on the table when discussing transformational strategies.