Newtown, CT – October 28, 2011
Why do smart professionals who individually get an A, collectively get a D – the grade given the US in the Commonwealth Fund's latest scorecard. It's mostly because they've turned into piece workers, focusing on their individual tasks and not on the patient's total care. They (and their patients) have become the victims of Taylorism, decades after the rest of the sectors of the economy abandoned that concept, understanding its negative effects on professional behavior, and the significant waste of resources that it leads to. And if you still doubt that, consider the recent paper we published that shows the amount of variation in costs of potentially avoidable complications. Typical costs, by and large, have little variation, but PACs pack a wallop. PACs are the waste, the bad variation that Deming and so many others sought to reduce and, in doing so, re-revolutionized the way in which products and services are made and delivered. Large and small companies focus on reducing defect rates, because a defect is bad for the customer. Of course, that means you actually have to care about outcomes, not just what happens in your little silo. And how much do some providers really care when this week, our friends at RWJF reported in Transformation Has Begun that "marquee" hospitals like Cleveland Clinic and others have stopped reporting infection data on all patients to the Leapfrog Group? Not much. And guess what the consequences will be for them in making that decision….nothing. There are no market consequences for failing to report, no market consequences for failing patients, no market consequences for bad variation. And that's how we go from a bunch of As to a collective D.
What this means to you – You get what you pay for, and for the most part, we're still paying for healthcare widgets. The CMMI's launch of the Bundled Payment pilot, the ACO Pioneer, the Comprehensive Primary Care pilot, and now the final ACO pilot regulations, all point to a permanent shift in what we pay for, which means we ought to get something different. We know from our own work that it will be better. But the private sector must follow the public sector's leadership. If Cleveland Clinic can get away with not publicly reporting all infection data (not just for Medicare patients), it's because the private sector will not act. And I specify WILL NOT. This isn't a question of ability, it's a question of intestinal fortitude. A little over a year ago, Lowe's announced a deal with the Cleveland Clinic to encourage as many of its employees who need cardiac surgery to go there. Time for them to stop that program unless Cleveland Clinic relents on its decision to not publicly report all infection rates. There are lots of good hospitals in North Carolina that can treat Lowe's employees, and those hospitals are reporting infection data. Lowe's demands excellence from the suppliers that stock its shelves and it should demand excellence from the providers that treat its employees. It's only by paying for good outcomes, demanding full transparency, and punishing mediocrity that we'll collectively get an A.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.