HCI3 Update from the Field: Survivors – Yet Still Incompetent?

Submitted by francois.debrantes@hci3.org on Friday, May 18, 2012 - 12:21

Newtown, CT – May 18, 2012

Organizations that currently dominate an industry have, as the theory goes, survived a process of brutal evolution. How is it, therefore, that they can sometimes be so incompetent? Let's examine the evidence. A benefits consulting and health care analytics company sends corrupted files, twice, and acknowledges they knew the files were corrupted. A large health insurance company spends months trying to load a claims file on a FTP server, to no avail. Another laments it doesn't have the resources to manage two bundled payment initiatives in a single state. A third can't seem to find the time or resources in their legal department to send out a standard BAA, hence stopping the shipment of a claims file for analysis. Provider organizations are not immune either to incompetence: ED visits for Medicare patients with CHF or COPD are rising dramatically in some communities; C-sections for low-risk pregnancies are rising throughout the country; close to half of PCIs are reportedly done on patients that don't need them. How does one explain this seeming level of incompetence? The theory of evolution would suggest that incompetent organizations would get eaten up by competent ones. That certainly appears to be the rule in the rest of the economy. So are they really incompetent or is this willful incompetence?

What this means to you – there should be no doubt to any of you that these actions are the result of willful incompetence. C-sections are rising because providers get a higher reimbursement and patients are asking for the convenience. ED visits are rising for Medicare patients because some readmissions are no longer being paid for, but 48 hours of ED observation are. Files aren't uploaded to FTP servers and BAAs can't be found because plans don't want to submit claims. Resources can't be found by a multi-billion dollar plan to initiate a payment reform effort because they don't want to participate. Much like Jerry Seinfeld and his puffy shirt, these organizations delude themselves into thinking that they continue to look good even when they look silly. And that delusion will continue until each one of us calls them out for their willfully incompetent behavior. They choose not to be competent because it's in their best interest. Punish them for incompetence, reward them for competence, and their interests will shift to where we'd like them to be. 


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org