Q. (from Dr. Earl Steinberg): In a reformed health care industry, what should be on a hospital's billboard?
A. (from a Consumer Advocate): We'll do our best to take care of you, and if you die, we won't bill you.
At a RWJF-sponsored meeting this week, some introspection was in order to take stock of the work done in communities across the country, and work yet to be done. During one of the more thoughtful panels, John Toussaint, Craig Brammer and Pam Mariea-Nason focused on many of the impediments that still exist to gather and analyze the data needed for providers to significantly improve their performance. A performance that, as John reminded us, harms hundreds of thousands of patients every year. All agreed that without payment reform, change is nigh impossible because every good deed gets punished. And towards the end of the panel, Earl Steinberg asked this provocative question, and got a real answer from a consumer advocate. The question also evoked another image, that of billboards that are present in almost all factories in America today and in countries across the globe: the number of days without an injury to a worker. What we have on health system billboards now are vague promises about caring for patients with certain needs, and paid up star ratings. Something akin to the 1950s and 1960s billboards advertising soap and detergents.
What this means to you – The consumer advocate's answer is indicative of the country's mood about health care. Average Americans want health care providers to commit to taking care of them, and to back it up by accepting the financial responsibility for making mistakes. That's because the third party payer system has turned increasingly into a two-party system, and consumers don't expect to pay if something bad happens. After all they can barely afford it when there isn't a mistake. Contrast that common sense to the debate that is going on between payers and providers in many parts of the country about the boundaries that should be drawn around financial accountability. Many providers are trying to stick to the provider-centric view that they can only be held accountable for what they do, not what happens upstream or downstream. It's absurd, but it's the reality, and unfortunately too many policymakers are buying that argument – literally. The consumer-patient, however, doesn't care about what the surgeon does, or the nurse, or the hospital; they care about the outcome. They don't look at each individual clinician as having a distinct responsibility, but rather as all having a joint responsibility. So what's our answer to Earl's question? In a truly reformed health care industry, hospital billboards should proudly announce how many days have passed since a patient was harmed and promise never to have patients pay for an avoidable complication. We're a long way from there, but perhaps, as employers and payers wonder about how to measure high value providers, they should consider this simple metric, and start holding the delivery system truly accountable for patient harm.