MEDICAL WAL-MART NEEDED

Post lifted from the Piper Report.

In an excellent new piece for HealthLeaders, E. Preston Gee asks an fascinating question with wide ranging implications for health care: "What if the mass merchandising giants like Wal-Mart or Target got into the healthcare delivery business in a big way?"

Highly efficient, consumer friendly, and tech-savvy companies like Wal-Mart and Target stand in sharp contrast to health care delivery. Many health strategists, including myself, have noodled on what it would take for hospitals and clinics to adopt consumer-focused, competitor-savvy practices of high performing industries like these "big box" retailers.

As Mr. Gee notes, the big retailers may never enter health care but that is beside the point. Health care providers must adapt to the new market realities. Employers and other demand-side players expect an end to the inefficiency, poor quality, and high error rates that plague much of health care delivery. After providing thoughtful advice on how they can adapt, Mr. Gee calls on health care executives to "lead their organizations into and through this new era of heightened expectations and emerging market-driven dynamics."




HIGHER STANDARDS ACHIEVED THROUGH LESS BUREAUCRACY

Specialty surgical hospitals in the United States trace their roots to ambulatory surgical centers (ASCs), which started to appear approximately 30 years ago. An ASC is a facility whose patients are admitted, treated, and discharged within a single day. No overnight hospitalization is included. Typically they are free-standing facilities not attached to or affiliated with a traditional general hospital. According to the American Surgical Hospital Association (ASHA), ASCs developed for several reasons, including:

** physician dissatisfaction with the work environment, efficiency, and quality of care provided in traditional general hospitals;
** advances in medicine that allow many procedures that once required an overnight stay in the hospital for recovery to be done on an out-patient basis;
** patient dissatisfaction with the hospital environment and lack of customer service; and
** increasing costs of medical care at traditional general hospitals.

A February 2002 report by the U.S. Department of Health and Human Services Office of Inspector General attributes the growth of ASCs to "advances in medical technology, increased focus on patient convenience, and economic incentives created by changes in reimbursement systems." According to ASHA, the ASCs developed slowly until 1982, when Medicare first approved them for reimbursement. From that point, growth has been rapid. There are currently more than 3,500 ASCs in the U.S.

The results of this industry growth have been impressive. By freeing themselves of the bureaucracy of a traditional general hospital, ASCs have been able to provide high-quality care at a lower cost. The key is specialization: A surgeon or facility devotes all of its energies to a few specific areas of care, resulting in increased efficiency and effectiveness.

From the ASCs developed modern specialty surgical hospitals. By focusing on a few surgical specialties, additional gains in efficiency and quality can be realized, this time in procedures that require an overnight stay or longer while the patient recovers.

Approximately 100 specialty surgical hospitals exist in the U.S. today. Some, such as Stanislaus Surgical Hospital in Modesto, California, offer a broad range of surgical procedures, including knee and hip replacement, hysterectomy, corneal transplant, and kidney surgery. By contrast, MedCath, a chain of 13 hospitals in nine states, focuses on cardiovascular surgery.

Specialty surgical hospitals are much smaller than traditional general hospitals. Medcath's 13 hospitals have between 32 and 112 inpatient beds each, and Stanislaus Surgical Hospital has 23 inpatient beds, while the average hospital in the U.S. has more than 160 beds. Hospitals in large urban area typically have several hundred beds, and some have more than one thousand beds.

Nurse-to-patient ratios are typically lower at specialty surgical hospitals. In a recent interview with Surgicenter Online, Stanislaus Surgical Hospital CEO Michael Lipomi said, "The nurses who prepare patients for surgery also recover patients, so patients see the same reassuring faces." At larger traditional general hospitals, a patient may see many different nurses during the course of his or her treatment, which can interfere with the continuity of care.

Many specialty surgical hospitals appear to provide better care than their traditional counterparts, as measured by patient outcomes......

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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