So, today I was at Stamford Hospital to give a talk, but as I waited I walked in the middle of the Hospital’s Town Hall Meeting. What I heard was troubling. The CEO Brian Grissler was speaking. He was talking about ACA, and how the cost of uncompensated care offered to undocumented immigrants is not aided by ACA. He did not mention any efforts to move the legislation in Congress about this problem. He also complained that the tax exempt status of hospitals and universities will be reversed leading to 20 million in extra expenses. These factors he called “headwinds.” The Hospital is in the middle of a building campaign for a new high rise facility. The CFO spoke next and he talked about ACA in a negative light. He mentioned that 1. Outpatient revenues were down due to the bad winter. He also noted that the hospital 2.. has not received any benefit from ACA manifested in increased numbers of covered patients . Considering the bulk of registrations for ACA in CT came in the last few weeks. Point 1 seems to contradict point 2. It’s too early to analyze the data. But that will come in a few more months. Their presentation was full of sarcasms and sotto voce sneers. I would expect more of a leader whose annual salary may be as high as 2 to 3 million dollars. The most troubling issue though is the strategic plan. This plan has been ongoing for the past 20 years. The plan is to grow the utilization: treat more patients with high cost services. The goal for health care should be on the other hand to decrease utilization, keeping people healthy with early intervention thereby preventing serious medical illnesses. For the past 20 years, 4 and then 3 hospitals have been vying for patient share. Stamford built the cancer center, then Greenwich built a cancer center, and a new hospital; Norwalk updated its facilities and now Stamford is building a new high rise. St. Joseph’s which was bought by Stamford, reducing the number from 4 to 3. All 3 hospitals are in a 10 mile or less radius. These facilities are filled with redundancies. Moreover the business model is zero sum. Each facility trying to “steal the sheep” from the other, leading to needless competition and not higher quality care. You can travel the area and see that Stamford has facilities in Greenwich, to lure patients to them, Greenwich has some in Stamford and Norwalk has some in other towns. As long as this business model continues, whereby health care is like Coke and Pepsi or GM and Ford, costs will be needlessly high and the “promotion of the general welfare” will suffer at the expense of private gain by any of the upper level players in each of these systems. The 10 mile radius can get by with 1 centrally located facility and then multiple conveniently scattered outpatient centers. This is the state of the art of health care delivery today. Yes these leaders can complain they don’t get enough money from the State, from taxpayers to pay for expansion and certainly for exorbitant executive salaries which are in my view unmerited. But as business people, yes, business people in medicine, they miss the point. They are not bound by Hippocrates; they are bound by Milton Friedman. Very sad, and unbecoming of leaders; and ultimately the health of all in our community are adversely affected. If you are from the towns I mention, please share this widely.
Posted on: Wed, 02 Apr 2014 21:30:12 +0000
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