Why Not Run Hospitals Like Firehouses?
Have you noticed that everyone always says the same thing whenever there's a true medical emergency: "Go to the nearest hospital."
This implies that a hospital -- any hospital -- is qualified to provide some basic level of medical care. In fact, with all the assorted evidence-driven protocols out there these days, that assertion isn't too far off. So why is there so much duplication of effort? There are so many hospitals in such close proximity that they're all squabbling over the same patients -- and spending mega-bucks on advertising and other publicity campaigns. Why not make hospital care on par with protection from the fire department?
Each neighborhood has its own firehouse, charged with protecting a given geographic area of the community. There are uniform policies from one department to another. When necessary, they share resources, generally working well together. Because the training is generally similar from one company to another, you don't have huge, expensive advertising campaigns touting the superiority of the Main Street Fire Company over the one on Church Street. Where you live determines which firehouse protects you. If you do happen to have a preference, then you make it a point to live in proximity to your preferred fire company; just like researching the schools when you buy a house.
What if each community were in charge of providing hospital care? Hospitals would be funded like fire and police departments, provided with a set annual budget that would cover all medical services provided there, including the services of hospitalists, emergency physicians, anesthesiologists, radiologists, pathologists and so on. Think of it as the ultimate in capitation: pre-paid care at the community level.
Get rid of JCAHO and put a federal cap on pain and suffering awards for malpractice (which is working great in Texas) so that the only documenting you had to do would be what you really need to take care of the patient. Implement a nation-wide computerized Personal Health Record (not technically the same as an EMR) to avoid duplication of studies from one institution to another and you're in business. Everyone working there earns a decent living. The only difference is that there's no profiteering from cherry-picking better insurances or healthier people.
Think about it: no more coding or billing for anything received in a hospital. Doctors could see patients as many or as few times a day as they needed. Nurses could actually care for patients instead of wasting seven hours of their eight-hour shift documenting. All those Utilization Review nurses would be out of a job; actually, they could hit the floors and actually go back to nursing.
How to pay for all this? Once you eliminate the need for all that advertising and redundant administration, there would be plenty left to pay doctors, nurses and people who actually take care of patients.
So what's stopping all this? I guess there are enough people who think things are working just fine the way they are. Too bad it's mainly administrators, PR firms creating all those marketing campaigns and other folks who aren't actually involved in providing medical care. As long as there's so much money to be made with the status quo, I suppose patients and the people who care for them are just out of luck.