Sunday, April 23, 2017

Who will lead a reform of health care?

The Centers for Medicare and Medicaid Services wants more transparency from the private accrediting agencies that inspect health care facilities, according to a report in ProPublica.

The major private accrediting organization, The Joint Commission, has for years evaluated facilities that, under federal rules, would serve as proxies for the state inspection of how well the facility is performing. If awarded accreditation, the facility would be eligible for reimbursement for Medicare and Medicaid. This is known as “deemed” status. But, as the ProPublica story points out, this system is deeply flawed.


“There’s increasing concern among regulators that private accreditors aren’t picking up on serious problems at health facilities,” the article state. “Every year, CMS takes a sample of hospitals and other health care facilities accredited by private organizations and does its own inspections to validate the work of the groups. In a 2016 report, CMS noted that its review found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.”

The condescending arrogance of the hospital industry resisting was predictable, and done with the typical style of faux-transparency by issuing statements rather than actually participating in the journalistic dialogue the public deserves. The American Hospital Association, in particular, showed its true colors in the ProPublica article by telling us that the American public is not smart enough to understand all this complicate health stuff. Of course, with the election of President Bannon and 45, they may have a point. After all, 45 didn’t know how complicated health care was when he and his fellow Republican traitors attacked the Affordable Care Act.

If a master’s in hospital administration and 25 years in various parts of the health care industry taught me anything, it’s that the interests of the organization will be protected well before the interests of the public. The confluence of the vested corporatist interests stonewalling — but ever so sweetly — taxpayers about what we are buying is deeply ingrained in the system and no idealist within or outside the industry will overcome that without radical changes in our political system. That means, the current crop of conservative and right-winger elected officials must be replaced by those who understand they work for the electorate, not the corporate interests that run the system now.

Additionally, the industry’s leadership must also adopt a new paradigm. It needs to drop the illusion of self-importance. (This came to mind recently as I scanned the University of Iowa’s Health Management and Policy faculty listing and saw several of the positions entitled “clinical professor.” Memo to HMP folks: Get over yourselves.) The leadership must understand its two constituencies are the real clinicians (doctors, nurses and others in direct patient care) and the patients themselves. Period.


The implications of such a paradigm shift mean the hospital and medical leadership must show courage and advocate for the patients’ interests and, only where there is a confluence with the patients, their own. For curricula based around the “don’t rock the boat” approach to leadership, this will be a long and hard row to hoe. The interesting question is now: Who will take the lead?

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