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CEOs’ Urgent, Shared Commitment to Change

2008_GaryKaplan

A few weeks ago, I joined five of my peers in health care leadership throughout the country to help launch Health CEOs for Health Reform, a coalition dedicated to transforming health care and creating a more sustainable health system. 

In mission, we committed to moving past policy concepts toward a detailed blueprint that would reconcile legislative goals with operational realities of the health care system. Our goals are lofty and the challenges immense. What struck me in recent months, with the current state of the economy, is the tremendous sense of urgency we all feel and the confidence we have that now is the time to truly transform health care. 
 

I read Michael Millenson’s post The Inevitability of Health Care Reform: This Time, the Politics Have Changed with great interest and personal reflection. What is different this time around? What do I think a handful of health CEOs can really do to change a system entrenched with waste and cost that does not add value to our very customer – the patient? 

First, it was clear to me last week that it is no longer “business as usual” for any of us. Health care reform can no longer be set aside or merely discussed. The New America Foundation has given us an opportunity to help make a difference and contribute to reforming our health system, but it is up to all of us to make the hard choices that will work – and every one of us will have to give up something for the better good.

As a medical doctor and a hospital administrator, I am proud to be a part of American medicine, but we can be much, much better. No other industry in the world tolerates the quality problems health care accepts as status quo. 

The defect rate in health care approaches 3 percent. Consider the gap in quality if other industries accepted a similar defect rate — about 2,000 airplanes would have unsafe landings a day, 12,000 checks would be withdrawn from the wrong account each day, and 20,000 pieces of mail would be erroneously delivered every hour. These levels of poor quality would be totally unacceptable.

As if quality standards were not enough to make the case, we’re also not getting what we pay for. According to a recent Washington Post article, U.S. health care represents about 16 percent of the gross domestic product (more per capita than any other nation in the world), yet we lag considerably in overall health. We’re 29th in infant mortality, 48th in life expectancy, and the worst of 19 industrialized nations in preventable deaths.

Our health care system is fraught with waste, which leads to poor quality and excessive cost. Nearly half of the $2.6 trillion in the U.S. health care system is waste that adds no value for patients and sometimes even causes harm. 

At Virginia Mason Medical Center in Seattle, we’re using our Virginia Mason Production System management method (modeled after the Toyota Production System) to show how health care can reduce cost while improving quality and safety. By eliminating the waste, we have seen over and over again improvement in quality, safety and the patient experience – all while reducing cost.

We’re seeing results in every area of our health system: ambulatory care, inpatient care, facility design, chronic disease management, finance, supply and the list goes on. As a result, we’ve created an environment where dedicated care teams can actually do their best work and have more value-added time with patients.

I’m confident patients in our country can get higher quality and safer care at less cost. It first requires participation of employers, health plans, government and others to truly achieve what is possible. 

At Virginia Mason, our work with employers, like Starbucks, Costco, Boeing and Microsoft, is yielding dramatic reductions in costs for those paying the bills; and better care, quicker return to work and more satisfaction for our patients. We, unfortunately, in the current payment system, reduce our profitability by doing the right thing. Despite my very supportive board of directors, they will not allow me to lead our organization into bankruptcy by doing the right thing. We need to change our payment system if we truly want to ensure universal coverage, improve quality and reduce cost. 

We all need to change our mindset and commit to our shared agenda of cost, quality and coverage. It will require delivery system reform and payment system reform. We must stop giving incentives to hospitals and physicians to do the wrong thing to provide non-evidence-based, non-value-added diagnostic and therapeutic interventions. 

We have seen what’s possible and we are anxious to share our experience improving care and reducing cost. It isn’t easy, but we are ready to roll up our sleeves and make it happen. The prize is worth it: quality, affordable health care for all Americans.

Gary Kaplan, MD is Chairman and CEO of Virginia Mason Health System in Seattle.

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32 replies »

  1. IT IS SAD THAT SCUMBAG IMMIGRANTS LIKE DESAI AND THEIR CROOKED ILK FROM GUJARAT, INDIA IS TAKING OVER OUR HOTEL INDUSTRIES AND NOW INSURANCE INDUSTRIES AND BANKRUPTING OUR PEOPLE…. THEY HAVE IMPORTED HIGH LEVEL CORRUPT PRACTICES FROM INDIA AND ARE USING IT HERE.

    IN INDIA IT TAKES MILLIONS TO BUY A PARLIAMENTARIAN BUT IN THE US IT TAKES ONLY A FEW THOUSAND DOLLARS DONATION TO PUT HIM IN THEIR POCKET. SUCH IS THE STATE OF OUR COUNTRY.

    WE HAVE BECOME A SPINELESS PEOPLE WHO TRY TO BE POLITICALLY CORRECT AND IN RETURN GET SPIT ON OUR FACE.

  2. Universal health care inc, st petersburg, fl is a company that had to pay 300-400 million aqs a fine for medicare/medicaid fraud. And if the tried to screw medicare imagine what they can do to you. Also this medicare advantage plan co is owned by de desai from india & believe all your personal & medical records are sent to india for procesing, ss#,ph#, address, and medical records. I know as I use to work there & i use to scan all claims including high dollar claims & have it scanned to NDS in india, only to have them denied several times. I see no difference in illegals comming to the US and taking our jobs, Universal helth care saint petersburg , fl actually sends us jobs to be done in india. people please check the better business bureau before signing up with this fradulent company. please read Mr. Gary M Ruehle’s blog on this company. we need to boycott this company not only are they screwing americans out of their money mainly our sr citizens, but also our work force. boycott, boycott, boycott

  3. It is SO simple to get ALL Americans very inexpensive FULL coverage for ANY medical need with no pre-existing condition exclusions. Get rid of the for profit insurance companies that pay their criminal CEO’s hundreds of MILLIONS of dollars in obscene salaries and bonuses. They get this money through post claims underwriting and denial of justifiable services killing over 50,000 adults and 25,000 children EVERY YEAR in their need for greed. This is murder for profit and no one is doing anything.
    This is why a single payer plan would work, it would eliminate BILLIONS of dollars in CEO salaries and bonuses which would then go to paying for the medical care we are now being denied. We do NOT need these CEO Criminals, they accomplish NOTHING except misery and pain for their customers when they need help the most by sucking all the money that we need for medical care into their obscene salaries and bonuses. For my personal horror story, Copy & Paste the following to Google: domestic terrorism/gary’s blog
    Health Insurance must return to it’s role as a profession, not a business. The health insurance companies continue to compensate their executives out of proportion to any known formula. This executive compensation— HUNDREDS of millions of dollars every year PLUS hundreds of millions more in bonuses and stock opeions—could be used to provide healthcare for millions of Americans.
    Most of these CEO’s should be arrested and put in jail for life because of the people they literally killed through denying them medical care when they needed it the most and the medical bankruptcies and physical and mental devistation they have caused tens of thousands of Americans just to feed their need for greed.
    NO ONE in Gods Creation is worth the obscene salaries these criminals are getting. Organized crime has blatantly taken over the health insurance industry and no one is doing a thing about it except REWARDING THEM! Where are our representatives???
    _______________________________________________________________
    ANNUAL COMPENSATION OF HEALTH INSURANCE COMPANY EXECUTIVES (2006 and 2007 figures):
    • Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834
    • H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
    • David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
    • Michael B. MCallister, CEO, Humana Inc, $20.06 million
    • Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
    • Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
    • Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
    • Jay M. Gellert, President/ CEO, Health Net, $16.65 million
    • William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
    • Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
    • James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
    • Cleve L. Killingsworth, President/CEO Blue Cross Blue Shield of Massachusetts, $3.6 million
    • Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
    • Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
    • Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
    • Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
    • Michael F. Neidorff, CEO, Centene Corp, $8,750,751
    • Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
    • Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
    • Michael F. Neidorff, CEO, Centene Corp, $8,750,751
    The compensation of healthcare insurance company executives should be tightly capped.
    Gary M Ruehle http://www.theanewyou.com

  4. DOMESTIC TERRORISM
    We have all read and heard horror stories about medical insurance companies and how they just plain refuse to pay for covered medical services and the horrible and life threatening and crippling strain this puts on the average American citizen, his family and his friends. Here is my personal horror story dealing with Universal Health Care Inc of St. Petersburg Florida, their CEO Dr. Akshay Desai from India and his medical director Dr. Edward Lowenstein. ENOUGH IS ENOUGH!
    My story is repeated tens of thousands of times every year putting Americans into medical bankruptcy and worse, death! This is illegal, immoral, and just plain murder for profit! WHY are our lawmakers not helping US instead of the criminal enterprises calling themselves health insurance companies?
    I have complete documentation from my doctors and the hospital showing my needed and emergency care. I have complete documentation from Universal Health Care Inc of St Petersburg, Florida fully authorizing my care with approval letters, letter of guarantee, 5 e-mail guarantees, 2 claim numbers and 8 phone guarantees. THEN after the procedure is finished, UHC denies my care through post claims underwriting! I almost lost my leg and died from this.
    While visiting in Thailand in August of 2008 I experienced escalating severe pain in my knee which was replaced by a prosthesis a year before. An examination and x-rays on October 15 showed a severe infection of the prosthesis that was eating away large amounts of bone material.
    The doctor said I needed as soon as possible to have an Urgent operation to have the infected prosthesis removed, that it is an Emergency to do this as I would loose my leg or my life if it was not done as the infection was eating large amounts of bone material and spreading rapidly.
    I knew my insurance policy was supposed to cover me for emergencies outside of the country so I immediately called them to determine my coverage. If not covered, I could fly back to the U.S. to get it done.
    I told the lady I was calling from Thailand and I had been out of the country for over one year and needed to know what if any coverage I had over here. I emphasized that in Thailand if you do not pay your hospital bill, they will put you directly into a hell hole of a Thai jail until your bill is paid so I needed to know for sure. That is the law here, it is called defrauding a hospital and I was concerned about it. The lady I talked to said I should not worry I was completely covered as long as it was an emergency and I was admitted through the emergency room. She said I would not be covered for any elective procedure. I was e-mailed a document showing $30K coverage every year outside of the country for Emergency and Urgent service.
    Three days later when being admitted to the hospital the office and I called again, 2 more times and was again assured I was completely covered, the hospital only needed to fax them copies of their bill and it would be paid is what they first told us.
    After my procedure, the hospital several times requested a letter of guarantee from UHC covering my care. UHC totally ignored the hospital. The hospital office then comes after me to call my insurance company and get it straightened out. So as I am laying in bed recovering from major surgery, I am having to call them several times every night at expensive international long distance rates, being put on hold for 10 minutes at a time, also requesting this letter of guarantee and was told not to worry it would be sent. They even gave me a claim number, number U02250952 to guarantee payment and show I was covered!
    The hospital did my operation, they had to remove my badly infected knee prosthesis, replace it with a TEMPORARY cement spacer to keep the bones from rubbing, and then I needed powerful IV antibiotics for 6 weeks EVERY DAY to get rid of the remaining bacteria. THEN they would replace my knee prosthesis with a second operation, this was the only way to cure my deadly infection, save my leg and my life and stabilize me.
    After this major operation I had to spend over 2 hours EVERY night for 8 nights international long distance being jacked from one person to another trying to get a letter of guarantee.
    THEN as I am laying in my hospital bed where I am supposed to be recovering, my insurance company now says they will not pay for the replacement of my knee as they now see that as an elective procedure that could be done in the U.S.! I have NO KNEE, am in a full leg cast and they say it is elective for me to get another one and I must return to the U.S. for it!
    This Is Incredible! I am in a full leg cast, IMPOSSIBLE to get on an airplane, must take IV antibiotics EVERY day which in itself is a 3 hour procedure I have no knee, only a piece of cement and they want me to come back to the U.S. and get it done where it will cost 80% MORE than in Thailand and where I have NO ONE to help me after it is over.
    My doctor said I could not sit for more than one hour in a car because it would cause cramps and muscle spasms yet UHC wants me to sit for 28 to 36 hours on an airplane I could not get my leg into because of the full fiberglass cast that totally immobilized my leg!
    UHC has now put me in a life and death situation, I cannot leave that CEMENT spacer in place of my knee for long or it too will become infected! They OK’d putting it in and will now let me loose my leg or my life by not finishing the procedure they sent my hospital a letter of guarantee starting to save a few lousy dollars!
    From My Doctor
    Ultimately, after the first half of the procedure was performed, UHC took the position that the re-implantation of the new prosthesis constituted elective surgery and would not authorize it to be done in Thailand .
    This position ignored that fact that the full leg fiberglass cast prevented Mr. Ruehle from boarding any commercial airliner, that the altitude would increase swelling, that the antibiotic was a procedure that from start to finish took approximately four hours each day, that Mr. Ruehle was through this time (and still is) in extreme pain and discomfort, that his leg was missing bones and he was to be transported as little as possible, that long distance travel to the U.S. constituted a major health risk that no responsible medical provider would authorize, and that the re-implantation was simply the second half of the original procedure.
    But that great healer Dr. Lowenstein knows better then all these experts and denies any care to me. To him it’s not an emergency, but an elective procedure. That he already authorized to be done here. Now he denies me.
    It was like talking to a brick, my doctor told him, I told him, the hospital told him, my attorney told him, we sent documents to them that I COULD NOT fly or travel over 1 hour but they insisted I had to come to the U.S. to get done a procedure that they OK’d in the first place to start here in Thailand.
    If I did not get the second part of the procedure done, I was again in danger as the cement spacer was only temporary, a foreign object in my body that in itself could cause new infection. I could hardly get around other than sitting or lying, unable to travel and NOW they refuse to finish this operation.
    I really got upset by this time threatening to go to the news outlets, writes my congressman, TV 8 on your side, etc. Calli in the complaints department FINALLY told me they would cover the rest of the procedure and for me to NOT CALL them any more that this was between the hospital and the insurance company and all my calls were confusing the issue! FINALLY, peace of mine…..or so I thought.
    My doctor decided that I was ok enough to have the procedure finished on the 23rd of February as my system looked cleared up of infection through the blood tests I had every week. So we made the appointment for the 23rd of Feb to finish the replacement started in November.
    As life would have it, about the 8th of Feb I came down with severe diarrhea, vomiting, could not eat and was sleeping 16-18 hours per day as I just could not get out of bed for more than an hour each day.
    It got worse. Being driven home from a check-up where I was given antibiotics I started to loose my eyesight, everything becoming a blinding white light, cars passing us just looked like spots, I was loosing awareness of what or who I was, or where I was. I felt in my mind like I was dying, I never felt like this in my life. When trying to get out of our truck, I just fell right back into it, I could not walk, even with crutches as I had no balance. I had to use a walker to get to my bed.
    My wife immediately took me to the hospital where Dr. Pinij took one look at me and immediately had me admitted. He said that I was dying when I was admitted and I would not have lasted more than another 24 hours.
    This was on Monday the 16th of Feb. They found my white blood count was dangerously low, my platelets were low, blood pressure was 90/70, my heart rate up from a normal of 68 shot up to 88 and I had acute infective diarrhea and Bicytopenia and my kidneys were in trouble.
    They started IV antibiotics immediately, blood transfusions, platelet transfusions and something for my kidneys as they too were in trouble. The doctor said I truly WAS dyeing and this was an URGENT EMERGENCY now. So they cancelled my knee replacement as I had to be bacteria free to do this so the insurance company was never notified to get prior authorization for the knee replacement.
    It is different in Thailand than the U.S. , if you don’t pay your hospital bill here, you go directly to a HORRIBLE Thai Jail, 70 men all hard core Asian criminals jammed into a large cage where you sleep on the floor. It’s called defrauding a hospital. You simply stay in jail until your friends and family come up with the money to pay off you bill then they let you out. THIS is where I almost went when UHC did not pay their bill, AFTER authorization my care at least 8 times by phone, a written letter of guarantee, a claim number given, and 5 e-mails from their own medical director, Dr. Edward Lowenstein, saying he would direct his claims manager to pay as soon as they received relative documents from the hospital, which they did, SEVERAL times.
    To me these are written contracts between UHC and my Hospital guaranteeing they will pay for my procedure. He said in writing he would pay when he received an invoice and documents from the hospital and doctor. He received these documents several times costing the hospital office staff many wasted hours duplicating things for them for nothing.
    THEN Dr. Lowenstein decides to deny payment saying the treatment given to me was elective and I needed to have it done in the U.S.! This was actually his 3rd excuse.
    After I complained to CMS he than said that my treatment was not urgent or an emergency and I was only covered for urgent or emergency care! This is his 4th excuse.
    My Thai doctors sent him several documents showing they had to do my procedure to SAVE MY LIFE! The good Dr. Lowenstein, medical director of UHC considered saving my leg and my life an ELECTIVE procedure that could be done in the U.S. That saving my leg and my life is not an emergency!
    The only thing he uses his medical license for is to further injure or kill sick people for a profit for his company and his bonuses. His medical license is useless for helping or saving sick people as the oath he once took supposes of him. It is used for one thing, to help the bottom line of UHC and feather his own pocket with his bonus money.
    This was his first denial of payment. He then proceeded to find 4 other excuses to deny me then he retroactively my many months prior to my procedure, des-enrolled me saying I was never covered in the first place and any approval letters and letters of guarantee, claim numbers, fax approvals and e-mail approvals sent by the good folks at UHC are now void and useless!
    This is total outright FRAUD and mis-representation. It is known as “Postclaims Underwriting” also called “Retroactive Underwriting” and Florida law flatly prohibits this practice but insurance companies do is routinely. Why are none of these insurance officials being arrested for breaking the law?
    At least seven written documents, contracts by Desais company they just arbitrarily toss out and refuse to honor leaving the patient to fight with them when the patient is at his weakest and most vulnerable. Attacked by their own insurance company when they are down.
    They took my money then denied payment when I needed it. They gave seven written contracts that they would pay. They broke these contracts leaving my family and myself destitute. My feeling is this is outright fraud. This is my complaint.
    And Dr Akshay Desai, their CEO agrees with this horrible decision as he has done nothing about it. Just take the money and have lavish parties and visit with big shots for photo ops and political donations.
    When they denied me service, the hospital stopped all treatment to me including the daily IV antibiotics and physical exercise I needed for another 6 weeks to kill the remaining bacteria in my system and started charging me EVERY DAY for my room and the medications I desperately needed to save my leg and my life.
    I had an armed guard put at my door to make sure I did not escape from the hospital without paying my bill. They were after me every day to pay on my bill or go to jail. My wife could not come to visit me without the collection department demanding money from her or her husband would go to jail. Everyone who saw me knows me as the foreigner that tried to cheat the hospital!
    Suddenly I am living in true TERROR. The horror of my immediate life became immediately apparent when they had the Thai Police come to my room and take a report of this foreigner that was trying to defraud them and they wanted to press charges against me.
    I just went through a major surgery yet had their collection department after me EVERY DAY trying to collect money or I would go to a Thai jail where I would get NO medical care and would probably die.
    EVERY DAY my wife had to come up with money to pay on my bill or they would call the police for me. This made NO difference to Universal Health Cares medical director Dr. Lowest Stein who proceeded to dis-enroll me saying I was now out of the country to long! This is called Post Claims Underwriting and is illegal, immoral, and outright murder for profit.
    He knew I was out of the country when he gave my hospital a letter of guarantee to start this 2 part procedure. He sent it.
    If I was out of the country to long, they should have told me that on my FIRST phone call and I could have flown back to the U.S. for treatment. They did not. They said I was OK. Many times.
    What a terrifying and horrifying experience I was going through. It was like a living nightmare brought on by the practices of Desai and his insurance company and how he runs it.
    Even CMS does nothing about it, just takes the reports.
    Dr. Lowerstein had previously FINALLY given the hospital a letter of guarantee that they would pay for my services, sent 5 e-mails to this effect, we had at least 8 phone approvals they would cover me, then this man changes his mind AFTER the procedure he authorized in the first place. He says after reviewing the several documents from Dr. Pinij, my personal doctor at AEK Udon International Hospital and my other doctors showing the urgent and emergency procedure they gave me to save my leg and life and the hospital offices themselves, he says he does not see this as an this as an emergency therefore it is not covered!
    He used no less than FIVE DIFFERENT REASONS to deny my claim. Even though my doctors, the hospital and later my attorney all appealed to this he denied my claim putting me in a horrible terrifying life threatening situation.
    I was terrorized EVERY day by the collection department and their threats of jail when I should be relaxing and healing from a major procedure. I did not know from one minute to the next if I would have the life saving IV’s removed from my arm and taken by the Thai police directly to jail with my leg in bandages that had to be changed every day.
    THIS is the horrible situation MY insurance company, Universal Health Care Inc, its CEO Dr. Akshay Desai and his medical director Dr. Edward Lowenstein has put me in. Living in fear EVERY moment of EVERY day. Not knowing if my wife found anything else from our house to sell so she could bring them some money.
    Universal Health Care took my money for my premiums every month knowing I was living out of the country for an extended period of time every year, what country and where I was at, I always phoned them to keep them up to date with where I was traveling at even! Living in a foreign land, available emergency medical care was most important to me and not neglected. And in my hour of need, they treat me like I am some sort of criminal and will allow me to DIE in a most HORRIBLE way and say….”sorry, there is nothing we can do?” They sold me a policy they knew at the time was totally illusionary to my requirements.
    My blood pressure rose dramatically and needed to be medicated. I was going crazy by this time, mentally exhausted, getting physically sick again my leg swollen down to my foot, in a foreign country and not knowing what to do. Now I am being CHARGED for every day I am in the prison hospital, charged for my room, my medicine and IV medication I desperately needed after a major surgery, any food I ate. Almost $100 per day was adding up against my bill that had to be paid in FULL before they would release me.
    My attorney sent letters to Dr. Lowenstein and Universal Health Care indicating that I could loose my leg or my life, the man was completely unmoved by all this, totally willing to let me DIE and actually now started using the full backing of Universal Health Cares powerful Legal Staff against me.
    They do not even try to help me, their customer, No in my time of serious need from those I put my complete medical insurance trust in, treat me like some mangy cur to be tossed out the back door and sick their legal dogs on me to scare me away no matter WHAT the consequences to me or my family or those around me who will be so tragically affected by these their decision so save their companies bottom line a few more precious DOLLARS and human life and limb be damned..
    WHY must we the consumer suffer like this at the hands of people like Dr. Edward Lowenstein whose sole job with Universal Health Care is to TURN DOWN as many claims as possible for his bonus money?
    And what to think of an insurance company that pays bonuses to their employees for policies that they cancel.
    I ended up having both a mental and physical breakdown with terrible swelling of my knee and leg and went into convulsions where they had to rush me to the Emergency Room for treatment and to get my shaking and convulsing under control and to reduce the swelling so I did not loose my leg.
    My doctor that did my operation and saw me in the ER as I was having my breakdown from mental stress and strain felt so sorry for what I and my family were going through because of Universal Health Care that HE gave the hospital over $2,000 of HIS OWN money to put against my bill and signed a hospital paper that if I did not pay the balance he would be responsible for it!
    My wife and family too were terrified, not knowing what was going to happen to me. I was not allowed to come home at night, I was a prisoner in the hospital with an armed guard every place I went, expecting to go to a real jail any moment.
    My wife was forced to pawn all her jewelry and wedding gifts and sell everything of value in our house for whatever she could get for it to pay on my bill to keep me out of jail loosing considerable face with her friends and neighbors, something very important to Asian people. She had to give her beautiful truck, a 2006 Isuzu to the hospital to keep me from being sent to jail. This in turn cost us the loss of our business as we had no transportation now or any money to work with.
    We were all terrorized not knowing from one minute to the next what was going to happen to us all thanks to the policies of Dr. Akshai Desai of St. Petersburg, Florida and Universal Health Care Inc.
    Finally after my extremely upset wife sold everything of value that we had in our house , even having to show the hospital our bank accounts then turning them over to the hospital and us borrowing from every person we could think of, the hospital finally released me.
    I now had less that $100 to take care of my entire family and pay our bills and eat. And no transportation or way to work.
    Universal Health Care and Dr. Akshay Desai left us medically bankrupt AND destitute with almost no food to eat. He totally sucked us dry in order to squeeze every dollar he can for his company and his excesses.
    I still needed the 6 weeks of IV antibiotic treatment EVERY day and had to beg and borrow again for this treatment which was never completed as each treatment was over $60 per day or over $2,500 for the 6 weeks. This made no difference to Dr. Loserstein whose only job I can see is to use his medical license as a sham to deny services and overrule the decisions of credible medical doctors.
    This is only a short version of the horrors I faced thanks to Universal Health Care of St. Petersburg , their staff and Dr. Akshay Desai in particular. And I say Dr. Desai in particular as he is the CEO of this corrupt company and obviously approves of the service his company fails to provide the people who depended on his company. Thinking they were covered only to find in their time of need UHC will certainly disenroll them using post claims underwriting and to see their formidable legal department turned loose on them when they are at their weakest leaving them to loose limbs or their very life. This is Criminal. These people are no different than murderers. They deny care letting people die.
    And remember, I am only one of hundreds of thousands of similar horror stories that feed the greed of these terrible health insurance companies. No one is reading about them. But we are literally dying because of insurance companies drive for profit.
    The insurance companies and health care industry, “Big Pharma” are bleeding us dry to where we have nothing left for ourselves and our families except medical bankruptcy and loss of our entire lives work and possessions.
    Who is helping us, the American Taxpayer? Why are our legislators bending over backwards to provide for the criminal INSURANCE COMPANIES? Their payoffs through their lobbyist at the cost of the health and welfare of American People must stop. We are dying out here, is no one listening?
    Gary M Ruehle
    727-827-8481
    *********************************************************************
    The following are the totally criminal acts Universal Health Care, “and others” has used to deny me “and thousands of others” care we were promised. Can you not help me to get back the money and life they have stolen from me? We have nothing left, not even enough to eat.
    “We believe that unlawful practices are pervasive across the healthinsurance industry, and it will take prosecutors, regulators, lawmakers,as well as policyholders all working together to bring these companies to justice and restore faith and fairness to America’s health care system,” “The process of rescission is not only illegal but it is crimilal as well.
    Because of the number of people who died due to rescission of their otherwise valid health care policies,25,000 children and 50,000 adults, we should put those who run the insurance companies, or reward their employees for terrorizing people by refusing care in jail. Forever. This is DOMESTIC TERRORISM on an incredible scale and is going unchecked.
    This is an outrage that can only be eliminated by making the insurance companies pay a price for the damage that they do. America, wake up! Each one of you who thinks that you are covered has no way of knowing – until it is too late – that this is the normal practice of the people who gladly take your money until you are sick or injured, and then they let you go down the toilet by dis-enrolling you on a pretense. It should be considered DOMESTIC TERRORISM.
    Some Of The Laws UHC Has Broken
    Being Victimized By Post-Claim Underwriting
    Post-claims underwriting is the practice of cancelling a health insured’s policy for supposed omissions of information in the insured’s original application for coverage after the policyholder submits a claim, usually a major claim.
    ________________________________________
    • Coverage Rescission. A rescission is the retroactive cancellation of health coverage, also called postclaims underwriting or retroactive underwriting meaning that not only is
    an individual’s coverage cancelled, but the insurance company is no longer responsible for claims previously
    submitted. when a plan rescinds an individual policy, it also refuses to pay providers after they have provided treatment.
    For individuals who have accumulated significant medical bills – the exact claims which prompted the post-claims underwriting – this can be a financial hardship or major crisis.
    The practice is “rescission”: an insurance-industry procedure of retroactively canceling approved health-insurance policies obtained in the individual market after the policyholders get sick and file large medical claims. when a plan rescinds an individual policy, it also refuses to pay
    providers after they have provided treatment.
    Post-claim underwriting is an unethical practice in the insurance industry. The contention is that insurers engaging in that conduct are acting improperly and in bad faith when, instead of looking to pay the claim, they begin to search for all the things in the application that will allow the policy to be rescinded. The whole purpose of insurance is defeated if an insurance company can refuse, without justification, to pay a valid claim.
    An insurer has an obligation to its insureds to perform all necessary underwriting at the time coverage is applied for, and not thereafter. It is unfair for an insured to purchase an insurance policy, pay all required premiums, and believe they are protected for covered losses, only to learn after the claim is submitted that they are not insured.
    The American Association of Justice (AAJ) has released a report which looks at the insurance industry’s rescission and cancellation practices. The report is entitled Tricks Of The Trade: How Insurance Companies Deny, Delay, Confuse and Refuse.
    Rescission
    The AAJ’s report dedicated an entire section to the insurance industry’s practice of abandoning the sick by rescinding policies – an issue which never ceases to be in the news.
    Consumer advocates say that insurance companies are driven by profit to revoke coverage based on even inconsequential discrepancies between the application and the medical record. Many insurers even pay employee bonuses for meeting a cancellation quota and for the amount of money saved.
    “This amounts to post-claims underwriting,” says healthcare advocate Jerry Flannagan of Consumer Watchdog, a nonprofit consumer education and advocacy group. “They’re supposed to look at your medical records ahead of time — but once they offer the coverage, you should be able to rely on it.”
    “Industry schemes to maximize profits at the expense of patients are unfair and unlawful, and they must be stopped. . “Health insurance companies may say they are providing coverage, but time after time they do everything they can to avoid paying for health care for their policyholders.”
    Last week, L .A. City Attorney Delgadillo launched a first-of-its-kind, prosecutor-sponsored website – http://www.ProtectingTheInsured.org in order to collect information from consumers, doctors, and hospitals as part of the ongoing investigation into the unlawful, fraudulent, and unfair activities of health insurance companies.
    For more information, consumers are asked to visit http://www.ProtectingTheInsured.org or City Attorney Rocky Delgadillo´s website at http://www.lacity.org/atty
    Just an example of what all health insurance companies are doing
    Rocky Delgadillo said the insurer, Health Net Inc. which is based in Woodland Hills (Los Angeles County), saved more than $35 million in medical expenses by illegally rescinding the policies of at least 1,600 members. The lawsuit was filed Wednesday in Los Angeles Superior Court. (The total suffering these people experienced is absolutely unmeasureable and criminal.)
    When a plan rescinds an individual policy, it also refuses to pay providers after they have provided treatment.
    Health& Safety Codes prevents a health plan from “rescinding a contract for a material misrepresentation or omission unless the plan can demonstrate (1) the misrepresentation or omission was willful, or (2) it had made reasonable efforts to ensure the subscriber’s application was accurate and complete as part of the pre-contract underwriting process.”
    Because of the number of people who died due to rescission of their otherwise valid health care policies, 25,000 children and 50,000 adults, we should put those who run the insurance companies, or reward their employees for terrorizing people by refusing care in jail. Forever. This is Premeditated MURDER and Domestic Terrorism on a GRAND scale. I was terrorized every day with jail.
    This is an outrage that can only be eliminated by making the insurance companies pay a price for the damage that they do. America, wake up! Each one of you who thinks that you are covered has no way of knowing – until it is too late – that this is the normal practice of the people who gladly take your money until you are sick or injured, and then they let you go down the toilet by dis-enrolling you on a pretense. It should be considered domestic terrorism.
    WHY are our lawmakers doing NOTHING about this?
    WHY are our so many of “our” representatives siding with these criminals?
    Gary M. Ruehle
    727-827-8481
    garyruehle@yahoo.com

  5. In reference to Rush Limbaugh’s comments that He is proof that we have the Best Health Care (that Money can BUY) in the world.

  6. Oh, No special treament for the fat Blowhard who has put a Free advertising plug in for the Industry. Tort Reform is not the issue as only 1 to 5 %percent of lawsuites proceed with any rewards. These are the most serious Cases of Medical Error that end in a lifetime of infirmity, Disability and Death. Tort Cases are the ONLY means of accountability! Otherwise, the patient would bare the insurmountable costs of Medical Error.
    The problem is,neither the doctors or the institutions want to be Held accountable for anything that may happens. If it be Medical Error or Hospital Acquired Staph Infections. They Contend that the patient is privledged for the knowledge and skill of the Doctor and the technology of the institution. If the results end to be; the amputation of all limbs from Preventable Staph Infections or simply operating on the wrong body part. No one is accountable . You should just be happy that you are alive and have not severed a critical organ. So what, if you cannot walk ,work ,or feed and cloth yourself! Doctors and Institutions do not accept any responsibility.
    Tort reform is not the answer. Accountability and responsibility for errors would lend toward fewer extremes and legal actions. Consumers are left out of the debate simply because the contracts are between Insurance and the Provider.

  7. Medicine must return to it’s role as a profession, not a business.
    The health insurance companies continue to compensate their executives out of proportion to any known formula. This executive compensation—millions of dollars every year—could be used to provide healthcare for millions of Americans.
    ANNUAL COMPENSATION OF HEALTH INSURANCE COMPANY EXECUTIVES (2006 and 2007 figures):
    • Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834
    • H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
    • David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
    • Michael B. MCallister, CEO, Humana Inc, $20.06 million
    • Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
    • Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
    • Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
    • Jay M. Gellert, President/ CEO, Health Net, $16.65 million
    • William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
    • Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
    • James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
    • Cleve L. Killingsworth, President/CEO Blue Cross Blue Shield of Massachusetts, $3.6 million
    • Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
    • Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
    • Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
    • Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
    • Michael F. Neidorff, CEO, Centene Corp, $8,750,751
    • Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
    • Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
    • Michael F. Neidorff, CEO, Centene Corp, $8,750,751
    The compensation of healthcare insurance company executives should be tightly capped.

  8. While there are clearly examples of “doing the right thing” having a detrimental effect on reimbursement, there is still ample opportunity to improve the variance in quality on a day-to-day basis INSIDE each hospital. Virginia Mason does a better job than most, but a cursory review of public data on hospitals reveals that the way in which care is delivered is unacceptably and unexplainably different from day-to-day. When hospitals can produce the same “output” every day of the week, then the focus on perverse financial incentives will be more powerful.

  9. That’s exactly my point. We shouldn’t have to force people to take care of themselves. Let me break this down a different way. Our current system is wasteful and we all know that. I just don’t understand why you want to focus on the symptoms of that waste. Let’s attack the underlying problems that caused those symptoms. If we get people healthier and do it at the primary care level, there will be less healthcare transactions. What will that mean? Less demand for specialist services, less financial incentive to continue the spread of costly imaging modalities, less need for administrative personnel to battle each other, less malpractice cases, less exposure to those greedy insurance companies you talk about, a more productive work force, etc., etc.
    Financing healthcare is a secondary event. Why would you want focus on changing the financing for something that shouldn’t have been there in the first place? If we took better care of ourselves and if the % of the population with chronic illness was 10% instead of 50%, we wouldn’t even be having this conversation right now and THCG would probably not exist.
    No one said healthcare reform was going to be easy. That difficulty is no reason to cut corners though.

  10. “The main reason is because the beneficiaries are not compliant with treatment plans and not willing to make all of the necessary changes to their lifestyles.”
    How do you force them?

  11. You can prevent pre-diabetics from become diabetic in a very short period of time. You can get people to stop smoking and realize benefits quickly. What you’re suggesting is that we are a stubborn nation that can’t change, so we need a workaround instead. Chronic conditions make up 75% of our healthcare spending Peter. Most chronic conditions are preventable. There is no faster way to drive down costs than to treat current and prevent future chronic conditions. Budgets don’t change that.
    Your wonderful public program called Medicare is having a horrible time with it’s Demonstration projects. The main reason is because the beneficiaries are not compliant with treatment plans and not willing to make all of the necessary changes to their lifestyles. How is Medicare for All going to change that?

  12. Deron, the true and transparent cost will be seen if there is a dedicated tax for healthcare, both at the federal and state levels. I’m not advocating using the taxpayer as a blank check, like Wall Street/Detroit is, I’m advocating a public system to reduce costs and save us money. But we will need budgets with a public system or it will fail as is the MA plan. If you think our unhealthy habit culture is what is driving costs then you will chain yourself to the approaching 20+GDP for healthcare. Not sure if that scares you or not.
    Even if you could make a dent in eating/exercise/pollution/smoking habits how long do think it would take before enough people did it enough for a significant period to make a difference? You’d also have to fight marketing/lobbying efforts by American food and other industries. As with global warming, we don’t have that much time, especially given the explosion in charity care due to the economy.

  13. Dr Kaplan, I appreciate your dedication to open discussion, which I believe is not as common as it should be among leaders of health care organizations. I also support your call for reforming the payment system.
    I appreciate your clarification of your comments on “profitability.”
    I am not trying to quibble, but I still have a problem with your emphasis on trying to produce yearly operating surpluses. I certainly agree that a not-for-profit that consistently runs deficits will not long survive, and hence not be able to fulfill its mission. I also agree that it is nice for a not-for-profit to have an operating surplus in a given year, because it does make it possible to invest it in new capital spending.
    But how is putting a priority on having an operating surplus (or net margin) each year different from trying to be “profitable?” It does seem to mean your thinking has become focused on making money, which is not the same as being focused on the health care and academic mission.
    Could not you fulfill your mission most years by keeping to your budget?

  14. Peter – I’m not sure how taxpayers are going to see the true cost of healthcare in their taxes. Are you suggesting that the government is going to have to breakout the amount of taxes attributed to healthcare? We’re already paying several trillion in taxes each year. I’m not sure another trillion or two is going to have much of an effect.
    The taxpayers and employers are already exposed to our high cost system through higher insurance premiums. There hasn’t exactly been an uprising to contain costs. You have to understand that containing costs is a responsibility of every American, but few are willing to admit that.
    I guess I’m just concerned that you are putting too much faith that a government run system is going to make everything better. Unfortunately, it’s not. Our society is simply not comparable to the comparison companies with single-payer. If you looked at chronic condition rates, gun violence, teen pregnancy, etc. you would see just how different our country is. We are all about excess and excess is why we are where we are today. I think Bill McGuire was a crook, but guys like him are only a small fraction of the problem. I’m more concerned about the other 95% of the issues.

  15. “Despite my very supportive board of directors, they will not allow me to lead our organization into bankruptcy by doing the right thing.”
    Gary, your above statement tells me you are trapped by the same money driven medicine the rest of us are prisoners of. The statement says there is plenty of room to introduce more cost cutting innovation, but because your hospital exists on billings you need to over utilize services to stay afloat and therefore add to the costs the rest of us pay.

  16. I am encouraged by the frank and open discussion. It is clear from people’s comments that we all have plenty of work still to do. It’s very important for me to chime in about a few comments here on the role of a not-for-profit board. Let me be the first to say our board and executive team are very focused on fulfilling our mission and vision on behalf of our patients and our community. This is our primary fiduciary responsibility.
    Also, profitability is not the goal, but a net margin is an essential ingredient. Our patients and community count on us to provide high-quality care; stay up-to-date with treatment and technology; employ smart, skilled medical professionals; and keep our doors open. We simply cannot do any of these things without diligence and prudence — and a net margin allows us to invest in our mission to improve the health and well being of the people we serve and our vision to be the quality leader in health care.

  17. Deron, yes I do pay taxes, in fact at tax time I send a check, not get a refund. If you look at the total mix of incoming money into the healthcare system (private & public) you see that both sides are paying way too much. My point above was that if we continue to allow the private sector to control healthcare because their income/profits depend on the creation of new profit centers, we will never get costs under control. Think about the dollars you would save if we spent 8% GDP on healthcare and not 16%+, think you’d have more disposable income, well maybe not because you are part of the system benefiting from the rest of us having to pay more than we should or could? If the government becomes the prime payer where all outgoing $$ is a cost not a profit, and taxpayers see the true cost of healthcare through their taxes, then the pressure will be on to reign in costs, not satisfy the profit motives of insurance companies, drug companies, device makers, hospital CEOs and specialists. We can then also turn to the other driver of health costs and that is sickness, which is looked on by the healthcare industry as an income driver not a cost to society.

  18. “it’s all considered an expense from a system point of view as the payer is the taxpayer”
    I’m starting to think you don’t pay taxes, Peter. Any taxpayer should find that statement chilling. It’s almost as if our paychecks offer a never-ending supply of funds to create all of these wonderful programs. Doesn’t sound much like freedom to me.

  19. Barry, until we look at healthcare as an expense not revenue or profit not much will change. That’s the advantage of a government run system, it’s all considered an expense from a system point of view as the payer is the taxpayer.

  20. “We, unfortunately, in the current payment system, reduce our profitability by doing the right thing. Despite my very supportive board of directors, they will not allow me to lead our organization into bankruptcy by doing the right thing.”
    Unfortunately, hospitals need to be able to sustain themselves financially. No margin, no mission. The incentives in the system, however, need to be changed. We need to move away from the fee for service payment model which rewards providers for doing more whether it’s effective and necessary or not. Bundled pricing for expensive surgical procedures would be helpful. For drugs, devices, tests and procedures that are not cost-effective, we should just not cover or pay for them. Anyone who wants those should self-pay. We also need tort reform that protects doctors from lawsuits based on a failure to diagnose a disease or condition as long as national (not local community) evidence based standards were followed. Interoperable electronic records could help to reduce duplicate testing and adverse drug interactions. Finally, much more widespread use of living wills and advance medical directives could drive down futile and often unwanted care at the end of life.
    At the very least, it’s good to see more focus on and recognition of the need to control medical costs rather than just throw billions more dollars at the same failed system to cover the currently uninsured and underinsured.

  21. Gary,
    I started a group on one of the professional networking site for the same purpose. Granted it does not have all the CEOs as member but it has over 100 member. We also created a site to discuss the Healthcare transformation in whole. If you want to check and drive the discussion, you are welocomed to read the mission at http://blogs.biproinc.com/healthcare
    Now here is the question however. Starting a group is relatively easy. The question is what have you done to reduce the cost and improve the access. I have been in the business of operation and quality improvement and strategy development. Have you looked into the ratio of manager to employees, ratio of clinicians to admin, the salary relative to other industries with same background, a good metric on quality control, accountability, the working hours of clinicians and non-clinicians…..
    The list goes on.
    I once had a VP (non-healthcare) complain all the time how things are broken and he is surrounded by incompetent. finally, I could not take it and asked him..with his power what has he done over the half decade. Goes without saying, he had made a career about creating projects to fix problems but never did and upon time he was the bottleneck to the solution.
    I will be honest I get worried when we create the groups, action committees…Why do we not build the momentum thruough action rather than through groups, committees, etc.
    Pls note that I am not picking on you or any other leader, I am just trying to say that it is time for leadership and action. CEOS have the power and the resources to bring about the fundamental changes with relatively little effort. If anyone is really willing to create best operations: quality, access, speed, etc, I would be more than willing to work with them in achieving the objective
    rgds
    ravi
    http://www.biproinc.com

  22. Roy:
    And Virgina Mason is a trophy property in the class of “coordinated” and/or “integrated medicine” elite….what does that say about all the others who are relentlessly fighting each for more of the depreciating health care dollar, amidst a declining share of a better paying patient mix?
    Where is the patient care mission in that cross current?
    Thanks for the boardsource reference and reminder of the non-profit board legal responsibilities.

  23. You said, “We, unfortunately, in the current payment system, reduce our profitability by doing the right thing. Despite my very supportive board of directors, they will not allow me to lead our organization into bankruptcy by doing the right thing.”
    You are surely right that the current system for paying hospitals (and physicians) is irrational, and need to be changed. You are right that often we are paid less to do the right thing.
    However, profitability should NOT, repeat NOT be your main concern. You run, as far as I can tell (see this link: https://www.virginiamason.org/home/body.cfm?id=93), a not-for-profit organization. Thus, your goal should be to fulfill your mission, and to try to raise enough funds to do so well.
    Your organization’s stated mission is:
    “Our vision is to be the Quality Leader – Our aspiration is not to be the biggest, but to be the best. We will differentiate ourselves on the basis of quality.
    Our mission is to improve the health and well being of the patients we serve – Healing illness is our first priority and is what gives our people the energy for our vision. We are also committed to providing a broad range of services that improve one’s sense of well-being and which prevent illness.”
    (See link here: https://www.virginiamason.org/home/body.cfm?id=121 )
    That all sounds good. I’m sure you are trying to fulfill it. But if your board is more worried about your “profitability” than fulfilling that mission, they are violating a fundamental duty of the board of a not-for-profit organization, the duty of obedience, the duty that requires “board members to be faithful to the organization’s mission. They are not permitted to act in a way that is inconsistent with the central goals of the organization. A basis for this rule lies in the public’s trust that the organization will manage donated funds to fulfill the organization’s mission.”
    See http://www.boardsource.org/Knowledge.asp?ID=3.364
    If your board does not understand that duty, they need to. I believe that ethically at least the CEO and other officers of the not-for-profit organization also have a duty of obedience.
    The notion that not-for-profit hospitals ought to put profits ahead of mission is the kind of bad thinking that was all too prevalent in the last 20-30 years in health care, and was probably a major reason why we are in the current crisis.

  24. Bravo! I commend your commitment, and lead. Health reform is inevitable if only for the perfect storm of a MBS/derivatives driven global economic meltdown, and the swelling ranks of the uninsured, and growing pools of under-insured Americans.
    The employer sponsored model has outlived it’s utility. We have more health plans and insurance entities including their TPA breatheren all with hands in the till, than we need.
    A handful of regulated public trust type, non profit insurers (a la Swiss model), will do. No more cherry picking, risk shifting, slicing and dicing of benefit plans, and the torrent of under-disclosed marketing efforts to sell these “affordable” products to a poorly informed public.
    The “diminishing returns” value of comprehensive plans, due to higher deductibles, increased coinsurance, expanded non covered services, capped benefits, retroactive underwriting, “mother may I” obstacles to care, etc… is nothing compared to the projected carnage we can expect from so called “limited benefit plans”, or their poorly understood discount medical plan alternatives, who target the uninsured.
    Hospitals must evolve beyond the clusters of operational silos that compete and rarely coordinate their down lines. Horizontal communication is too often the exception rather than the rule.
    Hospital medical staffs (aka a club of independent contractors) typically defend their turfs from a para-military (but w2 employed)organized nursing staffs, too often completed by temporary laborers via per diem pools.
    The non profits must give back more than merely counting their Medicare, Medicaid, Bad debt write offs, in exchange for their “community benefit” tax exemption.
    Roll it all up, and it’s not a very pretty picture. Inefficient, yes. In need of reform, absolutely.
    One can’t separate the financing component from the delivery piece. They go hand in hand.
    http://www.twitter.com/2healthguru

  25. “We, unfortunately, in the current payment system, reduce our profitability by doing the right thing.”
    That is reducing utilization where the results go to insurers or the bottom lines of corporate plans. This is why reforming healthcare with a free enterprise insurance model will not work – the innovators don’t benefit. With a single-pay system and universal budgets savings go to the tax payer and if structered right could reward hospitals and their staff for cutting costs.

  26. Dr. Kaplan,
    I admire your effort and your intention to improve the healthcare system. I’m especially interested in how you would describe what hospitals and doctors should be prepared to give up vs. the status quo for the greater good. Also, some more color on payment reform would be useful. Are we talking about episode pricing (one bundled payment) for expensive surgical procedures? Robust price and quality transparency tools that would be accessible to both patients and referring doctors? Pay for performance? Evidence based medicine? Comparative effectiveness and cost-effectiveness based payment criteria?
    As you well know, doctors drive virtually all medical spending through their decisions to admit patients to the hospital, order tests, prescribe drugs, refer to specialists, consult with patients and perform procedures themselves. It’s hard to envision reform that significantly improves value for money without doctors’ leadership, commitment and cooperation? With their decades long history of trying to stifle competition at every turn, why should they respond differently now?

  27. I realize many physicians obtained MBAs and many became CEOs over the past several decades. I admire them including Dr.Gary Caplan -the author of this blog piece.
    But I believe that the era of viewing the “former profession” of medicine as a business and using business models and business lexicon is over.
    This is also true of the “former professions” of law and journalism.
    We have seen the excesses of the unbridled free market applied to professions causing them to fail and lose their moral footing.This deification of the free market, ironically, is even backfiring badly on business itself as we are currently witnessing in daily headlines.
    It’s all cyclical.
    Welcome back to a renewed era of the noble profession on Medicine.
    Dr. Rick Lippin
    Southampton,Pa

  28. “Despite my very supportive board of directors, they will not allow me to lead our organization into bankruptcy by doing the right thing.”
    One of the best quotes I have seen about the reality of the challenges confronting our health care “system”.
    Great post.

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