Paul Taylor is CEO of Ozarks Community Hospital, a teeny 2 hospital system catering to the poor and senior populations in rural Missouri and Arkansas. He thinks that he’s figured out a way to deliver health care at government rates and is incensed that every other hospital claims it can’t make it on what Medicare pays. (That’s they I call him a renegade–I don’t mean that his hospital is called “Renegade”!) He also gets much less from the local Blues than he does from Medicare for the same services.
I wrote about Paul a while back and he sounded like a guy with interesting ideas on how to fix health care. So I called him up to see if he would be a good interview–and he didn’t disappoint!
Categories: Matthew Holt
Paul Taylor noted that fee for service reimbursement to specialists in hospitals provides an incentive for over-utilization and that maybe bundled reimbursement would be more cost effective.
If hospital peer review was more effective, more can be done about over-utilization.
One indication that hospital peer review needs to be fixed is the fact that almost 50% of hospitals in the u.S. have never reported a physician for a clinical privilege sanction
to the National Practitioner Data Bank, which opened in Sept. 1990.
Matthew,
You need a better microphone.
Mr. Taylor is basically advocating a return to the 1950’s and 60’s. That was the last time we had single payor, the patient. That is the only single payor that works. It has to be the patient who is the payor.
He clearly said we need to empower the primary care doc. That can only happen if you declaw the plaintiff attorneys. If the primary doc or extender is not lawyer proof, then you will have patients tested as we do now. Another point for Mr. Taylor.
It is also clear that Mr. Taylor, who employes and therefore supervises physicians and directs there actions, cherry picks patients. His hospital only provides services that it can provide at a profit based on expected payment. The expensive patients are shipped out. The only way that is legal is to not have the equipment and the staff to provide the service inhouse. If you can provide the service but transfer a patient based on expected payment you have violated EMTALA.
Mr. Taylor wants payments bundled to include physician payment. Right now federal law forbids doctors from discussing fees and payment contracts.
And last, if Mr Taylor gets paid by Medicare more than by Blue Cross it can only be due to Blue Cross seeing no reason to have their subscribers go to his hospital, coupled with a higher than normal Medicare payment due to political considerations of an underserved area with few physicians in the first place.
Mr. Taylor is basically Canada. He runs his hospital like Canada.
The patient has to be the payor and the primary care doc must be lawyer proof.
Thanks Matt- We need examples and CEOs like this. Although this is an atypical setting.
BRAVO!
Dr. Rick Lippin
Southampton,Pa
Interesting interview, and Kudos to Taylor for making his hospital work with limited resouces. But on the scale he is working, with only 35 beds, 1,2000 admissions and less that 100 inpatient surgeries yearly with no obstetrics and with his primary care docs sending 50% of their cases to other places, one would argue that Ozark Comm Hospital is not a microcosm of the American healthcare system, but rather a small atypical corner of the universe. Still, an interesting discussion and I thank you for posting it.