Saturday, March 12, 2005

Re: Managed Care CEO Blames Patients for High Costs

My additional thoughts on the post below by Roy Poses regarding Harvard Pilgrim CEO Charles Baker's brilliant idea of using patients themselves to "control medical costs" (i.e., increase his organization's revenues), as presented in the Boston Globe:

"To the credit of the [Boston] Globe, the article provided some pithy dissent. Katherine Putnam, President of Putnam Machinery Co, responded that too much "healthcare spending goes to administration, not to providers of care. Furthermore, administration "would be an easy thing to cut."

I think a better piece of dissent came from my alma mater, Boston University:

Alan Sager, a Boston University professor in the School of Public Health, said employees should not be responsible for lowering costs. ''We send doctors to medical school, so they learn what care we need," he said. ''You can't use patients as kamikaze pilots in a cost control war."

An apt description. Sure, let's depend on patients to decide how they can best deny themselves care. Brilliant! Let's examine Mr. Baker's clinical and scientific credentials:

Charles D. Baker is President and CEO of Harvard Pilgrim Health Care, Inc.... before coming to Harvard Pilgrim, Charlie was president and CEO of Harvard Vanguard Medical Associates. Previously he spent eight years in Massachusetts state government, serving as Secretary of Administration and Finance, and Secretary of Health and Human Services during the Weld and Celluci Administrations ... Charlie received a Master’s degree in Management, concentrating in Public Administration and Finance, from Northwestern’s Kellogg School and a B.A. in English from Harvard College.

While I make no specific comments on Mr. Baker, not knowing him, in my exposures to healthcare managers who have no expertise in healthcare sciences or actual patient care experience, my observations have been that of arrogant people who believe an MBA precludes the need for any knowledge of the nuances of healthcare itself in providing healthcare leadership.

This overextension of expertise, based on false assumptions (e.g., that medicine is a widget-making business like McDonald's), and underestimations (e.g., of the complexities of medicine), remind me of potential follies such as a chairman of a Department of Neurosurgery (brain surgery) who's only trained in accounting, or an automobile mechanic only trained in fixing televisions.

For example, I learned quite a lot when I was a senior medical resident. I was faced with three near-simultaneous code 30's (cardiac arrests) in the ICU, during family visiting hours, while a Mennonite minister-in-training was trailing my team. I learned much from when I was part of the resuscitation team on New Year's Eve 1986 when one of my colleagues, Abington hospital's fertility specialist, was brought in with a gunshot wound to the chest from a home intruder. I performed open chest heart massage while the ER trauma surgeons worked frantically in vain (the bullet had severed the aorta) - while having to evaluate and admit nearly thirty other very sick medical patients that same night. And when I, as a doctor, had to report to a clinical colleague who was phoning from his father's funeral that his mother, also my patient, had just passed away moments prior (I spared him this sad news until later, only saying on the phone that there was "no change" in mom's condition.) And when, on a hunch, I repaired a CT scanner via fixing its computer in the wee hours of the night between Sunday and Monday (when the company who made the machine stunningly provided no service) and prevented a lumbar puncture (spinal tap) from being performed on a young, delirious patient who turned out to have a hydrocephalus (massive fluid buildup in his brain) which could have resulted in a fatal brain injury had the spinal tap been done.

Tell me where those with book-study Master's-level degrees in business obtain better judgment on medical affairs than clinicians who've gone through tough doctoral and postdoctoral-level training in the most intense of clinical environments.

In the healthcare information technology (IT) sector, I've personally observed millions of dollars being thrown down the drain needlessly through such arrogance and lack of clinical knowledge in the IT decisionmakers. I've heard about hundreds of millions more from others, including the national press (see my other posts on this blog such as about the University of Pennsylvania CPOE problems for links to such stories). The differences between those specially-trained for clinical IT leadership and those trained in business IT is quite large.

Who can convince me that the decisions by non-medically-trained, business-oriented healthcare executives are any better than that of the CIO's they hire?

Could it be that the MBA club has become a type of cult, and that "MBA Mysticism" and "Management by Magazine" (fad) is harming healthcare -- not to mention other industries?

-- SS

1 comment:

Judith Nudelman said...

I worked for Harvard Pilgrim for almost twelve years. Luckily it was the more humane entity of RIGHA when I first started, which went bankrupt and was bought by Harvard Community Health, which then merged into Harvard Pilgrim. The final years I worked there (before they abruptly declared the Rhode Island and South Eastern Mass Health Centers a business failure and shut them down), the management specialized in blaming the physicians--providers, in their corporate speak--for never working hard enough. We had little control over our work environment, and responsibility without authority was demoralizing, a recipe for burn-out. Physicians' professionalism was utilized as a method to coerce us into working harder, and complaining was considered unprofessional. So blaming the victim, having health care decisions made by managment who never got their hands dirty, it's a Harvard Pilgrim tradition. I hear their ads on TV: "The best health care plan in the nation." Says who.