Deathcare Reform

This July our hospital begins a new phase in healthcare reimbursement.  In July we begin to get dinged, or rewarded, for "performance." Specifically, we will be financially incentivized by our ability to send home patients who are "completely satisfied." You may recognize that phrase if you've purchased a car or had one repaired at a dealership in the last few years.  It works the same for them.

The changes coming in healthcare are unbelievable.  Many of the changes which have evolved over the past 20-plus years of my career have been for the better, to be sure. And many of those proposed in the coming era of "accountable care" and "pay for performance" may also be for the better.  And I need to be clear here: the "better" I am referring to are the improvements which provide for fewer mistakes in care, healthier patients, and a better work environment for all involved.

The imposter in healthcare reform is that piece which is driven by those many corporate interests which look at healthcare as an industry with a significant capacity to generate, non-profit or otherwise, lots of money for someone. "Lean" ideologies which promote greater efficiency and cost savings in manpower and supplies are solely directed at the financial bottom line. These formulas have been demonstrated to work well in manufacturing as measured in profit. Greater efficiency, fewer "FTEs" ("employee" is too uncomfortable a term. It's easy, fun, and tres chic to "reduce FTEs" as opposed to firing people), purchasing groups, outsourcing, these moves cut costs and increase profits. In healthcare all of this is marched forward under banners which read "quality," "safety," "outcomes,"and "patient satisfaction." I guess the banner which reads "happy people" has been copyrighted by some other marketing interest.

Into this contemporary mix of modern healthcare and reform comes news of the recent death of Dr. Kevorkian, the infamous Michigan pathologist who promoted and practiced the belief that the terminally ill should have the right to die.  His passing gives me pause to wonder: In spite all of the controversy and moral outrage over the right to die movement, how long will it be before the "healthcare industry" recognizes the financial value and necessity of such an option and begins to advocate the very same philosophy? "Dignity in Death" or "Accelerated Terminal Care" or, perhaps, "Compassionate Closure." My God!  What a marketing bonanza.  But why, you ask, would healthcare reform take this direction? Because, like so much of everything else in U.S. healthcare, it's the money.  With 10,000 people a day turning age 65 it doesn't require a mathematical genius to calculate the financial burden we will be facing with care of the elderly in 20 years. People are living longer then ever before and many with greater disability requiring more care (read: "expense").  When it becomes financially unfavorable to provide decent care for the burgeoning population of elderly maybe it will give rise to a well marketed movement in healthcare to promote and offer euthanasia as a viable part of compassionate, patient centered, cost effective healthcare.  As a colleague of mine suggested, perhaps insurers will approach families of these expensive patients and offer them a deal:  Let Mom go and we'll not only provide her a comfortable end, we'll provide a cash settlement on her remaining actuarially adjusted years of care. Home run!  

So, I look forward to see how this all evolves.  As in so much of contemporary American life, I don't think it's the government we need to fear.  The death squads will be formed and staffed by those with a financial interest in your life, health, and longevity.

Historically it was the physician who looked after your health and physical well-being.  I have to believe that was Dr. Kevorkian's motive in his efforts to promote the right to death with dignity.  Next time around it will be the industry. And the industry will provide all the compassion and care financially feasible and allowed by law. And you will be completely satisfied.