Each day, patients trust physicians to make decisions about how to best treat illnesses. Physicians trust hospitals to provide them with the most effective medicines and medical equipment. Hospitals trust manufacturers to produce the most reliable, innovative healthcare products. Together, the healthcare industry shares a responsibility to honor this trust by abiding by the highest ethical standards.
Successful ethical standards help ensure that relationships among these healthcare actors are appropriate and transparent. Relationships between manufacturers and providers yield mutual benefits that positively affect patient outcomes. But when financial relationships that could influence decision making are established and not disclosed, a line has been crossed that can shatter patient confidence and damage credibility in an industry that depends on maintaining trust.
Understanding this reality, a groundswell of disclosure initiatives have started to emerge.
Universities such as the University of Pennsylvania and large hospital systems like the Cleveland Clinic recently started voluntarily disclosing all manufacturer payments to physicians. The top five makers of hip and knee implants have agreed to disclose all payments to physicians, and Eli Lilly, GlaxoSmithKline and Merck say they will follow suit next year. The Pharmaceutical Research and Manufacturers of America and the Advanced Medical Technology Association, two of the largest associations representing drug and device manufacturers, respectively, strengthened their codes of conduct related to gifts and other payments, and will make public the list of members who abide by the new guidelines. And, most recently, Senators Charles Grassley (R-IA) and Herb Kohl (D-WI) have re-introduced the Physician Payment Sunshine Act that would require manufacturers to disclose payments of value to physicians.
These and other disclosure efforts, when effectively executed, create transparency and can drive a more empowered culture of ethics. But today's efforts are not as comprehensive as they could be.
Trust requires that virtually every healthcare industry organization create a systematic process to ensure that all dimensions of this critical issue are thoroughly addressed.
Healthcare companies need to be regularly measured against their industries' ethics codes. Codes of conduct and the measures created to ensure compliance must be publicly disclosed. Participating companies should be benchmarked against one another to identify gaps and best practices. An external oversight body of experts in the field should provide input into the ethics and compliance process. Information about ongoing compliance should be publicly reported on a regular basis. And clear and understandable rules should be developed to punish those who fail to comply.
The Premier healthcare alliance, a healthcare group purchasing organization (GPO), has a high-level commitment to transparency, best practices in accountability and business ethics. Demonstrating that commitment, Premier led an effort to form an effective voluntary ethics oversight organization called the Healthcare Group Purchasing Industry Initiative (HGPII). HGPII provides a model for other healthcare organizations in creating a comprehensive, self-regulating program.
Developed with guidance from Kirk Hanson, a longtime consultant to industry ethics efforts and professor of business ethics, HGPII exhibits key elements of an effective voluntary effort. HGPII requires participants to follow six core ethical principles. Adherence to the principles must be documented in an annual accountability questionnaire, which is reviewed by a third-party ethics expert and updated or expanded each year to ensure it is reflective of emerging issues and ethical best practices. All responses to the questionnaire are posted publicly on the Web.
HGPII members must also participate in an annual Best Practices Forum to share business conduct practices with other GPOs and representatives from government or other organizations. HGPII plans to expand the current model to be governed by a third-party external advisory board, and to embrace third-party auditing. Failure to follow the HGPII recommendations carries the penalty of expulsion, which would raise questions about that GPO's commitment to ethics and affect its ability to attract customers.
Through HGPII, we have learned that industry ethics that are reinforced by external oversight, measurement, and reporting are effective. With HGPII's transparent system, the public can evaluate financial and business interactions to ensure they are in the best interest of hospitals and patients. In this way, GPOs are earning greater levels of trust.
Many healthcare organizations have implemented ethics programs and strategies, but the current climate demands industry-wide efforts, such as those undertaken by HGPII. Anything less will fail to convince a skeptical public that we are worthy of their trust. We need to commit to extra efforts to reassure consumers that we are serious about enforcing ethical behavior, and that we are doing everything possible to avoid impropriety.
With concerns about integrity at a critical point, and with a national healthcare debate on the horizon, we must ensure trust in the current system. We must heal ourselves first.
This is becoming one of those "get over it" moments for healthcare professionals. You can resist the notion all you want; the fact is patients more and more see themselves as consumers, and that's not necessarily a bad thing.
Sure, you might look back fondly on those paternalistic Marcus Welby days, when a patient not only knew his doctor's name, but took the physician's word as gospel. But the good Dr. Welby was canceled a long time ago, and today far too many people have limited access to care, or their employers are shifting more of the cost onto them.
With large employers, like GM, wrangling to get out of the bad business of paying for healthcare, it probably should not have surprised me that our new HealthLeaders Media Industry Survey reports that top healthcare executives say consumer-directed healthcare offers the best hope for the industry. (See below.)
Survey responses of 1,119 senior healthcare executives: In your opinion, which model offers the best hope for healthcare?
33.6% - Consumer-directed healthcare
25.11% - Government-mandated universal health insurance
21.89% - Government-funded universal healthcare
9.92% - Employer-sponsored healthcare
9.47% - Other
Many private global providers have recognized this shift and have developed a value equation based on service excellence, quality, and cost. Here in the States, there are patient-centered care movements that combine the best of quality care and consumer engagement, but too few hospitals and medical groups have the vision or wherewithal to design these kinds of experiences.
Whether to call them patients or consumers might sound like a debate over semantics. Far from it. I read recently a humorous essay on the Aggravated Doc Surg blog on this topic. The self-described general surgeon and blog author takes the idea of healthcare consumerism to the rhetorical extreme by wondering what healthcare infomercials might look like. (As a related note, at a recent conference a healthcare marketer seriously floated the idea to me of infomercials to promote medical tourism.)
This physician blogger—and there seem to be more of them every day—sums up his argument this way: "It is my privilege and duty to care for people who come to see me—as patients. There is a respect involved with that term which is absent from the term consumer, and which is important in maintaining the dignity of the individual as he or she interacts with physicians, hospitals, and other places where medical care is delivered. When we lose that perspective—when physicians are seen only as 'providers,' or interchangeable widgets, and when patients are seen only as 'consumers'—we will have totally lost any semblance of dignity as a profession, and by extension, as a people."
That might be a powerful emotional appeal, but then everyday experiences with the healthcare system are pushing people to see themselves not as patients but as consumers. I'll give you a couple of anecdotes from personal experience, but I bet you have plenty of your own.
As a healthy Gen-Xer (I turned 37 earlier in February), I can say honestly that even though my employer provides good health insurance, I've always had to be a mindful healthcare consumer for myself and my young family. When I visit a primary care physician, the impression I get is that my visit is costing the doctor money. He runs through his assessment as quickly as possible and makes a point to remind me that I don't need to schedule another visit for at least two years. The last time I saw him was about three years ago, and I'm really in no rush to go back anytime soon.
And I will never forget the tone of my son's pediatrician when we told him we were concerned about our toddler's development. We said that our boy, then only 3, seemed resistant to his peers, hypersensitive to sound, and was fixated on numbers and maps. This experienced senior physician dismissed our observations as he checked a few boxes off my son's chart. "Yes, I bet he knows all his shapes and colors by now, too," he said. It was more than a year later when our son's preschool teacher suggested that we have him tested for Asperger's syndrome.
Don't forget that we are among the fortunate ones who have health insurance, and I hardly consider these hard-luck stories. The fact is that I'm just like most people. When it comes to my health, I have to do my own homework and make my own decisions. When it comes to my kids, I end up getting the best help and useful information from teachers and non-physician providers. The tired notion that as a patient I have some special connection with a physician who partners in my health is an alien concept. I don't blame physicians for this; it's just the way the system has evolved. As a result, I have no choice but to be a conscientious healthcare consumer.
Consider this: In a down economy, U.S. employers are saying they cannot keep up with the cost of healthcare, and paying an average of $8,482 per worker for health coverage puts them at a competitive disadvantage globally. For the first time, American workers in 2008 on average paid more than $1,000 for employer-sponsored insurance coverage, according to benefits consulting firm Mercer, which is up 17% from $859 in 2007. What's more, the high-deductible, consumer-directed insurance trend is only expected to escalate in the coming years. Employers want workers to pick up more of the healthcare tab so that they will make smarter and more cost-effective health choices.
Healthcare consumers are a big part of the future of healthcare, and providers will need to interact with them in new and innovative ways.
Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at rjohnson@healthleadersmedia.com. View Rick Johnson's profileNote: You can sign up to receiveQualityLeaders, a free weekly e-newsletter that provides strategic information on the business of healthcare management from around the globe.
Atlanta-based Grady Memorial Hospital has announced 150 job cuts, in response to severe economic pressures and an increase in indigent patients, officials said. Among those who left was the head of the hospital's cancer center. The job cuts included about 140 layoffs, and about 10 positions that were not filled. The laid off included staff in the departments that focus on purchasing, nurse scheduling, and legal services, and also include one ultrasound technician.
Martin Luther King Jr. Hospital in Los Angeles would reopen in three years with an emergency room and inpatient services under a tentative agreement that would substantially improve access to care in one of the most underserved areas of the nation, according to officials. Under the plan, worked out in negotiations among Los Angeles County officials, the University of California and representatives of the governor, the hospital would be operated by a new nonprofit entity governed by a board equally controlled by UC and the county.
HCA Virginia has sued the Loudoun County Board of Supervisors for denying its application to build a 164-bed hospital, saying that the board's vote was "arbitrary, unreasonable, capricious and illegal" because the state health commissioner had approved the hospital's location. The lawsuit extends a long fight over a project that HCA proposed in 2002, and it marks the second time the company has sued the county board over its rejection of the plans.
Mayo Clinic officials have announced that it barely broke even in 2008 as expenses raced ahead of revenue. While the number of patients was stable, income from patient care fell by almost one third during the year. Mayo also increased spending on research, adding staff, and opening a hospital in Florida. Expenses grew by 7.6% while revenue grew 4.5%.
Massachusetts officials gave final approval to regulations banning pharmaceutical and medical device companies from providing gifts to physicians, limiting when companies can pay for doctors' meals, and requiring companies to publicly disclose payments to doctors over $50 for certain types of consulting and speaking engagements. Health officials said the rules are the most comprehensive in the nation; Massachusetts is now the only state to require disclosure by device makers, as well as drug companies, and just one of two states to make disclosures public, officials said.
Two Kansas City-area hospitals will modify their facilities as part of a settlement of class-action litigation in Florida against HCA Inc.-owned hospitals under the Americans with Disabilities Act.
Menorah Medical Center and Overland Park Regional Medical Center have agreed to make alterations to accommodate individuals with mobility, visual, or hearing impairments. The settlement is one of many entered into by HCA-owned hospitals across the country in the last several years.
Charlotte, NC-based Carolinas HealthCare System reported a net loss of more than $551 million for 2008, driven by significant investment losses and higher interest expenses. The system's investment losses for 2008 totaled $538 million. At the start of 2008, Carolinas HealthCare officials had anticipated gains of more than $100 million on the system's investments, or an 8% return.
Responding to warnings of a looming doctor shortage, existing medical schools are increasing enrollment, and new ones are opening or under development across the county. Medical school expansion plans are rushing ahead despite the severe economic downturn, even in the battered home of the nation's struggling auto industry.
