HealthCommentary

Exploring Human Potential

Is Tenet Healthcare Your Collection Agency?

Posted on | January 18, 2018 | No Comments

Mike Magee

When America’s politicians and business leaders elected to promote a free-enterprise approach to health delivery services in the immediate post-WWII period, they were choosing a course diametrically opposed to not only our Allies, but also our enemies at the time.

We rejected serious health care planning. Instead we chose to directly and indirectly infuse taxpayer dollars into the hands of entrepreneurs running research enterprises, hospitals, insurance companies, medical journals, medical schools, pharmaceutical companies and more. Remarkably, we did this while our own military leaders were simultaneously executing well-thought out implementation of national health delivery systems in Germany and Japan as part of rational nation building efforts.

Now, nearly three-quarters of a century later, we have stubbornly held on to the myth that “defeating disease” will leave health in its wake, and that “scientific progress” is synonymous with “human progress”. Course corrections, now in their third and fourth and fifth iterations have failed to correct for complexity, disparity, high cost, high variability, and poor outcomes including declining life expectancy.

Where simplicity and proper national planning are obviously called for, we instead are forced to witness ever expanding institutional gymnastics in the pursuit of compensating for the absence of appropriate “checks and balances” and the raw pursuit of profitability at the cost of our own mental and physical well-being.

Consider for example that medical debt is now a $75 billion affair spread over 43 million people, and that billing (including verifying coverage, eligibility, coding and documentation) is now a $24 billion market in the U.S.

Crazy, right?

But it gets worse. Case in point: Tenet, the Dallas-based for-profit hospital network that has “for-sale” signs up on many of its’ hospitals to get out from under $15 billion in debt. They have quietly shifted 5% of their assets to Conifer. That name may be unfamiliar to many, but the subsidiary names of Central Financial Control and Syndicated Office Systems LLC are all too familiar to many burdened with medical debt.

Tenet’s Conifer employs 15,570 people to harass Americans owing money to 77 Tenet hospitals. That’s bad enough. But the venture has been profitable enough, with profit margins double those in health care delivery, that they now contract services to  700 other hospital nationwide including many non-profit Catholic hospitals.

If harassing patients forced into debt by absent or skinny health plans with high deductibles and TSAs  isn’t your cup of tea, consider the joy of trying to run a hospital that routinely struggles to secure grey-market access to standard supplies like IV solutions or morphine. The Martin Shkreli’s of the generic world, working with entrepreneurial zeal in our Wild West version of a health care system, have finally caused traditional American health care leaders to go radical.

Consider the fact that Carolyn Clancy, now running Veterans Health Administration, and Don Berwick, along with former Senator Bob Kerrey, have signed on to a plan, led by the vaulted Intermountain Healthcare System based in Salt Lake City, to launch their own generic drug company. As the system’s CEO says, “We are not going to lay down. We are going to go ahead and try to fix it.”

Good luck with that – fixing complexity with one more step in the chain. Seems counterintuitive to a leader like Don Berwick who thirty years ago, channeling Deming, favored eliminating steps to improve quality and lower cost, rather than adding steps. It was Deming who famously said, “Quality begins with the intent, which is fixed by management.”

What is our intent?  To answer this, we need to do what all others did as their nations struggled under the chronic burden of disease returning after WW II. We need to ask the very basic question, “How do we make America and Americans healthy?” An honest response will require both universality and solidarity on a national scale.

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