Why one-third of hospitals will close by 2020

Why one third of hospitals will close by 2020

For centuries, hospitals have served as a cornerstone to the U.S. health care system. During various touch points in life, Americans connect with a hospital during their most intimate and extraordinary circumstances. Most Americans are born in hospitals. Hospitals provide care after serious injuries and during episodes of severe sickness or disease. Hospitals are predominately where our loved ones go to die. Across the nation, hospitals have become embedded into the sacred fabric of communities.

According to the American Hospital Association, in 2011 approximately 5,754 registered hospitals existed in the U.S., housing 942,000 hospital beds along with 36,915,331 admissions. More than 1 in 10 Americans were admitted to a hospital last year.

Hospitals make a substantial imprint on local economies. In many communities, hospitals represent one of the largest employers and economic drivers. Of the total annual American health care dollars spent, hospitals are responsible for more than $750 billion.

Despite a history of strength and stature in America, the hospital institution is in the midst of massive and disruptive change. Such change will be so transformational that by 2020 one in three hospitals will close or reorganize into an entirely different type of health care service provider. Several significant forces and factors are driving this inevitable and historical shift.

First, America must bring down its crippling health care costs. The average American worker costs their employer $12,000 annually for health care benefits and this figure is increasing more than 10 percent every year. U.S. businesses cannot compete in a globally competitive market place at this level of spending. Federal and state budgets are getting crushed by the costs of health care entitlement programs, such as Medicare and Medicaid. Given this cost problem, hospitals are vulnerable as they are generally regarded as the most expensive part of the delivery system for health care in America.

Second, statistically speaking hospitals are just about the most dangerous places to be in the United States. Three times as many people die every year due to medical errors in hospitals as die on our highways — 100,000 deaths compared to 34,000. The Journal of the American Medical Association reports that nearly 100,000 people die annually in hospitals from medical errors. Of this group, 80,000 die from hospital acquired infections, many of which can be prevented. Given the above number of admissions that means that 1 out of every 370 people admitted to a hospital dies due to medical errors. So hospitals are very dangerous places.

It would take about 200 747 airplanes to crash annually to equal 100,000 preventable deaths. Imagine the American outcry if one 747 crashed every day for 200 consecutive days in the U.S. The airlines would stand before the nation and the world in disgrace. Currently in our non-transparent health care delivery system, Americans have no way of knowing which hospitals are the most dangerous. We simply take uninformed chances with our lives at stake.

Third, hospital customer care is abysmal. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours. Name one other business where Americans would tolerate this low level of value and service.

Fourth, health care reform will make connectivity, electronic medical records, and transparency commonplace in health care. This means that in several years, and certainly before 2020, any American considering a hospital stay will simply go on-line to compare hospitals relative to infection rates, degrees of surgical success, and many other metrics. Isn’t this what we do in America, comparison shop? Our health is our greatest and most important asset. Would we not want to compare performance relative to any health and medical care the way we compare roofers or carpet installers? Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost — all of which will be necessary to compete.

What hospitals are about to enter is the place Americans, particularly conservative Americans cherish: the open competitive market. We know what happens in this environment. There are winners and losers.

A third of hospitals now in existence in the United States will not cross the 2020 finish line as winners.

David Houle is a futurist, advisor and speaker and Jonathan Fleece is a health care attorney, advisor, and speaker. They are the authors of The New Health Age: The Future of Health Care in America.

Image credit: Shutterstock.com

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  • http://www.threehourmidlifecrisis.com/ Dike Drummond MD

    I can see 1/3 of the hospitals closing and that not causing a large disruption in the provision of needed services. Here’s what seems more scary to me.

    The remaining hospitals will buy up the surrounding independent doctor’s practices in order to assure referrals for the surgical procedures that are the most profitable. Doctors will tolerate this temporarily until they tire of the hospital not coming through on their promises … then they will quit and need to go independent again. This see-saw will cause a big disruption in the quality and availability of care in the next decade … at the same time Medicare and Medicaid needs double.

    That’s my prediction … and everyone is looking at the same black box between now and 2020. Fingers crossed,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

      Hospitals have been buying up independent practices, mismanaging them and then giving them back to the principals for thirty years in my community. They bought and gave back some practices more than once in some cases. They will call the new organizations ACO’s and repeat the mistakes of the past. The difference is that today the employer- insurance company cartels control the patients and no one has a physician anymore to be their advocate and look out for them as the system based errors and mishaps occur and complicate their care

      • Anonymous

         Wow, all those dead patients and none of them are mine.  I must be the god of Medicine.  So if patients only see a podiatrist for all of their health care then we will all live forever, because none of my patients have died under my care.  Do you really believe that healthy people wake up dead in a hospital or do you think, maybe most of them are on deaths door step and the “errors” that kill them are the choices between 2 options equally likely to have an ill fated ending and when that ending occurs everyone believes the other option would have been better.
        There is NO free market in healthcare.  It looks to me like 5010, ICD 10, EHR, ERx, CPT globals and the very fees paid by so called private insurers are handed down gratuitously by the federal government.  There is no free market option except for the uninsured, which the federal government has vowed to eliminate.

        • Michael T Lyster

          No, no: I’m sure they were all pictures of health, and just walked into the hospital after a brisk 8 mile run, and then,—*voila*—dead guy.  Well put, Dr Garfield.  

          Would that any of the detractors of our admittedly FLAWED health care system exhibited even a fraction of the perfection that they expect of us all.  What would that be like, to have the correct answer always and forever?  Must be quite a burden, yes? 
          I’m sure that just ONE more layer of policy/procedure regulations and administration will fix all of these problems, however: because nothing improves healthcare more definitively than more management and regulations.

  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    How can Kevin let extremists such as these on this website, poor form kev. 

    • http://twitter.com/ThompsonAder Thompson Aderinkomi

      Even if he is an extremist, it produced good conversation that leans more towards the middle. Without statements like this, these types of conversations will not happen in any setting.

    • Michael T Lyster

      Yes, good point: let’s restrict this ‘free speech’ thingie that people keep talking about. Otherwise, some people might think, and even EXPRESS incorrect thoughts!

  • ckbm

    It is a tragedy to think that this many hospitals may be forced to close, badly affecting access to care.

    Let’s take a look at some specifics of this article.

    “100,000 people die annually in hospitals from medical errors.  Of this group, 80,000 die from hospital acquired infections.”  Um, hospital acquired infections are NOT medical errors.  They are complications.  There’s a difference.

    The authors then use the entire 100,000 figure to compute their numbers in the next paragraph, which belittles our nation’s excellent hospitals and providers of care.  Those 80,000 infections are included in that number.  We should be able to agree that not 100% of hospital acquired infections are preventable.  Some, certainly, but not all.  Patients are in the hospital because they are SICK.  Many are immune suppressed or victims of trauma.  Many have surgical wounds.  Some of those patients are going to have infections, no matter how hard we try.  We as physicians resent the implication otherwise.

    If you have a problem with the ER wait times, I wonder what you will think when all those hospitals (and their ERs) close.  The authors might consider the effects of EMTALA on wait times.  What other American business would tolerate being forced to provide services to anyone that walks in the door regardless of whether they can (or will) pay?  What are the statistics on the number of patients receiving non-emergent care through the ER, good sirs?  The authors might also consider that ER charting with a (mandatory) EMR also extends wait times, because it takes longer than paper charting.  Maybe more ERs would help cut wait times – but, no, remember that 1/3 of hospitals will be closing – not likely the number of ER’s will be going up…

    “Any American considering a hospital stay will simply go online to compare hospitals…”  Yes, that’s what most patients do when they are unconscious from a stroke, in the midst of an MI, or trapped in a wrecked vehicle after an MVA.  Uh-huh.

    Good sirs, you should not be celebrating the weeding out of what you consider bad hospitals.  You should be concerned about where you will get your health care for your emergency in 2025, especially if you live in a poor, rural area.  But you probably don’t, do you?…

  • http://twitter.com/PortiaChalifoux portia chalifoux

    There’s an erroneous assumption that hospitals serve as the foundational crux of American healthcare.

    Actually, public health infrastructure and programs rightfully serve (or should) that function.

    Viewing the optimal life as one with a long life of high quality and wellbeing, followed by a rapid and steep trajectory toward death instead of a long suboptimal state of chronic illness/disease with lower QOL, public health initiatives do the most to achieve the former, while hospitals poorly serve the latter.

    If I had my druthers, I’d prioritize funding public health programs which serve everyone and which focus on conditions of healthy living: clean air, fresh, potable water, safe housing, fresh and whole foods accessibility and availability, accessible/affordable/reliable public transportation, adequate public schools and libraries, green spaces/walkable areas which provide easy access to shopping, education, work and social/civic places, and which focus on disease prevention (vaccinations, contagious diseases) and general well-being (health literacy, social support and engagement).

    Since we already have a great deal of infrastructure to address these fundamental societal health needs, I suggest we do not allow special interests and politicians to do any further damage to it and to demand reparations and strengthening.

    Where to start?  The CDC, FDA, HHS and CMS, plus the EPA on the federal level, state departments of health and your local community and/or county health department are all deserving of your attention, support and vigilance.

    • http://www.facebook.com/timrichpt Charles Timothy Richardson

      Great comment, Portia. I agree that the the annual Medicare Physicians’ Fee Schedule congressional circus sideshow has sidetracked politicians’ attention since 2003 when their attention would be better spent on funding public health priorities such as the ones you mention.

      I would just add to your list one public health issue that can be broadly characterized as “behavioral health” that tries to persuade people and their families to choose lifestyles that promote healthy outcomes, such as low-fat diets, more exercise, smoking cessation and alcohol moderation.

      This, more than additional high-cost hospitals and clinics, will lead to Americans enjoying lower healthcare premiums and better health outcomes.

      Thank you,

      Tim Richardson, PT
      http://www.PhysicalTherapyDiagnosis.com

  • Anonymous

    Where’s the 1/3 figure come from? Out of the sky?

    • Anonymous

      Americans who do not work in health care are pretty unaware of what is going on these days.  As an RN with a very close friend in Hospital Administration (not where I work), I believe this writer/MD made a fairly accurate prediction in both his 1/3 forecast, and the approximate time line projection. It is too complex to try to explain how the competition set into motion by our government will cause this outcome. I’ve done extensive reading on this subject, and I recommend that everyone does at least some reading about the bonus incentives, the hospitals that will not get reimbursed for patients who need to be re-admitted within 10 days of discharge, etc., etc.               

  • Anonymous

    futurist? is that some kind of psychic?

    • Anonymous

      Glorified daydreamer.

  • http://pulse.yahoo.com/_6C65YWGCC7P5C6CGMMBK7VMFXE JenniferL

    The Magic Eight Ball says “One Third.”

  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    it is truly despicable that you refer to medicare and medicaid as federal entitlement programs, these are the most desperate neediest people who are part of these programs, we should toss them all to the wayside and allow private market forces dictate their care. I guess that works for conservatives who financially independant, and could careless for retired people with multiple medical problems or the working poor barely scraping by. That is currently being done by private insurance right now and it has paid huge dividends for them, their shareholders and NO ONE ELSE. Being a futurist, i’m sure you  are able to correctly predict the stock market and have made a fortune so its easy for you cast aside those who rely on federal funding for their healthcare needs. Others are not as fortunate. The last thing we need is a man from the future(in the year 2000)  and an attorney dictating the direction of healthcare. 

    • Anonymous

      By description Medicare and Medicaid are entitlement programs and if they were instituted with out the huge compromise to the “free market” or rather “free lunch” back in 1965 by the AMA and hospitals, with the subsequent rise of for profit health insurance we might now today have a model healthcare system that incorporates an appropriate place for capitalism and for a shared social responsibility -ie “we the people”.  

      But…  it got really messed up by Greed over the years – by the so-called Medical indurstrial complex - hospitals, Big Pharma, a lot of specialists, more technology, Big Ag and crony capitaliism and those who abuse both their bodies.   So we are in deep do-do now.  

      I think we need to work with ACA instead of making “despicable comments about it” - use it as a spring board into a health care system.  There are a couple of countries that don’t have what is often referred to as “socialized” medicine – take Switzerland and Taiwan – the latest countries to overhaul what they had.   

      Lots of things will change because of technology, because of our debt because of good ole American innovation.   And individually we have to change to – mostly how we take care of ourselves and don’t treat medical care as a “free lunch”.   But no country other that the U S would consider not taking care of their elderly, their poor and those who have a rare disease.   They all want to keep their systems – even with the warts and the few (not that many) who can afford and choose to seek out a world class physician or hospital elsewhere do.  And it may not always be the US.

    • Michael T Lyster

      Dear Vikas:
      Read a book. Start with Economics 101.
      They are entitlement programs by definition.  That doesn’t mean they should be discarded; it DOES however mean that they are flawed and subject to distortions induced by political expediency rather than efficiency.  My average patient is over 60, so: I think I’ve a little insight into this subject.  Medicare is shabbily managed, and rewards Inpatient care at the expense of independent outpatient management. WHy? Control. Plain and simple.

      If efficiency and equal access was the true goal, then the VA system would have been dismantled and folded into Medic are/Medicaid decades ago. But, it’s not: preserving political patronage and leverage, and preserving ITSELF are the goals of that program. Similarly every ‘initiative’ that Medicare undertakes, allegedly to improve access, or eliminate waste, or save the unicorns or whatever nonsense they come up with next. 

      If you choose to comment upon healthcare, perhaps eliminating the “it’s either Medicare, or the evil rich will let Gramma die!” angle from your posts would be useful. It’s tiresome, inaccurate, and stunningly anti-intellectual.  

  • http://www.facebook.com/Eric7480 Eric Cox

    Interesting theory, but as someone who has worked with over 40 hospitals in the Georgia area, I can honestly say that I don’t anticipate more than 13 of them closing their doors in the next 8 years. Almost every organization has had to adapt and trim the fat, but for the most part it has been streamlining processes and evaluating cost.  Also even though some of these hospitals may not have the best track records you have to take demographics, location, and patient education into account.  Patients who do not often have any fiscal responsibility will not spend any additional time to educate themselves on which hospital is the best.

  • http://twitter.com/Hootsbudy John Ballard

    I don’t recall coming across a hit piece on hospitals before. This is pretty shallow, something of a bull in a china shop. 

  • James Sinnott

    I can see that number of hospitals closing in Georgia I believe all these small hospitals less than 100 beds will be unable to produce the data or keep up with the technology.

  • Anonymous

    “For centuries, hospitals have served as a cornerstone to the U.S. health care system.”oh for heaven’s sake – if you bothered reading beyond this patently false sentence you branded yourself a naif. 

    Is the KevinMD brand worth a plugged nickel anymore?

  • Anonymous

    I do believe that the hospital industry isl going through dramatic changes.   My money is on consolidation to change the hospital landscape.  In most urban areas we are over bedded with duplicative, expensive services, while there is a shortage of accessible healthcare in the rural areas.  I would hope that the industry will adopt a hub and spoke model where consolidation puts a hub hospital with all the high tech capacity in the center of the wheel with smaller, albeit sophisticated clinics with some bed capacity for overnight observation.  In addition to expanding accessibility to more rural areas, satellite clinics would serve as the base for home care which would push healthcare delivery down to the patient’s home. 

    As our country ages, the demand for support that keeps people in their home for as long as their quality of life permits will require that primary care be brought into the home using nurse practioners with mobile diagnostic capabilities and teleconferencing capabilities back to the primary care physician located at the satellite clinics or the specialists in the hub hospital.  The existing model is not sustainable for economic and manpower reasons.  All the technology exists.  The challenge will be to create incentives to motivate individual to pursue primary care careers, and to overcome institutional challenges where communities and governing boards are so completely invested in preservation of their institutions to the detriment of effective and cost effective healthcare.

  • ICHawk11

    “Third, hospital customer care is abysmal. Recent studies reveal that the
    average wait time in American hospital emergency rooms is approximately
    4 hours. Name one other business where Americans would tolerate this
    low level of value and service.”

    The DMV.  The post office.  The courts that take years to see a case for the first time.  Just about any government agency that one has to go to these days.

  • http://twitter.com/hockeygrrl13 Jen Kwasny

    A four hour wait in an emergency room…is that the average or are we only looking at hospitals where the ERs are being utilized as urgent care or as a primary care source.  Many hospitals in metropolitan areas have those waits due to patients using them incorrectly.

    • http://profile.yahoo.com/MW6VKD3DDOXPKCVA5HM4V6M4QM j d

      I can’t think of a hospital where the emergency room ISN’T being used as urgent/primary care, metropolitan or not.  It’s just that the metro hospitals tend to have a higher patient to physician ratio.

  • Anonymous

    Where does the “third” come from? Nothing to back up that argument.

    Plus, the long wait at ER is mostly due to the fact that 30% of the US population do not have health insurance. So if they need to see a doctor for any reason (even if they have just a headache or if they just need medicine) they go to the ER because the clinics won’t see them without insurance or payment, bur the ER has to treat ALL patients that come in, with or without insurance.

    Universal healthcare would allow that 30% to go to clinics instead of the ER, and significantly reduce wait time as well as employee time and money spent on healthcare as ER visits are much more costly than a regular doctor’s visit. (Thousands of dollars compared to $200)

    • drjani

      the 30% will only been seen by a doctor if there are appointments available and doctors are willing to take the Govt controlled healthcare. All doctors are so busy that most of them do not need to see new patients except the few recently graduated doctors.
      Its a tsunami coming with healthcare
      Thanks to Obamacare it will get worse

      • Anonymous

        Yes you’re right, the new system will increase demand for primary care physicians greatly.

        I wasn’t trying to claim that Obamacare would solve all of our healthcare problems. I was only focusing on the ER use and money spent on emergency care, which will be reduced significantly.

        It will create other problems such as doctors will get paid less, and will have to work longer hours, etc. Many people outside the industry think that doctors make a ton of money, but that’s just a generalization based on old history. Doctors used to make a ton of money, but their pay nowadays is much less than it used to be, and especially if you calculate their pay based on the number of hours they work, you realize that a lot of doctors make less per hour than other healthcare workers like nurses. For instance an ophthalmologist in a big city, where there is a saturation of ophthalmologists, makes less than $100K, but with being on call and all, can end up working up to 80hrs/week. That would be comparable to a $50K income for a 40hrs/week job. Doctors go to 4 yrs of college, 4 yrs of med school where they rack up over $250K of debt in student loans, then do residency for 3-4yrs where they get paid $50k/yr and work up to 100hrs per week. If they would like to specialize further that’s another 1-2 years of fellowships. By the time they are done with their training, they really do not want to get paid less and work longer hours than they already do.

        I believe there will be a push for offloading some of the doctors’ duties onto other professionals such as nurse practitioners or physician assistants.

        On the other hand, there are a ton of private clinics (family medicine, like the one I go to) where they are never busy, they can always get me in the same day, etc. That’s because they do not accept anyone without insurance. They are always looking for more patients and referrals and I am sure they wouldn’t mind accepting the government insurance as long as it is half decent and they could easily accommodate their share of that extra 30%.

        The specialists on the other hand will present a challenge as some of them already have several months of backlog.

        • Michael T Lyster

          “Have to work longer hours”?  Really?
          Newsflash: we trade hours of our lives for money, just like everyone else. If that equation changes substantially, I will choose to spend MORE hours at home with my lovely wife, or take up fishing, and FEWER late hours seeing patients.  These pat ‘well, you’ll all just have to put in a little more time’ answers neglect basic human behavior and basic microeconomic behavior, as well.  

          Look: if someone paid me $1000/hour, I’ll work 110 hours a week. If you pay me $5/hour, I quit. In between those points, it’s a variable time:income relationship, that varies by individual. To expect that you will buy MORE physician time with LESS money in the aggregate just about violates the laws of physics: if it were true, then pay physicians $1.00 per hour, and we’ll work forever!  Not so.

          Enjoy Obamacare, if it passes constitutional muster.  I’ll be down at the dock, working on my casting.

  • http://www.facebook.com/mark.a.shackelford Mark Shackelford

    Very thought provoking article, but the whole premise as summed up in  the sentence “What hospitals are about to enter is the place Americans, particularly
    conservative Americans cherish: the open competitive market” is naive.  Moral indignation of the majority of society nor the power to boycott was never enough alone to effect change historically (by itself).  Change comes only when it is beneficial for both the controlling principals as well as the people the institution serves.

    I really do like the  200 747′s crashing analogy.  Perspective.

  • Anonymous

    I’m not sure I agree with your pronouncement on the future of hospitals, but I do have an issue with two points in your article:

    -  The JAMA article you cited was published in 1999.  To my knowledge there has not been an updated study since that huge wake-up call.  I’m not a ‘hospital person’ but I know that in the last 10 years, hospitals have made substantial inroads in medication safety, spending millions of dollars on computerized systems and other fail-safes to minimize adverse drug events.  I bet that if the study was conducted today, we’d see a reduction in needless deaths. 

     -  Your stat on ER waiting times is probably not too far from reality.  However, as you know, the triage process ensures that emergent patients are given first priority and care.  You also didn’t mention the large number of patients, who clog our country’s emergency rooms with conditions that aren’t emergent and which – in many cases – they’ve had for several weeks. This points to a lack of understanding by the patient of what constitutes a true emergency; access issues with primary and urgent care; relatively low cost-sharing for ER visits which removes any disincentive from using the ER as a PCP; and as mentioned in another comment, the uninsured.  In South Florida, hospitals advertise on billboards their real-time ER waiting time – not that I agree with this tactic, but it speaks to your consumerist view.

    Finally, I take exception to your comment regarding the “low level of value and service” a four-hour waiting time seems to convey to you.  The sophisticated level of care provided by highly trained professionals in our emergency rooms – especially given the number of truly non-emergent conditions, as well as the relatively low out-of pocket cost when compared to the true cost of the services – contradicts your point.

    • Anonymous

      Our book is full of up to date research that could be helpful.  Regarding “low level of value and service” the point is more directed towards Americans who use the ERs to treat the common cold.  That is like going to a 5 Star Restaurant for a snack on someone else’s nickel in many cases.  ERs should be dedicated to highest and best use to control health care spending.

      Jonathan Fleece – Co-Author “The New Health Age”

      • Chelle80

        And it is those who use the ER to treat the common cold who wait 4 hours to been seen . . . This information is being used to the author’s advantage in one part of the argument and ignored in the other . . .

  • Anonymous

    What’s the average wait to see a futurist without an appointment on a emergency basis at 3 in the morning? 

    • Michael T Lyster

      “Ummm…I’ll need to get back to you on that. Sometime, in the FUTURE.”

      Sincerely,
      The Futurist

  • aelfheld

    “[...] America must bring down its crippling health care costs.”

    Easy enough.  Get the bloody government out of it.

    • Anonymous

      The New Health Age will be full of more private / free market opportunities than ever before.  It is already happening.  The government won’t ever “get out it” but systems are being put in place to shift more to the private sector. 

      Jonathan Fleece – Co-Author “The New Health Age”

    • Anonymous

       Hello, I’m not sure what people mean when they make comments about the “Government” running health care, tell me if I’m mistaken, but CMS (centers for medicare/medicaid services) is a Federal agency, and ALL hospitals report to it and are paid reimbursement through this “Government” agency, and ALL health plans are subject to DMHC (department of managed health) oversight, also a, “Government” agency…. Check your resources people and wake up to the reality of what has been ,”Government” ran health care…

  • Michael Hattori

    As a healthcare provider working in a hospital, I do agree with your assessment of the economic demise of many hospitals. However many of your other “facts” are overblown and presented in an alarmist fashion which is I feel is deceiving to the public.

    For instance, your claim that hospitals are the most dangerous places to be in US and the “statistical” figure of 100,000 deaths per year from medical “errors” and that 80% of those are hospital-acquired infections is misleading.  An infection is NOT a medical ERROR!! Noscomial infections are, indeed, a major problem in hospitals, but they are most decidedly not the result of an error of judgement, which is how the average person would intepret “medical error.” Get it straight!

    And I agree with the others who have stated that 4-hour waits in ERs are not the result of poor care standards!! It is a result of people using the ER as a one-stop shop for minor ailments which do not require emergency services, such as colds (for which nothing can be done in the ER), sore throats, headaches, and the like. THEY are the ones responsble for creating 4-hour waits, not the ER staff, who are usually busting their butts. 
    Such dramatiziation is not only misleading, but irresponsible. And BRAVO ckbm for your response!

    • Anonymous

      The point here is not to play the “blame game”.  Our book does nothing of the sort.  The goal is to layout the changes that are occurring in health care and present the research as to why our times are so transformational.  The book helps people prepare, understand, and succeed in a new era. 

      The research from our book supports that the 100,000 deaths are attributable to errors.  Other infection rates are captured elsewhere in the data.    We totally agree with your point about ER wait times.  That is why many incentives are coming to encourage people to seek out other alternatives to ERs.

      Jonathan Fleece – Co-Author “The New Health Age”

      • Chelle80

        If you did not intend to play the blame game, perhaps you should use less inflammatory wording when discussing the 4 hour wait time. By pointing to this as an example of poor customer service, you certainly seemed to imply it was the fault of the ER staff. Please do more research and more thinking before giving this impression to the general public. They already think they are entitled to see a doctor in the ER immediately for their cold and you are not helping.

  • Anonymous

    “Such change will be so transformational that by 2020 one in three hospitals will close or reorganize into an entirely different type of health care service provider.”

    “A third of hospitals now in existence in the United States will not cross the 2020 finish line as winners.”

    What’s it take to be a futurist Mr. Houle?  Like others I didn’t see a validation of the “one in three” prediction and the author while noting the reorganization component of the 1/3 … doesn’t address what reorganization (including M&A) options might bring us. 

    Actually … every single HCO ought to be adjusting its delivery model as the market moves if it is to advance improved clinical outcomes within its budgets.  Has nada to do with 2020 … its got to be done all the time.  With any luck … all the government run HCOs will be in that 1/3 category.   

    As for the 200 crashing 747s … that’s weak hyperbole and in addition to being flawed use of the numbers is typical alarmist.  If you call yourself a futurist … define what the future picture will look like rather than publishing this weak perspective that could be written by a high school freshman. 

    • Anonymous

      Agree.  Speculation requires little data, but achieves great effect.

      It’s also been my experience that the number of field “experts” inversely correlates with the certainty of field knowledge.

  • Anonymous

    As a futurist I do research on the present, look to the past and then integrate with dynamic trends to provide forecasts.  So when Jonathan and I researched with book, we spoke with several hospital administrators that said there was a 25-35% excess capacity today in US hospitals.  We looked at the growth of wellness that will lead to few hospital visits.  We looked at the invevitable connectivity that is coming to hospitals which will lead to price comparison, performance information, knowledge of infection rates and the fact that in some cities such as Dallas, new hospitals are being built which increases supply on top of the excess supply that exists.  When supply increases and demand decreases, the competitive market will make for the less competitive hospitals to close.  We also researched the huge disparity in pricing of procedures in the country.
    All of this leads us to intelligently forecast what we did with this column.
    I am a futurist but I feel that I am the messenger of a future bad news that many don’t want to face.

    David Houle

  • http://twitter.com/ThompsonAder Thompson Aderinkomi

    Even if one disagrees with the rhetoric, the statistics, and the prediction (and perhaps the title of futurist) the main message is true. If our healthcare systems is making any type of positive progress hospitals in their current form closing or changing will be undeniable evidence that people are getting healthier. I think the 2020 prediction is inaccurate because large systems are difficult to change. Most of the current so called innovation in healthcare is skewed in the favor of maintaining the old and expensive ways of doing things. ACO’s are merely an incarnation of other failed attempts improve the health of this country by making minor changes that make most stakeholders happy which end up not changing anything at all.

    • Anonymous

      The economic tipping point is now.  By 2020 1/2 of the federal budget will be Medicare unless health care costs go down and Americans get healthier.  Health care systems will be rewarded for this outcome.  Hospital beds will transition to life coaching centers as one small example.  Corporate America can’t continue to pay so much for health insurance either.  Think of how quickly the financial markets responded after Lehman Brothers.  When the tipping point hits, things change fast.

      Jonathan Fleece – Co-author “The New Health Age”

    • Anonymous

      I disagree with your assertion that closing hospitals is indicative of a healthier populace. Rather, I believe it to be a result of a system in which it often costs a hospital more to treat the patient than they are paid. In my state, Alabama, the past several years have seen the closing of 3 hospitals within a 75 mile radius of my home; this in a state that regularly ranks as one of the worst by most measures of population health. We have created an environment in which the payor, when there is one, decides how much treatment they are willing to pay for, irrespective of how much treatment the patient needs. On top of that, even when a hospital is paid for a service they can’t really count on keeping that money because the carriers (led by CMS) are constantly looking for excuses to take money back (even money that was earned years ago). Those patients who are able to pay are, understandably looking for the best and most up-to-date facilities possible and choose the hospital that has the most bells & whistles, yet investing in facility and technology upgrades is vastly expensive.  Hospitals are now being forced to look at expansion if they want to survive. The worst part of that scenario is that they must now consider not what the true NEEDS of the community are, but rather what will be most profitable.

  • Anonymous

    Speaking from Brazil, I think that the same theory is valuable to us. Ours hospitals are in a similar way than the north-american ones, despite a litle retard. I think this change is very good, despite of the potential reaction from the doctors. I think doctors are too much conservative. The societies around the world need to fight against the maintenance of the medical stablishment like it is today. I speak it as a doctor. Doctors need to change theirs mind quickly, to adapting themselves to a enviroment of meritocratic competition. This is a good deal to the society.

    • Anonymous

      Agreed.  As discussed in our book, David Houle and I outline why the next decade could create the most profitable and life changing time for physicians who understand and adapt to the change.

      Jonathan Fleece – Co-Author “The New Health Age”

  • http://www.facebook.com/emilie.ratterman Emilie Ratterman

    All I can say at this point is Wow. I heard that in Dayton, Ohio a new hospital is being built and a outpatient medical center is being expanded to add quite a few inpatient beds. A lot of money is being spent on upgrading the look of hospitals as well as these above mentioned projects. I assume they are anticipating we baby boomers to fill them up. You are only talking about 8 years away for the closings, so if this is going to come to pass, they are being quite short-sighted.

    • Anonymous

      Just because one new hospital is opening in Dayton Ohio doesn’t change the dynamic and transformational shifts that are occurring as part of The New Health Age.  RIM did not necessarily reposition fast enough after the iPhone hit the market – it kept manufacturing the same old Blackberries.  That didn’t undo or prevent the change from occurring.  Using the iPhone as an example, ponder how much the device has changed the world in less than 8 years.  The pace of change is accellerating.

      Jonathan Fleece – Co-author “The New Health Age”  

  • Zeke Hat

    One thing that could resolve many hospital & physician issues is transparency. Each hospital should clearly state how many deaths occurred due to error and infection. Physicians hate transparency unless it works in there favor. Read all the physician responses below, they blame every entity but themselves. I remember when they used to show up in cigarrette adds.

    • Anonymous

      Transparency is coming to health care.  In a major way.

      Jonathan Fleece
      Co-Author New Health Age

  • http://www.facebook.com/people/Betty-Johnson/100001023551494 Betty Johnson

    A third of the hospitals in this country have already closed.  In Tulare County, California, in 1975, there were 8 hospitals.  Today there are 3 and the population of the county has doubled.  This has been the case  throughout California.  Hospitals are not as dangerous a place as the author suggests.  Medicine is still an art; patients still play a key role in their own care (check the stats out on how many patients follow their doctor’s advice) and statistics on hospital outcomes can’t possibly control all the variables.  For instance, private surgical hospitals that don’t take Medicaid patients or the uninsured will invariably have better outcomes than the public hospital taking all comers.  A private dialysis clinic in our county, owned by several Nephrologists, only took insured, compliant, non-medically compromised patients into their unit while referring all other dialysis patients to the publically owned hospital clinic.  Guess which clinic had the better outcomes and the higher satisfaction ratings.  That said, public hospitals can’t use that as an excuse not to ramp up their customer care efforts as well as their quality to the highest level and they are focusing on those issues.  The issue of cost is the single biggest issue facing our health care system.  Competition has not decreased cost or increased quality as proponents believed it would.  The opposite has occurred, at least with cost.  With 17% of our GDP now allocated to health care, our global competitiveness as well as our own standard of living is at risk.  The Health Care Reform Act did not address this issue, in fact it will become worse with insurance companies predicting a 30% increase in premiums by 2014.  The key to solving the health care cost problem lies with aligned incentives (like in the Kaiser system), a revamped payment system (allowing nurse based primary care clinics to bill for their services and re-allocating physician payment for parity between interventionalists/specialists and primary care doctors, and bringing some accountability to the patient for the decisions they make regarding their own health.  Absent those changes, which won’t come easily, we can expect a health care system to muddle on with increasing cost, increasing complexity and mediocre outcomes.

    • Anonymous

      Great post!  Generally consistent with our book!

      Jonathan Fleece
      Co-Author New Health Age

  • http://WiredPen.com/ kegill

    A friend just shared this article with me. My response:
    * The first stat re deaths is from a journal article published in **2000**.
    JMA, Vol 284, No 4, July 26th 2000  by Dr Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public HealthIt got a lot of attention at the time and there have been reports of changes in practices, especially in the case of preventing infections. There are also a lot of studies which report that there are no uniform, agreed-upon reporting requirements. And a 2004 RAND study suggests that a team of three doctors generally do not agree that all reported as “preventable” deaths were, in fact, preventable: rand.org/pubs/reprints/RP133.html

    That said, research seems to consistently point to ‘variability’ — in other words, the range of care seems too great. See sciencedaily.com/releases/2008/04/080408085458.htm

    [excerpt]
    The study says, “…more hospitals than ever are pledging to report their performance on safe practices and have agreed to not bill for preventable medical errors. Healthcare professionals are witnessing that zero defects is in fact possible.Progress is being seen. We now have convincing case studies that perfection is possible when will to change and improve is present and the effort is made to implement new practices. [end excerpt]

    * Are hospitals really the element pushing up the cost of health care in the U.S.? The authors provide no evidence for this (or any other) claim. Check out Kaiser data: kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx

    * Why are ER waits so long? Many Americans use the ER instead of a GP. Our population continues to grow, but the number of Emergency Rooms continues to shrink. From 1997-2004, the number of people visiting ER increased by almost 20%; the number of hospitals operating 24-hour ERs dropped 12%.

    Also, remember, an ER must accept a patient, regardless of ability to pay — someone has to pay that, and it’s the folks who are covered by insurance. Otherwise, the hospital and the ER has to close. 

    Oh, and that claim appears to be from a Yale study using 2006 data. Or maybe it’s this study, using data from 1997-2004 (which I cited): 
    washingtonpost.com/wp-dyn/content/article/2008/01/15/AR2008011501545.html

    What possible reason could the authors have to writing an article designed to elevate fear and anger? (1) They’re selling a book. (2) They’re selling their services. FUD is the universal lubricant for both.

    [Note: I have removed the http:// from the two links to minimize the chances that this comment will be caught by spam filters]

    • Anonymous

      The goal is not to solicit fear and certainly not anger.  We cite much of your same research in our book.  Our post and the book simply present the facts, based on the research.  We outline various frameworks of what will be … not because of us … but because of all the societal and free market changes.  Thanks for the comment.

      Jonathan Fleece
      Co-Author New Health Age

  • http://pulse.yahoo.com/_CLOEBQXPZSTRDBJ6X25LHZNCAI InferiorityComplex

    The financial drivers are the only obstacles in our healthcare system and I do agree in free markets, however the idea that 33% of all hospitals will close in 8 years is absurd because American culture demands medical care, baby boomers are approaching old age and along with old age comes medical needs and finally Americans are extremely obese and only getting more so, with many health problems related to obesity, drug abuse and alcoholism……I do not see hospitals shrinking in numbers as drastic as 33% decline. 

    • Anonymous

      Don’t confuse or blur the future with the past. America can’t continue on this path.  Without change 1/2 of the federal budget will be Medicare $ by 2020 and American businesses will be paying $20K a year per employee for health insurance.  Things have to change.  Hospital sytems that transform to preventing disease and managing it will succeed.  Those who don’t will fail.

      Jonathan Fleece
      Co Author New Health Age

  • Anonymous

     I agree with several points in your article. 
    However, using the example of 747 plane crashes is a very poor
    comparison to hospital deaths resulting from errors.  Let’s say that the
    only pilots available to fly the planes have life-threatening
    illnesses.  Let’s further draw this out to say that no one knew they
    were sick until the ilness progressed to a serious point.  Now, cure
    them before they have to land the plane.  Oh, and try not to make any
    mistakes despite the fact that curing the illness is not an exact
    science and despite the fact that their illness presents with several
    amiguous symptoms or that it might be composed of a combination of a few
    diseases.

     

    Now, I agree that it would be better to discover that the pilots
    are sick before the plane takes off (or that a patient is sick before he
    arrives in the hospital).  …but please don’t compare every
    statistical hospital death to a routine 747 flight crashing. 

    • Anonymous

      The 100,000 reference is tied to medical errors, not death from illness or disease.  We are not playing the blame game.  It is time to acknowledge however that payors are ultimately going to reward the high performers.

      Jonathan Fleece
      Co-Author New Health Age

  • Anonymous

    There is a big difference between predicting change, and predicting closure. You seem to try to do both. Necessary change is obvious, and inevitable. HOwever its that change that will keep hospitals open, rather than close them.

    There has already been much consolidation, but there will need to be a center of healthcare in the comunity. There will need to be a place to train residents. These needs will not change.

    Hospitals will need to redesign their mission and the way they do business.  That’s happening already.

    You try to mix all ills into the operations of hospital – costs, infections, and easy shopping.

    You write like a pair of consultants with too much access to data, and not enough understanding of people or their motives. 

    Hospitals will undergo much change, and improvements in care are a always a moving target. 

    • Anonymous

      Thanks for the comment.  We are living and working in the trenches with physicians and hosptials every day during these changing times.  Some hospitals will close and the strong will transform.  We seem to be in agreement that the old model is over.

      Jonathan Fleece
      Co-Author New Health Age

  • http://profile.yahoo.com/OYB4Q2PKVXBB5ULS4ICAUDSTOQ Audrey

    While it is a slow process, hospitals are chaging. They have to in order to meet the demands of customers and regulatory agencies. There are several points the author makes that are questionable or require further consideration. First, the statistic of a 4 hour wait in the ED is not so much a symptom of an ineffective hospital as much as an ineffective healthcare delivery system that creates an environment where the uninsured use the ED as their primary source of healthcare. Anyone working in an ED ,especially in an urban setting, can attest to this. The second is the idea that consumers will pick and choose which hosptal they will geet their care in. In the current model, with network restrictions, not all hospitals or providers will be equally accessible. Healthcare consumers will, more often than not, stay within their network in order to keep their out of pocket costs to a minimum. Healthcare does not function in the same way as other industries in a free market economy.

    • Anonymous

      David and I totally agree with your point about the uninsured.  That is why we have to do something about the 50 million Americans with no access to health care.  Their dollars simply get shifted to places like the ER at a much higher cost.  Hospitals simply pass the cost along.  How about prevention and access like the community health center/FQHC model?

      Regarding the free market comment, “times are a changing”.  David and I are working with employer clients who are developing provider networks tied directly to high quality at reduced costs.  Employers are demanding more from the health care system. The free markets will ultimately prevail in America. 

      Jonathan Fleece
      Co Author New Health Age

      • Moulay Alaoui

        The burden is on society as a whole to educate and cooperate on matters of acquiring and providing care. An area of interest is in fact reducig unnecessary visits. Organizations are being penalized in the form of reimbursment loss for providing care deemed unsatisfactory to many parties involved.

        It is a shame that all the money spent on healthcare provision is still keeping the providers, including doctors, technicians and nurses, away from what they were supposed to do in the first place: caring for patients.

  • info

    Good article with many good points-except maybe the last one. The “free market” is one of the reasons health care in America is astronomically expensive.

    It goes like this: You NEED a product or service, therefore the providers of such products or services charge what they want.

    Anyone who’s been to a gas station lately can see this first hand.

    Don’t get me wrong–the free market is great for many things. Bubble gum, athletic shoes, Mazeratis, and cheese burgers are some examples.

    But when it comes to things that people either cannot easily do without or things that are the pillars of our economy (like banking) SOME well thought regulation is needed.

    • Anonymous

      To compete in the global marketplace, Corporate America has no choice but to drive down health care costs in the US.  Because so many Americans are unhealthy, businesses are willing to pay major savings to physicians for helping to make their workforce healthier.  10% of Americans cost 70% of the health care dollar.  Time to focus on the 10%.  This free maket example will change health care going forward. 

      The same movement is coming to Medicare ACOs and HMOs.  Manage and prevent disease and CMS will pay big $$ to physicians. I had one client come into my office with a $400K bonus check for 2011 wanting help with investments - and his patients are heathier than ever!

      Jonathan Fleece
      Co- Author New Health Age

    • Anonymous

      Not sure one can say the health care sector is a good example of “free market.”  There’s actually a powerful disconnect between customer and vendor (clinician) … the third party payer.  Healthcare suprainflation and the use of third party payers correlate historically.  Some argue that customer and vendor haven’t cared about fees because a normal market transaction has disappeared.  Neither really cares about the fee amount … the third party payer cuts the check.  (Thus the evolution of intrusive 3rd party payer UM actions.)

      I’m no expert.  Nevertheless, as I’ve listened, talked and thought much about healthcare systems over the years, I’ve grown to conclude that the best solution for rising costs is to ALLOW market forces back into the clinician/patient relationship.  This can be accomplished through high deductibles backed by good catastrophic coverage.

      The insurance industry, over the centuries, evolved as asset pool products to protect purchasing entities from risk associated financial failure.  Somehow, in healthcare, that concept was lost.  Instead, healthcare insurance has become synonymous with “entitlement,” and one that has subverted normal market forces upon price.

      End note:  I also think there should be a social safety net, for the benefit of society and especially vulnerable persons – taxpayer-funded public clinics.

  • Paul Snell

    Healthcare Business News

     

    “Hey, that ultrasound machine is for me!”

    Photo credit: Getty Images

    Outliers: Budget strains push U.K. waiting times

    By Modern Healthcare

    Posted: December 19, 2011 – 12:01 am ET

    Tags:

    Outliers, Policy, Public Health

    Sometimes it helps to be a sheep farmer. David Evans, a 69-year-old in
    southwest England, found an agriculture-centric answer to his healthcare
    dilemma.

    Related Articles
    More in:During a nearly yearlong wait for surgery to repair a hernia—a wait that
    should have been no longer than 18 weeks, according to guidelines for
    the U.K.’s National Health Service—Evans became so alarmed by the long
    wait that he used an ultrasound machine designed for pregnant sheep on
    himself, to make sure he wasn’t getting worse, according to the
    Associated Press.
    “I was in quite a lot of pain,” Evans said of
    his ordeal in Cornwall. “It really restricted what I could do around the
    farm since I couldn’t lift anything heavy.”

    Waits for care in the U.K. are getting longer, as the government is
    looking to trim about $31 billion in healthcare spending from its budget
    by 2015.

    In January, the government introduced a new health
    bill that many fear will bring even more draconian cuts and competition
    from private providers. The bill, now in the process of being adopted,
    will ax more than 20,000 health jobs in the next two years and shut an
    undisclosed number of hospitals, possibly including the iconic St.
    Mary’s in London, where Alexander Fleming discovered penicillin. And
    doctors and nurses are in revolt.

    If things don’t improve,
    Outliers wonders if others will be inspired by Evans and perhaps sneak
    off to a veterinarian for a consult.

    Read more: Outliers: Budget strains push U.K. waiting times – Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20111219/MAGAZINE/312199948#ixzz1pgPFOlkm

    ?trk=tynt 

  • http://profile.yahoo.com/RMYFRTN5TRULA4RLG2O3CQ6ZQA Diane

    Alot of the reasons we have expensive health care cost is because of Lawyers!  There is too much talk of law suits.  A person was in the process of losing his life and was revived to be in an ICU and cared for many professional nurses and health care personnel and survived Cardiac, Respiratory and Renal Failure because of these health care personnal, but due to these life surviving measures he developed a big bed sore even with all the postioning, special beds, special mattresses this happened and a family member decides that they want to suit because of this bed sore.  What makes any Lawyer feel he can take money from a hospital and from those health care workers that helped this person LIVE? 

    • Anonymous

      As a health care attorney who represents physicians and as the co-author of The New Health Age, I totally agree and support federal Tort Reform. David and I cite in the book that defensive medicine is a major contributor to the increases in health care costs.  Vote with Tort Reform in mind this November.

      Jonathan Fleece

    • Edwin Mercado

      - ” What makes any Lawyer feel he can take money from a hospital and from those health care workers that helped this person LIVE?”

      Let me get this straight.  You feel that a patient of a hospital should have no right to NOT BE HARMED while in it’s care?  They should just take what they can get, shut up and be happy.  Is that what you are saying?  Because that’s a pretty ignorant stance to take.

      I hope your kind of thinking (or lack thereof) never prevails.  As an employee of a major hospital, it’s my first duty to, above all, to take care of the patient and DO NO HARM. 

    • http://pulse.yahoo.com/_FUVMGQJPFNYLNUXLHEFE2DORP4 Dylan

      @Edwin, I think you need to read what Diane wrote a little more carefully and after a few anger management classes.  Diane’s point is that the pt in question was given life saving therapy and developed a bed sore as a complication of a protracted hospitalization in ICU – despite preventative measures.  The pt’s family, rather than appreciate the fact their loved one survived multi-system organ failure, sued for the bed sore.  Sounds like the family is either petty or greedy or both and the plaintiff’s lawyer doesn’t sound much better.  An estimated 10% of all tests ordered by doctors are solely for defensive medicine.  This is not a small hunk of change in the health care industry and needs to be addressed.

    • Anonymous

       The first thing any attorney has to prove is that HARM was done, despite all the measures in place to prevent it. HARM occurs with constant debilitation, and there may not be a solution!

    • Anonymous

      Yes, I am a health care attorney who supports Federal Tort Reform.  We also need to have more discussions within our families about end of life care and advanced directives.  We cite a study in our book that most Americans want to die at home yet a vast majority die in the ICU.  A total disconnect.

      Jonathan Fleece
      Co-Author The New Health Age

  • Anonymous

    The only thing for sure in the business of healthcare is change and upset people.  Remember how mad doctors and hospitals became with the advent of the DRG, Stark laws, HMOs, network contacts, regulations beyond reason and the list goes on.  Hospitals are still here, nessessary and will remain “in business” why?  When you need a hospital you need a hospital and nothing else will do.  The hospital is a gathering place for all specialties and a place where you will get care even if it takes 4 hours.  I think we should spend our time finding ways to build more hospitals, rebuild old hospitals and embrace the changes.  Let me be specific, our population is growing and becoming older. Cost is going up so a hospital can not afford staffing ratios of the 1960′s or 70′s but our technology saves more lives than ever before.

    As for the 747 they are old and being updated just like the old referbed MRI’s of today.

  • http://twitter.com/DiNovia DiNovia

    My question is this: Your article seems to mark health care reform in the “done deal” category but is this accurate?  The public rhetoric these days seems to be largely focused on abolishing any health care reform hinted at by President Obama and his administration while at the same time stripping women of their health care freedoms and rights. 

    Can we count on the health care reform act becoming law?  

    • http://www.facebook.com/martin.hague1 Martin Hague

      “Stripping women of their health care freedoms and rights”…. What a load of tosh. Your right to contraception is not under threat; your ‘right’ to have me pay for it is. Silly Obamabot.

      • http://www.facebook.com/people/Ailan-Medici/1409476759 Ailan Medici

        Which is cheaper?  birth control pills, or government care for unwanted and abandoned babies who most likely will continue the cycle of unwanted pregnancies when they grow up?

        • http://profile.yahoo.com/TEUORQZH7RRRSNKQRWN6KDFW6Y Tim

          Well then if ya wanna make babies go buy some BC pills!!!  Why the hell do I have to buy them for you???

          • http://www.facebook.com/people/Ailan-Medici/1409476759 Ailan Medici

            Because it’s cheaper than you paying for the upbringing of those unwanted babies – either through foster care or expensive subsidies for the poor, single mother to bring them up.  Or can you offer a better solution besides abandoning these babies on the roadside somewhere and letting nature take its course?

  • http://twitter.com/mhealthstrat Chris LeBeau

    I would be curious to hear if you feel that the increasing proliferation of mobile technology will aid in connectivity and push healthcare out of the hospital from an efficacy standpoint.  If we become better in the coming years at managing chronic disease and utilizing preventative health it would stand to reason that this will decrease demand for hospital beds.  

    • Anonymous

      You nailed it!  Yes, yes and yes.

      Jonathan Fleece
      Co-Author “The New Health Age”

  • http://profile.yahoo.com/LBMS7MM5D5JBZJCCNCSYMACM7Q Sam Favis

    “Third,
    hospital customer care is abysmal. Recent studies reveal that the
    average wait time in American hospital emergency rooms is
    approximately 4 hours. Name one other business where Americans would
    tolerate this low level of value and service.”The
    oversimplification of this one statement is mind-boggling. 1.
    You’re being extremely generous with the 4 hour wait time times.
    Unless things are vastly better everywhere else in this country, a 4
    hour wait for a non immediately life threatening condition would be
    considered generally lucky. 8-12 (sometimes 24 hours or more) is more
    like it. Of course if you go to the Emergency Room for something that
    is an an actual emergency, i.e. your life will be in danger if not
    addressed within hours or minutes, then your wait time will still be
    more like 20 seconds (or however long it takes a tech to get a
    wheelchair), but that’s not what ER’s are being used for in this
    country any more, They are being used as free, 24 hour clinics much
    MUCH more often than as Emergency health care facilities.2.
    ER’s are outpatient facilities. Meaning, you are not legally or even
    practically considered a hospital patient there. This is not a minor
    point and the dangerous inpatient facts you pointed out do not
    include or apply in any way to the care provided in the ER (there statistics may be better or worse, but we really don’t have good numbers for that). Just like
    if you file an application with a company, your not considered an
    employee until your hired, your not considered a hospital patient
    until you are admitted to a room on a hospital floor.3. ER’s
    are mandated by law to treat all comers without asking for a dime up
    front. They can’t even legally ask if you have insurance until after you’ve
    been at least screened by a health care professional. So, why do
    people wait 4-24 hours for care? Because you don’t have to pay for it
    (the bill, like the proverbial check, is in the mail). To quote you, name one other business in America that
    operates that way. If you don’t like the wait at the ER, go to a
    local Urgent Care, hand over your credit card, and you will likely be seen in minutes. Want wait times to go down? Simply do away with this one law
    that mandates free care at the ER. 30 years ago ER’s were usually empty
    most of the time because they could legally turn away non-emergent, non-paying
    patients. The problem with that is that some turned away truly emergent,
    nonpaying patients as well! As the percentage of uninsured American’s
    skyrocketed, so did this problem. People started literally dying in the streets. That tends
    to make people and politicians a tad angry, hence the law mandating
    care so this is not an option I would advocate before fixing the underlying issues with the uninsured.There is a
    solution, let the government compete as a single payer in the health
    insurance industry. It was the single greatest failure of the
    health-care reform law (ObamaCare) that government will not be
    allowed to compete as an insurer (even under an optional single payer
    plan). Medicare pays 97 cents out of every dollar on health care.
    Private insurance pays 50-70 cents. How could a government program be
    so vastly more efficient that private industry? Because it is not in
    the insurance companies self interest to operate efficiently. Without
    allowing the much more efficient government health insurance to
    compete, we’ve essentially signed the death warrant for the providers
    and hospitals. No industry could OR EVEN SHOULD survive in a
    capitalist economy that wastes 30-50% of it’s revenue on
    administration overhead. So private insurance needs to go (or at
    least be threatened with competition where efficiency is a primary
    motivator), or the private health care provider will go. Until we
    have the political will to change this dynamic, our heath care system
    is on a death watch and it will either vanish or continue to
    degenerate into third or forth world conditions. My advice is to get
    used to it or educate yourself and do something about it.

    • Alan Turley

      ERs are not outpatient facilities; occupational health and urgent care clinics, outpatient surgical clinics, and your doctor’s office are (as you recognize elsewhere in your letter). Using the ER with the expectation that the same terms of service apply may lead to grave disappointment, aggravation, and near certain delay. Patients will share some of this – but not all.

      A visit to the ER is not just like applying for employment with a company – a mere application until accepted. Following that analogy, it’s more like applying for a job, and your application requires that you be interviewed. Depending upon the results of that interview, the ‘company’ is legally obligated to determine if you have an immediate need of employment; and if so, the ‘company’ is obligated to hire you on the spot in an appropriate capacity for so long as the immediate need exists or to find someone else who will and orchestrate your safe delivery to that company (quite possibly whether you want to work there or not).

      And, like it or not, you are an employee on your first day of orientation from the moment you arrive ’til that job interview frees the company to release you. You may be able to walk out of the interview at will, but in some restrictive cases you cannot, and the interviewer’s obligated to see it through regardless.

      In all cases, the hospital must perform an appropriate screening and see to your appropriate disposition subsequently – in an actual emergency, whether you can pay for this service or not, occasionally whether you want what they’re ordering or not.

  • http://twitter.com/mphillips70 Melinda Phillips

    What about Home Care?  Patients are going home more quickly and choosing home care to help them recover in a safe place. I think this may also have an impact on the changing face of health care.

    • Moulay Alaoui

      To caricaturize my remark, I believe many physicians are being pushed out of business or to go back to the old fashion way of patient consultation: home visits! The doctor would show up at the patient’s location upon request, caraying their tablet, a touchpad, iPad or equivalent and a Flotto handbag, if not a 56 COLD BE, at hand. Maybe a “Cash Only” or “Self Paying Patients Only” sign would be affixed to their cars for consent accomodation.

  • http://twitter.com/Inspiredqueen Rhonda S. Bell, DBA

    Kevin thank you for posting this article. Wow, what an eye-opening reality! Hospitals that want to be a winner will have to go through a paradigm BREAK, not just a shift. This will take intentional leaders who have been well developed.

    I found the HealthLeaders Media Industry Survey 2012 that came out yesterday very interesting. When asked the question: Rank your organization’s top three priorities for the next three years. Both Senior Leaders and Nurse Leaders chose the following as the top three:

    1. Patient experience and satisfaction
    2. Clinical quality and safety
    3. Cost reduction, process improvement

    Leadership, organizational development ranked 7th from Nurse Leaders and 9th from Senior Leaders. WOW!

    Could this be an indication of why 1/3 of hospitals will close in 2020? Leadership is the “horse” that drives the cart that offers the top three choices that were chosen. Without a well developed “horse” or leadership  there is not a chance for the top three priorities to exist.

    • Anonymous

      Totally agree.  The New Health Age will be a total paradigm shift for leaders and hospital administrators. 

      Jonathan Fleece
      Co-Author “The New Health Age”

  • Alan Turley

    First, I truly enjoyed the article. It strikes me as scholarly in composition and certainly thought provoking – conclusory but thought provoking.

     

    Still, regarding the third point cited as a significant factor driving the hospital’s changing role in health care, it’s worth noting that there are several intractable forces contributing to ER wait times, which appear conflated uniformly into evidence
    of “abysmal” customer care:
    · Visitors arrive constantly and without appointment or warning, every day and night, seeking to use the ER
    for primary care and for social service referrals, as food bank, homeless shelter, and as police detention facility.
    · New arrivals dynamically shift all visitors’ respective positions in the waiting queue.
    · Often, visitors waiting shift spontaneously from one category of need to another during a single visit,
    which may shift all visitors’ respective positions in the waiting queue.
    · Many arrive with boisterous and belligerent views that they arrived before ‘that’ guy and should therefore
    be served first.
    · And, all arrivals are hospital patients until “an appropriate medical screening examination” and
    disposition determine otherwise – even those without means to pay.

    Ultimately, while sharing one roof and feeling bad about being there, many of the ER’s visitors share little
    else in common beyond the sorting process for finding their respective place in line. The recent studies alluded to in the article should reveal that all visitors are not ‘waiting’ for the same thing, presenting the same needs, or looking for the same way out. And, characterizing visitors’ reception in this environment as a “low level of value and service” disparages healthcare providers more than it does the consumers arriving without an emergent condition or the policy architects who’ve structured this landscape.

    Point out one other business where Americans would tolerate this, indeed. If you show up at the shoe store demanding a matching purse they don’t sell, no law mandates that store learn about your wardrobe and whether your need is grave, freely entertaining you on the sales floor while calling other stores to inquire of stock and arrange your free transport there, while lawyers look to sue for malfunctions and mismatched socks. Indeed, in what other business would Americans tolerate this?

    • John Small

      Alan Turley’s thoughts most closely correlate with my personal experiences of 30 years working elbow to elbow as an ER physician with nurses, technologist, clerks and EMS personnel, in a dynamic tension with patient expectations, administrative short comings and harried, sometimes confrontational,  attendings as we attempt to satisfy all parties while doing no harm, stabilizing the  unstable patients and obtaining a higher leveling care for those requiring it.

      Many, indeed, most comments on the inadequacy of our disease oriented system appear to be offered by those not on the frontline of point of care.  No doubt well intended but frequently, sometimes wildly missing the mark, even  lacking face validity.  Tragically I believe this characterizes the majority of those in government who legislate, bureaucrats who write and administer the regulations and organizational executives who implement the rules by which our doctor-patient interactions take place.

      There are many insights and effects that can be attributed this causal chain of command.  That any genuinely decisive care is provided is an amazing feat of endurance, burning out many in the process.  The ER has performed as a safety net, progressively less and less satisfactorily as the now in vogue patient satisfaction scores sometimes reflect.

      I cannot speak as directly to other specialties, many if which are also hospital based and nearly all aligned with one or more hospitals.  Emergency medicine is typically responsible for approximately fifty percent of admissions in addition to its role as safety net.

      I believe medical care will continue to consume or account for, if you prefer the economically  correct term, more of our national output until we invest decisively and commit to long term funded basic and applied medical research, including joint MD-PhD programs, that result in a decisive shift from our current halfway-at-best technologies to a preponderance of genuinely decisive technologies.

      One measure of success will be a steady, sometimes rapid, decrease in expenditures on catastrophic illnesses.  However, like war and poverty disease will always be with us, and with it comes an insatiable demand for medical care, now and in the foreseeable future.

      In the meantime, if the past is a guide to the future – and occasionally it is not – I am not encouraged that those with an understanding of the complexities of current level of medical care delivery will be in a position to effect the legislation, administration or implementation of medical policies and delivery that currently does little more than reallocate an increasing expenditure of our nation’s abundant but ultimately limited resources.

  • Anonymous

    I have worked in healthcare for 30+ years and disagree with much of the article.  First, I think the 100,000 deaths per year is based on inaccurate data and is far from the reality but is accepted because if you say it and hear it enough, it becomes truth.  The main problem in healthcare past, present, future is non compliant patients who refuse to take part in their care or take corrective action on advice from healthcare professionals.  Overweight, smoking, alcohol, drugs, unhealthy personal behavior, lack of personal hygene, bad diet, etc all contribute to the healthcare problems.  No degree of Core measures, NPSG, nonpayment for readmits, etc can correct this until the patient decides to participate.

    What other industry provides the service then waits and hopes for payment, then get 37cents on the dollar.  What other industry gets denied payments because of a’ I’ not doted or ‘t ‘crossed, or because documentation did not include specific words.  I would love to walk into my local grocery store at any time of the day, have a complete staff of each department there to serve me, fill up my basket, get to the checkout, get my total, and the pay $37 dollars for $100 basket, or better yet, just say I do not have the money and leave with the groceries.

    No, healthcare and errors are not the problem.  The problem is a government that promises full coverage but does not adequately compensate the provider or denies payment.  Th problem is an insurance industry in the business of collecting premiums but not paying claims.  It is an insurance clerk telling a case manager that the patient must be discarged when the physician knows they are not ready, but then punishes the hospital when the patient returns in 30 days.  The problem is regualtions that really have nothing to do with improving healthcare.  The best solution would be to be able to adequately staff and spend time with the patient, not the chart.  One of my favorite past physicians always said the longed for the day he could treat patients, not charts. 

    The problem is a healthcare system driven by politics and financial considerations while healthcare workers work long hours, under paid, not appreciated by abusive, impolite,deranged(sometimes), unappreciative (sometimes) patients and families with  expections that exceed what is possible without them changing habits or lifestyle.

    We are not miracle workers, we just take technology, art and science and try to make miracles happen.

    • Anonymous

      As a response to my response, I in no way think that there are not errors and problems in healthcare.  I just believe that the issue is being used and blown out of proportion for political, financial, and vendor driven product sales gains and none are contributing to the real problems that healthcare faces every day.

  • Dan Escajeda

    This really is more of an essay, than an article, meant to sensationalize the plight of hospitals as much as possible. In doing so the authors serve up a pretty thin gruel, much of which, even worse, is regurgitated.

    They focus on cost, risk, customer service and customer choice as the Four Horsemen of the Apocalypse that will drive fully one third of the hospitals out of business in the next EIGHT years.

    Cost: Medical care is expensive. Is that news? Hospitals are no more guilty of driving up the cost of healthcare than grocery stores are guilty of making Americans obese. They simply provide the services that are demanded by an American public that has forever demanded that we do everything for everyone all the time at any time. The ninety year old patient with severe dementia who is bedridden, rolled out of bed, fracturing her femur and is now is scheduled to receive a thirty thousand dollar hip replacement is a commonplace example of expensive resources spent for very little overall gain. (In this real life example, the patient died peacefully on the first postoperative day.) But until we get a handle on how to allocate what everyone agree is a finite amount of resources, we will continue to essentially squander what we do have.

    Risk: The data listed by the authors is again not news, it is over ten years old. Do they really think that the world has stood still in the last ten years? One of the most common cause of “medical errors” is misdiagnosis, and again perfection in that arena is not attainable, by definition. Hospitals have actually become more dangerous as a result of previous misdirected “safety and quality” directives such as the “prophyllactic” use of antibiotics which have trained a whole new generation of multidrug resistant pathogens. And again, hospitals tend to be “me too” institutions. Whatever is viewed as progressive by one institution (e.g. requiring all employees and physicians to either be immunized against flu or wear masks) quickly spreads to surrounding institutions. How is that supposed to be a broom that will winnow out fully one third of the existing hospitals, then?

    Customer Service: Perhaps the thinnest part of the article, because it reminds one of the old Yogi Berra quote about a certain restaurant: “It’s so crowded, no one goes there anymore.” E.R. waits are hardly the defining characteristic of a hospital’s customer service. In fact, the patient who prefers an E.R. to a scheduled primary care doctor’s office visit for what really is non-emergent care is usually “money poor, but time rich.”  They will hardly then  be the drivers when it comes to a hospital’s survival.

    Consumer choice:  Most of the benchmarking data that the authors contend will drive hospital success already exists online. A google of “mortality after heart surgery in Colorado” provided a “dashboard” results for every hospital in my state. As I reviewed the list in my immediate area, I was struck by the fact that my local hospital had zero mortality in that category for the last year. And yet that program was closed six months into the new year and transferred to another facility when the cardiac surgeons transferred their practices. So much for performance being rewarded by success. The patient will choose a hospital based primarily on the recommendation of their doctor, and secondarily on location. Even if the Cleveland Clinic has the premier heart program in the country, only a privileged few will board a plane to get there if their local hospital can offer the same services. So again, hospitals will not close on the basis of patient choice driven by benchmark data.

    As tempting as it is to be sensational, the truth behind the success or failure of hospitals is how well they meet the demands of caring for an increasingly elderly population in their respective service areas. The Medicare population is booming, as shown by the fact that the fastest growing segment of the population is those over 100 years old. Eighty seven percent of the growth in surgical procedures in the last decade has been in those over 65. While Medicare payments to hospitals have been (precariously) stable, the Federal government has made the hoops that institutions must jump through to be paid smaller and smaller. At the same time, smaller hospitals are less well positioned to control costs of material and personnel, at least as free standing units in the marketplace. Still, that is a large chunk of patient care that has to be done somewhere, (unless we steer away from the traditional ” do everything” model.)  Assuming one third of hospitals did close under the authors’ theory, just where would this care take place and where would “winning” hospital administrators find the large amounts of capital necessary to invest for expansion in this feeble economy?

    A more realistic scenario is what is already happening, the formation of large organizations such as ACOs with the clout to negotiate fees both with payers and with suppliers. In this sense then, the local hospital may have a different colored sign out in front, but be closed? Don’t think so. Or at least this article misses the mark in making thatr case. But then of course, if the article was titled “Future of Healthcare So Bright, Hospitals Are Making Patients Wear Shades” is not nearly so provocative.

    • Anonymous

      Wow – many of your themes are consistent with our book and expand on the posted article.  Remember, these topics are much beyond a short title.  The topics are extensive, comprehensive, and challenging to solve.  Thank you for the continued dialog.

      Jonathan Fleece
      Co-Author “The New Health Age”

  • Doug Rothermel

    Wow, hospitals are the most dangerous place in the world?  That is a scary thought.

    If one-third of hospitals will not cross the finish line by 2020, I hope it’s due to being re-aligned in a health system, and not due to elimination.  Perhaps the Clinically Integrated Networks will wash out many inefficiences, and deliver better health care to our communities.

    • Anonymous

      Yes, you are right on track.  Note we stated “close or reorganize.”  Major re alignment has begun and will continue for minimum 10 years.  Thanks for the comment.

      Jonathan Fleece
      Co-Author “The New Health Age”

  • Anonymous

    Alarmist, naive, and misleading, but a common theme by pundits these days.

    Besides, the authors don’t make the argument for “why one third will …”  They are
    saying why one third SHOULD close (in their opinion).  The two are very
    different.

    They are clearly unaware of the reality of bankruptcy laws and simply how they work.

    They
    are unaware of the political reaction by local communities to a
    hospital closings.  They are unaware of hospital’s limited ability to
    provide service over a distance.

    This type of opinion will have an impact on
    investors.  Mom and pop will not want healthcare in their 401K’s.  Mutual funds will respond in kind, so less investment going to healthcare.  But
    some larger investors will see through this and make a bundle.  The rich
    get richer and I keep typing.

    The power of cause and effect over
    correlation over emotion … sure does help you think clearly if you
    know how to use it.  If you have money and don’t know how to use it, your
    money finds another place to hang out.

    I hope you guys have read:
    - The Choice by Goldratt.
    - Thinking Fast and Slow by Kahneman.  

  • LeftCoastRightBrain

    This is somewhat alarmist and, based on almost 30 years in health care, I have some additional comments.

    The 100,000 medical error deaths per year is a misleading statistic, analogous to the WHO data on infant mortality that healthcare “reform” advocates used to trot out. WHO backed away from their numbers and I wont’ be surprised when the medical error data is “revised”. We don’t and won’t have a perfect system. That said we can do better.

    But on to the substance of hospital closures. I’m of the opinion that the old 300 bed gigantic hospital is a thing of the past. Particularly when you have four similar institutions on the same intersection of any large city in the USofA. Additionally, while I recognize the desire for every small town and whistle stop on the interstate to have a hospital as the anchor for the medical services, that model will prove inefficient in delivering the healthcare of the future.

    We’re seeing that new hospital construction is up a bit from the 2009-2010 period. These facilities look nothing like those referenced above. The focus is not on inpatient beds, but on urgent and emergent care as well as providing clinic space for physicians.

    Changes in reimbursement are driving site of service down to its appropriate location. More procedures are being performed in physician clinics, ASC are now seen as the value equation by physicians and payers.  Inpatient length of stay saw it’s most significant drops in the mid-80′s to mid-90′s and is now pretty much at its sustainable level. Patient morbidity is up.

    I see specialty care cluster around “centers of excellence” in major to mid-level population centers with competition weeding out the inefficient systems (just how many cancer centers of excellence can one city support?). Those institutions engages in the medical center arms race of more service lines, bigger buildings, more endowments are re-assessing those business strategies.

    More and more rural and small communities are going to be served by tele-medicine solutions and this model is going to require that patients who need intensive care and therapies go to those larger cities where that care can be delivered. This is not really much of a change in terms of patient mobility. The technology adjunct just improves the diagnostic resources.

    Accountable Care Organizations are a great concept with almost no likelihood of showing meaningful improves in patient outcomes or cost reductions. They are not applicable to areas outside major metropolitan areas.

    Lastly, I firmly believe that we will continue to see physician shortages into the very distant future. Affordable Care Act (aka ObamaCare) does nothing to increase medical school enrollment (but does have some weird diversity language in it) while attempting to force 30million technically “uninsured” (lacking insurance coverage does not necessarily mean one lacks access to healthcare) into the system.  I’m sure there are much wiser individuals than I who also see a looming access crisis. Hopefully we’ll see significant increases in primary care physician compensation as this will be the new door through which those patients enter the system (assuming the old door was the ER).

    While I have opinions on InsCos, this is not the thread for that.

    • Anonymous

      Data is data regarding the 100,000. 

      I agree with your comments about hospital system changes, and we touch on this in our book.  We state that 1/3 hospitals will close or completely reorgaize.  Many will transform like you state.

      Tele-medicine is exploding no doubt. 

      We disagree on ACOs.  Some models work very well.  Check the Healthcare Partners example in our book.  Dr. Stuart Levine wrote a great Change Vision article in our book about how they have operated ACO like systems for years and achieved tremendous success.  I have clients too that are achieving tremendous success under ACO type models and making more profits than ever, with healthier and happier patients.  Don’t give up on ACO concepts.

      Actually ACA does have a lot in it regarding increasing medical education for primary care physicians but we will no doubt have physician shortages – especially primary care. That is why prevention of disease through lifestyle medicine and collaborations with allied health professionals and others will be the key moving forward.  The best medicine going forward is “the fork” (check Dr. Mark Hyman’s new book – “The Blood Sugar Solution”.

      Also investigate the Institute for Functional Medicine model. 

      Thanks for the comments.

      Jonathan Fleece
      Co-Author “The New Health Age”

    • Anonymous

      Agree that there will also likely be physician shortages and this will probably be more dramatic than anything we face today. If ObamaCare stands, then a consequence will be a dramatic reduction in the income of doctors.  Most of the doctors in nationalized HC systems make a lot less than $100k  - typically work 6 days per week and not uncommon to see 12 hour days – been there and visited with lots of them. Of course, most of their education is paid for so at least they don’t have any crushing debt. If I was in college today and knew that reimbursement rates etc were being cut – I would have to think long and hard about going to med school. Until things get sorted out, its a scary proposition. Not sure if it has affected the number of people entering the field yet, but it should and eventually will. I am always amazed at the number of medical doctors who end up choosing alternate careers in their countries in order to make more money –  many become sales reps and do quite well.

  • Ryan Clapper

    I am not surprised with the data in this article, or the prospect of hospitals (up to one-third) closing by 2020.  I actually agree given the climate and volatility of environment.  

    What is shocking to me is the complete disregard for why hospitals are in the state they are in.  Firstly, could it be that hospitals are the “most dangerous place in the world” simply because it happens to be a place where people that are already at high risk, that carry high-risk/highly contagious diseases, conjugate?  Could it be that there is no other more complicated service, that includes so many moving parts and variables?  It is appalling and insulting to hard-working healthcare employees to paint the state of hospitals as “disgraceful,” when they provide life-saving care for millions each year that would otherwise be on the street and in their homes left to suffer the effects of untreated disease and illness.

    Yes, hospitals have a lot of opportunity for improvement in order to more consistently provide quality care. However, with very low profit-margins, dwindling reimbursement, increasing patient acuity, accelerating changes in regulations and complexity, and so many pieces to balance, it is increasingly challenging to avoid some negative outcomes, contain cost and improve quality and efficiency.

    I invite this author to spend a week shadowing nurses and physicians in a hospital ED, ICU and med-surg unit.  Then spend some time with hospital administrations as they try to determine how to do more with less.  I do not divert the accountability and responsibility of hospitals to rise to this challenge, however I do ask that the system is not an easy one to change overnight.  Have understanding that people in healthcare are doing the best they can to improve in a volatile and obviously hostile environment. 

    And if we are talking about accountable healthcare, why don’t we also talk about accountable patients as well. Compliance is also declining, why is this not taken into consideration when qualifying someone’s access and reimbursement for health services?

    • Anonymous

      Good comments. You and I share some of the same views.  I actually grew up in hospitals – my mother was a RN and my father worked for Kaiser.  I have served health care professionals and hospitals as a health care attorney for more than 15 years.  In a few weeks I am spending several days with a hospital in the mid-west to develop a strategy to keep them in the 2/3 group.  You are correct – transformations are hard and will take time. That said, our book and writings are not about whether things are right, wrong, good or bad.  Our writings are about the data and what will be and why.  The market place is changing and the strong need to survive.  The weak will disappear.  David and I simply educate and want to help the industry prepare.  Be well.

      Jonathan Fleece
      Co-Author “The New Health Age”

    • Naval Asija

      why don’t we also talk about accountable patients as well. Compliance is also declining, why is this not taken into consideration when qualifying someone’s access and reimbursement for health services?
      This is the biggest failure of modern medicine to convince people to do something which is essential for ur health when american companies can sell coke in most remotest part of world and force people to comply…

      if people like u get ur way u would force everybody to comply with taking shit in the name of good health through legislation.. u have no evidence that all those doctors and nurses running around madly in a alien surroundings help raise life expectancy beyond a certain age irrespective of the dollars, money and hope invested..

      dude come up with something real rather than blaming patients for compliance.. refer to first para.. it is possible….. coke:)

      • Anonymous

        If I had a nickel for everytime I heard someone act like it was a bad thing that they can’t smoke as much with their cough or flu-like symptoms, I’d be rich! Yet, it’s been proven time and time again the hazards of smoke (both first and second-hand) on the human body. Furthermore, we are fast becoming a nation of obesitiy with the health complications related to this epidemic rising. It is theorized the next generation will be the first generatin to NOT live as long as their parents because of their life-style choices.

        Yes, patient accountability should be factored into the equation.

        • Naval Asija

          Dear sir

          then isnt the government accountable which lets the killer smoke to operate, isnt the peer pressure accountable, isnt the hollywood star who promotes the smoke company accountable. 
          If you make a victim accountable then near are the days when people will be accountable for getting fever from their children while caring for them. so its a parents fault why did (s)he bother 
          there is something called fairness… please consider that also

      • Ryan Clapper

        I do not purport to have anyone forced to comply with anything.  I am only suggesting that if hospitals are reimbursed based on their compliance with regulations and their quality outcomes, shouldn’t patients be as well?  For instance, if someone is going to seek medical care, and that comes at a cost, shouldn’t they be held accountable to follow the advice given to them in order to have that medical care reimburse by government or private agencies?  If you seek care, which is in essence asking for a healthcare team to make a plan to help you heal, should you not be required to follow that plan if you want it to be paid for?

        And just as an aside, there is plenty of evidence to suggest that western medicine is effective with a number of illnesses.  I recommend actually looking at some literature before making a claim as ignorant as “u have no evidence that all those doctors and nurses running around madly in a alien surroundings help raise life expectancy beyond a certain age irrespective of the dollars, money and hope invested…”

        • Naval Asija

          Dear Sir,
          here are few arguments:
          1. one does not do charity when one shares risk with somebody for pooling of insurance premiums, u may be in the opposite chair someday
          2. Reimbursing someone is not just providing security to the person. health is a public good. if i have swine flu it may result in your hospitalization after few days as it may spread and u taking  junk food does harms me thousands km away also. so investing in others health is for ones own security and we do no charity in securing others health
          3. It is a privilege provided under law in most countries to medical practitioners to reject a patient if (s)he doesnt comply in other than medical emergencies. who stops you. reject the patient straight away. you dont because u get ur fee irrespective of the outcome of patient.
          4. with regard to literature please refer “The Hospital: From centre of excellence to community based support” by Dr. Norman Vetter, a well known health specialist.
          5. I am myself a licensed medical practitioner in one of the countries in planet earth this is for your information.

          • Ryan Clapper

            Naval, here are some replies:1. one does not do charity when one shares risk with somebody for pooling of insurance premiums, u may be in the opposite chair someday.  
            –I am not sure I understand what you are trying to say here, however, I can assure you that I am a compassionate and empathetic caregiver myself, who often puts myself in the shoes of a patient.  Insurance programs, and financial & legal dogma is what has driven the health “care” industry into a heartless assembly line that is not even effective.  Responding to reimbursement stipulations simply to survive, and legal/regulatory compliance issues, has destroyed the human spirit of caring within healthcare…  however that is a different topic.  So, actually…  if I am understanding…  I agree with you.
            2. Reimbursing someone is not just providing security to the person. health is a public good. if i have swine flu it may result in your hospitalization after few days as it may spread and u taking  junk food does harms me thousands km away also. so investing in others health is for ones own security and we do no charity in securing others health
            –Healthcare is not a right, it is a service.  Health is not a privilege, it is a gift, and in some cases, it is the result of hard work of an individual.  There are, of course, illnesses that are completely unpreventable.  When I speak of accountable patients, I am referring to those patients with chronic or preventable illnesses that consist of 60% of the leeching of the resources on the public healthcare system.  
            3. It is a privilege provided under law in most countries to medical practitioners to reject a patient if (s)he doesnt comply in other than medical emergencies. who stops you. reject the patient straight away. you dont because u get ur fee irrespective of the outcome of patient.
            –I am part of a healthcare system.  I have absolutely no say in what patients I care for.  If I refuse a patient that comes to my hospital, I will be fired.  This is completely irrespective of their compliance and outcome.  I am not reimbursed my pay based on individual patient charges.  I am paid a flat rate, and I must care for anyone who comes through the doors of our non-profit hospital.  Part of our mission is to never turn someone away.  It is a service to people.  We do the best we can but we serve a largely indigent population that is often non-comliance.  Now we are penalized for poor outcomes due to reimbursement changes.  Outcomes we rarely have much control over.
             4. with regard to literature please refer “The Hospital: From centre of excellence to community based support” by Dr. Norman Vetter, a well known health specialist.
            –I will take a look.  I invite you to the ultimate in education:  A week working in the Average American Healthcare organization.
            5. I am myself a licensed medical practitioner in one of the countries in planet earth this is for your information.
            –I am the son of a RN.  I have an AAS in nursing, a BSN, and I am currently working on a MBA in healthcare.  I have worked as a frontline staff RN, a Clinical Coordinator, a Nurse Manager, and recently as an interim Director of Medical-Surgical Services for a 412 bed hospital in New York, USA.  I understand American Healthcare, and it is not simple…  and it scares me that the government is holding us accountable like it is.

  • Anonymous

    I have no doubt hospitals will reduce the number of medical errors–through the use of checklists.

    Check out “The Checklist Manifesto” by Atul Gawande. When hospital staffs (everyone from janitors to surgeons) is involved in patient care and accountability, healthcare will improve.

    • Anonymous

      Totally agree.  As David and I speak on this topic nationally, the examples like you reference that people bring up are endless.
      Jonathan Fleece
      Co-Author “The New Health Age”

  • http://www.facebook.com/people/Greg-Mercer/100001786695804 Greg Mercer

    Health care today has so many problems that the good news is this: anywhere you look, there’s plenty of room for improvement.  Hospital inventory control of necessary supplies, for example, is typically archaic, with Nurses and others wasting time they don’t have to track needs manually, resulting in overstock of many items, and much time lost when other items run out.  Solutions are available, fully tested and proven, in other industries, and such waste is inexcusable.  This is but one example, in which a relatively small and very safe investment offers proven savings, and would free up Nursing staff to actually do their real jobs, in effect boosting staffing without added cost.  The fact that a Nurse needs to publicly beg for hospitals to take such obvious steps, so many years since they became available, speaks to the sad state of hospital administration today.  Institutions that insist on failing will do so, but it is sad how much human suffering they will cause along the way.

  • http://www.facebook.com/profile.php?id=1199802681 Eric Aldinger

    Citations would help make these statistics more meaningful. 

    • jonathanfleece

      Our book “The New Health Age: The Future of Health Care in America” http://www.thenewhealthage.com (hit #1 this week on Amazon Kindle for Health Policy) is full of citations.  We teamed up with Saint Louis University’s School of Public Health and the Law School and filled the book with data. I agree that citations and researched data is critical to this topic.

      Thank you!

      Jonathan Fleece
      Co-Author The New Health Age

  • http://twitter.com/Chakrabs S.C.

    The authors appear to wear many hats (one of which seems to be a wizard hat – futurist, what is that!?) but none of them are physicians or have any involvement with the healthcare system. 

    • http://twitter.com/JonathanFleece Jonathan Fleece

      Actually I (Jonathan Fleece) have worked in health care for nearly 20 years.  David and I are not writing to play “the blame game”.  The research and work that we published above was inspired by our book “The New Health Age: The Future of Heath Care in America” http://www.thenewhealthage.com.  Our book prepares America, especially those working in the health care industry, how to prepare and adjust to the changes that are coming.  We are not causing these changes to occur, simply educating America about the dynamic flow changes.

      David Houle (futurist) speaks internationally about future trends and transformations (see http://www.davidhoule.com).  David has always been able to “see things” before mainstream.  He was on the founding team for MTV, CNN, and others. 

      Thanks for your comments. 

      Jonathan Fleece
      Co-Author “The New Health Age”

  • http://twitter.com/mxsn29 mxsn catalan

    i dont get the authors,, i feel like they were after something not favor to healthcare, but then they favor comments here that favors healthcare.

    one thing with the closure of hospitals, close the hospital and decelerate the type of healthcare u have on ur country, and so as ur people too.

  • http://twitter.com/mxsn29 mxsn catalan

    and for the record, we healthcare professionals doesnt automatically harm people. we are trained to do our very best, to give quality care and to be patient as well. but we cnt function optimally without the resources that the hospitals can offer. u have to accept that. yes they have the right to stay at their homes, but we are not to blame if we suggest them to be at the hospital.

  • http://profile.yahoo.com/7WQFCEGPQQSOUE6NLLZYDUZWL4 John

    I can only imagine that the prediction that a third of hospitals will close by 2020 is hyperbole intended to get eyeballs on the article.  The writers hedged their bets by also including “or reorganize into an entirely different type of health care service provider.”  You have to love a seemingly bold prediction hedged by a very subjective prediction. 

    As a conservative American I do cherish an open competitive market and I agree that there will be winnners and losers; however, I also believe that an open competitive market in which accurate information freely flows results in organizations making the necessary improvements to information and outcomes. 

    And secondly, the writers are not telling us anything new.  ERs have long waits, poor infection control, and poor customer service.  That information is already transparent.  Everyone already knows this, yet we don’t see a third of the hospitals out of business.  EMR will be the ticket to a lot of things, but it won’t be a one-way ticket to the auction block.

  • Anonymous

    As a RN for 20 years and having worked in ER and Cardiology I am not sure what you are basing your observations on.  If the ER was utilized as an “Emergency room” and not a walk in clinic or “cant’ see a dr cause I don’t have one or  perhaps the wait wouldnt average four hours!  It is common practice that Emergent Patients are treated first and non-emergent are not.  As professionals we provide the best care and work with the resources we are given, that is the bottom line.  We don’t make the policys and procedures, we just have to comply with them.    o many chiefs and not forgetting the people that make a difference.  The nurse to pt ratio and hours that we work are all factors that can affect care, the replacement of RN;s and LPN’s withother employees to save a dollar has made an impact on care and outcomes as well  Lastly, health care workers have some the most expensive and less than desirable health isurance. .Hospitals are top heavy, paying out big dollars for too many executives and they forget the people that make a difference.  Perhaps the upper levels of hospital administration should be examined and made to be responsible for decisions they make regarding the way things are done and they need to be reminded of why they are there,

    • Anonymous

      Well said! However, as someone who’s also worked in the ER for 20+ yrs, I’ve seen a trend lately that I’d like to add. Many are now coming to use/abuse the ER who have a provider but either didn’t bother to call or called & couldn’t get in for a “same day appointment”. IMHO, this is related to several factors:
      1) Law suit avoidence (the clerk at the MD’s office says “if you fell it’s an emergency, you should go to the ER” and the patient takes as a direct order) and
       2) Patient education. People no longer know when to “wait and see”, how to treat with OTC’s, and when to go the the ER. Emergency Rooms are for Emergencies and no one can fix a viral cold or allergy with an antibiotic!

      With the current condition, Obamacare will make the ER backlog and stress level (employee stress = patient safety) much worse as Primary Providers will greatly decrease. It doesn’t matter if every patient can have a PCP if there are no PCP’s to take the patient!

    • Anonymous

      Amen to that!  The ever increasing “suits” who receive handsome salaries, and their constant need to attend conferences in resort areas of the country, have created the increase in costs of hospitalization while the worker bees continue to be treated as second class citizens.  Hospitals managed quite well prior to the extreme levels of administration that we now encounter, and patients received excellent care. Hmmmm
      Quite a conundrum the “suits” have created!

  • Joe Spencer

    Adding the above mentioned reasons for decline, I expect that as states implement nurse triage services fro medicaid and medicare patients, the demand will shrink.  As people consult with qualified care givers from home, they will be diverted away from overusing hospital emergency rooms as a primary care provider.  Companies Like Nexus Alert and Instant Care are making nurse triage 15 times more effective than is currently being experienced in the industry.

  • Anonymous

      It is a well known fact that if Obamacare goes ahead, and he becomes our next president, a full one third of all hospitals, doctors, nurses and techs will not be needed so will cease to exist.  There has already been a good one third of today’s doctors say they will leave the medical field if Obamacare goes ahead, and Obama knows this.  Without that many doctors, the hospitals will be forced to admit fewer patients (i.e. lack of doctors to admit them), which means fewer nurses and techs will be needed.  Of course, with Obamacare, there will be virtually no need for business or accounting offices.  One person there will be doing what about 50 people do now.  I’ve been in most aspects of hospitals and doctors offices throughout the last 51 years and I do not like the trends I see for the future. 

  • http://twitter.com/dentalmedhero Jackie Bailey

    This is very sad, but not surprising.  As I work with private physicians everyday, I am taken aback by the arrogance they have,  and the idea that they are untouchable.  I try to help them see how important it is to their profitability that they improve their leadership, communicatin and people skills, but they don’t see the connection.
    I believe it will happen as you say, and it will have been preventable.

    • http://www.facebook.com/DrRowlin Rowlin Ron Lichter

       It is not arrogance. It is disguised fear. Be more perspicatious. It is hard to communicate relaxedly when everyone from the maid to the pPresident is starring down your back. Call itparanoia but look at the facts!

  • Bryan Uslick

    The 100,000 diet is an urban legend based on a faulty study in 1999.  The real number is much lower based on a JAMA article:  

    http://www.mddionline.com/article/medical-errors-leading-cause-death-or-urban-legend 

    • http://profile.yahoo.com/OVYTO32M6R236TOHOEOSGHYR6A Douglas

      I concur.

  • Anonymous

    This is a very sad situation however the hospitals are in competition with the physicians for survival. Daily I see more and more physicians taking patient procedures out of the hospital and performing procedures in their office, outpatient cath lab or at some joint venture ambulatory surgery center that several other physicians own. The physicians send the most complex, costly and no insurance patients to the hospital but keep the others for themselves. Physicians need to realize they are part of the problem they have not partnered with the hospitals to make them successful but only look after making more money for themselves. I am not sure MIchael Moores portrayal SICKO misses the issues that we are experiencing.

    • http://profile.yahoo.com/5LQVS4SXKTBSL34UGCDU7GCE2Q Jirka

      and leaving these “physician owned” “hospitals” alone was one of the major reasons why AMA supported Obamacare – what a disgusting betrayal of health care professionals and community hospitals …..

  • http://www.facebook.com/profile.php?id=100001044621845 Sayeeda Yasmin

    A very negatively skewed article………………understandably so coz’ it’s written by a lawyer. Come on guys , give me a BREAK………………..SERIOUSLY.

  • Gail Anderson

    It’s a good thing.  Something needs to work to promote better care in HOSPITALS!!!  They take for granted their jobs!  Competition is GOOD.  I never pay for something when service is crappy!!

    • http://profile.yahoo.com/N2F2MSOOWNCWEMHBTA5GTF2KVI SusanP

      Hospital already compete. I have worked in a hospital for 35 years. Granted at the start of my career, we took our jobs for granted but it hasn’t been that way for 20 years. The competition is fierce.Maternity patients hospital shop regularly. Even those without insurance or money to pay the bill.As someone else says, doctors are taking procedures and many diagnostic tests to their offices. They also can refuse the uninsured and those unable to pay. Guess where  those people land?? I’m glad you don’t pay for bad service. When is the last time you worked for no pay? Hospitals and many drs are expected to do that every day. When bills are sent to collection, the medical professionals are considered cruel., You need a clue, Miss Anderson

    • http://profile.yahoo.com/N2AUSZRYTRSBGRLXUFQR2ZCAAE Debra ann Gambini

      Not every hospital or their workers take their jobs for GRANTED!!!! Hospitals are the core of most cities in America and the Insurance companies, Politicians and the Federal Government need also to take their share of the responsibility with what this country has been facing for YEARS in the Healthcare Industry.  I have worked in several Major hospital sytems in this country and for the most part (95%) those employed there from the MD’s, RN’s to the environmental service people truly do care. The reason being that at one time or another WE ALL have family that have been or will be hospitalized. If a hospital system needs to be reorganized/restructured due to financial issues it is the entire COMMUNITIES responsibility to get involved and fix it!!!  The problem is no on wants to get involved “just leave it for the next guy or maybe it will just go away attitude”.  This is not going to fix what is wrong; each of us have a responsibility to our families and ourselves – GET INVOLVED………

  • http://profile.yahoo.com/OVYTO32M6R236TOHOEOSGHYR6A Douglas

    Look at the first sentence.  “For centuries…” Then you know that the rest of the article is going to be composed of hyperbole. Don’t waste my time.

    • http://www.facebook.com/zoffix Zoffix Znet

       Yeah, this article makes zero sense. How the author came up with one third is beyond me. In fact some of the statements are contradictory: 4 hour wait is due to too much demand; not enough hospitals.

  • http://www.facebook.com/people/Ginger-Mars/783582862 Ginger Mars

    If the country focused on preventative care, maybe there would be much less need for emergent and acute care.  Since people enter the system later, invariably, they enter sicker; consuming more resources and upping the cost.  Its time the US learned something from other countries with better health care records.  In addition, rising malpractice costs and changes to the residency hours coupled with decreased reimbursements to hospitals and physicians have added to the financial burden that hospitals and healcare providers must deal with.  Our current health care system is a mess and to date NO ONE has come up with any mechanism to fix it.  Motto – Don’t get sick!

    • Anonymous

      That’s my motto, too, but I know that no matter what I do I’ll die someday.  And that probably won’t involve dropping dead without any illness.  Preventive care is great, but it won’t save $$.  In fact, it is likely to increase costs if nothing else is done.  Improving quality and the way patients and their providers relate to each other may make a difference, as well as looking at how, what, who, and when we pay for care could reveal cost savings as well. 

  • http://profile.yahoo.com/5LQVS4SXKTBSL34UGCDU7GCE2Q Jirka

    the 4 hr wait in the ER is because everyone gets treated – even the ones without health insurance or money – so a huge number of people going to the ER are going there instead of going to their PCP…. because in the ER they can not be turned down …. so it’s for FREE to them (not free to the hospital, not free to the community, not free to the responsible citizens and so on…..) it is the lack of individual responsibility to blame 
    (leave alone the whole issue of frivolous lawsuits – BTW isn’t it interesting how lawyers never talk about that problem when they talk about health care????)

  • http://twitter.com/tconcannon Thomas Concannon

    2,000 hospitals will close in the next 8 years? Baloney. 

  • Anonymous

    Dear Authors,

    I read with interest your above manuscript and I have the following comments.

    1- it’s a fact that health care cost in the US and all over the world is becoming very high to the extent that many employers and health insurance systems are facing trouble matching the rise. This may be due to many gfactors in the diagnosis and treatment processes, however, the purpose of this comment is not to analyse the cause but to agree with the fact.

    2- Comparing hsopitals and health care to car accidents is unfair and faulty. In contrast to car accidents where most of which are dependable on a human error, complications are an inevitable part of medical care whether in a hospital, clinic or a medical center. We try our best to decrease those complications by deligent quality improvement andreview programs and committees, yet we never expect to achieve zero complications. Based on the number cited by the auther about 80% of the complications reported as a cause of death are due hospital acquired infections. A fair comparison would be to the rate of death from community acquired infections and we all remember the death rate from epidemics that might be as simple as a flue. unfortunately, despite all the activities we perform in the hospital at large and the operating room in specific, we will never be able to avoid infections. Bacteria are present every where and when we irradicate all bacteria we can then expect to acieve zero infection rate and as such hold hospitrals accountable for any infection rising in their setting. Another important issue is that many of the patients present in a hospital are there to be treated from a certain problem and many times the problem or the treatment itself whether surgical or medical will decrease their innate immunity making the patients more prone to dealy infections even from bacteria that would not cause infection in a healthy individual.

    3- Another similar mistake the authors fell for was when comparing health care to airline industry. Most companies use Six Sigma tools to asses their efficiencies and processes. This means they operate at errors of 1 in 100,000. If people in the health care industry operate at this error then I am sure the authors will wittness much more disasters than the ones they have cited. Nobody goes to a hospital for a vacation; they all go to be treated and they all expect to get better and hospital workers deserve some acknowlegement for the efforts they exercise each day to achiev this goal.

    4- Similarly, a hospital’s main reason to exist is not to make good custumor service but rather to treat sick people. So waiting in the ER for long hours, though untolerable, is an indication that we need more man pwer and facilities to deliver earlier and better care rather than closing them. If now the average wating time is 4 hours then immgine how much it would be if one third of the hospitals closed.

    5- It’s true that most people practice comperative shoping. However, immagine that there are 2 surgeons who do the same procedure. However, one of them sees patients who are usually more sick or who have other complications to their disease. Would it be fair to compare their death rate or complication rate. Of course the one with sicker patients will be expected to have higher rate of complications including death. To do comperative shoping you need to compare oranges to oranges and not to apples. This is a very important concept that not only the authors but also people reading this article should pay attention to.

    Finally, it’s good to always be critical of our actions in order to be able to improve or outcomes. What is bad though is to treat health care like any other business without looking into the tiny details probably th most important of which is that doctors save lives before they make money.

    Shady Hayek, M.D.

    • http://profile.yahoo.com/5P73CJEGEGK5SCLFVS2332RKJ4 drkirish

      My thoughts exactly.  Thank you.

  • http://www.facebook.com/people/Edward-DiCarlo/678027285 Edward DiCarlo

    A few years ago, my hospital chose to participate in a Harvard School of Public Health initiative to save 100,000 lives in 18 months.  At the end of that period, after following all of the reporting and other paper-pushing procedures, we were informed that STATISTICALLY, we saved the lives of 8 patients during that period.  This is wonderful, especially since, in our almost-exclusively-elective-surgery-patient population, the average number of deaths in our hospital is less than 1 each year.  Aren’t statistics wonderful?

    • http://www.facebook.com/people/Ailan-Medici/1409476759 Ailan Medici

       Statistics on hospital errors or patient deaths are pretty much worthless because they rely on the honor system, thus are not verifiable.  Reluctant witnesses in the operating room and M&M conferences know the real truth.

      • shalomam

         People should be pro active and take care of themselves and try to prevent a hospital stay. I work in a hospital and so many people come in expecting care , to be cured of things they themselves could have prevented. 

  • Anonymous

    There are both good and bad aspects of hospitals closing.  Just as with any “company”, there can come a time when it wouldn’t be worth it to stay open for various reasons.  It is important to make sure that if a hospital closes, the people who would have gone there have another equal or better place to go.  In my opinion, when hospitals specializing in different areas of care combine, in the end the patients win because they will receive more comprehensive care. Patient care is the center of health care, and positive progress is essential to the patients as well as the careers of the health care workers.  That being said, people need a place where they can go for their healthcare needs to receive dependable care.  While competition is good and can help to keep employees on their toes, it is important to realize that it is very difficult to make generalizations in any field, especially healthcare.  Every patient’s medical and personal situation is different and this makes statistics somewhat difficult to form reliably. While every individual is entitled to make their own informed decision, they really need to remember that.

  • Anonymous

    I am an ICU nurse of twenty years so, I have lived in the trenches.  The statistics that everyone rely on are frankly….laughable to those of us that see the daily drama unfold.  Most of the committees that orgainize and produce these statistics, rely on these statistics to affect their bottom line and frankly are know to be so far from reality they are a joke. These committees are made up in part of nurses that are so removed from the bedside acute care setting, they refuse to offer to help during severe shortages because their skill level is so out of date, and quite a few of the MSNs and PhDs of nursing have NEVER worked at the bedside.  There is a difference between theory and practice.  Why are these people suggesting, recommending, mandating policies and procedures?  They couldn’t do the job if patient’s lives depended on it, hence the waving white coats over business dress attire that has no problem of participating in the mass exodus at 5pm monday through friday despite critical staffing levels.  And….how about the 10 nursing managers, all degreed RNs, lamenting about 3pm staffing shortage…they have calls out to all at home staff, all nursing agencies, they may have to mandate continued shifts of several nurses on the units to have safe staffing levels….do they forget they are each staring at nine other nurses that ironically are skilled enough to monitor, evaluate, award and discipline regarding the care at the bedside but are incompetent to do the work itself.  This is only part of the many problems of our healthcare system. 

    I do believe that statistics are important, but I don’t believe much of it accurately reflects what is going on inside the walls of the hospitals, clinics and doctors’ offices.  I have worked at a hopital that was forced to close after the collapse of it’s open heart program.  There were politics, rumors, false restarts and an aggressive campaign of a group of doctors with a vested interest in benefitting from the collapse of this program as they had just created the competition for the business.  Really, I will never look at medicine as the noble profession I once did.  I would advise doing your homework, keep track of your own records, seek alternatives, take responsibility of your own care and make “informed” decisions.  The American public is accustomed to showing up and turning over your health issues with the faith you will be taken care of.  Usually that is exactly what happens because the majority of the staff, nurses, doctors and other healthcare professionals take personal responsiblity of their practice and do an amazing job in spite of the environment they work in.  However, a hospital is a dangerous place to be for various reasons.  Talk to your nurses, utilize case managers and ALWAYS bring someone with you as an advocate and witness to your experience.

  • http://pulse.yahoo.com/_CR32NSWJDEEVL4T2NWDT6ZCWMM Joules

    We as a technologically advanced society are causing health care costs to rise. We dont know when to say, “Grandma or Grandpa had a great life. lets just let them go.”  We spend millions of dollars on elderly patients in their last 2 years of life trying to save organ systems that have no hope. Families say,”Do everything you can for Grandma and Grandpa.”  I say if you want everything done, then you can pay a portion of the costs out of your own pocket and not Medicare’s pocket, or….should I say the taxpayers pocket.  As soon as you put the burden of cost on the family, they will say, “You are right, Grandma and Grandpa had a great life, just let them go with dignity.”

    I see it every day at work. Turning those elderly every 2 hours to prevent bed sores. What quality of life is that? Let them go and save millions on a lost cause. That is reality my friends. You don’t see this type of wasteful spending in in other countries the last couple years of the elderly’s life just to extend their suffering and poor quality of life.

    Until we change that …..healthcare will bankrupt us. By the way, I am a Nurse working at a hospital and I pay $525 a month for the family plan insurance. Not to mention…$20 copays for office visits, $100 for my own ER copay for a a visit…and $10 for basic prescription copays. I pay that as I take care of many many patients for FREE who come in everyday. Nurses and other healthcare professionals get no break in healthcare. So dont say we take our jobs for granted. Oh…and I have gotten about 2% in raises over the last 5 years since the recession.

    • http://profile.yahoo.com/5LQVS4SXKTBSL34UGCDU7GCE2Q Jirka

      yep – but grandma and grandpa are voters and so are the “kids” – and no one wants to angry the voters …….  and should we use some “statistics” – it is estimated that up to 50% of all health care cost is used in the last 6 months of patient’s life …..  

      • http://pulse.yahoo.com/_CR32NSWJDEEVL4T2NWDT6ZCWMM Joules

        Exactly….if the family wants everything done for a hopeless cause….then have them pay say 20% of the actual costs. See how long they will keep Grandma and Grandpa around.

        • http://www.facebook.com/profile.php?id=807178451 Tony Scott

          But who makes the call that a cause has crossed the line into hopeless?  The nurses? Doctors will say they’re not qualified and most nurses will deny the responsibility. The doctors? Lawyers and family members will jump at the chance to attack or blame them for their loss.  The government?  Ya thats what we want further government mandates and involvement in healthcare…not.

          The decision to respect and preserve the elderly and life in general is rooted in the cultural identities of multiple subgroups in the population.  Where one group would say if you can’t afford it let them (the elderly patients) go, another might respond that they should be let go either way, and a third would advocate radical intervention despite the cost.

          With the advent of technology, policy change with regard to reimbursement, and the increasing malpractice costs, the question of providing end of life care is no longer a matter of the doctor saying “I’ve done all I can do” to “I’ve done all that will be payed for” or “all that will keep me out of trouble.”  Members of the medical community are taught to practice good medicine first and the rest will fall into place, but the dynamics of the healthcare system today are far less understanding.

          • http://pulse.yahoo.com/_CR32NSWJDEEVL4T2NWDT6ZCWMM Joules

            Tony:

            No offense dude…but apparently you dont work in a hospital or nursing home. Its a no brainer when its time to let them go. They are gorked and turned every 2 hours to prevent bed sores. That means they are not moving on their own and probably not totally aware of what is going on. Pull the plug baby….or let the family pay their 20% share. The taxpayer is tired of paying for hopeless causes.

          • Watchdog_Mel

            Joules and others,
            Most of those that are in the end stages of their life have paid into SOCIAL SECURITY THEIR ENTIRE WORKING LIFE! This means that they have paid to be able to use medicare as their health insurance. They are not the ones who come into this country when they are already advanced age just to get “free” healthcare and then go back to “their country.” ( I have personally heard and seen this many times. Our senior  citizens have been paying into Medicare system since 1965. Where you people need to place blame is in the politicians who saw the coffers of Medicare growing huge and in the early 1970′s decided to pilfer the fund to pay for such things as child who have ADHD and the sorts. Sorry but Medicare was not designed to take care of children or those who have never paid a cent into it. 

    • JO_RN

       I totally agree with you about extending “life” when there is no life.  My fear is that slippery slope where older folks in their 60′s-70″s who are otherwise in good health are denied care that would extend their quality of life … knee, hip replacements, cancer treatments, surgery.
      I would not like to see government entities making all decisions.

  • http://profile.yahoo.com/YDCUOCUHTFFJEDBIS4X3SDCKOE Hong Choi

    interesting.  are you really a physician?  do you actually practice clinical medicine?  your adjectives and superlatives are laced with the perspective of an actuarial education with absolutely no experience or insight into medical care and delivery.  unfortunately, the lay public and policy makers who also lack this insight will be most impressed with your supposed expertise, guaranteeing you income while taking away the livelihoods of those of us who truly labor to bring much needed and quality care to our country’s most marginalized people.  good luck looking in the mirror every morning, parasite.

  • Anonymous

    A huge problem is not directly malpractice, but the “cover my ass” or CYA protocol, as I refer to it when on the wards. I have only been an MD for 1.5 years and already seen patients meet their demise much sooner as an indirect result of tests that were not needed. A perfect example of this, which I am sure happens at several places, is the infamous vascular consult (I will leave out any specific details, but I’m sure we can all think of a case). Instead of putting the whole story together and stating clinically, the chance is something is low and no further work up is needed, a CT with contrast is often demanded even if it is already known will cause permanent renal failure and possibly death in someone with severe heart failure. I’m all for CT’s, but many MDs miss the “big picture”, aka “what is really going to kill this patient”, and for instance if a patient has an estimated 50% risk of renal failure form contrast, often permanent in sick elderly patients, but only about 10% chance of having what you are worried about, in a stable patient, getting the scan is complete nonsense. Doing so would SAVE patients AND money, rarely in medicine do you get to do both.

    • http://pulse.yahoo.com/_CR32NSWJDEEVL4T2NWDT6ZCWMM Joules

      Yes…..defensive medicine is killing us. There is no skin off the ER docs nose if he orders a CT scan for anything. It is passed off to the patient and the insurance. If there is no insurance then the hospital eats the bill. The ER doc has nothing to lose to order every test in the book. If he does not do one….he can be sued for that possible miss. CT scans are about $800 bucks or so. But again…there is no incentive not to order tests to cover their butts. The lawyers will sink there teeth in them.

  • Stuart Gray

    Take what you will from this op-ed but, being a healthcare professional, I can say, with some degree of certainty, that medical errors are grossly under reported in hospitals. Why? Because clinicians and healthcare providers stand to be disciplined at the very least or terminated for reported mistakes. There is absolutely no incentive for healthcare workers to accurately report medical errors. That being said, how can there be “transparency” if hospitals are “cooking the books”, so to speak. The PR departments of hospitals are going to report what their customers want to hear – not what they should. Even if the information is provided from sources like Joint Commission and not the hospitals directly.

  • http://www.facebook.com/profile.php?id=839565715 Madolyn Marie Mertz

    This article has so many logical fallacies, I’ve quit counting. 

  • ewanon

    websites like http://www.healthgrades.com/ already provide consumers with information to comparison shop among hospitals and doctors and dentists.  If consumers were paying the care provider directly (vs through an insurance provider) – i think they would be more likely to shop around.

  • Anonymous

    Until the last paragraph citing the cherished values of the Anerican conservative, one might have thought they were reading a reformist argument from “another” (and I say that because I am quite exhausted with con vs lib labels) perspective. I say that makes it well balanced and rational. Others may be confused. Regardless, some very important points to consider.

    Perhaps among the more important is the *predivtion* that 1/3 of American hospitals will close in the next 8ish years; certainly a good number of these will be the rural hospitals which not only serve as perhaps one of a county’s largest employers, but also serves a critical purpose as a rural critical access hospital in an area where the next nearest choice could be 90-120 minutes away and unrealistic for these communities already in economic distress, then put further there with the closure of a major employer.

    The book Methland details how the cessation of a single local economy driver can destroy the fabric of a small rural community. In that book the community was in Iowa, and the industry wasn’t healthcare but was food processing, however the story repeats itself over and over again. We can not, as a nation, continue to repeat our same errors.

    Healthcare reform should be a platform of ingenuity, thoughtful cost containment, and careful consideration of the economy, the patient, and the communities as equally important in the final product…better yet, never consider anything a ” final product”, and instead look at reform or healthcare as a whole, the same way the field of medicine in general is appreciated—as an entity *always* evolving, improving, moving forward.

  • isaac sinha

    this article is a comparative real picture of the healthcare scenario all over the world. In deed the there are various parameters to be put forward into consideration. One of the most important ones being accreditation. In India, the revolution to improve healthcare facilities at the grass root level has been initiated through a national body called NABH (national accreditation board for Hospitals). In general, the standards are picked up from parts of ISO 9001, JCI standards and ISO 15189, etc. But, inspite of hospitals getting accredited, the transparency of data related to infection control rates, reported medical errors and surgical site infections often remain hidden with the hospitals themselves. it is high time that such data be made available to public through centralized and unbiased portals, so that only those hospitals which have a genuine protocol for providing healthcare services, stay in the industry.

  • http://profile.yahoo.com/SNU2DT4ZK2GO2WACBIG6J3TUG4 john

    I work in health care and  the article says the sad truth. Here we go on our way to becoming a third world country. Health care and education, luxuries not necessities.

  • http://nhsvault.blogspot.com Richard Blogger

    “Second, statistically speaking hospitals are just about the most dangerous places to be in the United States.”

    might that be because that is where the sick people are?

    You say that there are 100k preventable deaths a year in hospitals, but what proof do you have that moving the care out of hospitals will mean that those deaths will stop? HAI has the word “hospital” in it because that is where the sick people are, but many of the infections are brought in from the community before being spread to patients in the hospital, is there evidence that infections like MRSA do not occur in patients who are only treated in the community? And when it comes to medical errors, are you suggesting that it is only hospital doctors who are negligent and that community doctors never make mistakes? (Also, if you close a hospital then surely the hospital clinician who is fired is likely to be a community clinician the next month. So won’t the errors be transferred to the community care?)

    I am not arguing against community based care, I am just saying that your argument that since there are 100k preventable deaths in hospitals, the solution is to close hospitals. Better training and regulation will reduce medical errors in both hospitals and the community; more appropriate uses of antibiotics would have prevented resistant bacteria, and screening means that you can prevent infections getting into hospitals in the first place. Have you actually thought through the problem? 

    (FWIW, my local hospital in England closed an orthopaedic rehab hospital – about 20 beds – so that recovery from hip replacement was in patient’s homes using community-based staff. The outcomes were better with quicker recovery. That was a careful study with lessons learned about how best to impliment the policy. It involved up-front investment – more community-based staff – but the outcomes are that there is a reduced re-admission rate, and hence a long term saving for out wonderful free-at-the-point-of-use NHS. This pilot is now influencing the wider policy in our community of 270k. The main hospital has 450 beds and expects to close 60-80 beds in the next couple of years as further care is moved to the community. [I said "closed" but actually we expect to open a new maternity unit, of the same nuimber of beds, during the same time.])

  • http://profile.yahoo.com/UV3O5NQVFRFS3MIGCCVTCWIFRU luvmibug

    Just a weigh in…I am retiring from nursing in a few months and life in my hospital has changed so drastically that I am both mentally and physically exhausted…and this is NOT from patient care. The shift as I see it is that in the good old days of the 80′s and 90′s most of the patient’s were paying with private insurance and a very few with medicare so the money was flowing..we were actually getting REIMBURSED for doing “preventative” care and testing even before surgery began..OH, I am a pre-op nurse. We very often noted crazy elevated blood sugars in people who had no idea they were diabetic. We did chest xrays routinely and discovered a pneumonia or lung compromise…an EKG on people over 40 and discovered signs of past heart attacks and a routine urninalysis that showed infection…IMAGINE knowing these things BEFORE anything further happened to a person entering a hospital…NOW FORGET IT..we can do NONE of these things without the patient FIRST having some history/symptom of the above disease processes..SOOO translation to we discover these as the patient’s “admitted” treatment is underway. Well…Medicare/insurance companies  will now FIND a way to blame the hospital for “causing” these illnesses and deny payment…My Generation of Baby Boomers are in many ways the reason that this is happening since we are NOW THE MAJORITY of the patients in the hospitals and are paying with MEDICARE NOT private insurance…SO, my hospital has been forced to change from a wonderful homey environment where I felt OK about being a human being and NOT knowing EVERYTHING ABOUT EVERYTHING to an “employee” who has to spend 80% of her time in documentation and charting AND checking behind the young, new Nurses (they are cheaper) to be sure their patients are getting thorough assessments/care AND do my work TOO….geeezzzz, I am exhausted…

    • Josiah Golles

      I never reply to articles but this one is beyond elementary. The read the article expecting some line of reasoning related to hospitals closing.  Yes, costs and quality are an issue but that is why the NCQA has instituted HEDIS metrics to force hospitals to provide quality of care. 

      I know this because my entire job is to ensure that we’re meeting the HEDIS goals which are considered evidence based medicine by Medicare. In about a year, Medicare will start cutting hospitals’ reimbursement based on their quality as told by these HEDIS measures. This entire article doesn’t say anything about the actual reason hospitals will be phased out. 

      We’re moving everything to outpatient care. The burden will be on the primary care providers to make sure we PREVENT illness early on and the hospitals to prevent re-admissions.  This is where the savings are. In my job we play the numbers because we know if a doctor doesn’t have his patient screened with a colonoscopy and that patient gets colo cancer its going to cost us $$$$$$. Anyone here who actually wants to read a something that isn’t BS read ‘Health Care Will Not Reform Itself’ by George Halverson Kaiser Permanente CEO.  The guy is a genius.

    • Elisa Richard

      DITTO that —  been nursing over 20 yrs —  complete DOWNHILL spiral in our WORK environment in the past 18 months ! !  Electronic charting was the FINAL nail in the coffin …..  It was pushed thru as a way to make patient care “better”/”quicker”  –  A bunch of BS …..  there is NO time for patient CARE anymore –now we are reduced to DRONES in front of a screen that is the ROOT cause for MORE ERRORS than I have ever seen in healthcare………  SAD SAD DAY for all of those who have been in the healthcare field LONG enough to remember the DIFFERENCE. 

  • http://twitter.com/sagular Steve Agular

    Of the points you mention, I think that the 4th – technology developments’ leading to the ability to compare hospitals’ quality – may prove to be the main driver leading to the decline number of hospitals in the U.S. However, in my utopic view of our healthcare system, I’d like to believe that improvements in quality of and access to primary care and chronic disease management will be the ultimate catalysts. Two examples that come to mind are the direct primary care model and programs focused on our sickest/costliest populations.  The net result would be an overall improvement in the health of Americans with declines in hospital admissions and ER visits. A statistic cited by Atul Gawande in a piece he wrote for The New Yorker (http://nyr.kr/HpBikW) gives me hope: A few decades ago, Denmark had over 150 hospitals for its population of 5 million people. After a concerted effort to improve access to and quality of outpatient primary care, that number has been cut by over 50% (by 2010). 

  • http://profile.yahoo.com/YR3ZV6JUTEZQ63QXVH7LDHUNIM jules

    “Third, hospital customer care is abysmal. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours. Name one other business where Americans would tolerate this low level of value and service.”  
    I have a problem with this statement. I used to work in the Emergency Department for years. The wait time issue, is in part due to the population of patients that come to the E.D. I found that quite often, patients use the E.D. as a form of urgent care and/or general care management, instead of using the E.D. for what is it designed: emergencies. Many of our patients in the E.D. 1.) are seeking pain control for a chronic ailment, as opposed to emergent care for severe acute pain; 2.) have ignored symptoms for some time and now are not able to cope (the disease or disorder is not emergent, nor appropriate for the E.D. care/intervention, but require full medical work up and long term care plans); 3.) are seeking care for cold, flu, or some other winter viral culprit; 4.) only require simple intervention for minor injuries, such as extremity x-rays, sutures, irrigation, or brace/cast (and the facility does not have a MIIC.) The main trouble with all of these described situations is that while these folks are seeking care in the E.D. for their symptoms, the E.D. is often simultaneously bombarded with incoming ambulances transporting emergent patients in life threatening crises (i.e. MI, CVA, sexual assault/domestic violence, MVA, trauma, DKA, child abuse, GSW, burns, acute respiratory distress, drownings, etc.) With the ambulance bay constant traffic flow, and the fact that patients are seen by acuity and not by “first come, first served” protocol, the sickest are treated first while the less acute are forced to wait. I’ve always thought the public should be educated on “how to effectively use the E.D.” as well as what is the goal and purpose of the E.D. Knowing how the E.D. functions helps the public seek care appropriately as well as provide folks with realistic expectations, reinforced with truthful explanations and knowledge. This would diffuse quite a lot.

    • http://profile.yahoo.com/A2PRP66WADPGB7ZLVXWTS6EL3E barbara

      I have worked in health care for 18yrs the last 8 in the ED and I agree. Education to the pt and families about chronic vs acute care is sadly lacking. I can’t tell you the countless times a pt will state they called pcp and were told to come to the ED for further evaluation. Educating people so they can be proactive instead of reactive is desperately needed. Pcp offices need to be more accessible to pt’s and not just thrown to the ED. It is also necessary to make a pt accountable for their own health and being compliant with medication or care prescribed by the doctor. Frivolous lawsuits need to be addressed. Wonder why every test under the sun is ordered when a pt comes in with a complaint that should be addressed by pcp. Patient’s come into the ED that are SOB or chest pain, yet they refuse to stop smoking or decide they can’t buy medication but they can buy cigarettes and alcohol. How about the “frequent flyers” that drain the system once a week or two to three times aday. Homeless, psych pt’s, medicaid pt’s and pt’s that don’t pay there bill and the hospital has to “eat” that expense. Medical technology and research is expensive but everyone thinks they are entitled to the best. I have had pt’s that are intoxicated, reek of cigarette smoke tell us they cannot afford antibiotics but will continue to smoke and drink then tell us we don’t care about them because we won’t give them the medication for free. Hospital’s are just as guilty. They try to do more with less. When pt’s are admitted they are sicker and require more care which will require more staff but management in their ivory towers tell us they don’t care about acuity and outcome, just do the best you can. I would like management to spend one 12 hr shift in the ED to see what really goes on. I could go on and on but it seems like you are talking to a deaf/blind man. So what we put in is what we get out. Good luck to us all. 

  • Anonymous

    This is a very populistic approach lacking the slightest attempt for nuance. Most patients who are admitted to a hospital have a disease which is life threatening within days, months or (sometimes) years if left untreated. So mortality in the population would be much and much higher without hospitals. Having said that, we all know that individuals and organizations, especially complex organizations like hospitals, are not perfect. Worldwide health care professionals constantly are trying to improve their knowledge, capacities, abilities etc., as individuals and as members (and frequently leaders) of continually changing teams. To get the most out of these improvements health care professionals working in different hospitals have to collaborate, not compete. Therefore I sincerely doubt that ‘open competitive market’ for health care will lead to improved and (at the same time) less costly health care for all citizens of a nation. The only way to check health care costs is to allocate fixed budgets to regions covering primary and hospital care and ordering the health care providers to keep the population in that area as healthy as it could be. Then, automatically to keep costs as low as possible, these health care workers would embark upon efficient programs for prevention of diseases, whereas in a competitive market professionals in the ‘cure sector’ lack this incentive and will strive to treat as many patients as possible since prevention does not go with fees.
    Dr. C.M.A. Bruijninckx, MD, Phd, surgeon
    Rotterdam, Netherlands

    • JO_RN

       The only thing you left out was the power of the patient to make his/her own healthcare decisions.  The med floors are full of frequent flyers who have chronic conditions, eg: diabetes, copd, etc… who do not check glucose, eat right, and still smoke. Then they show up in the ED in crisis expecting to  get “cured.” When their lifestyle choices catch up to them, they file a lawsuit and blame it on the physician and hospital.

      • http://profile.yahoo.com/NHIOGJMPS7HE36RPS6Z5URAIKE Lorraine

        In addition, we don’t get paid for the repeat offenders that are non-compliant. There has got to be a better solution???

  • http://profile.yahoo.com/5LQVS4SXKTBSL34UGCDU7GCE2Q Jirka

    Rule # 1 – don’t get sued 
    Rule # 2 – get paid
    Rule # 3 – do what is best for the patient
    IN THAT ORDER – somewhat cynical – I know 
    ( #1 LAWYERS, #2 insurance companies and federal government, #3 physicians and health care professionals) 

  • http://www.facebook.com/laurashowers Laura Grace Showers

    Working as a lawyer that specializes in health care does not make you a “health care worker.”  You are not the staff on the front lines taking care of the patients.  Instead you are lobbying for laws that are not always in the pt’s best interest or even realistic.

  • michael kraemer

    Your article has a large flaw, the number of admissions (36,915,331) you cite are not unique admissions, quite a few patients are readmitted (could be >10%) so the number of patients in hospitals with DISTINCT visits are much less then you present. What you did not hit upon were the number of patients seen which are outside of hospitals visits, such as surgery centers, dialysis, cancer treatment, etc…

  • Anonymous

    As someone who has been employed as a clinician by hospitals for the past 20 years, I get very tired of all the blame for high healthcare costs being directed at the hospitals. Why don’t we stop focusing all this negativity on the people that are actually providing care? Make no mention how little money most healthcare workers are paid for the level of education many of us have and are required to continually update at our own expense. Trust me, it is not the hospital caregivers salaries that are driving up health care costs in the hospitals. 

    Why don’t we start demanding some accountability from the real money-makers in healthcare (i,e the pharmaceutical companies, the insurance companies)? Why don’t we demand that hospitals be allowed to turn away the uninsured from the ER when they show up for care and have no ability to pay? That would be mean and heartless, right? No, that is just life. That’s where personal accountability comes in. When hospitals get shrinking reimbursement from private insurance companies for those patients that do have private insurance and shrinking reimbursement from state and federal entitlement programs, how can they be expected to NOT provide shrinking levels of care. You are asking less people to perform more services and you are surprised that it doesn’t come at a cost to quality?

    Think about it. When was the last time your private health insurance premium went DOWN? Never. Yet, reimbursement to those that are actually providing care (i,e hospitals) does goes down. Where does all that money from those increased premiums end up?  You actually thought it went to the hospitals? Wake up America. All of the blood has been squeezed from that turnip.

  • http://twitter.com/FEARthecreator jon green

    Recipe for this article:

    Pull together a few facts (used commonly by others)
    Misinterpret, or misapply most of them in a  “top 4″ list format to make ideas seem important
    Turn challenges hospitals are facing into a random guess from a “futurist” about how many will fail
    Voila!

    Maybe they’re too smart for me. Or maybe this is a horribly written attempt to garner attention for their book. 

  • http://profile.yahoo.com/NHIOGJMPS7HE36RPS6Z5URAIKE Lorraine

    I strongly agree. The demise of the hospitals as we know them is starting already. In the Cleveland area only 1 hospital remains that has not been dissolved or bought by one of the 3 systems. It baffles me, that with the Medicare reimbursement cuts and the drive to do more with less, we are still seeing an ongoing “Keep up with the Jones’” mentality of building new hospital facilities and centers. There are still only so many patients out there. The competition is out of control. Instead of building new facilities and centers to try to suck up the competitors business, we should be focussing on improving the quality (which includes adequate staffing) on the existing facilities. Instead, I see cutting staffing to bare bones at an existing facility only to staff a new facility waiting for a patient base.

  • http://twitter.com/SusieScout Susan Upson

    Regarding the wait time in the ER…stop showing up for routine and non-urgent care and you won’t keep getting pushed aside for critically ill patients. THOSE patients do not have to wait, nor should they. Go to your physician or urgent care to be seen unless you are criticall ill. I can’t tell you the number of people over the years who come to the ER because they “didn’t have time during the day”, or they don’t know where the urgent care is, or they don’t have an established physician…AND THEN THEY”RE MAD BECAUSE THEY HAVE TO WAIT. This article has obviously been written by someone who has never worked in the healtcare field. Yet, change is definitely coming and the smart hospitals are already planning for it.

  • http://www.facebook.com/people/Doug-Lohse/100001203461120 Doug Lohse

    The only reason hospitals will be closing is by going bankrupt.  In what other industry would a company keep providing high-cost services to customers who have no ability or inclination to pay for them?

    Hospitals are mandated to provide the best care possible regardless of ability to pay.  Since the government is about to go bankrupt, there is no one else to pay for this mandated care.  Hospitals are already budget-crunched, so expect them to start closing their doors…and expect health care costs to only spiral upwards as the supply of care dwindles and the demand for care continues to rise.

  • http://www.facebook.com/people/Cindy-Woodyard/100000051934885 Cindy Woodyard

    All the more reason for healthcare to embrace hospice as a lower cost vehicle to provide end-of-life care.  With the baby boomers coming to age to need this type of care, it only makes sense for hospitals to partner with alternative means to provide care.  Also, studeis show most people would rather die at home than a hospital or a facility. This also helps reduce their mortiality rate. I say hospital hospitals should change before they have to to survive.
     
     

    • 1BaySide

      FYI- Medicare pays for Hospice Care. The average patient on Hospice is consuming an average of $3500 a month in care for this program alone. Also, not everyone on a Hospice program dies. Some actually get better and graduate from Hospice prolinging death and in some cases ending up in long term care facilities that can easily cost Medicare/Medicaid $10,000.00 a month ++ per patient.

  • Saladin Sec

    “hospital are the most dangerous place” so ridiculous. sorry for my poor english. but one question : what’s the hidden aim of this author ? this famous number of unwantted dies,  explain clearly the source, please ! do you think you you’ll go to hospital if you are in good shape ?!? “stay competitiv ” , hum, even China has understood that population (and all population) health is THE challenge of a country success .
    do you this the good future is to export all US patient ?! you are a wealthy person, and you don’t care (!) for the health of the majority of people of your country. it’s not a question of shame, it’s just stupid. 

    • deltalmg

       There the most dangerous place because the most people with disease and accidental injuries die there :-) Preventable infections are a huge problem. My work is going a little to cultish about it for my taste (emails pretty much every week, desktop wallpaper set remotely to a “Score card” of department vs department etc) bit it is serious problem. It was something in the neighborhood of 80% of the time that doctors see a patient they wash their hands properly. 80% sounds good until you are someone with a serious injury that has been hospitalized for a week. Then you are talking about several times that a doctor was poking around in your wound after touching who knows what.

      It also isn’t just the infections themselves, if say 80k people die from infections there probably were another 1M people that had their hospitalization extended, had medications prescribed, longer followup etc. We are talking billions in healthcare expenditure that could have been prevented by a couple million dollars of soap.

  • Chelle80

    There are many problems with the way this information as been provided. The author seems to imagine that 100,000 perfectly healthy people go into hospitals each year and die because of mismanaged care. Can any of us really accept that picture? I am an Emergency Department Technician and I have been so inspired by the care and attention given to patients by my colleagues that I have decided at the age of 30 to go to Med school. Prior to working in the Emergency Department I worked on a cardio thoracic unit where we did see occasional deaths. Most of the patients on the unit had just undergone either heart or lung surgery. A small percentage would end up with infections or “bed sores” due to a compromised system. We knew who the likely candidates were and spent extra time caring for them trying to avoid these complications. I was a CNA at that time, so I was the one responsible for “turning” weak patients on a set schedule. I particularly remember one patient who had a rare complication due to a drug reaction. Her sore was painful and she called me in every half hour to be turned. She was so sweet but just couldn’t stand it. She went home after 3 weeks with us and is still going strong. Some others were not so lucky. Doctors are not gods. Sometimes nature wins. It is natural that there is a concentration of deaths in hospitals. There is a concentration of sick people in hospitals.

    Also, if the author is not happy with ER wait times, perhaps he should help us to educate the public about why the ER is there and what constitutes a legitimate need for the ER. I’m sorry that your throat hurts sometimes, but we have to care for the man having the heart attack or the elderly woman who fell and broke her hip first. We triage people when they come in to make sure we at handling the most critical patients first. It makes sense. There are only so many beds and so many doctors available. If you are dissatisfied with the wait time, please feel free to utilize your PCP or the local Wuick Care.

  • MedoMedo

    you obviously have no medical experience or expertise. enjoy your two year wait for your socialized medicine while you die of you terminal disease in 6 months, you fool. our system is not even close to perfect, but you are only going to make it worse. and you want a bunch of over simplified metrics that your pea-sized brain can interpret but are essentially meaningless. so one hospital has more infections…do they also take care of more immunocompromised patients? there are numerous variable that go into these figures that you do not take into account, nor do any of your attorney friends running this country. how about some medical advisors that are raging morons?! please…the health of america would benefit from some logical thoughts and some people who actually know hospitals. and for the record, your article is a highly ignorant read for anyone of a medical background. A nosocomial infection is not a medical error. That brings your stats to 20,000 medical errors and 34,000 wrecks. Google it, buddy. Sure your capable of that.

  • http://www.facebook.com/profile.php?id=847400233 Mianmian Sun

    ER waiting time is 4 hours, and the solution to that is shutting down one third of hospitals?

  • RNOH

    This just skims the surface. Health care is the most complex industry there is and this post does not even scratch the surface re service delivery, workforce, interface with other industries, etc. No background, just opinions and then the grand statement that one third of hospitals will close by 2020. Wish I had that crystal ball. Having worked in health care for over 40 years until recently, have seen lots of prognostications come and go. The one constant is that the horizon will contain surprises. This prediction is nothing more than a guess.

    • Naval Asija

      dear sir, medicine is an empirical science, we learn from ones and others experiences but unfortunately this essential truth often conversely turns more experienced into dogmatic who get occupied with their formed notions and ignore the coming reality, hope you see the change in 2020 or may be 2025. did you know what was treatment for hanta virus 40 years ago? the knowledge increased over time but still we are far from perfect. the day our antibiotics become resistant we will be back in 19th century with docs roaming around door to door for treatment

  • RNColo

    I totally agree with you RNOH.  I’m not sure I disagree with the article though.
      I have been an RN for about 20 years and have seen hospital administrators make agregious mistakes in prioritization.  (If anybody knows a hospital that ACTUALLY cares about their nurses let me know!)  No, there is no easy answer, with Medicare breathing down their backs…demanding computerized charting that requires a nurse to sit by a computer for half their shift.  Yes, there are ways to do the charting bedside, but it needs to be better.  The bottom line is, that the public should not tolerate absent nurses and rushed doctors.  It is way to dangerous.  People have know it for awhile, if you wanna get sick, just go to a hospital. 
    Hospitals  will have to REALLY satisfy the public more than medicare, or they will shut down. 

    Hint…Medicare, another one of govt’s mismanaged systems…along with the judicial system and the legislative, Medicares’ parents.

  • shalomam

    People please ,be pro active and take care of yourselves and stay out of the hospitals. I have been in healthcare for over 30 years and I would say that 80% of the people in the hospital could prevent a stay by taking better care of themselves.
    Do not smoke, eat a healthy diet, exercise…get up and take a walk, take several deep breaths a few times a day and de-stress.

    You go to a hospital for people to take care of you when you do not care about yourself?

  • http://www.facebook.com/profile.php?id=1669240440 Richard Anesko

    I find it very short sighted of this author to omit the biggest problem facing hospitals today and the most likely reason many may indeed go out of business in the coming years:  the fact that many uninsured use the emergency room as if it were a neighborhood free clinic.   This fact further fuels the fire that some sort of (national?…universal?) affordable health care system needs to be implemented in this country…

  • lcecil

    I’ve worked in and around healthcare facilities for over 22 years as a project manager.  I have heard many times patients, and some staff members alike, express their lack of concern with the cost of healthcare, since it’s mostly paid by insurers, taxes and other patients in the form of higher costs as they are passed on to others when internal revenue shortfalls are not met.  As a former non-clinical employee, I’ve seen external suppliers for years do the same for everything from light fixtures to band-aids. . .simply because they can get away with it.  The only time they seem to be concerned with costs is when they end up on the loosing end of the deal.  I have seen staff wheel in equipment into patients rooms that was never used for patient care, only to increase the billing rate to insurance providers, construction projects where hundreds of thousands of dollars were spent on engineering and construction projects for the hospital only to have the equipment not operating while paying for the full cost.  Back office deals made with vendors for nurse call systems where service costs are tied directly to one vendor only, as prices increase year after year.  Certainly, someone is making a boat load of money with the current structure, all simply doing it because they can, and everyone thinks it ok.  Finally feed up with the whole game, I returned to the University where I receive my MBA specializing in Healthcare Management, in hopes to find maybe I was wrong in my analysis. . . . .Unfortunately, I’m not.  This much I will say, the whole system is going to come crashing down one day as costs continue to increase, internal revenue shortfalls explodes and hospitals can no longer afford to play the game.  Then, I suspect, you start to see CMS and Joint Commission start to pull hospitals certifications, thus forcing them to close their doors or sell out all together.

  • hturner16

    Problem identification has its place, but without suggested solutions it amounts to little more than complaining. A check list for all procedures done in a patient’s room, along with careful attention to antisepsis, has been shown to go a long way toward preventing infection. Intravenous infusions and all catheterizations can and should be treated as minor surgical procedures involving careful antiseptic cleansing and sterile draping. No matter what that costs, it’s a whole lot cheaper than treating in-hospital acquired infections.
    Harvey Turner, M.D.  

  • Lab2012

    A pity this article is so poorly written. High school level, really. Unless they can provide reliable citations and far better developed arguments, these two amateurs (a lawyer and a… futurist?) have no business discussing healthcare. Houle and Fleece, come back when you’ve at least gotten GED’s and an editor.  

  • http://profile.yahoo.com/N4VU6JKUBLQEMGCPOFTW7PDOPM Piper

    No one can avoid death. When people are facing death, they dont’ call their family, family physician and priest, neither they board Boeing 747, they go to the hospital. Few people face the death with dignity, surrounded by ones they love, listening to background noise of their grandchildren. Most want to squeeze the last drop from their life at any cost (most dont pay for it even if they are on medicare, no responsibility), resuscitated and die with fireworks on rollercoasters (CPR, defibrillations, epinephrine). Don’t listen to government/media propoganda and find escape goat. Need to look at primary desease and consequences of it, before blaming hospitals, since infection will be the killer in the hospital or outside of it of immunosupressed patients (cancer, heart disease, lung disease – which would be blamed if infection would cause the death oputside the hospital walls).
    All we will have to die, no one can avoid it, better later than earlier, but living healthier lives (obesety, smoking, noncompliance…) will delay that, unless striken by unsuspected causes…

  • http://www.facebook.com/people/James-Hanes/100001768727795 James Hanes

    Care has to be provided somewhere. So, are the authors saying that care will be more safe when evermore surgery and complex diagnostic procedures must be provided at ten times the number of outpatient centers?  How does the system maintain quality under that scenario when only a dangerous level of quality care can be maintained in relatively few hospitals which are already tightly regulated?

  • http://profile.yahoo.com/76I3GINY76HWRZFW7MZ66P6JA4 Jay Lee

    I usually never comment on these things, but this article is so poorly written. Wasted a minute of my life skimming it. Equating hospital acquired infections with medical errors makes no sense. This article is a complete waste of time.

  • http://www.facebook.com/profile.php?id=510879102 Rebecca Ann McNeil

    What studies show that average wait time in a hospital ER is 4 hours?

  • CidDog91

    What a ridiculous article…..First, the healthcare expense cited in the article is a direct expense of insurance premiums not necessarily health care costs.  We forget the “middle man” here that generates huge profits annually……THE INSURANCE COMPANIES!!  We so often focus on the healthcare provider but rarely on the insurance plan.  Second, you go to a hospital because you are sick (most do anyway).  So the likelihood that you may die is much greater than on a recreational flight on a 747.  And finally, the waits in the ER are directly proportional to the number of people that access this care point inappropriately.  What other industry provides the service up front knowing that 60% of every dollar of revenue generated will never be paid.        

  • http://www.facebook.com/people/Donna-Fallis/1173604605 Donna Fallis

    Winners and losers exist in all walks of life. It can easily be assumed given your statement that you believe the government is better equipped to decide the winners and losers. I’ve read the health care bill and have family in the medical profession, and so-far, the health care reform act has ensured less care and more pay. Hospitals won’t survive because of the burden the government has placed on them.

  • http://www.facebook.com/profile.php?id=1073893272 Phil Tomlinson

    Let me join the chorus proclaiming how poorly this article was constructed and written.  The entirety of it forms a logical fallacy so big you could drive an ambulance through it.  The conclusion that hospitals are going to close does not follow any of the points previously made and the authors provide no stepping stones to get there.

    Furthermore, several of the points are either pure speculation or simply unsupported.  Most patients do not choose their hospitals, for example, their doctors do.  This is especially true for the elderly, the largets hospital consumer group by far.  Retiring baby-boomers will shift this somewhat, but people will still go where their doctors tell them. 

    If I were grading this paper it would get a “please rewrite” and not so much a grade.

  • wheretheressmoke

    What an absurd article.

    The primary argument seems to be  “hospitals are a dangerous place and therefore people will stop using them”; this, based on the number of people who die in hospitals every year. NO mention of why people go to hospitals in the first place or how many of those people recover from their ailment.

    A logical extension of this absurd line of reasoning would be that “graveyards are even more dangerous” since everyone there is dead. I guess people will plan to avoid using graveyards…. and thus avoid death? Another great reason to avoid graveyards would be…….. the “grave” service. Really….the service at DisneyWorld is so much better.

    After being embarrassed by the ridiculous premise of this article, I looked down at the writers’ credentials hoping that it wasn’t written by someone actually in healthcare policy- making; and then the sensationalist fear-mongering made sense. An attorney and a …… futurist. I can guess the ilk of lawyer the writer belongs to, to but will someone please tell me what a futurist is?

  • Dale Hannegan

    I too, am not impressed by this article.

  • Robert Wetmore

    While I agree that this is a poorly written article, and that there is  no evidence cited to support any of the authors claims, I will have to disagree on so many of the comments that have been made.  I work for the largest healthcare system in my state.  It is a large not-for-profit hospital system.  Believe me, we pay attention to all these little numbers that you claim are meaningless.  Why, because the majority of our population uses them to make decisions about everything.  The more electronic we become, the more pieces of healthcare reform take hold the more these little meaningless numbers mean to us in healthcare. 
    Though it is a poorly written article it gives us something to think about.   Keep doing business the same old way and you will not survive. Our leaders are pushing to become more tranparent, to pay attention to patient satisfaction scores, and medical/medication errors.  Because they all effect our consumers.  We are also trying to push wellness and prevention. Why? Because treatment is expensive. It is much cheaper to prevent illness in the first place.   So before you judge this article too harshly look a moment at the points he is trying to make.  Which orafice he pulls the 1/3 out of I don’t know. But a large chunk of hospital will close or restructure regardless of what changes they make, but the number is likley to be less if they heed the warnings. 

  • http://profile.yahoo.com/ZOL2KLVDODXBQZGCWYEBWSBXNY RAHWA

    As the population grows, there will be more patient’s who needs care. So as the population grows, the number of hospitals will grow.   

  • Lynn McVey

    We can all have our own opinions, but not our own facts. Maybe if this article had citations for his comments, the readers would be more convinced. As a self-proclaimed Data Junkie, who is writing her masters thesis on Evidence Based Management in healthcare, I am quite familiar with the references the author wrote and totally concur with him. We are in denial if we believe things will ever go back to the way they were in hospitals, it is simply not an option. A huge disruption is on its’ way. I believe most of our hospital beds will not be needed in the future. The End.  

    • Robert Wetmore

      I am not a “data junkie” per se, but I am a Lean healthcare process consultant for a large hospital system, and I agree with you complete.   I trend towards wellness and prevention will, hopefully, eliminate need for so many beds. Healthcare systems will actually start to look like what the name implys, healthcare, not sickcare.

      • RecruiterJean

        I agree with Lynn and Robert.  All the hospitals around the US are running less than 50% of the licensed beds now anyway.  Since the states hold their CON (Certificate of Need) the big secret is that keeping the bed census at 50%, bringing the patients into the rooms out of the ER when they have enough patients to open a few more beds;  cardiac, neuro etc. holding down their expenses but their fixed operational costs are too high to spread it across the platform.  So when the states are downsizing as several this year, it is smart.  Population has shifted out of certain areas into new ones and they haven’t added new hospitals in the new areas but haven’t closed any in the old either.

        Big changes needed since we as a nation, participants in the healthcare continuum know that hospitals aren’t the be all and end all there is a more cost efficient method to handle patient care.  Hospital ACO’s will become like the chains of hospitals, holding on to everything and still driving up the costs…

        Efficiencies are needed and are in process;  EMR is a big one and the territorial hold that hospitals have effected have caused the costs to escalate.  Example if you aren’t a patient inside of a hospital your MRI/CT scan is 1/3 of the cost in freestanding facilities versus the hospital…why high fixed operational costs.  Consumers need to be educated to these facts even though they state it, educate them to ask questions and become informed consumers and save some of your healthcare costs to the plans and thus not passing on those high costs to everyone concerned. 

        Disease State Management is another one – retraining, education and case management of high disease states can bring down the costs.  If you look at the model in Tennessee which has been around >10 years it is working.

        I don’t think anyone has the answer but hospitals will fall by the wayside as cost prohibitive to average consumer there is no choice – downsize and stop being so territorial for the good of the whole! 

  • Tim Rowan

    I cannot disagree with the general consensus that the article presents a weak argument and no specific solutions. But some of the comments miss the point too. The problem is not sick people who come to the hospital and then die. The problem is sick people who should have recovered but are killed by avoidable errors: operating on the wrong side of the body, misreading decimal points on med doses, improperly combining dangerous drugs, etc. The argument that unnecessary deaths should be excused because only sick people go to hospitals is as specious as the original article itself.

    The answer is to form alliances between hospitals and community-based post-acute care networks, where home health care, hospice, SNFs, ALFs, rehab and PCPs coordinate post-discharge care. Discharging a patient “to the curb” with a one-page instruction sheet almost guarantees they will be readmitted within 30 days. Poor self-care may be the patient’s fault but premature discharge, poor discharge planning and absent follow-up contribute to poor self-care (except smokers, who should not have access to the healthcare system at all, but that’s another story). The average recidivism rate within 30 days is 20%. When discharged to home nursing care, the rate is about 29% over 60 days, and falling. The monthly cost of home care is close to the daily cost of a hospitalization. Yet only 16% of patients are discharged to home care. Why?

    • Robert Wetmore

      you know, you didn’t reference all of your stats so how do i know you didn’t just pull those numbers out of your ass. I expect to see a APA citations in all work posted on the internet and a full reference page. Thank you.   :)

      • Tim Rowan

        Seriously? Citations and references pages in a blog comment?  You haven’t demanded that of any other commenter. Why just the one on home care? 

        I pulled these widely known and frequently published numbers out of a different body part, the one that stores information gathered from my 19 years in home health care, including 13 as editor of the industry’s most respected technology newsletter. 

        Perhaps you would be so kind as to cite the source of your authority to impose your expectations on anyone at all. 

      • Tim Rowan
    • here_we_go_again2

      not everyone has insurance coverage which will provide them with home care…many are not even at the residence they claim to be going “home” to when services are being set up pre-discharge…they fail to keep the appointments made for them for after care and then present back to the hospital with the same problem they were initially treated for…

      • Tim Rowan

        here_we_go_again2 is reaching to find problems with home care.

        In a small, insignificant percentage of cases, as in everything, there will be minor obstacles. That doesn’t mean you throw out the entire solution. A few drivers run red lights but we don’t give up on automobiles. In my 19 years, I have never heard of a hospital patient lying to a discharge planner about his or her home address.Home care successfully serves millions of people. Medicare and Medicaid and most insurances pay for it. For those not covered by either of these payers, there are still solutions. One not yet tried, but under discussion, is Shared Savings, which asserts that it would be worthwhile for hospitals to take some of their revenue from caring for a patient and share it with post-acute providers who can keep that patient from failing to thrive and from returning to the hospital. The cost of sharing revenue would be far less than the cost of the coming penalties for failing to control readmission rates.As for non-compliant patients, supporting patient compliance is one of the benefits of home care, one of main reasons for using it! To avoid using home care because some patients don’t take their medications is like avoiding schools because some children can’t read.Home care reminds patients of their physician appointments. We know when their prescription medications are a financial burden and we send in social workers to help find community resources. We discover medications in the home that conflict with newly prescribed meds from the hospital and thus prevent dangerous interactions. We use home telehealth technology to watch their vital signs every day. We call them on the phone. We drastically slash the overall cost of care per patient. Without home care, payers would go broke paying the increased costs of longer hospital stays and more frequent readmissions.The argument that home care shouldn’t be used because it can’t be paid for is backwards. Home care does not cost, it pays. 

        • here_we_go_again2

          As a former supervisor/nurse case manager, I am very much in favor of home care as an alternative to in-patient care where appropriate. I do see many patients being re-admitted with the same problem (only much worse off) because the home care agency was unable to track the patient down after discharge to actually provide the care ordered.  Perhaps our patient populations are different than where you are practicing, but our poor, immigrant, english as a second language patients have a hard time understanding when we ask where they are going during the discharge process or that we want to know where the home care nurse can meet them.  Wrong phone numbers, addresses and the like contribute to the confusion.  We are dealing with the mentally ill, drug addicted and the impoverished who sometimes do not give accurate information to hospital personnel as a means of avoiding financial responsibilities.  I am not bashing home care.  It takes a village to make the system work and if the patient does not buy into the home care plan, there is no savings when they present back to the hospital with the same illness, whether it  is an infected wound or another round of detoxing.

          • Tim Rowan

            I understand. In service areas where the demographics are skewed, you can experience a higher percentage of one kind of problem than would be found in another area. Bilingual and trilingual nurses are often hard to find. Perhaps people who are mentally ill and drug addicted need a third option besides acute care inpatient and home care. We used to have funding for such places. I don’t know where it went.

  • twohoofs

    Patient satisfaction surveys will soon help determine how much Medicaid will reimburse our hospital for expenses incurred to take care of those without insurance. We have more than our share of the patients that are unemployed, irresponsible, drug addicted, those having teen pregnancies, old, and homeless  because we are a non profit hospital.  We also have patients from other countries here on Medicaid that have money but get us to pay there bills because they are here as “students’. How that happens I don’t know.  We have patients write poor satisfaction surveys because we catch them stealing sheets and towels and have to tell them nicely that they can’t take our linens home with them.  They order extra food at each meal because they are feeding all their guests. When we  tell them we can only feed the patients they get made at us. They expect everything and don’t seem to appreciate anything. And THEY determine how much we get paid for their bill?   We have gone from taking care of 6 patients each to having 11-12 each because we are trying to cut costs. That means less money for employees raises and more work expected out of them. As nurses we get called off work unless we have enough patents for us all to be working hard. I get called off almost weekly. When I do work I know I will be running all day for 12 hrs with little break.  Many of our patients also are malnurished even thought they are often overweight. They can order healthy food but want fried food and junk. We try to get them up ambulating after surgerys but many are very lazy and will lay in bed and refuse to get up. These patients often return in a few weeks with blood clots or pneumonia from going home and laying around.  Not all our patients are like this for sure.  I’m just saying a good percentage of people will write a poor statisfaction survey regardless of how well you care for them.

    • Robert Wetmore

      Is this the entitlement system that all everyone complains about???   I feel your frustration and agree with your post.  My sentiments are the same. 
      Of course you know, it is all your fault, because the customer is always right.  So we spend millions placating and enabling the masses so they can remain fat and lazy instead of saying “No, get off your fat butt, quit smoking, get a job, get some exercise, etc.”   We cannot say these things out loud because they are political incorrect. We don’t want to hurt feelings and lose a customer or get sued by the ACLU.

  • Fadeproof

    I concur with the sentiments that this is a poorly written article with little support for any of its proclamations and that its short on solutions. Its main solution, one that naievely states that as soon as consumers can compare simple performance metrics between hospitals, all problems will suddenly resolve themselves is absurd.

    There’s no way to compare stats between hospitals without any context. Take mortality rates as an example. The hospital with the lowest is obviously better, right? What if the hospital with the higher mortality rate is the Massachusetts General Hospital where some of sickest patients in the region go because of their ICUs and specialized care and the lower mortality hospital is an outpatient hospital that specialized in small opthalmology and day procedures? How can you compare places with lots of oncology (cancer) care with a community hospital? The healthcare system is far too complicated to be placed on some simple consumer platform and considered to be fixed. The author obviously has very little actual knowledge of what he is talking about.

    • http://profile.yahoo.com/RBNLV4YHV2ZRS4PI2XZTVKKIFA jkrob

      Go to hospitalcompare.com and see how they do the risk analysis.
      This might be rather enlightening for you or is you don’t trust the government.
      There are any number of other sites that can explain how the hospital comparison are arrived.
      The author actually has a great deal of knowledge. 
      Enjoy  

      • Fadeproof

        That would be a great argument, except the only link you provided to support it leads to a spam site. I still don’t see any valid references made by either the author or you, so I stand by my opinions.

  • http://profile.yahoo.com/RBNLV4YHV2ZRS4PI2XZTVKKIFA jkrob

    For those of you who doubt the authors premises there are any number of websites you can go to that discuss the methodology of risk and the results. Try googling hospital compare, it’s a government site but it will give you a lot of interesting facts and figures. If you don’t trust the government try the AMA site or any hospital quality site.  

    • http://profile.yahoo.com/YGG5TPV4TTVXMWJ26OXDAXE7DQ Chuckster

       These days the AMA is in cahoots with the government, they don’t represent the
      American physician anymore

  • http://pulse.yahoo.com/_SJMUEMDIQKPBKCTOVKW7ROXYBA richard

    Having been in the Medical field for 30 years and the secrecy that used to be so prevalent,  new open discussion and records should lead to better health care for all. Government interference will undermine all increasing unnecessary paperwork and waste. I do not see a massive closing of hospitals but a radical change in delivery of services.

  • Joanna Rossi

    I think that this article is myopic, at best.  Of course the medical community can do better to reduce error and reduce the incidence of hospital acquired infections.  But to celebrate that some hospitals cannot compete and will close because there are “winners and losers” is absurd. Do you think that your 4 hour emergency room wait will be any shorter if there are fewer facilities available to deliver care?  It is also rather sophomoric to equate something as complex as healthcare delivery with roofing and carpet installing.  Do the people who fix your roof need to have 15 plus years of education before becoming a roofer? Or even a college degree? 

    I agree that health care costs are rising at an alarming rate, but is your only solution to simply pay less despite the actual cost of goods, services, and expertise?  It blows my mind that everybody wants the latest care, the newest pharmaceuticals, with the most technologically advanced facilities, but NOBODY WANTS TO PAY FOR IT.  Can you go into a Lexus dealer (or Target, for that matter) and say that you are only going to pay 1/3 or 2/3 of the bill and actually get your item?  That would be stealing, right?  But not in healthcare. We’ll bill you for it and get paid the fraction of our bill some several months later.  What successful “business” operates like this?

  • VSant

    This article really has such a one dimensional view of the healthcare industry and doesn’t focus on the positive advances being taken to reduce costs and errors. This article fails to mention facts about healthcare reform, focusing on preventative services instead of reactionary treatments, 
    moving away from fee for service towards incentives for better outcomes, and the ability to integrate patient information using standards instead of silos full of vendor rich systems. While it might be true that there will be fewer hospitals, its also true that newer hospitals will be constructed with architecture that are conducive to efficient workflows and equipped with technology that allows providers to focus on the main priority, patient care. 

  • Paul Bonis

    I am glad these “experts” what a joke, are not acting as my financial advisor.  I would not be taking legal advice or banking on any future predicted by these two.  If 1 in 10 Americans utilized the services of a hospital in 2011 how many more encounters will there be in the future given that 2011 was the first year that the baby boomer generation became eligible for medicare.  Medicare recipients utilize hospitals 5 to 7 times more often than the average citizen below the age of 65.  With the onslaught of baby boomers on their way for 17 more years, healthcare will see the largest increase in patients needing their care than it has ever seen in our history.  If 1/3 of all hospitals close where will these people receive their care.  

    In summary the need for healthcare provided by hospitals will increase dramatically, not shrink as suggested.  Overall I agree that there is room for better efficiencies and lower costs and yes competition will drive that as federal programs will need to curtail their current payment protocols.  Hospitals will need to lower costs to compete, and patients should go to those hospitals with the highest quality and overall value ratings.  A value rating should be established that ranks hospitals both in terms of cost and quality.

    If a hospital is unsafe, it should go out of business, but this is simply not the case overall.  Each year for the past decade, the nations hospitals have improved their quality ratings each year when taken in aggregate.  Thousands and thousands of lives are saved each day and the quality of life of millions more are improved thanks to the dedicated work of healthcare professionals working in hospitals all across this nation.  If you agree with the premise of this article, I would urge you to call a futurist or an attorney for help should you be unfortunate enough to have a heart attack, a kidney stone or simply need stitches at 2am.  

  • jim clark

    Gee Wiz , no explanation or solutions offered.  How about UNIVERSAL HEALTH CARE WITH SINGLE PAYER???   OH I forgot this is a business as usual , and affordable health care conflicts with big bucks for big hospitals and big doctors and vendors and insurance co’s.   Oh, many people die in hospitals because the care they can afford to receive that may be preventative or about WELLNESS is not available to them.   You guys are cynical, greedy jerks who offer us nothing in terms of a through,  plan to revamp the system.  .   Really, who pays your salaries?

    • http://pulse.yahoo.com/_5IB4QAL4XUJT245DT2QAYKJMQY Geno

      Most hospitals do not make “big bucks”. Many small (less than 200 beds) hospitals are struggling to make enough money to replace their crumbling infrastructure to remain competitive or compliant. Every hospital is not created equal from a financial standpoint. There are huge hospitals that are sitting on $2-3 BILLION+ in cash reserves and doing little to assist the less fortunate with it – and some of the worst offenders are church-related (Methodist Hospital in Houston comes to mind.) Others keep plowing their dollars into newer and bigger buildings with ornate finishings and huge lobbies, all a waste. But the latest trend is more alarming – physician welfare! Faced with declining reimbursement (apparently it is a struggle to get back on $350,000 a year), physicians are demanding to be bought by their local hospital or they will move to the big city hospital to get the $$$ they want. Local hospitals are losing millions on these guys, all due to a gun that was placed to their heads.

    • cherwin

      I have an answer for you. Get rid of the freeloaders who don’t work, don’t contribute to society, suck off the tax payers and use ER’s for mesquito bites. Did you ever sit in an ER on a busy night and watch the antics going on. It’s a big party for the freeloaders. Food, phones, boomboxes and family reunions. Come on this has been going on for years and years but it isn’t PC to say it. Well I said it and until you change behaviors which liberals aren’t willing to do because they pretend they are so sensitive to the needy. The truth is they have put the poor where they are and they work hard to keep them there. But people are tired of carrying the load for the leeches of society.

  • SHAHRIL KAMAL SHAFIE

    The author did mention that people go to hospitals to get treatment for diseases or for serious injuries. So, if huge amount of dollars have been spent on Americans to treat their diseases, why isnt the healthcare system concentrating on healthcare issues instead, such as PREVENTION of diseases rather than CURING diseases?? The Government spent millions of dollars on heallthcare expenditures but at the same time, not putting a stop on the growth of fast-food chains, tobacco industry etc…It’s a vicious cycle! Dont compromise on treating the sick, but spend EVEN MORE on promoting quality healthcare.

    Closing down hospitals wont make it any better for the masses. With reduced number of hospitals, people have lesser options for treatment, therefore overcrowding the only hospitals available left. Dont u think this will worsen the waiting time for patients in ER?? It’s true that hospitals will then try to improve their service by reducing the waiting time for patients in order to overcome the competition, but then, wont the doctor be sacrificing his/her quality consultation time with the patients?

    • Karl__W

       Preventing disease does not decrease lifetime expenditure on health care. If anything it increases it, because people live longer, but still eventually get sick and consume resources receiving care over many more years. This is the problem with viewing healthcare as a ‘business” – it is not. Disease is a cost to society. The only question is how the cost is shared among various parties.

      • http://profile.yahoo.com/GMQLE454UCZPGHJEBPBHKCPJXU Andy

        While I share your view that disease is a cost to be shared by people, I think the cost of preventing disease is a complicated issue that is not easily to jump to conclusion.

  • http://profile.yahoo.com/XCC7QUSMG2WLZSNCUGAJGH6QZY Kristina

    We need health care like it is in Germany. Everybody (I mean everybody) is insured there. Kids are insured through their parents, and workers all have to pay 13% of their paycheck, 6.5% pays the employee, 6.5% pays the employer. It doesn’t matter how much you make. If you are above a certain pay grade (about $3,500 monthly), you can decide to insure yourself or to not be insured. If you are not insured you better have cash or no doctor will look at you. If you are unemployed, the governemnt pays your insurance from your unemployment benefits.
    So, while Americans hate this strategy because it imposes on their freedom of choice, the ones who do decide to have health insurance have to pay for all the people that don’t have it. No wonder that a 4 hour stay at the hospital with 2 hours in the waiting room and 2 hours forgotten in bed because the doctor spent 2 minutes looking at you, then disappeared, and the nurses can’t find him to discharge you will cost $800. It’s because someone else doesn’t have the money to pay their hospital bill. And somehow hospitals have to survive and bring the service to us, right? And how can it be that a doctor charges $900 to put 3 stitches in a cut, while the hospital charges another $600 for the 1 hour in bed? It’s because the uninsured don’t pay their bills!
    Let’s face it, unless we get health insurance for everybody or refuse treatment to people who don’t have their creditcard with them nothing will ever change.

    • Rick Robb

       Kristina,
      My family is from Germany. Yeah, if you’re young and healthy, Germany’s system is great (except for the fact that they tax the crap out of you for it). But if you are inured, sick or elderly, the actual delivery of health care in Germany is abysmal! Mostly because the bureaucrats who allow for the spending (the dreaded “death panel” that is also a part of the recently-passed Affordable Health Care Act in the U.S.) make decisions as to who and what is allowed to be treated. So you pay the tax all your life and, then when you really need it, some pencil-pusher (not a doctor) decides who gets treated and for what. My Uncle Paul sat for years with arterial blockage that caused him to lose function in his legs and made it painful to walk. The government would not allow for the expensive surgery because he was too old. He was in pain and very bitter when he finally died. My father had the sense to emigrate to the U.S. and he had the same problem with very different results. He received the surgery in his 50s and spent the next 35 years in good health and lived very comfortably and happily in the U.S. We are headed down the road that Germany is on. I am very afraid of what will be available if I need healthcare in the future!

      • Tim Rowan

        Death panels created by the ACA is a myth invented by the Tea Party, Fox “News” and other Obama haters. The myth was soundly debunked by serious news outlets long ago. U.S. insurance companies have always had death panels, just like the pencil pushers you mention in Germany. Withholding care in the name of profit will continue as long as healthcare is a for-profit system. In our manipulated, controlled, unfree market, human life always comes second.

        • cherwin

          You are wrong about the death panels Tim, and obviously have not read the law. It is not referred to in those words because liberals can’t deal with real words anyways, but there is most definately discussion Obamacare that deals with life and death and decisions on who will get the care and when. So get INFORMED before you attack the Tea Party and the ONLY news station that isn’t up Obama’s butt and has the sense to tell the truth.

    • Rick Robb

      Also, Kristina, there is a VERY great difference between “being insured” and “having access to healthcare”. How many of you have been in a car accident with insurance, but the insurance company disallows the payment for certain repairs because you “didn’t have coverage” for that? Same thing goes with healthcare. Beware what you think is a “good deal”!

    • RickTim

      Germany who is ranked 25th by the World Health Organization would not be the one I would model

  • RN2long

    I agree with RNColo. Working as a Nurse for 20 years, I have seen many patients use the ER as opposed to what I call “Doc-in-a-box”. It’s getting worse as time goes on.

    RNColo talked about “absent nurses”. How many people do you know work three to four 12-hour shifts in a row and can function without making mistakes? I would be willing to bet that the last four hours of that shift are the times that the most mistakes are made. I’d love to see research on that.

    I don’t know about Doctors but Nurses make a lot less, on the whole, that they did 20 years ago. I have to work mandatory overtime just to keep up with my salary when I first started Nursing. Cut out the middle-men and insurance company mega-profits and start putting the money towards shorter shifts and more staff.

    Paperwork is insane. More time on computers than taking care of the patients, but you have to document everything or you might get sued. In general, I think the whole system requires an overhaul.  

  • http://www.facebook.com/people/Valerie-Love/100000425767741 Valerie Love

    Are you saying that “hospital acquired infections” that cause hospital deaths are “medical errors”? 

    • Edison Kivatsi

      No they are not but both are surely there

      • Stephen_Harris

        If we as clinicians continue to believe that hospital acquired infections are inevitable our dismal record of avoidable deaths will continue.  Unwashed hands, neckties, stethoscopes, tape on bedrails, central line dressings hanging off the neck, vent. tubings intertwined with IV access, all are actual agents of death that we need to ackknowledge and respect.  We love to jump at new technologies like DaVinci Robotic systems and the latest PET scanners, but continue to ignore simple precautions that save lives.

    • http://www.facebook.com/people/Smita-Poi/1093705206 Smita Poi

       HAI is sentinel event and obviously a error where medical and non-medical components contrubute to it. (according to NABH)

    • http://www.facebook.com/profile.php?id=1378653054 Denise Vincent

      Healthcare Acquired Conditions (HACs) were defined by the Centers for Medicare/Medicaid during the Bush Administration: “Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are:  (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.”

      So yes, any harm that could have been reasonably prevented, including hospital acquired infections, are considered medical errors, regardless if death occurred.  It’s not as if Dr. Kevin was making this stuff up.

      FYI, the 10 categories of HACs include:
      Foreign Object Retained After Surgery
      Air Embolism
      Blood Incompatibility
      Stage III and IV Pressure Ulcers
      Falls and TraumaFracturesDislocationsIntracranial InjuriesCrushing InjuriesBurnsElectric Shock
      Manifestations of Poor Glycemic ControlDiabetic KetoacidosisNonketotic Hyperosmolar ComaHypoglycemic ComaSecondary Diabetes with KetoacidosisSecondary Diabetes with Hyperosmolarity
      Catheter-Associated Urinary Tract Infection          (UTI)
      Vascular Catheter-Associated Infection
      Surgical Site Infection Following:Coronary Artery Bypass Graft (CABG) – MediastinitisBariatric SurgeryLaparoscopic Gastric BypassGastroenterostomyLaparoscopic Gastric Restrictive SurgeryOrthopedic ProceduresSpineNeckShoulderElbow
      Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)      Total Knee Replacement
            Hip ReplacementPayment implications will begin October 1, 2008, for these 10 categories of HACs.  Found at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html

  • pachomius984

    As a hospital chaplain, I see the frustration daily of people waiting in the ER, waiting on doctors, waiting on hospitalists that they don’t know and have never met before, and the list of concerns just goes on.  I don’t have the answers to health care reform, but it is most surely needed.   Yes, we probably will have to pay more, but some sort of European model seems to be a better answer for all concerned.  Doctors need to be willing to be paid less, families and patients have to not expect everything to be done in all cases at whatever cost, and whatever lack of insurance the person might have.  We don’t have the best health care in the world, not even close to it.  We need to stoop kidding ourselves, move away from denial, and face the facts; we have the resources, it is just a matter of reallocating them in a fairer and more equitable way.  if we once put “men on the moon,” then, surely, we can make common sense, affordable, fair, and efficient health care a top priority.

  • http://www.facebook.com/profile.php?id=100000249047819 Lawrence Mazzuckelli

    Socialization of a system that is NOT broken is most definitely not the answer. The authors make much of 100,000 preventable deaths and while any death caused by medical error is unacceptable it is also important to recognize that this represents only 0.2% of all hospital admissions. In other words, there is a 99.8% chance of NOT dying due to medical error.

    This is hardly what one can reasonably characterize as a “dangerous” situation.

  • http://www.facebook.com/people/John-Frederick/100002243450008 John Frederick

    Where are all the references for sources of information? 

  • mrc1963

    The problem with reimbursement being tied to patient satisfaction is that often appropriate medical care is confused with SERVICE. I’ve been a nurse for over twenty years. Our hospital pays hundreds of thousands of dollars for patient surveys that tell us patients see themselves as customers. Patients want instant service in the Emergency Room for an earache or a cough- they have no appreciation for the fact that the reason they came in is NOT an emergency. Patients want their call light answered in 3 rings even if they want their purse from the chair next to the bed, AND there is a family member right there. Patients want their IV or blood draw done with one stick even though they are obese and/or dehydrated. Patients want their linen changed everyday even if it is not soiled. Patients want their food to be delish -they have no concept of the restrictions the dietary department has to address to provide food to so many people with diverse dietary restrictions. Patients want a good outcome when they have been methodically destroying their own health for over 30 years with cigarettes, alcohol,drugs,food,and a sedentary lifestyle. People want a perfect baby when they have had no prenatal care,poor nutrition, a drug habit, alcoholism, and a multitude of untreated sexually transmitted disease. In short there is a  disconnect between medical care and service-between what is possible and what is not. I don’t think a patient should not get good SERVICE but there is a difference between appropriate medical care and SERVICE. We are pinched to give both! Tying reimbursement to outcomes is also a tough issue when someone who is obese, smokes, and drinks has a poor outcome. That is not fair either. No answers just an observation!

  • pingjockey

    If the authors and/or the website wanted to stir controversy they succeeded (based on the >200 comments mostly negative). While many cite the authors’ lack of disclosure re: references and one-sidedness, the editor of the site that claims to be “social media’s leading physician voice” is not without blame.
     
    With all the information (and misinformation) out on the web it’s a shame to see what level some sites will descend to simply to gain attention – not unlike a misbehaving child who seeks the parent’s attention even if only to scold them…

  • http://www.facebook.com/people/Amy-Geddes/1374881056 Amy Geddes

    I work in healthcare IT as a contract developer/business analyst – to me one of the biggest problems in healthcare is the amount of overhead – let me give you 2 examples at opposite ends of the spectrum, example 1 I am working with an organization right now that has over 1200 software platforms – many with overlapping functionality but different business owners – each business owner isn’t willing to give up there little empire – even though it is creating a silo effect with their operational information – not to mention the maintenance and support contracts that are required to keep 1200 systems with overlapping functionality running – exmaple 2 – I worked for an organization that is hardly using any software applications to run their business – they keep hiring more people to meet their mandated quality/financial/patient satisfaction reporting – not only are they spending a ridiculous amount of money on overhead salaries but they definitely have too many cooks in the kitchen and it takes them forever to make a decision on where the organization should be headed – if hopsital organizations could find the right mix of administrators who have a clear vision of how to use technology it could dramatically change the healthcare experience – not to mention put the focus back on patient care – oh and for those who work in healthcare the other big problem I see day in and day out is there aen’t many career paths/opportunities to advance your career – therefore healthcare isn’t attracting the most talented people.

    • dritzkoff

       large healthcare providers are subject to the whims of the large bureaucrats that ultimately fund them. hospitals are terribly impatient with and improvement measure. Including the adoption of software platforms. They rarely allow sufficient time for any initiative to prove effective. They need to be able to demonstrate to some payer that their improvement process IS working by some arbitrary date. Its unheard of that they would debate the feasibility of achieving results by an assumed deadline. Nor do they often chose to accept slightly lower reimbursement to make an investment that they truly believe will pay off.  If they will be penalized in reimbursement, they will make it look like it works, or they will fire the company who has just begun to provide a complex but ultimately could result in actual improvement.

      Penny wise and pound foolish.

      They waste the cost of their initial investment. Then spend that same cost with another provider, to repeat the process again.

      Although it does justify the need for more salaries for administrators to determine how to fix these inexplicably mounting problems ….

      The brain drain in administration, and this is speculative, as I’ve never seen any administrator answer a medical question, may be a voluntary refusal by those “qualified” to participate in an element that is perceived to be full of exactly the people you observe — those who would not do well at practicing medicine, never mind bean counting …

  • Alan Wyatt

    I have been in the health care field since the mid 70′s. I have watched when hospitals had a free hand of billing for everything to DRG’s then managed health programs.  At the same time, there was criticism of  health care rising faster than inflation (at least since the 90′s)  healthcare ignored all of these warnings. This recession, with lay offs, hospital closings due to lack of insurance and the companies trying to get more for their dollar,  hospitals are either going bankrupt and laying off employees and closing.  It was unheard of in the past that new nursing and other medical field graduates would have difficulty finding jobs.  It is now happening.  We have a surplus of people that we have never seen before.  It does not surprise me that healthcare has had demands for tightening the belt to the point that we will no longer have what used to be unlimited growth.  Something has to give and healthcare must become more efficient.  We need to look at the necessity of tests and therapies that are not needed and not do smoke and mirrors when trying to deliver care.  If we do not reform, the government and businesses will.  It is already happening and it will get worse, no doubt. We need to reform the American health care system to improve care for less.

  • nucmedtech

    I’m a Nuclear Medicine Technologist. My supervisor was forcing us to leave patients unattended, and, thus, unmonitored, while their scan was going on, with no one in the department. She even admitted it was a serious safety concern, but it continued. The director of radiology said that nobody had been hurt, yet, and would not change the practice, even though it went against hospital policy. When I took the matter to the next level, I came under attack, and was fired.

    I can’t find another job. Hospitals say that they want people with integrity, who will do what is right in caring for the patients, but the truth is that management is concerned with profit only. This is why patients sue. This is why neglect is abounding–it’s because of the love of money. 

    Reform is needed, but won’t help until people of integrity are running the institutions. Bottom line.

  • http://www.facebook.com/people/Alieta-Malwitz-Eck/565880983 Alieta Malwitz Eck

    Once this monstrosity of a “health care system” collapses under its own weight, we will be left with patients who need care and physicians who can deliver it. Patients will come to our offices and pay cash.

    Allowing third parties to get in between patients and physicians was the first step in destroying the best medical care in the world.  We need to eliminate the middlemen and the politicians from the equation and will find that health care is affordable once again.

    Alieta Eck, MD
    President, AAPS

    • kwbridges

      No one can really afford it now. Most people couldn’t afford one day at the hospital without insurance, which works to spread the cost over a large group of people who pay premiums but don’t access it like others. Unfortunate the burden must be shared by all. Very sick individuals could never just pay for it themselves. Sorry, but your statements are unrealistic too!

      • Rick Robb

         I mean this in the nicest way possible, kwbridges, GET YOUR HANDS OFF OF MY WALLET!!!

        • kwbridges

          What? My hands are not on your wallet. I simply replied to Dr. Eck’s thought process that individuals by themselves could ever afford to pay cash, and that is why they CHOOSE to be part of a collective group (ie: insurance) to spread around the risk and cost.

          • dritzkoff

            to echo the above: if you elect to use any system or lack thereof, no one is touching your wallet. If you like insurance for your needs, you should be free to use it as you have.
            If others elected to pay of pocket, as they may do of their own will now, that does not require that you select a different option for your needs.

            BUT

            perhaps if hospitals werent the the main institutions being kept alive by insurance payments, particularly medicare, and those insurance providers (particularly medicare) werent the same people that are invested in presenting that at least basic emergent or urgent care can be found somewhere in this country, these two seemingly separate interests would actually become separate. Then hospitals would have to compete on price, as well as other measures. That does concern me a bit, as I believe consumers could be mislead if hospitals become for profit institutions. 

            But the US government, the parent company of medicare, has a vested interest in being able send patients that are being treated (perhaps in an already very limited or restrictive way, due to cost saving measures) *somewhere* when it appears that at least some patients are getting sicker with their very limited care options. Hospitals are needed by the insurance companies so *they* have somewhere to send patients (and someone to shift blame) when they really need more care than just the 10 minutes allotted them or the three month trial on a single medication that has not been effective, but was required before another drug would be approved. Then they would really have to accept responsibility for providing just the minimum standard of care (if that’s what they do provide). 

            Without hospitals, insurance companies and medicare, couldn’t just blame those hospitals when the same patients who now require hospital, (all those cases that cant be resurrected from lengthy highly cost controlled eg minimum necessary or perhaps below minimum necessary treatment is effectively enforced — which is at every single non-unified outpatient care provider or facility), had no treatment alternatives at all. 

            Insurance companies need hospitals so they CAN otherwise refuse to pay for adequate care in as many instances as possible,  and have someone else to point the finger at when that doesnt go just swimmingly.

            We may very well see the cost of daily hospital stay go down, in some instances, if much of the system that no one chose to pay to support disappears.

  • James Austin

    Frightening figures

  • doctor_taurean

    I don’t agree with any of these numbers. Even if they are true, the author should be allowed to visit the disinfection practices in hospitals and learn more about Nosocomial infections. Nosocomial or hospital acquired infections are one of the most challenging and stubborn infections the physicians have to deal with. There might be some mistakes at the hospital level in maintaining proper disinfection levels. But in practice it is extremely difficult to maintain that. Only the most resistant bacteria are left after disinfection procedures which lead to lethal infections in already ill patients. Hence there is such a high death rate from the hospital acquired infections.

    • http://www.facebook.com/profile.php?id=1378653054 Denise Vincent

      I suggest that you review CDC NHSN data.  You are entitled to your own opinions, but you are not entitled to your own facts, Dr. Bull.  Your post reveals that you have no experience in infectious disease and that you have no idea what measures are used in acute care settings to prevent nosocomial infections.

      • cherwin

        I agree Denise. Unfortunately most Dr.’s do not pay attention to infection control. To some it is above them and they feel the staff under them are responsible. As anyone in medicine knows if one persons breaks the chain of defense the whole chain fails rapidly.
        Sorry Docs, no offense intended but it is the truth in many, many cases.

  • deedee610

    THE HOSPITAL I WORK FOR IS DELETING JOBS OF BLACK FEMALES WHO GO ON FMLA AND REQUIRING THEM TO REAPPLY UPON RELEASE FROM DOCTOR. MOST OF THESE WOMEN HAVE BEEN EMPLOYED 15 YEARS OR LONGER AND OVER 50YO. THESE ARE EXPERIENCED NURSES AND THEY HIRE GN TO REPLACE THEM. WHAT ABOUT PATIENT CARE?

  • KMH43

    GP in England.
    There is a lot going on here about patient choice of hospital and closing small units to allow much more concentarated specialist centres.
    One of the objections from the public is that the inevitable result is that many individuals will have to travel further for care, and the effects of this both for emergency and non-emergency care.
    Distances are much greater in the USA: centres of excellence for particular conditions (especially rare ones) need a certain volume of new patients to maintain the expertise which makes them attractive (in a patient as shopper environment) and be easy to reach.
    How many areas in the USA will find themselves with no emergency hospital care  or means of reaching it in reasonable time?

  • Robert Stone

    I believe the authors’ assessment is accurate. I would hope, however, that one of the major factors driving the reduction in hospitals is an increasing awareness of the inescapable fact that the real culprit in rising health care costs is illness that is largely avoidable. A greater focus on prevention supported by effective programs to help individuals make more health appropriate lifestyle choices is arguably the only sustainable way to mitigate the growing demand/need for services. The focus of the entire system must be redirected from treating people after they get sick to keeping every individual as healthy as possible for as long as possible, 

  • drollins431

    Nothing in this article supports the claim that 1/3 of hospitals will close by 2020.  It speaks to general costs of hospitals but it does not compare it to the overall costs or physicians costs or any other section of healthcare.  Further, it doesn’t provide any data to support the assertion based upon profitability, reimbursement trends, demographics, or patient care changes.  This article simply rehashes generic perceptions and does not address any of the changes that hospitals have been going through.  This article was worthless and was merely grandstanding and it does a disservice to hospitals and communities throughout this country.

    • mariannehpolicy

      Yes, I agree.  There is little substance below the claims made in the article, which probably is a realistic option for the future, but does nothing to contribute to our understanding of the problem.  So, where will all the sick people go as we all age and have been medicines to sustain us to get to age 90??  Why wouldn’t  Skilled Nursing Facilities just step in and grow in number to take up the needs that the fast-paced hospital admission?  Is it the cost of labor?  The total daily cost of a bed?  the lack of intermediate care?  The technology?  the testing?  The hospitals these days are seeing the sickest of the sick and not much more.    When the baby boomers age in to the over 75 yr old bracket, don’t you think the numbers of the sickest will grow??

  • Darlene Wilson

    I agree with the authours assessment. Healthcare is definitly in trouble, related to rising healthcare cost. and not enough focus on prevention and wellness. The effect on hospital is currently trickiling down to the community health centers especially in underserved areas.  

  • Hemant Godara

    I don’t agree with comparison shopping for hospitals. Lay public doesn’t understand the difference in care at a tertiary care hospital vs a podunkville hospital. As soon as these smaller hospitals see any complications, the pt is off to a tertiary care hospital. So if you gather sickest of the sickest in one place, who do you think will have a higher mortality rate? How is a lay person going to decide between higher incidence of death for a tertiary care center with advanced cirrhosis, necrotizing pancreatitis, unresectable advanced cancers – people will just see the numbers and even if you give them details, how many will understand the difference?

    I also disagree with comparison of EM wait time to other businesses. If you are going for a haircut, and you are next in line, you will get whatever style you want and leave and same for grocery store or drive through. However, if you are in an ER with a cut on your hand and not bleeding to death, suspected MIs, strokes will take precedence. So I don’t think it is a fair comparison of services. ER is not a food store. Death is permanent. So serious cases will always trump non-emergencies. Those of us working in the hospitals, know most of the pts hanging out in the ER are not real emergencies that can’t be handled by PCP/GP in the morning.

    And lastly as other posters said, where is the analysis of the headline? How are 1/3rd hospitals going to close based on what has been said in the article. Sensationalization anyone?

  • dritzkoff

    i would cease to use the example of wait time in ERs, at least without some comparison to volume, trauma level, pt complexity.
    I havent worked in an ER setting in years, as I am a psychiatrist. However, throughout New York, particularly when I trained for my MD at NYU at the Bellevue ER, but quite the case at all of the NY ERs I have had cause to interact with, patients are waiting because treatment providers have increasing demand for care (ie the number of patients presenting continues to escalate). Why do patients wait at these ERs for 4 hours to receive bad service? They have no where else to go. And by closing hospitals, they will only have fewer places to go, I imagine. Is there some suggestion of an alternative place for these patients to present? I understand that emphasis on preventative care and increased access to health care should decrease presentation to ERs, but people will not cease to have emergencies period. And we have not proven definitively how much we will lighten the load on Ers by those presumed solutions in any large scale reliable manner with great success.If patients wait for hours, perhaps because they know they need ER care, or believe they do, and are waiting, because they know they are in the most appropriate setting they can find.How long would they wait if there were fewer ERs? If I just guessed at one of two options, I might guess longer. Would we then decide to close more hospitals and their ERs?That seems rather back-words, no?

  • http://twitter.com/Aminor5th Mark Levesque

    The Internet was suppose to create the educated health care consumer but healthcare systems got smart. They either have partnered with the area’s largest employers or absorbed any local competition. The average person is frequently limited to using the area’s healthcare system or being penalized by paying higher out-of-pocket expenses by going out-of-network. Especially if you are employed by said healthcare system. The freedom to make a choice is not the same as the ability to make a choice.

    • http://www.facebook.com/ed.wood1 Ed Wood

      Right on. The words “competitive market” have no relevance to present day American health care and will have less in the the future.

  • http://openid.aol.com/majcam01 camille sturdivant-daly

    I work in an Emergency Room. Traumas, Code Strokes, Cardiac STEMI;s all come through the door, either by ambulance or as walk-ins. People with myriad other conditions come in to the system from the emergency room.. Part of the problem is adequate staffing to effectively handle the load. Another problem is called  ‘through put’… how rapidly a patient goes through the system.. Telling a nurse who has 3 -4 patients that all orders must be implemented within 10 min of being written is an impopssible, albeit wonderful goal. One RN cannot be in all rooms at once, and some procedures take longer… each patient is diifferent, and medical care is not like an assembly line. One MD may have between 7-11 emergent patients to care for. If there are admissions, patients must wait for a bed assignment. There had been a practice of trying to care for patients in hallways, but that was unsafe. Some of the patients waiting could be cared for in a doctor’s office, or an urgent care, but have no way to pay; emergency rooms see everyone, regardless. An institution that also does a great amount of charity/indigent care as part of it’s mission  willl al attract a larger number of people seeking care.  Ambulances usually get right into a room and the popel in the waiting area sit, unless they are triaged at a high acutiy that cannot wait.. an ED can go on divert, where amblance have to go to another facility while the ED deals with the patient waiting who need to  be seen, but that takes an OK from administration… and is frowned upon for some reason,, yet that would decrease the wait times for the walk-in patients. Care cannot be given in the ED waiting room, as tthere can be 30 people to 1-2 nurses as assigned at the triage area.
    Just a few thoughts from someone of the front llines

    • mariannehpolicy

      The real matter is that how can a patient rapidly go through the system when the doctor stops by for a 15 minute visit every morning.   Hospitalists are there round the clock, but private physicians want to keep their patients in two hospitals I have done CM/UR at, and they only have time to view the progress of the patient once per day, rely on phone calls from nurses, and recommend that more specialists stop by to view and treat.  Hospitalists call on specialists also, but they do not do a very good job when the private physician is also writing in the progress notes.  They are last in command.    

    • Robert McManus

      As an RN in an ER, your remarks outlined the major problems I see every shift. Inadequate staffing, unrealistic goals set by administrators who have no clue. The attitude from above seems generated by protection of bonuses, over-extensive administration posts/costs, spreadsheet-driven decisions, and just a general notion that we can operate on some production schedule. We are not a just-in-time factory floor, nor are we a WalMart handling “products”. Countless pleas for increased staffing are poo-pooed, treated as childish naivety. Still, I would not do anything else.

  • TerryFlowers

    A single-payer national healthcare financing healthcare system (such as H.R. 676) would go along way in resolving many, if not all, of the challenges outlined in this article.  H.R. 676 would greatly reduce the nation’s cost of healthcare AND provide the financing for the healthcare for every man, woman and child…from the womb to the tomb.  It would reduce the over-use of our emergency departments if everyone had healthcare financing.  With the nearly 1/3 of our healthcare insurance premium dollars currently being expended in non-healthcare ways (CEO compensation/wages/perks/bonuses, lobbying, campaign contributions, shareholder profits, etc) being recouped for actual healthcare needs, there would be plenty of revenue to finance the system.

  • RichardGarn

    Healthcare is not a market.  It has become an entitlement.  As an entitlement it will break/brake the country.  When the money that has been set aside by someone outside your family, like a business, or a government, or a union… the costs have no market controls.  There is no competition.  No mechanism to check costs.  There is absolutely no way a beer o crate in  Washington can make any decision that will be beneficial to an individual they don’t know.  The Washitonians will cover their own butts… and they will set up a dictatorship of beer o crates.

    • GS61

      The issue as to whether health care is a right or a priviledge has been up in the air for years.  As another poster wrote, our health is our greatest asset.  However, Americans feel that money is our greatest asset. Ergo, entitlements is a four-letter-word.  Without our health, we have no opportunity to make money.  Hence, healthcare is a right that we are priviledged to have at this time.  If a third of the hospitals close, some other innovation or expansion of an existing health care entity will come in its place.  I personally feel health care has been exploited by the masses from all walks of life.  It may very well end up being the death of the U.S. economy.

  • http://twitter.com/onmyyacht RJ

    David Houle and his liberal agenda have no place in the healthcare debate. The statistics he cites are retreads from IHI, Don Berwick’s (yet another health care communist from Havard) socialist organization designed to wrestle the health care industry from the free market.  If we REALLY want to bring health care costs into line the following needs to be done 1) TORT reform…in spite of the Trial Attorney’s flawed claims, a FULL 40% of costs could be removed if the threat of litigation were removed.  2) Allow full blown interstate commerce of health care plans.  3) Put incentives in place for end users of healthcare to a) stay healthy b) put pressure on healthcare providers to keep costs in check 4) Remove end of life healthcare costs…a HUGE percentage of Americans pay for nothing more than prolonging their dying process in the last 2 weeks of life…this needs to be stopped immediately.

    • Tim Rowan

      RJ’s is the familiar argument from the private insurance industry. While much of his recommendations may help, the actual first step that must be taken is for all to acknowledge that the market has not been free for a long time. Private, for-profit insurance has bought and paid for as big a chunk of Congress as Wall Street has. If there were a true free market, you would never see actuaries and high school graduates who follow the actuaries’ guidelines making your healthcare decisions. You would never see premiums rising parallel with profits, both at a faster rate than actual healthcare costs. You would never see lobbyists writing bills and handing them to overworked Congressional staff who are only too happy to have their work done for them. Look closely at all of RJs recommendations and you will see that every one would increase insurance profits, in addition to whatever else they would do. Read Wendell Potter’s “Deadly Spin” if you want to know what motivates the RJs of the world.

  • Toni Brown

    I work in healthcare and see many dedicated employees do there very best to care for patients because that is why they chose the field they are in, they want to help people.  With insurance companies deciding the plan of care for patients based on their “guidelines” instead of allowing the clinicians to decide what is needed, hospitals take the heat from patients when they don’t get what they thought they should have.  There are too many uninsured in our country who have to use the ER for primary care because they won’t get turned away and then get angry because they have to wait.  With hospitals having to fight to get reimbursed to even cover the costs of providing healthcare, everyone is expected to do more with less.  Perhaps more time needs to be spent questioning insurance companies who deny claims, contract with hospitals to pay a “fixed” rate no matter what resources are utilized and make hospitals fight for every dollar.  Even when they do decide to pay a claim, follow-up by hospital staff has to be done to insure they paid what they contracted to pay because sometimes they don’t and if the hospital isn’t aware, then oh well.  How much money is spent in insurance premiums annually? I can’t quote figures as the article did, but I am willing to bet that insurance companies are not being asked to “tighten the belt” as much as hospitals are. 

  • mrwmd

    As a practicing hospitalist I agree with this conclusion. I function as a nocturnist and thus I evaluate patients for their actual true need for hospitalization, once they have been seen by the Emergency Physician. If there were better coordination with next day primary care outpatient follow-up clearly 25% of the patients I admit could be better served without hospital admission, and are predominately social admissions with a strong expectation or even family refusal to leave without admission. A simple solution is for the patient and family to bear the direct cost of such admissions or at least a higher percentage of the costs. They will rapidly disappear under those circumstances. Currently private insurance and medicare policies protect the guarantor from the cost of inappropriate admissions. The increasing Federal requirement for measures of patient satisfaction which drive reimbursement deters physicians from making and presenting the hard decisions to such patients and families. Increased patient responsibility for forcing unnecessary hospital usage would stop the majority of these admissions.

    Another 25% could be adequately served with disease-focused specialty follow-up within the next 24-48 hours. In my opinion as much as 50% of hospital admissions are avoidable with more coordination between ER/Urgent Care facilities and outpatient providers. This is where the free market can drive change.* The 100,000 death statistics are mostly misleading when presented to the public, but nevertheless, the point that hospitals are highly complex and dangerous environments is well taken. Eliminating the overload of less than necessary admissions would decrease complexity and introduce greater efficiency & safety, and thus decrease the need for so many hospitals. This will undoubtedly happen.

    I derive my income from hospital-based care, but consider that this a time limited option. I remain ready to transition once again, as I did from traditional internal medicine practice to hospitalist work, before my career is ended by retirement.

    * The current structure of Medicare and Medicaid fee “negotiations” and the slavery of reimbursement to CPT and ICD10 codes completely prevents innovation within a true free market. It just doesn’t truly exist.

  • alamator

    This scare tactic headline is just an attention grabber.  With the load at all of the local hospitals, none are in danger of closing…as a matter of fact, we could probably use a couple more in the near future.

    Some very good points are addressed but most of it is speculation…at best.

    The hospital where I work is at SWAC (service while at capacity) nearly all the time….while construction for additional rooms is being done..!!

    Don’t believe the hype.  The health care industry will be around forever.

  • jdromeo

    jd

  • http://www.facebook.com/people/John-Wright/100000758804148 John Wright

    Throw some so-called futuristic predictions at the wall and see which ones stick! Makes for fun reading but it’s a bunch of baloney at best. Maybe not near you, but hospitals close all the time. And new hospitals open as well. What is most interesting to me: Not a single source or citation of statistics for the entire article. AND the single “fact” the author states in the opening sentence is not a fact at all: “For centuries, hospitals have served as a cornerstone to the U.S. health care system.”  Let’s do the math… oh wait the U.S. has only been around for two centuries. Frankly, I find the author a blustering, verbose, unachored pontifcator about nothing.

    • BenBrucker

      Thank you!!

  • sampath subramaniam

    Healthcare  cannot be simply compared to buying household goods from a supermarket. You cannot go into a shop, pickup any stuff and say I don’t have the money to pay & get away. In healthcare you can! The corollary though is that if you are really sick & need healthcare services, it is inhuman to deny it. If we can distinguish between these groups the moment they walk into the hospital, before they utilise any of the services (starting from triage nurse, to labs to imaging), you can save millions. Can we do that?
    Here comes the next issue – when I am hit by car & my body is mangled, have a heart attack & gasping for air or have a hole in my colon & vomiting feces, do I care whether the hospital stats show an infection rate of 20% vs the other hospital 50 miles away that has an infection rate of 15%?, as long as they have all the facilities & personnel to care for me & they have been doing this for several years.
      Here is what we need – a 2 tier health system:
    1. A system similar to VA system or NHS of UK, to take care of emergencies, elderly, those with multiple comorbidity & the unemployed, the drug users & the other less fortunates. THis system will be paid through taxes & other contributions. However the key is that this system should not be covered by tort laws & free of malpractice issues. The healthcare workers including physicians are usually salaried.
    2. A privatised free market system – for all elective, outpatient, cosmetic & preventive services where healthcare facilities should be transparent, subject to tort laws, with published statistics on their outcomes & paid for by purchased insurances obtained from the market place.
     Physicians & other healthcare workers can work in both systems. Obviously there may have to some regulations on this. Tier 1 will also serve as excellent training hospitals. Governing bodies like ACGME will have to regulate these.
    Our current struggle with the healthcare system is a failure to realize that there are 2 distinct healthcare users & providers who are confusingly mingled & intertwined leading to the mess that we are in.

    • BenBrucker

      EXACTLY!!!

  • http://www.facebook.com/profile.php?id=1378653054 Denise Vincent

    I think that this is Dr. K’s most important statement: “U.S. businesses cannot compete in a globally competitive market place at this level of spending.”  Exactly.  Whenever I notice comments whining about ‘Liberals’ or ‘socialism’ I’ve begun to assume that some people cannot grasp that not only are we competing in a global economy where other nation states provide healthcare more efficiently but that we are also in competition with nation states that use state capitalism and corporate lobbyists to undermine any attempt to improve our competitiveness, whether it’s alternative energy or more efficient healthcare.  I truly believe that reforming healthcare delivery is essential to our survival as a nation.  Change, or be swallowed up by the competition.

    • 7citizen7

      I’ve seen first hand the “efficient” healthcare in other nations!!  You wait for years for a gall bladder surgery (and die waiting!), your medicines are only filled on the date prescribed (if you, personally, cannot pick them up because of illness, you must start all over with the process!), you do not have “appointments” like in the US–oh, yes, you do–like waiting all day in our “free clinics” ,(which is why so many go to the ER instead of the clinics in the US!), and on and on.  Yes, the care if “free” if you do not include all the tax money that goes into it. 
      I agree–we do need a complete overhaul, insurance, drugs, doctors, hospitals, emergency care clinics, labs, the whole industry.  But not Obamacare!!!!!  Not national healthcare in any shape, form or fashion!!!!

  • NClendenin

    It’s complicated!
    Hospitals actually goes back to the Roman era and not 200 years. Dr. K’s article does hit on some issues but not all the issues with regard to hospital codes / regulation, Federal / State legislation (medicare/medicaid), infection control, required patient privacy of the IT systems, extreme hospital building/equipment costs, misuse of the emergency rooms, and more. In CA for example, seismic state legislative laws has caused 1/3 of the hospitals to close because hospitals cannot afford to comply to these State laws by 2020. This will certainly change because of demand for hospitals and so will the efficiency.
    We focus on healthcare now because of a political movement and its been highlighted by the media. We are in a economy crisis and are led like “sheep” because of it.

  • BenBrucker

    A hospital acquired infection is NOT a medical error! If JAMA is grouping hospital acquired infections with medical errors, then that’s misinformation. And what kind of wait do you think people will have if hospitals are forced to close? It’s all about money. There aren’t enough nurses in hospitals to ensure safe care because hospitals can’t hire more resources due to cutbacks and layoffs. And why the cutbacks? Because Medicare and Medicaid reimburse for less than half of the cost to provide care to those patients. Why is the cost focus on healthcare when it should really be on national defense. We spend SO much more on our military and defense and what standards are they held up to??

  • PhilPhillips

    Nothing lasts forever but IF hospitals start closing it will be due to Government interference. The cost of HC has been driven up for decades by gov’t interference. When the lawyers, accountants, executives and CONGRESS can no longer fill their pockets with our $ they will move to something else. In a HC system driven by our taxes, who will provide the tax revenues when Gov’t HC runs our economy into the ditch?

  • http://twitter.com/Amish_Twitt Daniel Gingerich

    While you “hit” on some good points, your ideas are elementary and without premise.  I think your article is to get people talking so you can use their/our ideas as an avenue to acquire intelligent information.  Comparing plane crashes/auto crashes with healthcare… you are comparing idiots to oranges, respectively.  Emergency room customer service should be “crap” … except for the people that actually need to be there.  If you have ever worked near a hospital, you will know what my next statement actually means: you can tell how many people “need” to be at a hospital when you look at the number of beds filled before a holiday and then compare those numbers to the ones in the hospital during a holiday.  The same concept applies to the emergency room situation.  If you don’t know what that means, then you are clueless about the healthcare system.  Americans, including physicians and hospital administrators, are in control of our healthcare in the United States.  I’m not a CEO, or a physician at a hospital, but I know how the game is played.  It’s just business.  If we don’t get the business someone else will.  The government is going to “fork out” the money… why not get our share.  I appreciate people that go to the hospital even when they don’t need to be there.  By the way… the government will “bailout” the 30% that you are predicting that will close.  This is all good for the economy.  When currency stops circulating, things will get fairly boring.

  • cherwin

    I agree that Medicaid and Medicare are extremely draining to the health care system. But… let’s differentiate a little and not be so fast to talk about those two entities in the same light. Medicare is a system that was developed for a purpose and money is paid into it while people are capable of working. Medicaid is a total freebie that the people who work also have to pay into via taxes but there is no end purpose for Medicaid as it is never ending!
    If Medicare was left alone for the purpose it was developed, it would be working. However it has been tapped into for years and given away to persons other tha who it was designed for such as what goes towards Medicaid. Among other things it goes to persons with developmental disabilites regardless of the parents age or means of income. Who ever said that was a fair place to spend it. I worked in this field for 30 years I am so sick of seeing parents of every child with a disability dump their kid off for the taxpayers to take care of for life. I don’t care how wealthy the parents are, they are not required to contribute any money to the cost of care for their child. Yes, I care about the disabled but I care as much if not more about the elderly who have worked all their lives and paid in the system in order to have some, “Social Security” when they needed it. But they do not get a quarter of the money or care that the disabled get. They live in homes beautiful homes with no more than 5 other individuals, they get round the clock staffing, which includes doing their laundry, housekeeping, cleaning, cooking, shopping, grooming, driving, teaching, etc.etc.etc.
    They wear the best of clothes, go to the movies, casinos, and every activity you can imagine. They have every new electronic you can name. Separate TV’s in their rooms and most are overweight because even if they are not suppose to eat something, no one is allowed to prevent them. Parents take them home and do not follow any of the health or behavior plans that tax payers have paid professionals to develop for them. Then when the slightest difficulty arises the parent is ready to sue the state. They go on vacations every year and when they accumulate too much, tax payers, money in their SAVINGS accounts they do what is called a spend down and blow money on whatever can be bought just to use up the money so they won’t lose their Medicare and Medicaid. Keep in mind Mommy and Daddy don’t have to be responsible for one dime of their care.
    This all becomes sickening to me when you see the elderly living in mini institutions, lacking adequate care, mistreated, left alone and left with no dignity. That is how we treat our elderly in this country. You know the ones who worked all their lives and paid into the system so the retarded or disabled or just plain lazy slugs can have the best of everything. What the hell is wrong with this picture?

    • http://www.facebook.com/profile.php?id=100000005780258 Robert Hill

      I agree with your summary 100%.  The system needs a complete overhaul and drastic changes need to be made.  I know many elderly and disabled people that live on very little while those that abuse the system flaunt their new found wealth.  What is needed is someone to take charge of this and take responsibility for making the necessary changes and get the abusers off the system.

    • 7citizen7

       I agree with you.  There is another group that I think should be addressed.  Those are the ones that willingly fried their brains with illegal drugs.  If anyone belongs in “nursing homes” those people should.  Leave the SS & Medicare to the seniors, not these scumbags nor the other departments of the federal government!!

  • Guy Average

    “Health Care Reform” is simply the US Government taking over the lives of its citizens, or more accurately is subjects.  The government will eventually limit how many people can be born and will set the time for people to die.  Anyone who cannot see those implications is not looking and living in denial.  

    • http://www.facebook.com/profile.php?id=1023999523 Susan Torbush

       guy average you are paranoid see your hcp stat

      • 7citizen7

         susan–have you been reading  what is in  Obamacare plan???  I am a senior and I have been reading about all the things discovered in that piece of garbage.  There is, and this is truth, things in place in Obamacare that restrict medical care and medicines for seniors with  health problems.  Things that could & would prolong their lives.  For instance, my cholesterol medicines would not be available to me after age 70, and I am almost there. My cardiologist says that high bad cholesterol is 80% inherited and diet & exercise will not help.  Without the medicine, I would not be able to live another 10 years, even though I am physically ok in all other ways.  This is only a drop in the bucket compared to “end of life” stuff that is in this horrible bill.   This is part of the government takeover, not to help the economy, but to end a lot of seniors lives, prematurely!!! 

  • http://www.facebook.com/profile.php?id=100000005780258 Robert Hill

    You brought out 2 excellent points, hospitals are an extremely dangerous place and that hospital customer care is abysmal.  Having been a nurse for over 30 years I have witnessed first hand more incidents to support this than I could ever list here.  The lack of caring and compassion has been replaced by excessive paperwork or electronic charting by the nurses.  There are insufficient staff in hospitals to care for the patients and this due to financial cutbacks that never stop.  Nurses especially are overburdened, poorly paid and treated poorly not only by administrations but by patients and families that expect one on one services.  Changes to this catastrophe have to happen starting from within the healthcare industry mainly in the medical centers, skilled nursing facilities and other facilities.

    • 7citizen7

       When our nurses can work 5 days of 8 hours instead of 4 days of 10-12 hours, with charting on top of that, then I think we will see our nursing services return to the professional level they were 40 years ago.  When investors in insurance companies expect medium, long term gains instead get rich quick schemes and come down in insurance premiums, more people will become insured.  These two things alone will help both the medical field and also our economy. 

  • mjsmart

    This is why Obamacare (aka; Obama) must be defeated in Nov.. If left to stand, it will create a government run monopoly of our healthcare system, which means that bureaucrats set the doctors’ salaries, hours, and even location (otherwise they just won’t pay the doctor). This also means that few A-students will be foolish enough to enter a thankless field, and many doctors who are still in their medical-prime, will opt for early retirement. In essence, medical care will be essentially “free”, as are all ‘rights’, but unavailable. The socialized medicine model from abroad cannot work in the U.S., with all the plaintiff lawyers, regulations, and “empowered” entitled consumers. 

  • Venkatesh Prasad

    Hai ,

    Would like to compare statistics relevent to the health care system like, No.of patients admitted and treated to the No.of patients who die . Emergency medicine and Intensive care is a place where most of the people admitted for treatment are already in their last stages of life. So comparing airline accidents/ road traffic accidents are like comparing earth to sky.

    • Tim Rowan

      Not exactly. The issue is not sick people who die when they are supposed to die. The issue is accidental, avoidable deaths caused by mistakes by clinicians. To change the discussion so that it centers on elderly people at the end of life who die in hospitals is not helpful. Accidental deaths, caused by medical errors, at a rate equivalent to a commercial airliner crashing every day is a problem. It needs to be addressed, no matter how many people hospitals save.

  • http://profile.yahoo.com/U3QQTPHTQQZP2TK76A5G3ILZWQ Jim

    I agree with Venka, comparing hospital-induced death rates vs. total patients cared for is a key factor. 10% of all Americans going into a hospital in 2011 can also be somewhat misleading. For example, CMS statistics show the vast majority of health care costs are generated from  less than 20% of the eligible Medicare/Medicaid recepients. And that is why bioscreening is a key element in healthcare. Medicare patients at high risk for CV events can have an advanced metabolic screen provided at minimal out of pocket. Issues like BNP, total cholesterol count (small vs. large), glucose, LPa, etc. can be reviewed in one sitting and basic treatments plans created to reduce risk of a CV event in otherwise healthy people. Why wait till the first stroke or MI? I helped kick start an advanced lipid clinic in Ohio but after I left it fell apart. Why? No one to push the initiative, other clinic issues, etc. Meanwhile, otherwise healthy people now going to see the cardiologist regularly to check INR’s, stent blockages, etc. because they didn’t know it was coming.

  • http://www.facebook.com/people/Smitty-Johnson/1723805303 Smitty Johnson

    It’s fun to give statistical data without any citation or companion data to back it up. 83% of all people know that.

      

  • Mark Hanna

    I think your theory is interesting and that you make some solid points, particularly about ER wait times and declining quality patient care, but I don’t agree with your prediction. How does shutting down hospitals solve any of these problems? If anything it will worsen them. 

    Also, about your “comparison shop” statement, hospitals are headed down a slippery slope if they indeed begin posting statistics about their med errors. Reporting med errors on its own is a difficult thing to do what with lawsuits and malpractice breathing down the health provider’s neck. If you start posting “med error stats” then one of two things will happen: 1) health providers will become more reluctant to report med errors since their will be even more at stake or 2) hospitals will simply fudge the numbers so theirs comes out looking best. Hospitalists know this and I doubt that we will ever get to the point where a patient can “comparison shop” according to med errors.

  • Monagean

    The change in American Healthcare is parmount.  It has to change to compensate for cost.  We are moving towards more outpatient treatments to decrease errors in hospitals and cost.  In the outpatient arena the stay is shorter.  In the outpatient arena there has been traditionally, more checks in place to decrease errors.  However, we are seein more checks and balances in the inpatient setting now to decrease errors and a vigilance in monitoring these. 
    Still, the need for large facilities will decrease I feel, as more procedures will be done in the outpatient arena because technology will provide the way to accomplish this.  This decreases the number of persons involved, thus, decreasing the probabilty for error.

  • Jim_Alseth

    I have worked in urban, acute healthcare for 25 years. This is a much needed warning, but it is not enough. Western healthcare must cease to be driven by the pharmaceutical industry, with its symptom-oriented, costly, interventional approach to health. Strong, personal accountability for one’s own health is the only answer to the North American healthcare crisis.

    • Michael T Lyster

      Get back to me when you develop cancer, and want it cured with herbs and interpretive dance.  Last time I checked, antibiotics, cardiac medications and chemotherapy helped increase median lifespans by 20 years since 1900. 
      People are lazy, obese and soft. That said: people eventually die of something.  Proven fact.  If you put off dying of pneumonia, lymphoma, or myocardial infarction, you live longer. Stifle Pharma, and plan on never hitting Medicare age. Count on  it.

      • Jim_Alseth

         Michael, I recommend a book: Younger Next Year by Chris Crowley and Dr. Lodge. It will change your life, or, you can rely on Big Pharma if you want…

        • Michael T Lyster

          Thanks, but I think I’ll just remain an oncologist. I suggest, in contrast that you read The Emperor of All Maladies, by Mukherjee, 2010.

          • Tim Rowan

            Jim and Michael, do you pack your lunch or do you take the bus to work? 

            “Most automobiles do not get 50 mpg.”  
            “Oh yeah? Well, some do! So obviously, you’re wrong.”

            Both of you need to learn the rules of debate. Cancer drugs do prolong some lives, so Michael is correct. Pharmaceuticals are dangerously overused, so Jim is correct. If you could decide the ground rules of your conversation, you would both be able to offer more light than heat to this otherwise interesting page.

  • Michael T Lyster

    The nonclinical observer’s belief in EMR and ‘cloud-based’ data improving healthcare is touching. And wildly inaccurate.  EMRs are designed as CHARGE CAPTURE and LIABILITY TRANSFER devices. They have little or nothing to provide the clinician.  I receive EMR based progress notes from physicians daily: Five pages of verbiage; two sentences of meaningful data.
    EMRs, particularly in hospitals are massive time wasters.  The only people who like them are administrators and software designers.  Good luck improving healthcare with a data entry system.
    “100,000 people die in hospitals due to errors”–first, I recall that the estimate was from 20,000 to 100,000; journalists routinely choose the higher number because it’s…the higher number.  Anyone check lately as to the number of people who DIDN’T die, as a result of hospital admission?Some hospitals should close; particularly in over saturated urban settings.  Hospitals are inefficient. Some of that can, and should change.  To suggest, however that fewer hospitals will improve mortality figures and reduce error-induced deaths is on par with suggesting that fewer lawyers will reduce crime. 

  • http://profile.yahoo.com/RP7QBRAYN2HWC5STGR7TCHQHWY paul

    The following “statistics” are so much BS that I am tired of hearing about it:statistically speaking hospitals are just about the most dangerous
    places to be in the United States. Three times as many people die every
    year due to medical errors in hospitals as die on our highways — 100,000
    deaths compared to 34,000. The Journal of the American Medical
    Association reports that nearly 100,000 people die annually in hospitals
    from medical errors. Of this group, 80,000 die from hospital acquired
    infections, many of which can be prevented. Given the above number of
    admissions that means that 1 out of every 370 people admitted to a
    hospital dies due to medical errors.
    People keep coming to hospitals with illness acquired over years of self abuse (obese, alcohol, etc) or serious illness, That is the reason they die. ICU patients have up to 50% mortality and “top 5″ hospitals have 10% thirty day postoperative mortality-because the illness is the cause!

  • AnkotaCEO

    There is a fifth element, and that is the rise of Accountable Care Organizations & similar models. These will drive more care, delivered earlier, and provided outside of the hospital setting more and more. As economic incentives align and technology enables Care Coordination (particularly among multiple providers), the population will be better cared for at lower overall costs. Brilliant piece! Keep ‘em coming. -Will Hicklen, CEO Ankota  http://Ankota.com

  • Ace

    The baby boom population will cripple the health system as they age into their 70s and beyond and will have a significant effect on the healthcare system as we already have seen to begin.  Costs will begin to outweigh profits and the businesses (hospitals) will close.  No amount of government subsidy OR reform will be able to maintain stability and this market will crash.  I am suprised this reason is not even mentioned in “statistics”.

    • 7citizen7

       I see!!  You have been fed and swallowed the libs lies!!!  Baby Boomers use the medical field only when absolutely necessary, unlike the younger generations that run to the Dr. for a cold!!! 

      • Ace

        It’s not a political debate here.  Just a matter of supply and demand.  The hospitals will close when the demand goes away or by getting swallowed up by larger hospitals.  The article doesn’t mention the amount of care given, just that hospitals will close.
        I don’t have a problem with baby boomers using hospitals.  No offense from my end.

  • http://twitter.com/shimagyoh Shima Gyoh

    If hospitals are so dangerous, why not close all of them?

  • 2Salim2

     It is really surprising. If this is what pertains in America then am worried the situation is horrible in third world countries like Uganda were hospitals are ill equipped, understaffed, and were the few available health workers lack morale. Oh God Help us You know better our destiny!!!

  • TigreMV

    A futurist and a lawyer…  I guess I shouldn’t be surprised. Two people who get paid for theorizing. This is an awful article, if one can even call it that. Its more like a vomit of random thoughts. You do not include one shred of statistical documentation. You hyper-generalize and feed on fears rather than demonstrate a logical, coherent argument. And to top it off, you’ve given it a broadly over-stated title that doesn’t even match with your premise – you really aren’t arguing that 1/3rd of hospitals will “close” (queue dramatic music!), you are saying they will “reorganize into a… different type of health care service provider”. Far less ominous when read that way… right? You’re predicting that their business will undergo a major shift in the way they operate over the next decade? Now THERE’S a groundbreaking concept… 

    Does this really constitute forward thinking in the health care industry? Are we so starved for voices of strategy in health care that these four very general points tied to an overbearing “conclusion” of massive industry change counts as leading thinking? This is 11 paragraphs without facts based on an undefined syllogism. Rubbish…

    As an aside, this article could have been published 5-10 years ago in its exact form, with the sole exception of replacing “health care reform” with “internet and computer technologies”.

  • BeachJoy2012

    Oh my god, would everyone stop the rhetoric about taxes.  This is not the primary issue.  This is about the risk of infection within the hospital – properly called a nosocomial infection.  The cause is, in my opinion, two fold.  1.  Hospitals, many of them, are teaching facilities which means that there are people learning and sometimes this learning goes on without proper supervision.  Medicine is a science – but it is also an art and certain aspects of this learning need to be experienced.  2.  Doctors, while smart, are arrogent and stubborn people who believe the rules do not apply to them.  Proper hand washing techniques would lower these numbers significantly but try telling a physician anything and chances are you’ll have your head blown off.  While arrogance is just what I want when I’m in an emergency operation, if physicians would cut the crap and practice what hospitals require – as in hand washing and proper supervisions of medical students, interns, residents – many of these deaths can be avoided.  

  • http://pulse.yahoo.com/_TR6KED6IYPLIBAQN3WRCHG4OYQ Anonymous J

    This article doesn’t even bring into play the model of the Community Health Center. For example, in Colorado, see http://www.cchn.org  You can get great primary care at Community Health Centers, which saves alot of money compared to going to the hospital, which has huge overhead, etc. Check out a ‘Federally Qualified Health Center (FQHC)’ near you!  They cover people who are both un-insured AND under-insured, medicaid/care too, and have payment pricing scales. CHCs are the future of health care!

  • 7citizen7

     Have you read all the pages of Obamacare??  I trust all the politicians which have brought to light so many things in the bill.  Since Pelosi said it had to be passed before it could be read and debated, plus the fact it was all written without being bipartisian, should tell the average citizen that skunks do stink with surprised or threatened!!

  • http://www.facebook.com/valerie.norberry Valerie Norberry

    Well I worked in Hospitals and doctor’s offices for 25 years and got sick of enabling so called smart people who are not from this country to speak English, I was a transcriptionist…

  • http://twitter.com/erikleander Erik Leander

     I’m not seeing really any reasons why a third of hospitals will close?  Just b/c a lot of money is spent, doesn’t mean anything will be done about it. 

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