Friday, January 24, 2014

A DEEPER KIND OF HEALTH CARE REFORM


Many of us are disheartened by the state of health care today.  The solutions being proposed to repair and reform it are not sustainable for physicians or patients.  Every system functions from operating principles that govern and direct its mission.  In order for us to understand why health care is dysfunctional, we need to analyze and understand its business model as it relates to is mission.

Nearly two decades ago, physicians delegated the business of health care to administrators and accounting experts to manage and run it.  Unfortunately, their mission was in conflict with that of the health care system. Theirs was profit centric rather than patient centric.  They believed that patient care interfered with generation of profit.  They began to see time spent with patients as a compromise of their mission.  They began to value numbers over people. Health care’s mission became disjointed when two contrasting missions were being served. Profit became the dominating mission for health care as business managers established control over physicians and regulated and limited their time with patients for maximal revenue.

When I worked in this system, I was unable to find meaning in my work.  I was also unable to sacrifice my mission as a physician for the mission of health care administrators.  I was told that my work in their health care system was a conflict of interest to their mission.  My patients were staying well and not generating enough hospital dollars.  I left traditional health care to create my own business model.  As a physician who remains devoted to my patients I wanted to create a model that generated value for both my patients and my business creatively.   I have never sacrificed mission for profit. I run my business with good business savvy, all the while devoted to my purpose as a physician.  A health care business model risks losing its way when it becomes profit centric.  For healthcare to be successful and sustainable, mission must never be compromised for profit. Our health care system has lost its way.

We have many examples of profit driven health care in our country today and especially in southeastern Wisconsin.  These systems purport to care about health, but on closer examination, we see otherwise – they rely on sick care.  Health care is a conflict of financial interest. Currently, the highest expense in health care are administrative costs.  Many layers deep, administrators manipulate and control physicians, nurses and employees  serve their mission of profit over health or care.  This has demoralized physicians and nurses and driven away patients. Moreover,  it has increased the incidence of medical errors, placing patients and physicians at risk. 

Author and president of Business Ethics Magazine, Marjorie Kelly, defines a business model that functions with this type of focus as ‘extractive.’  Its’ purpose is merely financial – maximization of profits.  Worth is extracted from workers to generate profit by layers of administrative hierarchy.  The extractive business model is prevalent in most corporations today.  Outsourcing work to Third World countries for cheap labor to increase profit-margin is extractive.  Extractive economics are bad for our country’s economy.  It displaces domestic workers and extracts as much work as it can from the remaining workforce to serve profit margin.  Extractive economics deplete meaning from work.  Employees find themselves working merely to pay the bills for survival.  They lose pride and meaning in their work. As a result their physical and mental health suffers.  We all pay the price for extractive economics.  The state of our country’s middle class is a result of extractive economics. 

The majority of health care systems function from this extractive model.  Health care employees are currently working merely to meet quarterly projections.  For health care to operate in this manner is unethical.  Health care’s mission is to serve and heal.  When the vulnerability of patients is used to generate profit, they are deeply harmed. The ‘care’ they receive is motivated by the drive to maximize testing and treatment.  Physicians are unable to diagnose and treat cost-effectively when working for an administrative system based on extractive economics.  They must follow the rules of the game to keep their jobs.  Patients are left with super-sized bills for mere symptom management.  Administrative bonuses depend on this.

A ‘generative’ business model provides services that generate value.  Health care based on generative economics focuses on health and healing rather than maximization of profit.  The focus shifts from one of greed to one of service. Patient care is not provided at the cost of profit, and there is a balance between both without compromising either.  A health care model based on generative economics operates from the principles of sustainability.  There is a fair exchange between doctor and patient. 

What this would look like in the health care system is already visible at The Ommani Center for Integrative Medicine.  Patient care as well as sound business principles are utilized to serve patients cost effectively.  In addition, the most cost-effective diagnostics available in the community are recommended to patients.  Small businesses in the community, such as organic grocers, complementary practitioners and businesses dedicated to health and sustainability that operate from a high standard-of-care, receive support and collaboration by practitioners through patient referrals.  Education and empowerment are of foremost value and achieving optimal health at all levels is served.  All retail profits are used to subsidize business overhead to keep health care visits affordable for patients.

Practitioners work collaboratively with patients to uncover the causes of illness and empower patient responsibility.  The mission of health care is served and all profits are reinvested to support the staff and employees of the Center.  The business is also dedicated to the health of the environment and recycles to reduce its carbon footprint. 

The Ommani Center is a generative business. 

Those who administer the business of traditional health care state that a mission centric model cannot succeed financially, that a generative business model is not profitable.  Nothing could be further from the truth.  Shifting the focus of a business from profit to mission, from extractive to generative can actually draw in more revenue in service of its patients.  In addition, in a model like this, patients are truly served by physicians practicing from heart without the demoralization they currently experience within an extractive model of health care.

This is health care reform at the level of its core mission.


I believe this is one of the key solution’s to healing our broken system of health care.  This can also restore the soul of our sacred vocation.  

4 comments:

  1. Thank you for your reflection. I agree-and am blessed to be apart of CDI where the number one focus is the patient. It is accountable care at it's finest ensuring every patient walking in the door is met with dignity and QUALIFIED radiologists are reading. As an Advance Practice Nurse working in collaboration with a clinical breast radiologist, I am so proud of our and know patients are receiving the absolute finest, collaborative care.

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    1. I refer many of my patients for diagnostic radiological tests to two local companies including CDI.
      My experience with CDI's expertise and professionalism and humanness is the reason I continue to refer. It is great to read what you are saying even about its internal workings. This gives me hope that as the grass roots has the solution to our current health care crisis.

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