We are not a light switch

John Taylor: June 29, 20120 Comments

Legal wranglings over healthcare reform went on for more than two years. Concurrent political dogfights won't end anytime soon. All the while, there were two implicit messages being sent to hospitals, physicians, drug makers and insurers: Continue doing whatever it is you do. And, watch if you want to, but your world is being changed.

Hospitals, sadly, have become accustomed to government budgets and regulatory rules either being staggeringly slow or being rushed through with only an occasional nod to the needs of patients, workforce limitations or establishing cost-effective, quality care as a coherently deliverable benchmark.

It takes a decade or more to "create" a medical practitioner. It take even more time for those doctors, nurses, respiratory technicians, pharmacists, physical therapists to excel in their vocations.

It takes years to design and build a hospital. It also takes devoted fund-raisers to assist in raising the nearly $2 million needed to "create" a hospital bed in hyper-regulated California.

It takes a minute to create a medical emergency.

It takes a lifetime or two to hard-wire in the public a culture of healthy habits and lifestyle choices, an attentiveness to personal well-being that enriches one's quality of life and staves off health expenses.

But some public policymakers and elected officials still adhere to the heresy that healthcare has an on/off switch. Their's is a "Heck, there's always an emergency room" mentality.

So, what sounds like great public policy on a grand geographic or ethical scale might prove a disaster to certain regions. Take, for example, the well-chronicled shortage of primary care physicians in the Central Valley. As the Affordable Care Act fully rolls out, more uninsured patients will seek to enroll in Medi-Cal. But reimbursements for the dwindling numbers of physicans in the Valley who will take Medi-Cal patients have been so historically poor, that these new patients may have nowhere else to go -- except to the dwindling number of hospitals who have emergency departments.

Luring physicians takes time and a strategy. "This isn't Ventura County. This isn't Malibu. This is the Central Valley," a San Joaquin County official said in the Fresno Bee.

One top official at the Centers for Medicare and Medicaid Services, a key federal health agency, told a California Hospital Association official that big numbers spread over a large area always wash out. While that may be actuarially sound, if you're a hospital caring for a dozen patients each of whom is racking up to a million dollars or more in uncollectible bills, you might be inclined to toss that regulator off his Mount Olympus.

Against the backdrop of health reform, hospitals like Community Medical Centers have been working to evolve the healthcare delivery (so-called) system. The goal: getting people the right care at the right place at the right time. We're doing so in the face of what some call "fiscal cognitive dissonance." Government, especially in California, is downsizing both reimbursements and services, while the folks in DC are encouraging the most massive ramp-up in medical coverage in more than 40 years.

It's a time of lofty goals. It's not a time for the faint of heart. And, irrespective of the dithering and political mouthwashing, Community and those we serve are not light switches. The need of patients, and our commitment to addressing them and improving the ways we do so, is always "on."  

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