U.S. Healthcare Executives Are Talking Their Book
U.S. medical officials have repeatedly said – almost like a mantra – that Ebola can’t possibly effect our country because we have the “strongest” and “best” medical system in the world.
Were they speaking as scientists … or salesman? After all, the U.S. has the most expensive medical system in the world. And – like all good salesmen – they have to talk up and justify the super-pricey product.
In fact, independent studies rank the strength and quality of our system as low. In June, the Washington Post headlined, “Once again, U.S. has most expensive, least effective health care system in survey“:
A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 — as other nations did with concerted effort and significant reforms — it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system.
“Although the U.S. spends more on health care than any other country and has the highest proportion of specialist physicians, survey findings indicate that from the patients’ perspective, and based on outcome indicators, the performance of American health care is severely lacking,” the Commonwealth Fund, a New York-based foundation that promotes improved health care, concluded in its extensive analysis.
How could that be?
Roy Poses, MD – Clinical Associate Professor of Medicine at Brown University, and the President of the Foundation for Integrity and Responsibility in Medicine – notes:
From 1983 to 2000, the number of managers working in the US health care system grew 726%, while the number of physicians grew 39%, so the manager/physician ratio went from roughly one to six to one to one (see 2005 post here). As we noted here, the growth continued, so there are now 10 managers for every US physician.
We have frequently discussed how generic managers in charge of health care organizations may follow business-school dogma at the expense of patients’ and the public’s health. In particular, they may also prioritize short-term revenue ahead of all other concerns, and hence may favor high-technology and procedural care, often performed electively, ahead of the the less glamorous and remunerative parts of health care, e.g., ED care of poor, uninsured, febrile patients.
Unfortunately, much of the country’s efforts to ward off Ebola are likely to be lead by generic managers who may have little understanding of epidemiology, public health or virology, and little understanding of the state of health care at the sharp end. So unfortunately I expect continuing “glitches,” or worse. Hopefully, the country, although not every single one of its inhabitants, will survive them. Then we need to seriously reflect on the wisdom of handing control of health care over to generic managers, rather than health care professionals.
Dr. Poses gives a specific example, the Dallas hospital – Texas Health Presbyterian – where sloppiness has caused 2 nurses (so far) to contract Ebola:
USA Today published on October 14, “Texas Health Presbyterian was a respected, renowned hospital.”
Instead, it appears that the leaders appeared tremendously overconfident, and worse, may have silenced employees from raising concerns that could have reflected badly on leadership. This occurred in a context in which transparency was imperative so that other people who might have to deal with Ebola patients might be better prepared.
On the other hand, based on what we have been posting on Health Care Renewal for nearly 10 years, the conduct of the Texas Health Resources leaders should have come as no surprise. On Health Care Renewal we have been connecting the dots among severe problems with cost, quality and access on one hand, and huge problems with concentration and abuse of power, enabled by leadership of health care organizations that is ill-informed, incompetent, unsympathetic or hostile to health care professionals’ values, self-interested, conflicted, dishonest, or even corrupt and governance that fails to foster transparency, accountability, ethics and honesty.
We have seen many examples of hospital executives who seemed vastly impressed by their own brilliance, egged on by board members who were themselves executives of other organizations, and by marketing and public relations functionaries dependent on these executives for their own career advancement. In particular, we have posted examples of hospital CEOs and other top executives making millions of dollars a year based on their supposed “brilliance,” or “visionary” capacity, at least according to the board members who supposed to be exercising stewardship over their institutions, and the public relations people they hired. Such brilliance has often been asserted, but rarely been explained or justified (The latest example was here, and much more discussion is here.)
Most such ostensibly “brilliant” hospital executives had no direct experience in clinical care, public health, or biomedical science.
Making hospital leaders feel entitled to make more and more money regardless of their or their institutions’ performance seems to be a recipe for “CEO Disease,” leading to disconnected, unaccountable, self-interested leaders. Hospital leaders suffering from the CEO disease may be particularly willing to countenance suppression of any facts or ideas that might raise doubts about their brilliance.
So the leadership of Texas Health Resources may in fact be very typical of that of large non-profit hospital systems. THR is such a system. A Dallas Morning News article about Mr Doug Hawthorne, the Texas Health Resources CEO who just retired in September, 2014, stated
In 1997, Doug Hawthorne helped reshape the health care industry in North Texas by leading the creation of Texas Health Resources, an alliance of Presbyterian Healthcare Resources, Harris Methodist Health System and Arlington Memorial Hospital.
With more than 22,000 employees in fully owned and joint venture operations, Texas Health is one of the largest care providers in North Texas. For its 2012 fiscal year, it had $3.7 billion in total operating revenue and $5.3 billion in total assets.
For leading this system, Mr Hawthorne made a lot of money, although apparently no recent data is available on his compensation,
He was among the most highly compensated not-for-profit CEOs in the region. For 2012, the most recent information available, his base salary was about $1 million and his bonus was about $1.1 million.
It should be no surprise that to justify this compensation, Mr Hawthorne was proclaimed a visionary. According to the Dallas/ Fort Worth Healthcare Daily, Mr Hawthorne was inducted in 2014 into the Texas Business Hall of Fame. At that time,
‘A healthcare visionary, Mr. Hawthorne is at the helm of one of the largest faith-based, nonprofit health care delivery systems in the United States, Texas Health Resources,’ the Hall said in a release announcing the induction.
Yet Mr Hawthorne had no direct patient care experience, public health experience, or biomedical or clinical science experience. Mr Hawthorne is on the board of directors of the LHP Hospital Group Inc, a for-profit that provides capital and services to non-profit hospitals. The official bio, posted by LHP stated his educational background only included
B.S. and M.S. degrees in healthcare administration from Trinity University in San Antonio.
Furthermore, as we mentioned earlier, the current CEO of Texas Health Resources, Mr Barclay E Berden, who has only been on the job since September 1, 2014, also was hailed by system board of trustees for his “unique leadership strengths.” His current compensation is unknown, but I would guess is likely over $1 million/year. He highest degree is a MBA, and like his predecessor, had much experience in hospital management, but apparently none in clinical care, public health, or biomedical science.
Lambert Strether notes:
I found this the most vivid:
Among the nurses’ allegations was that the Ebola patient’s lab samples were allowed to travel through the hospital’s pneumatic tubes [instead of being hand-delivered], opening the possibility of . The nurses also alleged that hazardous waste was allowed to pile up to the ceiling.
What could go wrong? Isolation wards won’t do the trick if the specimen tubes got contaminated. Dear Lord. IMNSHO, it’s not aerosolization we have to worry about, but out-of-control neo-liberal infestations that hollow out our rickety, “jalopy institutions.” Institutionally, this is third-world stuff, and it’s an especially noxious and lethal form of American exceptionalism to pretend that it isn’t. If there were a specimen tube that ran straight to the CEO’s office, or medical waste piled up outside his door, you can bet these problems would be fixed toot sweet, but since that will never happen, more canaries will have to suffer and die.
While Democrats pretend that the Affordable Care Act (i.e. Obamacare) will help fix this problem, real liberals say that Obamacare is really just a giveaway to the big, for profit healthcare companies … and will only make things worse.