Robin Hood or Hoodwinked?
I recently read a wonderful article by Jonathan Rauch in the December 2013 issue of the Atlantic Monthly entitled “The Home Remedy for Old Age”. A remarkable doctor named Brad Stuart noticed back in medical school that elderly patients were being treated aggressively for illnesses and had the out-of-the-box thought (at the time) that maybe this wasn’t such a good idea. He has since started a program that treats many elderly patients at home and provides ways for caregivers to avoid hospitalizations. As George Taler MD, of Georgetown University and MedStar Washington Hospital Center says: “Hospitals are hugely dangerous and in-appropriately used. They are a great place to be if you have no choice but to risk your life to get better.” Well put.
One home-based primary care model is called Advanced Illness Management progra (AIM), which I believe is Dr. Stuart’s program. Here each patient has a team of doctors nurses, social workers and therapists who get together once a week to discuss the patient and decide if a home visit would be beneficial and to adjust care as the patient declines. They provide a phone number that caregivers and family members can call instead of 911. Advocates say that such programs save Medicare (most of the elderly are covered by the government) money, and systems like the Veterans Administration have seen results that back this up. This cost savings is because Medicare pays for hospitalizations, not home care or social workers or home doctor visits. The ACA, which penalizes hospitals for readmissions and has grants available to hospitals testing new care models, has made a start in making these home-based primary care models financially viable, but most still operate at a loss.
So this is great! I’m all for it. That’s the way I want to be treated when I’m frail. Along with cabernet and chocolate chip cookies.
I was brought up short while reading the Atlantic article when I realized who the good Dr. Brad Stuart worked for: Sutter. Uh Oh. That rings some sort of bell doesn’t it? The New York Times just did a big piece on exorbitant hospital prices and which network do you think showed up as the worst offender?
“Sutter Health, California Pacific Medical Center’s parent company, operates more than two dozen community hospitals in Northern California, almost all in middle-class or high-income neighborhoods. Its clout has helped California Pacific Medical Center, the state’s largest private nonprofit hospital, also earn the highest net income in California.” http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html?ref=health&_r=0. The NYT cites exorbitant charges like $36 for a tylenol with codeine pill or $137 for a bag of IV fluid. We’ve all heard stuff like this before.
Yeah. Hmm… But ok, maybe Sutter uses it’s overcharging to pay for money-losing enterprises like AIM. Well, it outsourced it’s dialysis services (poorly reimbursed) and tried to convert a hospital it had acquired in a poor community into an out-patient clinic. So it looks like at least in these two cases it tries to get rid of money-losing enterprises. But maybe Sutter uses all it’s money to do some sort of separate charity work. Well, one of it’s main hospitals, California Pacific, made $200 million dollars net in 2011. It spent $16 million on charity work. But maybe Sutter needs to upgrade it’s facilities and that’s what they use all that money for. The NYT: “California Pacific, Sutter’s main campus, is in upscale Pacific Heights. It has just broken ground on a $2.7 billion renovation, which includes a new flagship hospital. Though the project was initiated to meet new state earthquake standards, the facility is designed as a sleek glass and marble structure with all private rooms, underground parking and roof gardens with flowers and bees “to enhance the quality of the healing environment,” according to California Pacific Medical Center’s website. Its Facebook page has called it “the coolest hospital in San Francisco, possibly the country and even the world.” Oh. Hmm… But ok, maybe Sutter has more than the usual number of people it has to pay. After all, 28 of it’s top officials earn more than a million dollars a year. The CEO earns $5 million.
So if Sutter is so expensive and so money-grubbing and so selfish, why is it pioneering AIM and actually expanding it? You will not believe this. It got a $13 million dollar innovation grant, a GRANT, to expand AIM. The fancy new hospital, which Sutter is supposedly trying to keep people out of with AIM, and the CEO’s fancy salary will not be shortchanged. Thank goodness for the ACA.