The Best Healthcare Administrators can Destroy

Posted: Jan 05, 2015 12:01 AM

Herewith, a thankful but frustrated reflection on a family health crisis and the American healthcare system. My wonderful father-in-law was diagnosed this summer with multiple myeloma, a form of blood cancer that isn’t leukemia. The doctors and care were great but the system sucks. The policy crux and administrative dilemma comes at the end.

His care and the resources available to save and extend his life for many years have been amazing, if bureaucratic, unpredictable, and frustrating. The first sign was a bad blood reading at a routine physical just days after he and my wife completed their dozenth or so annual long summer hike. The doc said it didn’t look like his kidneys were working and put him on dialysis. Multiple tests and then a bone marrow biopsy confirmed the grave news.

He has been on dialysis and cycles of chemotherapy for months.At times, he has been completely in the dark about what professionals were thinking, about what test results showed, or about what comes next, and he’s had to wait in agony or emotional suspension sometimes for days for some expert to get around to talking to him.

About three weeks ago, he went into the hospital for a bone marrow transplant that ideally will fight and hold off the cancer for years. It involved a stronger round of chemo that basically destroyed his immune system. He was confined to a near-bubble boy environment for three weeks until his system could grow back.

His progress is encouraging, and a couple days ago, he was told he could come home today, Sunday the 4th of January. But, the process of checking out of the hospital took essentially all day. Nurses, family docs, and one specialist after another, as well as hospital administrators and others, all had to come in and have their see, and say, and check off. It’s not clear if the parade is a management tradition, a liability prophylactic, or medical necessity.

Now, like I said, the care has been amazing. But at the multi thousands every day this process is costing insurance and/or Medicare, there really must be a way to check a patient out that doesn’t take all day. For that matter, there have been other maddening gaps where he waited in silence and ignorance. I don’t know if the answer is coordinating specialist visit schedules, or siphoning information through navigators who can relay what the specialists would say personally in their syncopated visits throughout the day, or what.

I’m probably not smart enough to suggest the solutions, either. Untrained in the field, I’m not Henry Ford, Sam Walton, Steve Jobs, or Jeff Bezos. My mind is clever, but not revolutionary. But I can tell you why health care has stagnated—no, make that health care administration has stagnated—luckily, health care technology is still struggling upward. It is because the care/finance environment is static and oppressive. It is occupied by library stacks of federal statutes, rules and regulations and secondary tomes of insurance policies and riders and hidden scripts for adjusters and administrators and supervisors. It’s all topped with volumes of hospital operating procedures and memos from the legal department and stacks of jury verdict case law provided by medical malpractice insurers.

No theoretical risk must go unpapered against. Procedures must be followed. Disruption is not rewarded, it’s suppressed.

The paperwork better be right or there will be an auditor to pay. The coding better be right, or Medicaid fraud will ruin your practice and your life. It doesn’t pay to try to change the world on that planet. Reformers wouldn’t be approved. They would be audited. They would be investigated. They would be denied. They might be the subject of vicious investigative reporting fed to cub reporters by nasty bureaucrats. They’d be muzzled or fired by politically cautious managers.

In short, there is nothing remotely like a free market environment in health care where reform ideas have a chance against the interests of entrenched incumbents who care far more about securing next month’s checks than they do in shaking up the system or just improving it a little. It would be like asking a regulated utility with guaranteed rate of return or the teachers union if they wouldn’t really rather work in a dynamic environment of progress, innovation, risk, and reward.

No, they wouldn’t.

Anyway, I’m delighted Ken came home this afternoon. I hope we have decades to enjoy. But I’m certain his whole experience has cost society hundreds of thousands of dollars more than it would if government weren’t so invested in taking such good care of us.