Caught in "too big to care"?

 There have been two compelling articles in the “New York Times” over the past few weeks focused on healthcare. The first article dated Tuesday, October 30, 2018, is entitled “A Sense of Alarm as Rural Hospitals Keep Closing1 and the second article dated November 14, 2018, entitled “When Hospitals Merge to Save Money, Patients Often Pay More2. These two articles are really bookends of the same set of issues emerging in our healthcare delivery system.


"Since 2010, nearly 90 rural hospitals have shut their doors. By one estimate, hundreds of other rural hospitals are at risk of doing so." 1 In many communities these hospitals are amongst the largest employers in the area. Because of the availability of medical care, communities establish a sense of stability that sustains existing businesses and presents opportunities for new commercial enterprises. The reality is that the cost of delivery of healthcare, which continues to accelerate, makes these rural institutions less capable of sustaining the level of quality of care emerging in this era of rapidly expanding technologies.


Do you stay or go?


These rural community hospitals are relegated to providing primary care services and very few of the specialty services that are available in centers of medical excellence in metropolitan cities. This situation continues to increase the need for patients to migrate to larger communities in order to obtain the specialized services their healthcare will require. This raises an interesting paradox addressed in the second article focuses on increased consolidation of healthcare services in huge healthcare systems with almost monopolistic power in key healthcare markets. "The latest giant hospital consolidations continue to stir concerns. Dignity Health and Catholic Health Initiatives, two large chains are expected to become one of the nation’s largest groups ---- with 139 hospitals in 28 states--- by the end of the year. And two of Texas’ biggest systems, Baylor Scott & White Health and Memorial Herman Health System, recently announced plans to combine.” 2

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"In the national analysis, a third of the metropolitan areas experienced increases in the cost of hospital stays of at least 25% from 2012 to 2014, from roughly $12,000 to at least $15,000.”2 Thus, these hospital system consolidations are doing exactly the reverse of what was anticipated as they are continuing to accelerate the cost curve rather than bend the curve with additional savings.



When you look at this emerging picture of healthcare from the perspective of the individual from a rural community who needs specialized care, the system is fraught with confusion, anonymity and increasing costs. We at Curus referred to this as the "What do I do now? syndrome". In order to seek out the highest quality of care, patients are left to their own ingenuity to figure out what are the best options that are most cost-effective and are in network? This is where the doctor-patient relationship is devolving into an impersonal process where the patient is on the conveyor belt of healthcare delivery. Further complicating the decision-making in this scenario is the fact that physicians are becoming part of the "corporate practice of medicine". While legally that phrase has certain implications in the real world, it represents the fact that physician affiliations to these monolith healthcare systems or to huge practice groups dictate much of the decision-making with regard to the referral patterns to specialists. 

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A patient coming from a rural hospital is at the mercy of the system in which he/she seeks specialty care. They no longer have the familial relationship with the provider that is the historic bedrock of care in rural communities. When we started Curus, we were often confronted with the question of, “What do I need a healthcare manager for?” As we see the continuing consolidation of the healthcare delivery system where the patient has ceased to be the focal point of the care delivery process, the question has begun to answer itself. Without a dedicated team of skilled healthcare professionals who understand the nuances of the healthcare process, patients are directed rather than engaged by the healthcare professionals. They are part of the system, a process.  As one physician told me recently - when the healthcare systems are run by “bean counters”; the role of both the patient and the doctor suffer.    


In 2007 and 2008, the nation talked a great deal concerning the financial industry about the problem of "Too Big to Fail". Well, surprise! That is exactly what's happening in healthcare today. Systems of tremendous power are centralizing the delivery process and the patient has become a commodity in the system. In our Curus model the patient is the center of the universe. That's what being patient-centric means. Our role is to ensure the best possible choices so that our members can make value judgments that we can assist them in implementing. Our fundamental goal is to return control of the health care process to the recipient of that care. The reason one needs Curus to coordinate, navigate and evaluate all aspects of the continuum of care is to ensure that the human side of the healthcare experience is one of top quality care, compassion and concern.  


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Filed Under: Insider, Traveling, Health Management, doctor shortages, healthcare quality, changes in healthcare, pros and cons of concierge medicine, medical access

Unlocking Access to Healthcare

          Some years ago,  a physician friend told me this story, and it has remained with me. He was one of the finest diagnosticians around and highly respected for his medical skills. He was visiting with his family members at his daughters home and realized he was in the process of having a heart attack. He requested his son immediately take him to the hospital. There was a hospital with an emergency room quite close.  However, even in the midst of his coronary, he insisted that his son drive to another hospital that had a highly respected coronary team. 

I asked him,  "Why didn't you go to the first emergency room?" 

I'm still startled by his response. 

"Because I thought the quality of care there would kill me."

It was worth the risk of continuing to the drive to get to a facility he believed was highly qualified to handle his cardiac event.

3D person entering a red door isolated over a white backgroundOne size does not fit all and all providers of healthcare are not comparable. There are numerous entry points into the system and choosing the right entry point can be the most critical choice in the process. So what doors are worth going through and what do you look for in quality medical access?

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Know your facilities and their specialties.


My friend's story really defines the concept of access to healthcare. The reality is hospitals and providers have varying skill levels that are discernible only to those who spend their lives understanding our healthcare system and how it really operates. In the hospital world there are notable centers of excellence for all of the critical specialties in medicine. When you evaluate where to receive care the evaluation must begin with a determination of exactly what is the problem? Once we have a sense of what the problem is only then can we begin to look to find a provider or center of excellence most qualified to provide the care required. Since we don't have the skills that my friend the physician had in determining that he was in fact experiencing a coronary we need to rely upon the expertise of others to lead us to making good judgments.



3D character leaning on a key isolated over a white backgroundFind Doctors that Respect You and Your Time


Access is not just a concern in an emergency situation. During routine visits with our providers we often experience the indignity of the devaluation of our time as compared to that of the provider. In a "Huffington Post" article, Inga Offen wrote about finding the following sign at a local doctor’s office she was visiting: 


"'Please be advised that your waiting time could be extensive. If you are unable to continue your wait, please let the receptionist know and she will reschedule your appointment. Thank you for your understanding and patience as the doctor takes the time to provide excellent medical care to all.'"


Ms. Offen offered a translation of the above note. 

"'We make absolutely no effort to schedule in any meaningful way or to respect the time and comfort of our patients. Be prepared to sit here all afternoon because we have egos the size of Connecticut and think the sun rises and sets on our board certified tushies. Should you get so fed up that you leave, our hostile office staff will assure you that the same thing will happen the next time so you might as well suck it up and stay since you’ve already paid for parking. Regardless, we’re keeping your co-pay'”


          The translation you just read is in fact harsh, but I doubt that anyone who takes the time to read this article will deny that they too have experienced this disregard of their time and value at a physician's office. In fact, when we have those unusually high blood pressure readings often referred to as "white coat syndrome",  they may really reflect our frustration from  the excess time we have spent attempting to obtain medical care. Let's not forget the time we spent on the phone attempting to coordinate our care or make an appointment to be seen by our physician.



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Know Your Doctors Limitations


The current model for most healthcare, never demands excellence nor efficiency as it expects the patient's to be available and accommodating.The referral patterns with both hospital employed physicians and private practice physicians are dictated by the networks and relationships they establish which usually are mutually beneficial. For example, employed physicians in a health care system are "expected" to refer to specialists within the system. That is simply how it works.


           Should you as a patient want to go beyond that system to ensure you are receiving care from the most highly qualified provider you are very much on your own. You need to figure it out and coordinate the care on your own. This requires both expertise and significant blocks of time to navigate the health care maze in each of these varying systems. The providers fully understand the complexities of the system and rely upon patient inertia to move them through utilizing their service model.  


There are alternatives to explore beyond this most common model. The Concierge Healthcare Management Model, for example, is a patient centric system. Choosing the best providers and expecting them to perform at the highest level and quality with consideration for the patient is the focus.  Going around the red-tape to evaluating the needs of the patient over that of any particular health-care system ensures the patient is more likely to receive the best care for their situation. 

Click to Download a PDF on the Concierge HealthCare Management Model 



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Demand this Service Industry Serve You.


In each of the above scenarios there is an overarching theme. Healthcare differs from almost every other form of a service business in our society. Nearly all service businesses have a singular focus on the customer. Only healthcare is provider centric, where the terms of engagement are established by the provider and the recipient of the service is expected to accept those terms. Access should mean providing the highest quality of care in the most expeditious manner, while maintaining at all times the patient's dignity and sense of self. 


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Note from CEO, Mark Schlussel 

Access to quality healthcare is knowledge driven. We at Curus focus our attention on the details of care.
Each member of Curus is unique.  That is why we tailor their care to suit them. 


Filed Under: Health Management, concierge healthcare, changes in healthcare, work-life balance, medical access