By Gregg Masters, MPH
As if there wasn’t enough criticism of the ‘Patient Protection and Affordable Care Act’ and it’s provisioning for the logically developed, and sound market tested tenets of ‘accountable care’, and the entities in which both the culture and operational where-with-all can be infused. Now where have whining 2.0, with beauty pageant-esque positioning statements by politicians who ‘know healthcare.’
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There will be winners & losers. Smart money is on: ‘Future of Accountable Care, ACOs & Payment Reform http://t.co/usKwXF4 ACO #ACOchat |
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Dan Fogelberg (RIP) nailed the strategic v. tactical planning confusion of most hospitals/system parents. lyrics to follow…. |
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‘It’s never easy, and it’s never clear. Who’s to navigate, and who’s to steer…. |
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‘…So you flounder drifting ever near the rocks’. (metaphorically speaking). |
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@JimCanto Hi Jim, clearly t’was context & gateway for Fogelberg’s message; though it crystallizes strategic v. tactical plan confusion. |
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At it’s core the governance model is a failed enterprise. Christensen recognized one of its major failures in the Innovator’s Prescription. |
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Yet, none of that has slowed the rate of CEO compensation packages whether proprietary or so called non for profits. |
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@JimCanto then they ‘delay & pray’ the referee (ie, their agent), the CEO, supported by a paramilitary nursing organization can pull it off! |
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@JimCanto typically a lay board of directors, delegate broad clinical (regulatory) authority to a club aka the voluntary medical staff….. |
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There has been, and remains so today, a leadership vacuum. The continued push-back from ‘accountability’ is avoiding the duty of care. |
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@JimCanto 3 legged wobbly stool no longer (if it ever) served general hospital governance. |
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Drill down is ‘cultural, ie., the ops. v. staff silos inherent in the typical general hospital org culture. Ops = power, staff marginalized. |
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Staff includes: marketing, IT, PR, planning, etc., ops = departmental silos mostly driven by comand & control vertical silos. |
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p.s. we need add ‘social media’ departments to the impotent(?) ‘staff’ mix. more marginalization in the making? |
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The few examples of service line or matrix-ed organizations have shown some value adds. Though 3 legged wobbly governance trumps progress. |
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Absent restructuring of the healthcare borg. So called ‘consumer directed health plans’ = ‘the road to serfdom’. Watch what you pray for! |
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Many legitimate ‘tactical’ R issues duly noted re: NPRM; yet, vision is sufficient for strategic direction. So WAYW – why are you waiting? |
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If health plans with hundreds of thousands if not millions of members can’t effectively negotiate or restrain medical CPI, how can patients? |
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