Rushing to the front of the line at HFMA


As I prepared to wing my way to Florida for the Healthcare Financial Management Association's Annual National Institute at the end of this week, I was confronted with a choice: spend $50 for a conference rate admission into the surrounding Disney World resort once the afternoon sessions concluded on Monday, or stay close by my hotel.

The offer was tempting: It costs nearly $100 to get into Disneyland (close to where I live), so this was a relative bargain. I hadn't been to Disney World in nearly 20 years, and it is a dazzling achievement of engineering, imagination and scale.

I ultimately passed. It came down to Florida's steam bath summer climate, and steeping in it while waiting on a long line. It was an entirely rational decision, but it troubled me nonetheless.

That's because it's an American tradition to find a way to avoid or beat the lines, while we mock our European brethren for stoically enduring them. The humorist Calvin Trillin once wrote a dryly funny essay claiming he had spent years "studying degrees of ovalness in Italian lines," and observing that "a lot of English people line up for fun." We use that aversion to lines to avoid a serious discussion of both our current reform movement and a single-payer healthcare system, deriding the fact that in countries like Canada and Britain you actually have to wait to undergo surgery.

But this ignores the inconvenient fact that Brits and Canadians--and 32 other nationalities--live longer than Americans, according to a new study by the University of Washington. As a matter of fact, in large swathes of America, the life expectancy has actually decreased over the past 20 years. Those swathes are almost entirely in the Red States, whose residents have most vehemently opposed healthcare reform and whose lawmakers have cut their Medicaid programs to the bone.

If we cannot effectively communicate on these issues amongst ourselves, perhaps it would be instructive to study the recent maneuverings of British Prime Minister David Cameron. In order to introduce greater efficiencies to the National Health Service, he has had to condemn American healthcare delivery. Loudly.

"We will not be selling off the NHS, we will not be moving towards an insurance scheme, we will not introduce an American-style private system," Cameron stated emphatically during a nationwide televised address earlier this month.

Despite being a Tory, Cameron had no choice. As the Los Angeles Times observed, "ask a Briton to describe 'American-style' healthcare, and you'll hear a catalog of horrors that include grossly expensive and unnecessary medical procedures and a privatized system that favors the rich. For a people accustomed to free healthcare for all...that millions of their cousins across the Atlantic have no insurance and can't afford decent treatment is a farce as well as a tragedy."

I'm as American as the next guy, but arguing this point with anything other than jingoism is difficult. A report issued by the Centers for Medicare & Medicaid Services last week concluded that many hospitals routinely perform double CT scans on their patients, exposing them to unnecessary radiation while the facilities rack up millions in additional charges. Then there's the recent Wall Street Journal report about orthopedic surgeons who earn millions of dollars a year performing spinal fusion surgeries whose necessity is in doubt. In McAllen, Texas, there are cardiac surgeons closing in on their 10,000th bypass procedure, helping to make its healthcare costs double that of any other city in the country. Such stories are seemngly endless.

The agenda at ANI does not suggest there's going to be hard talk about these facts. But there will be several seminars about how to prepare for and counter revenue audit contractors--the program CMS launched to try and cut down on overcharges.

That's not to say that many of the 5,000 execs in attendance aren't under pressure to try and make ends meet with less, and many of them do so heroically. Some have even succeeded in reducing their costs. But considering we spend twice as much per person on healthcare as any other nation, it's an odd starting place.

ANI attendees will also talk plenty about quality and outcomes. If any correlate it to the ultimate result of living longer--and selling that notion to a public that is too often overly skeptical of supporting its best interests--I'll let you know. That's assuming I'm not waylaid by Mickey Mouse, fairy glitter and all the other distractions available at the Happiest Place on Earth. - Ron

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