FROM THE CHAIRMAN

by Michael Gregory, M.D., Chairman

I’m from the Government, and I am here to help...

September 18, 2009

I’m from the Government, and I am here to help... If that phrase doesn’t strike fear into your soul, I am willing to bet that you have not dealt with our government on any significant level. I am the first to say our health care system needs fixing. However, I think it is a bad idea to throw the baby out with the bath water by implementing a wholesale remake of one of the most complicated and intensely personal businesses on the planet. Too strong of a statement? Perhaps. But consider this; we have had Medicare for 48 years. Looking forward, it is a financial disaster that makes the current financial crisis look like a rounding error. According to the Congressional Budget Office, the gap between Medicare income and promised payments is $37 TRILLION dollars over the next 75 years. Over the past 50 years, Presidents and Congresses from both parties have overseen Medicare with alarmingly similar results.

So, do we need to make changes? Absolutely. I have two main concerns with the current path. First, should we completely overhaul the most complex and personal industry on the planet based on a plan that has been devised over the past eight months? Second, and most importantly, is government the best man for the job?

On the latter, I have on my desk a Request for Proposal (RFP) for a Hospitalist program from a very small county owned hospital in Florida. The Request itself is 15 single spaced pages that spells out exactly how the process will be conducted. The RFP further points out (in the first seven pages) that it is in compliance with all state, county and local regulations. It spells out the exact page layout, form, content, technical details, cost, references, qualifications, and experience the proposal must include. Which in concept makes sense, and would be the meat of any proposal, right? However, the best part is contained in a section called “Supplemental Information.” In this section we are required to: list any subcontractors that we intend to utilize, directly or indirectly, their relationship to us; a summary of any litigation we have been involved in over the past three years, along with a brief description of each case, outcome and/or predicted outcome; any pending or historical disciplinary action by any governing body against any employee or affiliate (which I guess could include parking tickets); two years’ tax returns and financial statements on Apogee, its affiliates and sub-contractors; the list goes on. Needless to say, we can’t respond to this, even if we wanted to, the process is just too arduous.

The above is a real world example of how well-intentioned government regulations can destroy the intended outcome. The folks at this hospital no doubt need a Hospitalist program. However, they are so tightly bound by government regulations that they are prohibited from asking the most important and basic questions. Heck, at this point they don’t even know what they need. Further, how can we, or anybody create a meaningful proposal when we have never stepped foot in their facility? We have never met the people we would be working with? The worst part is that we are experts in Hospitalist program development, implementation, and operation. However, we are being told what questions are important and in exactly what form they should be answered, all of which are being asked by someone or some committee that has no clue as to what a real Hospitalist program can or should do for their hospital, physicians and community.

Speaking from personal and professional experience, I have yet to see any process or application that government can’t make worse. Just like the RFP above, the devil of health care reform will be in the details. Candidly, there isn’t a single member of Congress that can claim they have read and understand all of the proposed changes or the long-term implications of this legislation. If this legislation is passed it will be based on eight whole months of work by the very political parties that told us how “cost effective” and “budget neutral” Medicare and Medicaid were going to be when those “Health Care Reforms” were passed decades ago.

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