International healthcare consultants infuse fresh thinking into new book on America’s broken healthcare system
ST. LOUIS, MO. – On the first page of the foreword, David Nash, MD, cautions readers that Healthcare at a Turning Point takes some unpopular positions. It confronts some unpleasant truths … that hospitals aren’t in the wellness business and as a result, “a transformation of hospitals as the source of wellness and prevention in the 21st century is probably wrong-headed.”
“Even though it was never our intention, we somehow managed to offend,” noted Michael N. Abrams, MA, of Numerof & Associates Inc., who co-wrote the hot-off-the-presses book (CRC Press, 2013) with fellow healthcare consultant Rita E. Numerof, PhD, a former hospital administrator and founder of Numerof & Associates.
This straight-forward, highly informative book on America’s broken healthcare system’s impact on our crippled economy, Healthcare at a Turning Point is turning heads.
“The idea came up in the run-up to the passage of Obamacare,” said Abrams, a former adjunct professor of organizational behavior in management. “Healthcare was such a topic of conversation. People were starting off asking what’s wrong with this system? We increasingly felt there was room for our voice, based on nearly 30 years of working with hospitals and healthcare systems. We felt we had a lot of experience to bring to bear. An awful lot of people that were talking about it didn’t have enough experience to be saying what they were saying – or they were leaving out significant parts of the picture. Healthcare is a big sprawling problem that needed someone to unpeel. We hope we accomplished that.”
The book begins with a vision of tomorrow instead of burying it in the last chapter as climactic or an afterthought. The writing duo tackles seeds of disruption, comparable industries in transition, and a shared dream of a fundamentally bright, more positive future for American healthcare.
Other chapters focusing on redesigning healthcare delivery cover how hospitals were never meant to be destinations of choice; consumers and employers are at the eye of the storm; the payor environment is changing; big pharma can regain success; medical device and diagnostics manufacturers can adapt; and also place significant value at the center of healthcare.
The greatest challenge of organizing the content was deciding what to leave on the cutting room floor.
“We’ve been writing about the healthcare business for nearly 30 years,” said Abrams. “Unfortunately, many problems we’ve talked about are still relevant because so little structural change has occurred in the industry. It was difficult to sift through and decide what belonged in the book and what didn’t.”
In section 5, “Redesigning Healthcare Delivery: Hospitals Were Never Meant to be Destinations of Choice,” Numerof and Abrams drew on their early work experience contracting with hospitals.
“We weren’t working with many healthcare systems then,” said Abrams. “Even in the ‘80s, hospitals were struggling to execute on the things they said they wanted to do. One of the key issues, even back then, was that many of them hadn’t taken healthcare seriously as a business and they hadn’t really taken the idea of a manager in healthcare in the same sense that managers are managers of any other form of commerce. Much of our earlier work had to do with building management infrastructure, turning a unit manager into a true manager and not just another pair of hands who jumped in when others called in sick. They were, for the most part, waiting on the sidelines. Nobody taught them about true management. And nobody required that they learn it.
“Unfortunately, that hasn’t changed all that much between 1980 and now. In healthcare, we became much more strategic, and have more data to reinforce our own ideas and experience about the issues and structural solutions. The big issue for us is that hospitals are pseudo-monopolies. Many of them dominate their immediate market area. If they’re not the only place to go, many of them are substantially in an oligopoly situation.”
Abrams declined to predict the impact of healthcare reform post-presidential election. (At press time, the presidential elections hadn’t been held.)
“Both parties agree that the healthcare system business model is broken, and we can’t go back,” he said. “We need healthcare reform. Where they disagree is on how to fix it. I believe the Democrats think now that they’ve essentially hyper-regulated the insurance business, the problem’s fixed. The top-down fix they’ve put in place has thousands of pages of regulations and people employed to enforce them as the way out of ‘this mess.’ Rita and I think an approach that gives consumers more power to drive change has more potential for the outcomes that everybody wants.”
Abrams also believes that alternatives to the Democratic approach should lend consumers more power, and provide more transparency in an effort to reshape the system using market forces.
“Either way, the healthcare system is in for a wrenching change,” he said. “If we allow the healthcare system to become a creature of government regulation, we’re not going to be happy with the results. Healthcare is just not terrific about implementing change, and although the industry has gone through a lot of change in the last 30 years, there’s no relationship to the change that’s ahead.”
After a book tour and lecturing circuit, Numerof and Abrams will likely tackle healthcare safety and quality. “That’s going to be very much on the table for the next few years, too,” he said.