by Tom Emerick
First posted on Cracking Health Costs on 02/11/2013
In my last post, I mentioned the failure of 30 years of trying to patch the health care system in America and the need for an overhaul of the system itself, not just more patches.
Dr. Charles Denham is one of the smartest and most devoted people I know, and a dear friend. Here is a link to his Wikipedia profile.
Here is a suggestion by Dr. Denham that would begin the process of a true systemic reform:
“The rate of overuse, underuse, and misuse of healthcare services is at catastrophic proportions. Much of it is due to fragmented care processes and occurs in the hands of well-meaning caregivers. However, for those organizations that have been systematically excessively charging patients improperly or intentionally performing unnecessary procedures for financial gain, it will be hard for any of us not to expect that they bear the same penalties others do in other businesses and for instance pay triple damages for such behavior. They are spoiling the reputation of all of those who take the public trust as an honor. It is time to put the care back into healthcare and the trust back into the public trust.” (Bold type mine.)
That will change things, and fast. In short, if it is determined that a provider has done unnecessary tests or procedures for financial gain, apply triple damages.
Step 1: Demand that your PPO add this kind of language to provider contracts going forward.
Step 2: Make sure your PPO enforces this provision.
Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.