Feature | June 12, 2008 | Rick Dana Barlow

Memo to Pols: Take Outpatient Care Seriously

Amid the endless and monotonous droning and posturing about healthcare reform throughout this election year it’s time for the nation’s politicos to take outpatient care seriously as one of the valid and reliable solutions to a problem in which they’ve only scratched the surface in understanding.

Whether you’re referring to the imaging, oncology or surgery segments within outpatient care, these facilities offer a viable alternative to the acute care hospitals, the specialty hospitals and in those cases that don’t involve complex procedures, especially the physician-owned hospitals.

Like the ill-fated Clinton Administration healthcare reform proposals dredged up by the Jackson Hole group of policy wonks and pundits during the early-to-mid 1990s, current healthcare reform plans, regardless of political candidate, still miss the bus. When you peel back the layers of their argumentative onion, you’ll find their plans have less to do with improving operations and quality delivery – and little, if any, on how to pay for anything – and more to do with access. But again, no actionable and tangible ideas on how to pay for easier and wider access.

In fact, they’re spinning their wheels. After all, access is an insurance industry problem, not something the acute care or outpatient care facility industry can debate. Because if they accept Medicare and/or Medicaid funds and/or enjoy not-for-profit tax status they have to treat anyone who walks into the emergency room’s swiveling doors with the sniffles – even if the patient’s flat broke. Who pays for that? Ultimately, you and I do. Whether the presidential candidates – or any other politician running for office, for that matter – turn up the heat on the payers and managed care companies that comprise the insurance industry may turn out to be nothing more than political theater for the cameras and the print headlines. That’s because the insurance companies deftly contribute considerable funding to political campaign coffers. And money talks.

Physician practices and clinics have been around for several centuries. The nation’s oldest hospital – Pennsylvania Hospital – was founded in 1751 by Benjamin Franklin and Dr. Thomas Bond. Other outpatient care facilities, including ambulatory surgery centers, diagnostic imaging centers and cancer treatment centers, can trace their roots back some 40 years. There are tens of thousands of them scattered throughout the nation. Those who don’t make it either exit the market or are acquired.

The bottom line: The American healthcare system isn’t broken like some posit. If that were the case, it would be fixed by now by those who need it to work for them, namely those earning money from the system. Hence, the American healthcare system is working for some groups and just not others. The trick is connecting the dots between payers and providers, bridging the gap between the hospital and non-hospital segments and striving for parity. But it won’t be so easy to achieve. Just ask the key executives of the professional sports leagues.

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