There’s a really cool show on BBC America called “Top Gear.” It’s a witty, irreverent, brutally honest car show hosted by three dry-witted Brits: Jeremy Clarkson (blog here), Richard Hammond, and James May. Last season they road tested the new Mercedes S-Class (video clip). The S-Class is the big, expensive standard example of wretched excess in wealthy parts of the western world. It has long been the chariot of the privileged: for taking the kids to boarding school…their crested blazers neatly folded in the trunk, or ushering African royalty through the impoverished village square behind bulletproof glass. However, it’s also the example of automotive innovation. Top Gear host Jeremy Clarkson makes a big deal of this when he introduces the latest generation S-Class. The new model has active cruise control that adjusts the car’s speed according to traffic around it. It also has an infrared camera system that gives the driver “night vision,” which increases visibility on poorly lit rural roads. There are dozens of other features that have never before appeared on a car. Many of them sound ridiculous…but the truth is - many of these features will be on every car in 10 years.
The S-Class was the first major production car to have a 3-point seatbelt (1965). It was the first car to offer anti-lock brakes (1978). It was the first car to have an airbag (1981). It was the first car with crumple zones (1959). It was the first car with electronic stability control (1995). It was the first car with satellite navigation. These are all standard equipment on most cars today, and if you note the dates above, it often took nearly a decade for these innovations to flood the mainstream. The S-Class is the laboratory and testing ground for automotive safety innovation. In fact, many of the innovations conceived in the S-Class, once thought ridiculous extras, have become so critical to public safety that they are required by law on all production vehicles. If there hadn’t been an S-Class, or, really, an automotive marketplace that encourages competition and innovation, we would be living in a much more dangerous (and expensive) world. I’ve written about how competition drives innovation before: in this post.
The S-Class is my metaphor for specialty hospitals. After several posts singing the praises of primary care physicians, I’d like to give specialists their due credit. If primary care doctors (internists, family practitioners, general practitioners) are the medical profession’s voice of reason and judgment, specialists are the risk takers…the frontier. Without a frontier, the status-quo would never go anywhere. Specialty hospitals are privately-owned (usually by the physicians who run them) hospitals that focus on medical specialties like cardiology or orthopedics, for example. Because they only treat certain conditions, they devote all of their resources to those conditions, and preliminary studies show they have better patient outcomes for it. Specialty hospitals are our testing ground for prototypical advances that could make their way into the mainstream and save lives. And Congress is killing them.
An article by Dr. Ashok Roy of the Heritage Foundation, entitled “How Congress is Killing Competition: The Future of Specialty Hospitals,” explains how Congress’ moratorium on physician referrals of Medicare patients to specialty hospitals could become permanent, effectively killing the hospitals off completely. The reason? Community hospitals have loud voices and those voices are crying “unfair competition.” As Professor Regina Herzlinger, Nancy McPherson Professor of Business Administration at the Harvard Business School, has observed, this congressional attempt to suppress competition was not advanced in the interest of patient care: “… no one alleged that the specialty hospitals were bad for the consumers’ health. No, instead, the general hospitals alleged that the specialty hospitals were bad for their health.” (emphasis mine)
In fact, research presented to Congress shows that specialty hospitals are helping patients and improving health care. The government’s own research committees found:
(1) Specialty hospitals had no significant negative impact on the financial condition of traditional hospitals.
(2) Specialty hospitals could promote innovation in patient care.
(3) Specialty hospitals provide predictable scheduling and patient care.
(4) Specialty hospitals have higher rates of patient satisfaction.
(5) Specialty hospitals have lower mortality rates.
(6) Specialty hospitals have comparable costs to traditional hospitals.
(7) Physician referrals to specialty hospitals are not self-serving.
Yet the community hospital lobby is powerful, and Congress could make some temporary changes permanent…which would amount to a death sentence for current specialty hospitals and contraception for future ones. If competition is stifled permanently, we will have yet another example of interests contrary to improved patient outcomes and economic efficiencies throwing American health care under the proverbial bus.
The S-Class was the first major production car to have a 3-point seatbelt (1965). It was the first car to offer anti-lock brakes (1978). It was the first car to have an airbag (1981). It was the first car with crumple zones (1959). It was the first car with electronic stability control (1995). It was the first car with satellite navigation. These are all standard equipment on most cars today, and if you note the dates above, it often took nearly a decade for these innovations to flood the mainstream. The S-Class is the laboratory and testing ground for automotive safety innovation. In fact, many of the innovations conceived in the S-Class, once thought ridiculous extras, have become so critical to public safety that they are required by law on all production vehicles. If there hadn’t been an S-Class, or, really, an automotive marketplace that encourages competition and innovation, we would be living in a much more dangerous (and expensive) world. I’ve written about how competition drives innovation before: in this post.
The S-Class is my metaphor for specialty hospitals. After several posts singing the praises of primary care physicians, I’d like to give specialists their due credit. If primary care doctors (internists, family practitioners, general practitioners) are the medical profession’s voice of reason and judgment, specialists are the risk takers…the frontier. Without a frontier, the status-quo would never go anywhere. Specialty hospitals are privately-owned (usually by the physicians who run them) hospitals that focus on medical specialties like cardiology or orthopedics, for example. Because they only treat certain conditions, they devote all of their resources to those conditions, and preliminary studies show they have better patient outcomes for it. Specialty hospitals are our testing ground for prototypical advances that could make their way into the mainstream and save lives. And Congress is killing them.
An article by Dr. Ashok Roy of the Heritage Foundation, entitled “How Congress is Killing Competition: The Future of Specialty Hospitals,” explains how Congress’ moratorium on physician referrals of Medicare patients to specialty hospitals could become permanent, effectively killing the hospitals off completely. The reason? Community hospitals have loud voices and those voices are crying “unfair competition.” As Professor Regina Herzlinger, Nancy McPherson Professor of Business Administration at the Harvard Business School, has observed, this congressional attempt to suppress competition was not advanced in the interest of patient care: “… no one alleged that the specialty hospitals were bad for the consumers’ health. No, instead, the general hospitals alleged that the specialty hospitals were bad for their health.” (emphasis mine)
In fact, research presented to Congress shows that specialty hospitals are helping patients and improving health care. The government’s own research committees found:
(1) Specialty hospitals had no significant negative impact on the financial condition of traditional hospitals.
(2) Specialty hospitals could promote innovation in patient care.
(3) Specialty hospitals provide predictable scheduling and patient care.
(4) Specialty hospitals have higher rates of patient satisfaction.
(5) Specialty hospitals have lower mortality rates.
(6) Specialty hospitals have comparable costs to traditional hospitals.
(7) Physician referrals to specialty hospitals are not self-serving.
Yet the community hospital lobby is powerful, and Congress could make some temporary changes permanent…which would amount to a death sentence for current specialty hospitals and contraception for future ones. If competition is stifled permanently, we will have yet another example of interests contrary to improved patient outcomes and economic efficiencies throwing American health care under the proverbial bus.
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