Balancing more-profitable, less-profitable, and no-profit

Marketplace did a story on ambulatory surgery centers.  If you’re familiar to healthcare you have heard it all before.  Moving care to the most cost-efficient locale is the right thing to do.

But what’s frustrating is what this reality highlights about the system.  Hospitals, generally, aren’t cool with physician-owned surgery centers because they tend to take away the more profitable cases away from the hospital. See, the way hospitals are paid for what they do makes little sense.  Hospitals need the less complicated, more-profitable care to subsidize the more complicated, less-profitable care.

The problem with all this is that less-complicated care should be taking place in less-costly environments.  The fact that there’s a struggle between physician-owned ASCs and hospitals shouldn’t need to be (the physician-owned ASC vs the hospital-owned ASC is a different matter, though a more truly competitive one).  But since hospital finances depend completely upon getting the right balance of more-profitable services over less-profitable services while still offering money-losing services that are needed by the community, you can see where the issues develop.

No real point here, just one of those “this is stupid” scenarios that are all too familiar in healthcare.

A couple more relevant, unrelated thoughts:

I love how the actual scene of care is a secondary thought in this statement about infrastructure (health reform overload, maybe?):

There’s a whole infrastructure that comes along with health care in this country. Not just the billing and the bureaucracy, but the actual places you go to get care.

This statement from the anesthesiologist who runs the ASC mentioned in the story is actually scary:

We haven’t actually done the whole budget for next year yet, but we’re probably going to anticipate 15-20 percent margin next year.

Oh you know, just a 15-20 percent margin next year. Wow. That place doesn’t require management of any fashion. That’s a lot of profit. Since that’s a lot of profit and there’s a lot of government involvement in healthcare, I’d advise you to get while the getting’s good.  But not too much, because they’ll get ya.

Relatable learning from teaching

Amanda Ripley has a wonderful article in the Atlantic, “What Makes a Great Teacher?” The similarities between healthcare and education are astounding.  The article is full of relatable lessons to any endeavor.  Read the article, below is but a sampling.

Years of experience are less important than previous performance:

Things that you might think would help a new teacher achieve success in a poor school—like prior experience working in a low-income neighborhood—don’t seem to matter. Other things that may sound trifling—like a teacher’s extracurricular accomplishments in college—tend to predict greatness.

The power of a vision:

First, great teachers tended to set big goals for their students.

Always evolve; if something isn’t working as well as it should: blow it up and find a better way:

They were also perpetually looking for ways to improve their effectiveness. For example, when Farr called up teachers who were making remarkable gains and asked to visit their classrooms, he noticed he’d get a similar response from all of them: “They’d say, ‘You’re welcome to come, but I have to warn you—I am in the middle of just blowing up my classroom structure and changing my reading workshop because I think it’s not working as well as it could.’ When you hear that over and over, and you don’t hear that from other teachers, you start to form a hypothesis.” Great teachers, he concluded, constantly reevaluate what they are doing.

Include the constituents, keep focus with the purpose, have an objective, be relentless:

Superstar teachers had four other tendencies in common: they avidly recruited students and their families into the process; they maintained focus, ensuring that everything they did contributed to student learning; they planned exhaustively and purposefully—for the next day or the year ahead—by working backward from the desired outcome; and they worked relentlessly, refusing to surrender to the combined menaces of poverty, bureaucracy, and budgetary shortfalls.

Effort is not always equal to success. The thing about smart work is that it is hard work:

“You want to work smart, not hard,” he tells me later. “If you just show them the traditional method, not everyone understands.”

It’s possible to learn from anyone:

He actually learned the method last year—from one of his students.

Personal reflection is paramount, maybe it’s the person in charge who is preventing people from becoming successful:

When I talk to Mr. Taylor after class, I notice that he tends to redirect questions so that they reflect his own performance. When I ask him if his first year on the job was hard, he says, “I found that the kids were not hard. It was explaining the information to them that was hard. You paint this picture in your head about how you will teach this lesson, and you can teach the whole lesson and no one gets it.”

Anything is possible with right mindset:

For decades, education researchers blamed kids and their home life for their failure to learn. Now, given the data coming out of classrooms like Mr. Taylor’s, those arguments are harder to take. Poverty matters enormously. But teachers all over the country are moving poor kids forward anyway, even as the class next door stagnates. “At the end of the day,” says Timothy Daly at the New Teacher Project, “it’s themind-set that teachers need—a kind of relentless approach to the problem.”

Testing assumptions without the fear of failure is a great path forward:

Once a model for outcomes-based hiring was built, it started churning out some humbling results. “I came into this with a bunch of theories,” says Monique Ayotte-Hoeltzel, who was then head of admissions. “I was proven wrong at least as many times as I was validated.”