Years ago, there was a saying making its way around that ‘everyone needs to work at the top of their license.’ There were all sorts of coded messages in that idea…some people wanted someone else to do the crappy work; some people with a lot of letters behind their name wanted to remind everyone else of their importance; someone wanted to cut staffing costs.
I tried telling my wife once that I shouldn’t do the dishes because I was concentrating on ‘working at the top of my license.’ She looked around – just me, her, and the dog – shrugged and tossed me a sponge.
Everyone knew what was really going on, but we all felt better couching it in an idea that came straight out of the consulting buzzword generator. That is unless your lack of a license puts you at the bottom. Someone must wash the dishes.
I want to take this idea, used more by the denizens of the hospital C-suite than anyone else, give it a little twist, and throw it right back at them.
As stated last week, I strongly believe there is an important role for continuing fee-for-service (FFS) reimbursement, that the idea of moving all care to a value-based care (VBC) model is not smart and will not solve our cost problem. A lot of effort, nothing to show for it.
But we need better FFS care.
The first, and easiest – by far – way to get more bang for our buck is to apply the old ‘top of the license’ adage to where care is delivered. Move it as far down the food chain as possible where you can still get the quality and safety that is needed.
That means out of the hospital and to a surgery center; out of a surgery center to a procedure room in a physician’s office; out of the office and to a virtual visit; out of the pharmacy and to a cardboard box at your front door.
Sorry hospitals, but we just don’t want to pay you any more for your ‘license’ (all your collective capabilities and costs) for things that can be done better, faster, cheaper elsewhere. Just bundling that into a VBC package is not the answer. It is still too expensive.
The anti-Jeffersons, we’re moving on down.
Yes, yes, this trend has been going on for years. I am not exactly breaking new ground here. Further, advances in technology, new business models, and even the pandemic continue to accelerate the migration of care towards its lowest cost, most efficient location.
But there is a danger that the whole VBC dance is a sophisticated ploy by incumbents to slow this move and put some lipstick on the pig named ‘Status,’ last name ‘Quo.’
The fastest way to more value for our healthcare dollar is to simply pay less for this or that.
I think the technical term for my argument is ‘no duh.’