Basir Gill

I heard from an administrative colleague about a meeting that made his jaw drop. He was summoned to an “emergency summit” to discuss his health system’s decline in heart failure admissions. The cardiology department had been focused on reducing heart failure admissions and readmissions The focus of the “summit” would make anyone with a consicence blush: How do we increase our heart failure admissions? The most benign view is that the system wanted to get a larger share of a shrinking pie of admissions in the community. But the subtext of the meeting was unmistakeable: when patients win, hospitals lose. In many ways, outpatient management of heart failure was “too effective.” High margin heart failure admissions and ICU stays were shrinking in number. And, yet, rather than declaring victory and the stunning success of the cardiology team, the hospital was in a panic. Revenue was declining—and the hospital’s finances were suddenly in disarray. They needed more admissions—and fast. Said another way, they needed more sick people to need their services. Traditional administrators would say the dynamic is an outgrowth of our broken fee-for-service health systems. That incentives from value-based care do not make up for loss of volume. But there’s something more nefarious in this short vignette: it’s the unquestioned institutional focus on finance over health. “No margin, no mission,” some might glibly say. But has the mission been fundamentally corrupted? 
Is our mission: Keeping our beds full? Our margins high? Our doors open? 
Our teams employed at all costs? Or is our mission to promote the health and well-being of the community? We have clearly lost our way in important respects. For if it was the latter, the emergency heart failure admissions meeting would not be an institutional crisis, but a celebration. Celebration of community health. 
Celebration that patients were able to spend more time at home than in the hospital. Celebration that patients were healthier and so needed services less, not more. But, yet, health service organizations too often measure themselves by traditional business metrics: Volume. Revenue.
 Profit. Which of course are the wrong metrics for (mostly not-for-profit) health systems and hospitals who are chartered to serve the public good. It is the (hard) work of hospital administration to work proactively with payers to ensure that they are financially rewarded for doing the right thing. Not to blame the system and perverse incentives. forbes.com/sites/sachinjain/…