Care-Givers Must Consider Customer

Health care was back on the agenda this week as U.S. Senators Bill Frist (R-Tenn.) and Joe Lieberman (D-Conn.) hosted a Senate roundtable on the status of quality in the health care market.

Currently, most health care purchasing decisions by companies providing health care benefits are based on price -- in large part because there is little information on access, effectiveness, consumer satisfaction or other quality measures. Yet, as managed care approaches have succeeded in containing or slowing cost increases, patients are increasingly unhappy with the way they are treated by managed care professionals.

As increasing numbers of people are herded into managed care programs, they find administrators and green eye-shade types shaping many of the treatment decisions that used to be made by a primary care physician. At a recent meeting of Western state legislators in Santa Fe, one health care analyst explained the problem with a story. It went something like this:

The president of a large managed care facility also served on the board of the symphony orchestra. When he could not attend a scheduled concert, he gave his tickets to one of his colleagues, his health-care cost containment director. The next morning, the president asked the cost-containment director how he enjoyed the performance. Instead of a casual, polite remark, the director handed the president the following memo:

"I appreciate the free tickets to the performance of Schubert's "Unfinished Symphony" by our city's symphony orchestra. But, as your cost-containment guy, I was appalled by clear evidence of waste. It's no wonder you have to spend so much time fundraising. Let me share with you my observations and offer some recommendations that might help you improve the efficiency and productivity of the symphony.

"First, the attendance of the conductor is unnecessary for public performances. The orchestra has obviously practiced and has the prior authorization from the conductor to play the symphony at a predetermined level of quality. Considerable money could be saved merely by having the conductor critique the orchestra's performance during a retrospective peer review meeting.

"Second, for considerable periods, the four oboe players had nothing to do. Their numbers should be reduced and their work spread over the whole orchestra, thus eliminating peaks and valleys of activity.

"Third, the twelve violins were playing identical notes with identical motions. This is unnecessary duplication: the staff of this section should be cut drastically with consequent savings. If a large volume of sound is required, use new electronic amplification technologies which are capable of very high levels of reproductive quality.

"Fourth, much effort was expended playing 16th notes or semi-quarters. This seems an excessive refinement, as most of the listeners are unable to distinguish such rapid playing. I recommend that all notes be rounded to the nearest eighth. If this were done, it would also be possible to use trainees or lower grade musicians with no loss of quality.

"Fifth, no useful purpose would appear to be served by repeating with horns the same passage that has already been handled by the strings. If all such redundant passages were eliminated, as determined by a utilization review committee, the concert would have been reduced from two hours to about 20 minutes, resulting in substantial savings in salaries and overhead. In fact, if Schubert had addressed these concerns on a cost-containment basis, he probably would have been able to finish this symphony!"

Almost anyone who's been to a managed care provider knows from experience that "customer satisfaction" isn't a high priority for an industry that hasn't worried much about its customers. The time to change is now, and those who do will win in the marketplace.