Lab Soft News

Bundled Cash Pricing May Provide an Ideal "Transparency" Solution for Many Hospitals

Major changes are now underway in the healthcare industry including the impending CMS price transparency rules that are eliciting marked opposition from various segments of organized medicine  (see: Ohio Healthcare Network Serving Amish and Anabaptist Communities Could Provide Blueprint for Hospital Price Transparency). Below is an excerpt from an article on this topic in Dark Daily:

.... [O]n Jan. 1, 2021, a new Centers for Medicare and Medicaid Services (CMS) final rule (CMS-1717-F2) on price transparency goes into effect. It requires hospitals to publish their standard chargemaster prices, as well as payer-negotiated prices, online for customers to review. A companion proposed rule (CMS‑9915‑P) will, if passed, require health plans and healthcare insurers to disclose covered healthcare costs to customers upon request, including “an estimate of such individual’s cost-sharing liability for covered items or services furnished by a particular provider.” These rules have created a fire storm of controversy. Hospital systems and healthcare organizations like the American Hospital Association (AHA) argue that revealing payer-negotiated rates will undermine health networks’ negotiating power with insurers and increases hospital prices.

....Pomerene [Hospital located in rural Millersburg Ohio] has developed bundled care packages for more than 300 services...for Amish and Anabaptist patients as well as any other self-pay patients who pay their bills in full at the time of service....The initiative came in response to concerns raised by the area’s Amish and Anabaptist communities, which make up roughly 40% of the county’s population. They do not use commercial health insurance. Instead, they pay their medical bills out of pocket....Church members asked Pomerene for guaranteed bundled pricing....In total, nearly one-quarter of the hospital’s patient revenue comes from bundled-service packages, with 3,387 packages provided last year....For competitive reasons, Pomerene does not publicly post its package prices and only prospective cash-paying patients are provided the cost breakdowns. 

I have blogged frequently over the years about the inefficiency and opacity of our current hospital billing systems (see, for example: Two Reasons Why Medical and Hospital Bills Are Such a Mess). I support any CMS initiatives designed to make hospital billing processes more transparent. The opposition to this new program stems, in my opinion, from the need on the part of hospital executives to resist any change to a broken system. For them, this new set of rules can be summarized as an attack on a system that they "understand" despite the fact that many healthcare consumers are being financially destroyed by it (see: 34 Devastating Stories About How People Are Still Crushed By Medical Debt). 

Veteran readers of this blog may remember some of my earlier notes about Bumrungrad International Hospital in Bangkok, Thailand, which was a pioneer in bundled up-front cash payments as part its medical tourism initiative (see: Interview with Bumrungrad Group CEO, Curt Schroeder) Bumrungrad's current web site offers three "Healthy Heart Packages" including various types of surgery based on anticipated risk (see: Packages & Programs 2020).

I suspect that the larger U.S.health systems are holding back on programs of bundled prepayments for various types of "care packages" until one of the industry leaders like Kaiser or Cleveland Clinic move in this direction. After such an initiative, they would then be forced to follow suit because of competitive pressures. The development of appropraite prices for such packages would be relatively simple once the general outlines of the strategy are established. 

Possible Funding Tension Between Wellness Programs and End-of-Life Care

It is a well known that a large percentage of the total U.S. healthcare spend is devoted to end-of-life care (EOLC) for a small number of patients (see: How We Spend $3,400,000,000,000). To quote the subtitle of the article:..."[M]ore than half of America's healthcare spending goes to five percent of patients." I think that we are approaching the time for an earnest discussion about this disproportionate allocation of healthcare resources and whether some of these resources could and should be reallocated to wellness programs. In my mind, it is out of the question about whether to increase spending for both wellness and EOLC given that the total healthcare expenditure, currently about 18% of the GDP (see: How has U.S. spending on healthcare changed over time?), is more than double that in other developed countries.

In this current note, I want to first raise some of the reasons why expenditures for EOLC have grown so large:

• Organized medicine is generally focused on the treatment of disease rather than the promotion of wellness. Expensive and prolonged end-of-life measures are a consequence of this focus on disease.
• In a parallel manner, the training of physicians and nurses is devoted almost entirely to the diagnosis and treatment of disease, suggesting that this disease treatment orientation among healing professionals will continue in upcoming years.
• In our system, physicians and hospitals are reimbursed almost entirely for the diagnosis and treatment of disease with little devoted to the promotion of wellness. 

By way of contrast, I offer below a bulleted list of forces that are now coming into play such that some percentage of the EOLC resources may be reallocated to wellness:

• Our for-profit health care plans, with an eye toward their own bottom lines, are promoting wellness programs. Corporations are also eager to see this happen.
• More Americans are dying at home of natural causes for the first time since the earliest part of the 20th century (see: More Americans are dying at home. Is that a good thing?). The surely represents a "vote" on the part of consumers against extended and expensive EOLC in hospitals and extended care facilities. 
• Big Tech is a new driver regarding wellness, including Apple, Google, and Amazon. These companies see this market as ripe for innovation and sales of their home-based healthcare devices. As I have commented in previous notes, health plans, Big Tech, and CVS/Walmart are controlling a growing percentage of primary care (see, for example: Walmart Shapes Its Own Primary Care, Unbundling Strategy; CVS Expands Its Healthcare Presence with Its New HealthHUB Stores). They will also thus control some of the referrals to health systems for more complex care and will soon be able to exert more control over the cost of this care.

The "Amazoning" of Health Care; What Exactly Does This Mean?

A recent blog note raised the topic of the "Amazoning" of healthcare (see: The ‘Amazoning’ of Healthcare Will Bring Challenges and Opportunities for Health Plans). In the article, the term "Amazoning" was defined in the following way:

At a recent healthcare conference I attended, it sure sounded like it. I heard healthcare professionals using “Amazoning” as a verb referring to the rapid delivery of products and services, relentless focus on customer experience and cost optimization, and threat to various industries like retail, computing and entertainment.

There is no question that Big Tech companies like Amazon, Google, and Apple are aggressively pursuing healthcare projects (see, for example: What Are the Consequences of Big Tech Entering the Healthcare Market?; Big Tech Is Knocking on Hospital Doors; It's All About the Data; Healthcare Will Contribute a Sizable Portion of Future Earnings for Apple). The key question with regard to Amazon and its competitors is what component of healthcare is most appealing to them for business ventures. I feel certain that they are not interested in competing in the area of inpatient care. Health systems already have invested huge amount of money in infrastructure. The field is also too regulated and health systems lag considerably in their expertise and foresight in IT deployment. Moreover, Big Tech companies have had little difficulty incentivizing large health systems to share their clinical data with them (see: In a ‘Wild West’ environment, hospitals differ sharply in what patient data they give Google). 

No, the focus of Big Tech will inexorably be on wellness and primary care. This lends itself well to (1) rapid delivery of products and services, (2) relentless focus on customer experience and (3) cost optimization. I have recently blogged extensively about the increasing sophistication of health wearables and their integration into what I have called wearable health ecosystems (WHEs) (see: The Evolution of "Wearable Health Ecosystems" and Associated Partnerships. 

In my opinion, a large percentage of health-oriented consumers in a few years will have many of their health diagnostics monitored by home-based smart phones, smart watches, and integrated diagnostic devices (see: Digital Health Wearables Can Be Used to Detect Gait Disorders, Undiagnosed Diseases). I have suggested that WHEs in the future will generate specific referrals to health system specialists, bypassing one of the primary roles of PCPs (Status Reports and Hospital Referrals from Wearable Health Ecosystems; Fitbit to Be Acquired by Google). It has been estimated that hospital PCPs are responsible for accounting for about 90% of hospital costs on the basis of clinical referrals. If my prediction about WHE-generated referrals is correct, Big Tech will have a significant grip on a large percentage of hospital referrals and thus revenue.

Outcomes-Based Pharmaceutical Contracts Can Shape the Future of Healthcare

I think that it would be a very good idea if drug costs, particularly for the most expensive ones, were based on outcomes for patients under treatment. This is to say, payment for the drug would be based on evidence that the drug is both efficacious and safe. Outcomes-based drug contracts were the basis for a recent article (see: Outcomes-Based Contracts Can Shape the Future of Health Care) and an excerpt is presented below:

 

Over the past decade, much of the health care economy has shifted from rewarding quantity (fee-for-service) to instead rewarding quality (outcome- and value-based payments). And yet, pharmaceutical manufacturers and pharmacy benefits lag in this transition. Drugmakers continue to be compensated based on the volume they sell and not whether their products are making people healthier....A new standard unlike traditional drug pricing, outcomes-based contracts hold the manufacturer accountable for its product by linking its revenue to whether or not the medication delivers on its intended outcomes.

 

A PBM negotiates a price and measurable outcomes with the drug manufacturer on behalf of a health plan. If the treatment delivers the intended outcomes, the plan will pay the agreed-upon price. But if a patient does not respond as expected, experiences adverse effects, or is unable to complete a course of treatment requiring a change to a follow-on medication, the drugmaker will issue a rebate for part, or all, of the cost....This type of money-back guarantee is common throughout the US economy.......[B]ecause many legacy PBM platforms don’t come standard with the necessary tracking capabilities, the industry must create new tools to meet these needs....Although some drug makers, such as Amgen and Biogen, are boldly experimenting with outcomes-based contracts, the majority of pharmaceutical companies have been slow to get on board.

 

There is no doubt in my mind that outcomes-based contracts for some drugs are important and necessary. However, it's naive to assume that major pharmaceutical companies would spontaneously agree to such contracts absent intense pressure. It doesn't seem to bother these companies that their current prices are driving many families into bankruptcy (see: Medication costs fuel painful medical debt, bankruptcies; Study: Almost half of new cancer patients lose their entire life savings). Intense pressure would need to come from health system consortia, professional physician organizations, and the federal government to have any effect. Putting this aside for the moment, however, I would like to discuss briefly the data-driven rationale for outcomes-based drug payments. In other words, exactly who would be responsible for assessing the efficacy and safety of drug treatments and what criteria would be used.

 

I disagree with the author of the article cited above that PBMs are the logical entities to track and interpret such data. They have already been shown to reap excessive profits from their current drug purchasing responsibilities (see: New federal guidelines target excessive profits by pharmacy benefit managers). Also, health systems have sufficient data in their EHRs to make such determinations and there is no need to share even more patient information with PBMs. However, we do need some type of pre-defined metrics about how to measure drug efficacy/safety that all involved parties can agree upon.

 

I envision that such reports would be generated using health system EHRs and then reported back to PBMs and pharmaceutical companies post-treatment with a request for a price rebate when necessary and appropriate. I am sure that Medicare, as the major funder for healthcare costs (see: The Facts on Medicare Spending and Financing), would support such an approach. The challenge would then be how to counter the pharmaceutical lobbying efforts against such an initiative (see: Big Pharma spends record millions on lobbying amid pressure to lower drug prices).

 

Addendum on 11/27/2019: A Billionaire Pledges to Fight High Drug Prices, and the Industry Is Rattled

Sanford Health Pays $20M to Settle False Claims Act Allegation

Physicians should be prohibited from having a financial interest in companies that manufacture or distribute medical devices and implants when such physicians benefit financially from the use of these devices in their practices. This rule is pretty basic but the concept seems to have alluded the executives running Sanford Health in Sioux Falls, S.D. The health system has been socked with a $20M penalty by the Justice Department for false claims (see: Sanford Health to pay $20M to settle False Claims Act allegations; Physicians accuse Sanford Health of defrauding Medicare: 5 things to know). Below is an excerpt from the first of these articles:

Sanford Health will pay the federal government $20.25 million to settle allegations that one of its neurosurgeons received kickbacks for using implantable devices distributed by his physician-owned distributorship....Colleagues of [neurosurgeon] Dr. Wilson Asfora allegedly warned the Sioux Falls, S.D.-based not-for-profit health system that he was performing medically unnecessary procedures involving the devices in which he had a substantial financial interest. Despite these repeated warnings, the DOJ alleged, Sanford continued to employ him, allowed him to profit from the devices he used in surgeries and continued to submit fraudulent claims. ....Sanford said in a statement that it denies any liability or wrongdoing, and that it chose to settle because the amount is far less than the unnecessary costs and operational disruption that would have persisted for multiple years.

Why do I think that there is more to this case than meets the eye? How about a discussion of the role of the Sanford Health executives and hospital in this scandal. According to one account, Sanford had fired Asfora in 2015 (see: Sanford Health, top surgeon defrauded millions from government, complaint alleges). Where is a quote from this article:

At one point, in October, 2015, Sanford fired Asfora. The complaint says that Asfora ran into [physician colleague] Wellman and another spine surgeon, Dr. Troy Gust, and told them he had "dirt and skeletons" on Sanford. Asfora predicted he would be reinstated, and he was two weeks later.

The fine of $20M on Sanford seems pretty stiff but one wonders about a couple of things. For one, to what extent did the hospital benefit financially from all of the unnecessary spine surgery that Asfora was performing. A second question is to what extent some of the hospital executive officers were personally benefiting in some way from the Asfora's distributorship of spinal implants.

 

Google Said to Be Seeking Data and B-to-B Relationships with Fitbit Purchase

I have been blogging recently about the rationale for the recent Google purchase of Fitbit (see: Google to acquire Fitbit, valuing the smartwatch maker at about $2.1 billion). At first glance, it's somewhat unusual because Google is primarily known for software and not hardware. On the other hand, the huge wellness and fitness market is an attractive target. A recent article speculated on the "real reason" for the purchase (see: The Real Reason Google Is Buying Fitbit) and below is an excerpt from the article:

Google already has plenty of hardware and software chops. What else does it get out of the Fitbit deal? The most obvious potential lure is the health data of millions of Fitbit customers. Fitbit devices have been tracking wearers’ health metrics for over a decade, cataloging behaviors like steps taken, calories burned and exercises performed. That’s just the kind of thing Google, fundamentally an advertising company, needs to further build out its profile of, well, you. Advertisers already take educated guesses at your health status, with apps like period trackers sharing your info with Facebook and others....

What else, then, does Fitbit have that’s attractive to Google?....Through its health-focused Verily subsidy, Google has been working on cardiovascular health, diabetes and more, but it hasn’t been publicly pushing healthcare as a business proposition. Fitbit, however, has been doing exactly that....Gartner senior analyst Alan Antin says Google could benefit from Fitbit’s expertise in working alongside corporate partners and other stakeholders in the healthcare world. “There’s the lesser known side business-to-business side of Fitbit, which is their partnerships with health insurance companies and direct corporate wellness programming,”....“Those are things that are a little bit harder for a company like Google to do.”

This point about gaining access to Fitbit's B-to-B relationships is important for Google. I have previously commented on Fitbit's relationship with companies such as Humana, UnitedHealthcare and Blue Cross Blue Shield (see: Fitbit Shifts Its Business Model Toward Services with Attention to Chronic Diseases). Let's get specific about why health insurance companies want to exercise control over wearable health ecosystems (WHEs) for which the Fitbit products will play an important point (see: The Evolution of "Wearable Health Ecosystems" and Associated Partnerships).

In a recent note, I speculated about how WHEs will shortly be able to generate referrals for acute care or hospital admission based on solid diagnostic information and predictive algorithms (see: Status Reports and Hospital Referrals from Wearable Health Ecosystems). I further speculated that such medical decisions would be triaged by PCPs. It is not unreasonable that some of these PCPs would be employed by health insurance companies, particularly if such companies were to provide a WHE gratis to policy holders. In so doing, these companies would gain control of some percentage of hospital admissions and thus be empowered to exercise greater control over hospital costs without putting their own bottom lines at risk.

High Risk Surgical Patients Have Lower Mortality Rates at Major Teaching Hospitals

I firmly believe that it's important to get oneself to a major teaching hospital if you fall into the category of a high risk, general surgery patient. A recent article put some numbers to this advice (see: High risk patients have lower mortality rates at major teaching hospitals). Below is an excerpt from the article:

New research published in the Annals of Surgery shows that high-risk general surgery patients have greater survival rates at major teaching hospitals than at non-teaching hospitals....The 30-day mortality rate for these high-risk patients was 15.9% at major teaching hospitals, compared with 18.2% at non-teaching hospitals....They examined the medical records of 350,000 Medicare beneficiaries who underwent general, vascular, or orthopedic surgery at 2,780 hospitals across the country, including 340 major teaching hospitals....The study examined costs and patient outcomes—including 30-day mortality rates—for procedures, such as mastectomy, appendectomy, gastric bypass, blood vessel repair, total knee replacement, and more. The researchers calculated the cost of care within 30 days of admission, including office visits and readmissions....The mortality rate of high-risk vascular surgery patients was 15.5% at teaching hospitals compared to 16.4% at non-teaching hospitals. The mortality rate for orthopedic surgery procedures was significantly lower overall than the rates for vascular and general surgery.

In my view, the reason why major teaching hospitals provide better care for high risk surgical patients is that academic physicians tend to be more specialized than community physicians. Because of this orientation, they are more apt to be knowledgeable about new technology and techniques relating to a particular surgery and some surgeons may have performed a procedure very frequently because of this specialization. Another factor leading to lower mortality is that teaching hospitals have an organizational hierarchy with multiple layers of oversight including house officers and staff surgeons. Absent such oversight, physician incompetence can be overlooked or intentionally disregarded. One of my recent notes about malpractice in a VA hospital provides an extreme example of the consequences of weak physician oversight (see: VA Pathologist Indicted for Multiple and Continuing Errors, Resulting in Deaths).

The flip slide of this coin about which hospitals to patronize is that major teaching hospitals may provide lesser quality service for common conditions (see: Teaching Hospitals and Quality of Care: A Review of the Literature). Below is an excerpt from this article:

Despite their reputation for highly specialized care and for treating rare diseases and severely ill patients, teaching hospitals in fact rely heavily on income from more routine services, such as the care of heart disease, pneumonia, and stroke....It is possible, however, that for common conditions, teaching hospitals may offer a lower quality of care than do nonteaching hospitals, particularly if the substantial involvement of inexperienced trainees and the attenuated role of senior physicians in teaching hospitals results in more fragmented and less appropriate care. Both purchasers and patients have an interest in knowing whether teaching hospitals provide added value through a higher quality of care or whether services of comparable quality could be obtained at a lower cost in nonteaching hospitals.

Bottom line and to repeat comments above: If you are a high risk surgical patient, you can reduce the likelihood of a bad outcome by seeking care in a major teaching hospital. 

Walmart Expands the Range of Services of Walmart Health

I have posted a number of recent notes about CVS' initiatives in primary care (see, for example: Push-Pull at Work in the Expansion of CVS Health into Primary Healthcare). Its major competitor in this space (i.e., healthcare offered in big-box and retail drug stores) is Walmart and a recent article discussed how the company is greatly expanding its range of services (see: Walmart tests dentistry and mental care as it moves deeper into primary health), Below is an excerpt from it:

Walmart is opening up a new health clinic, called Walmart Health, in Georgia....At the new clinic, the company will offer hearing tests, 60-minute counseling sessions and vision tests....It also went online with the site “Walmarthealth.com,” where patients can set up appointments....The Dallas location, which is set to open its doors next month, will give patients access to comprehensive and low-cost primary care, including...mental health issues. The clinic is in a separate building next door to a Walmart store to give a sense of privacy for patients....Walmart is already one of the largest pharmacy companies in the U.S., offering in-store sections for prescription drugs in almost all of its 4,700 locations across the U.S. The company said health and wellness, which includes pharmacy, clinical and optical services, accounted for about 9%, or $36 billion, of its roughly $332 billion in U.S. sales last fiscal year....Primary care is a newer market for Walmart and puts it in competition with a different set of companies, ranging from large health systems to emerging businesses like One Medical, Circle Medical and Forward. Walmart’s distinct opportunity is that roughly 140 million people visit its stores every week, and it has about 1.5 million U.S. employees spread across cities of all sizes, including in rural areas where there’s a shortage of health-care services.

Here's a list of the range of services being offered in the Walmart Health (see: Walmart’s First Healthcare Services ‘Super Center’ Opens):

The larger Walmart Health Center puts “key health services under one roof,” a first for the world’s largest retailer when it comes to offering primary care, dental, optometry, counseling, laboratory tests, X-rays, hearing, wellness education and behavioral health.

I came up with four points about this Walmart news that struck me as interesting:

• The goal for the company seems to be to offer a comprehensive set of primary services under one roof including dental, optometry, and behavioral health. I recently blogged about how this latter type of care is emerging as the health service favored by employers. Walmart may be angling to attract some of this business on a referral basis from companies. 
• I was unaware of the fact that pharmacy, clinical, and optical services, accounted for about 9% of Walmart sales in the U.S. as noted above. This is on the basis of $332B in U.S. sales. I suspect that this percentage could double in the near future as a result of its expanding healthcare unit.
• Not to be ignored is that Walmart has a keen interest and financial stake in serving rural populations in the U.S. where healthcare is dangerously faltering, certainly from the perspective of hospitals (see: Nearly a quarter of rural hospitals are on the brink of closure). Thus, this expansion of primary healthcare will face little market competition and will also be highly valued by its customers. 
• I anticipate that Walmart will graft some types of virtual specialty care onto its current primary care offerings, a continuing need for rural populations. CVS is already providing such services utilizing the NPs who staff its Minute Clinics.

Funding the National Health Service by Selling Access to Patient Data

In a recent note, I discussed the challenges facing the National Health Service (NHS) in the deployment of IT across this huge health system (see: National Health Service a "Balkanized" Mess; Special Problems with IT). Now comes news that a former British politician is advocating the sale of NHS health data as a source of new revenue (see: A Former Science Minister Wants to Fund the NHS by Selling Access to Patient Data). Below is an excerpt from the article:

Now, as...[NIH] finances face increasing pressure, [Paul] Drayson, a former U.K. science minister, is on a mission to help save the government-funded NHS by selling access to patient data to drug and device companies.....Drayson founded Sensyne Health Plc, a for-profit company that’s trying to get divisions of the NHS to agree to put patient information, including DNA sequences, into a large database. Over its 71-year history, the NHS has collected records on its patients and, in recent years, launched an intensive drive to collect and use patients’ DNA data for care and research. Sensyne’s initial target is to gather information on 5 million NHS patients; ultimately, Drayson says, he would like to have access to the data on all 55 million members. According to a coming report from EY consultants, the data could be worth as much as $12 billion annually in better patient care and health, and benefit to the U.K. economy. So far, Sensyne has signed up six of the NHS’s 150 hospital divisions, known as trusts, representing about 3 million patients, with each trust receiving Sensyne shares worth about $3 million. Private companies increasingly have tapped into the NHS data—contracting with trusts for access or through companies providing access—to inform their own efforts to develop new drugs and devices. As rising costs, poorly planned expansion, and the Brexit-fueled worker flight threaten the NHS, U.K. lawmakers and patient advocates say it should be compensated for its data.

The demand for access to patient health data is insatiable. Among other things, the genetic data is being used partly for drug research by pharmaceutical companies. A broader swath of data is used to develop diagnostic and predictive analytics. I personally believe that anonymized health data can and should be sold but in a way that benefits patients rather than lines the pockets of entrepreneurs (patient data stewardship). Moreover, there also needs to be broad access to the data rather than exclusive contracts with insiders. Paul Drayson may meet this latter description.

Of great interest is the fact that Sensyne has already signed up "six of the NHS’s 150 hospital divisions, known as trusts, representing about 3 million patients, with each trust receiving Sensyne shares worth about $3 million." Much of what I now believe about the sale of patient data I have learned from the Memorial Sloan Kettering/PaigeAI scandal. C-suite executives were enriching themselves from the sale of data to PaigeAI on an exclusive basis (see: Controversy at MSK Cancer Center Regarding the Pathology Archive and Database; Some Ideas Governing Patient Data Stewardship by Hospitals). The hospital appears to have corrected many of the problems that prompted the scandal but I will monitor the situation to make sure that this has happened.

National Health Service a "Balkanized" Mess; Special Problems with IT

For many years, the U.K. healthcare system, the National Health Service (NHS), has been referred to in the U.S. as a prime example of the success of a national healthcare system. Here's a brief summary of the NHS from Wikipedia:

The National Health Service (NHS) is the publicly funded national healthcare system for England and one of the four National Health Services for each constituent country of the United Kingdom. It is the largest single-payer healthcare system in the world. Primarily funded through the government funding and overseen by the Department of Health and Social Care, NHS England provides healthcare to all legal English residents, with most services free at the point of use. Some services, such as emergency treatment and treatment of infectious diseases, are free for everyone, including visitors.

A recent article discussed in great detail the IT challenges being experienced by the NHS (see: In the UK, health care is national and popular. Its health IT is a Balkanized mess). Read the whole thing if you are interested. Below is an excerpt:

For nearly 20 years, the British government has launched one initiative after another to build a digital records system that will improve care at its famed National Health Service. But its clinicians still struggle with a dearth of communication among care team members, leading to prolonged wait times for appointments, confused patients and needlessly repeated tests and procedures. In the United States, progressive Democrats supporting single-payer...contend that a health system deprived of profit motive would make care less wasteful, more efficient and generally just easier for patients to navigate. But if Britain’s struggle to modernize the NHS is any indication, a single-payer system alone wouldn’t necessarily solve the maddening bureaucratic morass that is the $3.5 trillion-per year American health care system. That would take an unprecedented level of cooperation that’s been elusive in the United States, even 10 years after Washington plowed tens of billions of dollars into bringing health care fully online....

But modernizing the NHS, particularly its IT systems, has been a massive headache and a drag on the government’s effort to keep health care spending in check amid the growing expenses of an aging population....While the NHS pays for the vast majority of health care in the United Kingdom, the system is more decentralized than an outsider might think. It consists of scores of “trusts,” each consisting of one or more hospitals. In England, 191 individual boards oversee the provision of health care. Depending on their funding models and priorities, and sometimes on the strength of the local economy, this has resulted in vastly different levels of digitization and coordinated care in different areas of the UK, sometimes even in the same city....The top third of British hospitals have digital technology that’s nearly comparable to U.S. levels in terms of its sophistication. The bottom third still rely on clunky old computers or even paper records.

It probably should come as no surprise that the NIH hospitals are being challenged by the deployment of IT. As in the U.S., clinical record sharing is complex as are computerized financial systems. The latter systems are critical in the U.K. despite the fact that care is free to the patients there. Even for the NHS, budgeting and finance are vital for understanding costs and how to contain them. I don't need to remind the readers of LabSoftNews about the problems associated with the rollout of EHRs in the U.S. and the continuing challenges of interoperability.

I was preciously unaware that there are 191 individual boards representing the various NHS "trusts." Despite the fact that I believe Medicare is generally well run, I am wary of its expansion which is one of the current Democratic proposals, sometimes referred to as Medicare for all (see: Medicare for all: fears and facts). I only need to cite the continuing political machinations around the VA healthcare system as one example of the chaos that can ensue when politicians seek to exert authority over such a massive healthcare system (see, for example: Why the Military and the VA Healthcare Systems Are Not Amenable to Change; Comprehensive History of VistA; What's Next for This Early, Highly Functional EHR?).