Article 107. How States Can reduce Costs through Reforms

How States Can reduce Costs through Reforms

Lawrence Rosier Consulting
12143 Cedar Grove Rd.  Rolla, Missouri 65401
Phone 573 578-4716 lawrencerosier4@gmail.com  
See Article 102 About Lawrence Rosier

My Reform Models:
1. General Reform Model (Enterprise Lean, Management budgeting & scheduling and Team Management).
2. Consolidation Model (used where applicable mostly in the Federal Government)
Ref: Article 48, 81. Consolidation in the Texas State government
3. The Effectiveness Test (used where applicable mostly in the Federal Government)
Ref: Article 49
I Recommend Enterprise Lean
Enterprise Lean developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in government processes. It has also been successfully implemented in the Cleveland Clinic well known for its health care.  The process consists of working teams that meet regularly to review and discuss how the work they are doing can be improved upon. I recommend that Enterprise Lean be implemented throughout state government. State employees become excited about their jobs with their involvement providing innovative solutions to work problems. 

My General Reform Model works best with the following Criteria:

• Repeatable processes (relatively routine)

• Sufficient Backlog for Continuous operation 

• Operation efficiently designed (Enterprise Lean & New Management Sys.)

• Balanced Operations, Budgeting, Scheduling, Reporting

Balanced Work Loading
Savings are from working smarter not harder and elimination of wait times.
90% of all inefficiency is from people waiting on others to do their jobs. This because we have come to accept the fact of waiting as just a part of the job. We can eliminate or at least significantly reduce wait times by doing the following:

• Determine the sequence of the flow of jobs from work group to work group.

• Set a reasonable Time for all work groups to process the work.

• Balance the work load by adding and removing personnel so that each work group can do their work within the time set. This balanced process will eliminate wait times.

Examples of Major Savings in Health Care:
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons).  Drs. Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors.  The Doctors were doing about 200 eye surgeries per day.  I give you this example of how little a cataract surgery actually costs in Burma $25 in the US $4000 both eyes.

Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo. Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients.  In a week he can perform 40 eye surgeries paid for by Medicare at $2000 each eye. The surgeon is grossing nearly $4 million annually from Medicare.  These examples prove that certain health care operations can be reduced significantly in cost.  By following my approach most routine health care operations can be reduced by 60%.

Third Example:
The developers of Obamacare were only interested in passing the bill and not in trying to reduce US health care costs.  US Private health care costs double that of European Government provided health care. This suggests that we move Medicaid and Medicare routine operations to state run Primary care hospital systems where management reforms can be implemented.
These examples prove that there are $billions to be saved in the current Healthcare system by following my recommendations.

My Recommendations to States for making Major Reductions in Health Care Costs 

State Government Run Urgent Care and Primary Care Hospitals
Urgent Care Hospitals for Critically ill Patients need only to implement Enterprise Lean.

The Process develops Savings in Primary Care Hospitals
Primary Care non-profit Hospitals for Routine non-life threatening operations without an ER, implement Enterprise Lean with efficiently Daily plans.  The State may enter into an agreement with nonprofit hospitals to implement these reforms or implement the reforms in state operated hospitals.  These hospitals may already be serving mostly Medicaid and Medicare patients.   Medicaid estimated savings is 60% of current Primary Care costs, close to $1 billion in the State of Missouri. Ref: Articles: 106, 105, 104, 101.

Government Run Cataract Surgery Clinic Suggestion
The State can establish Cataract Surgery clinics in each of its major cities. Saving 90% of the current cost of Cataract Surgery. This is a massive savings to Medicare and can be funded by the Federal Government.

Rural and Urban Emergency Health Care (Solution to over-run Urban ERs)
Combination: Fire Station, Ambulance and Emergency Health Care Clinic.  This approach significantly reduces the cost of over-run hospital Emergency Rooms in Urban areas.  The Clinics provide emergency health care for small rural towns.

Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com