Developed by Lawrence Rosier Consulting on November 27, 2017. Ref: LawrenceRosierConsulting Blog Articles 112, 111, 109, 107.
This plan embodies far reaching strategic thinking that overturns false ideas about Health Care and reduces the cost of Health Care in Missouri significantly. Because of the movement from Private for-profit Health care system to not for-profit Missouri government managed hospitals a five year adjustment period is needed. This is an important backup plan that brings Missouri into solvency in health care regardless of what the Federal Government does in a National Health Care plan.
Facts about the current health care system, it is a growth industry that appears to have no limits in cost projections. US Private health care costs double that of European government based health care, neither have the efficient approach embodied in this Plan. Converting from a Private profit based to a not for-profit or government based health care system is expected to reduce Health care costs by 50% due to the reduction in fraud and other efficiency reasons but with increased efficiency I have estimated a conservative 60% reduction in overall health care costs in the new high volume/low cost specialized health care system.
Medicaid
Medicaid costs in Missouri is 9.9 $billion. Only about 10% or $1billion of this cost can be reduced by the efficiency in hospital operations presented in this Plan. Much of Medicaid costs are in long term care where some efficiencies may be implemented by Lean Teams.
Medicare
Medicare however presents a much different view because funding by the Federal Government would go directly to the state of Missouri providing the funding needed to convert private hospitals acquired by the State in its conversion to the Missouri Health Care System (MHCS). An agreement with the Federal government to pay the full amount of Medicare costs to the State until the new efficient system can be developed may be required or the Federal Government might chose funding Missouri’s MHCS. Ref: the example Cataract Surgery Clinic with a 90% decrease in costs at LawrenceRosierConsulting Blog Articles 110,109.
Missouri’s Health Care System (MHCS) Open to all Missourians
As the system grows in the last years of this plan the Missouri Health Care System would be available to all Missourians, open to those with or without insurance. MHCS expected costs to be 20% to 50% less than Private Hospitals. Insurance companies may provide incentives for those insured to use the new system.
Starting the Reorganization
A not for-profit General hospital is selected in a large city. General Hospitals do nearly all procedures therefore they are low volume/high cost facilities. Nearly all routine procedures are removed and reorganized into high patient volume/low cost specialized Clinics. The General Hospital now serves vital care and emergency trauma care patients. How the specialized clinics use the old General hospital space will require a good deal of planning. But the in-patient special clinic patients will require hospital bed space and will most likely remain in the General Hospital facilities while out-patient procedures will be in new individualized Clinics.
List of implementation events for the Missouri State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid patient area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
Lean Teams may require help in designing Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid and $6 billion in Medicare & Regular health care costs for the State.
8. States may also agree to share Daily Plans & facility designs.
Overview of the Missouri Health Care System (MHCS) Plan
Stage 1. The Startup Stage Beginning January 2018
The State Government may acquire General Hospitals under financial stress at little to no cost or enter into an agreement with a private not for-profit hospitals. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired in St Louis, Kansas City and Springfield in stage 1. As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Stage 2. Medicaid and Medicare Patients continued move to new system
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
Stage 3. Accommodation of Patients without Health Care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the new facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the MHCS.
Stage 4. The MHCS will be Available to all Missourians
The expanded MHCS will be available to all Missourians. Health Insurance Companies will gradually require that patients move to the less expensive MHCS. Private Hospitals will still be available for those who want them.
The MHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 to 50 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Criteria for the Selection of Routine Procedures:
- Repeatable processes with the time being the same for
- all patients (relatively routine)
- Sufficient Patient Backlog for Continuous operation
- Daily Plan efficiently designed by each Lean Team
- Balanced Operations
Routine Outpatient and Inpatient Procedures
Outpatient Testing and Procedures
1. Radiology/Diagnostic Imaging Including MRI, CT scans, ultrasound, nuclear medicine, mammography and x-ray.
2. Colonoscopy
3. Prenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
4. Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Inpatient Testing and Procedures
1. Appendectomy
2. Natal care (Baby Deliveries)
3. Cesarean section (also called a c-section)
4. Cholecystectomy (surgery to remove the gallbladder)
5. Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
6. Hemorrhoidectomy (surgical removal of hemorrhoids)
7. Hysterectomy (surgical removal of a woman's uterus)
8. Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
9. Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
10. Prostatectomy (surgical removal of all or part of the prostate gland)
11. Tonsillectomy (surgical removal of one or both tonsils)
Savings for Routine Procedures
With Cataract surgery at 90% reduction of costs it appears that there are other procedures where savings were estimated at 60% are now estimated at 70% to 80% reduction in costs. These savings appear to be impossible but this approach has never been considered before.
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesion's. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
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