As healthcare costs in the U.S. continue to rise, more and more of the burden falls on patients. But when patients can?t pay their bills, the debt piles up at hospitals. As part of our series, Profiles in Health Care, NHPR?s Trish Anderton spoke to one hospital administrator about his efforts to keep people healthy while keeping an eye on the bottom line.
TOM CLAIRMONT IS A SOFT-SPOKEN MAN IN HIS MID-FIFTIES. HE KNOWS LAKES REGION GENERAL HOSPITAL AS WELL AS ANYONE ON EARTH. NOT ONLY HAS HE WORKED HERE FOR THIRTY-two YEARS - HE WAS BORN HERE. CLAIRMONT STARTED AS AN ACCOUNTANT AND WORKED HIS WAY UP. WALKING THROUGH THE EMERGENCY ROOM, HE EXPLAINS HOW THE HOSPITAL REVAMPED THIS AREA TO MAKE IT MORE COMFORTABLE.
we designed this in such a way that people come in and they?re triaged and seen by nursing before they?re put through the name, number and all that stuff.
LIKE JUST ABOUT EVERYTHING TOM CLAIRMONT OVERSEES AT THE HOSPITAL, THE REDESIGN HAD TWO GOALS. IT DID MAKE THE PATIENT?S EXPERIENCE MORE PLEASANT. IT?S NICE TO TALK TO A NURSE BEFORE YOU FILL OUT THE INSURANCE FORMS. SECOND, IT HELPED KEEP COSTS IN LINE. AS CLAIRMONT EXPLAINS IN HIS UPSTAIRS OFFICE, TRIAGING PATIENTS SAVES MONEY BY KEEPING THE LESS-URGENT ONES OUT OF THE E.R.
basically that was a way to sort out patients who need different types of care and make it more affordable ? really we don?t need people tied up in the emergency room if they don?t need to be there.
TO RUN A HOSPITAL IS TO WORRY ABOUT BALANCING THE BOOKS. CLAIRMONT KNOWS FOR EXAMPLE THAT HE WILL LOSE MONEY ON EVERY MEDICARE PATIENT HE TREATS. BUT HE WELCOMES EVERY PERSON WITH MEDICARE WHO COMES THROUGH THE DOOR. IF ONE THING SPARKS THE CEO?S CREATIVE SIDE, IT'S TRYING TO FIND WAYS TO SERVE PEOPLE AND SAVE MONEY AT THE SAME TIME. IN THE LATE 80'S, HE HIT ON A STRATEGY FOR CUTTING COSTS BY KEEPING PEOPLE OUT OF THE HOSPITAL.
007 133 one of the first care management programs we stumbled on by accident was having a nurse call patients every day for a while after they were admitted. And we found the readmission rate was cut in half. so its that constant care, by not having the use the hospital, and stay healthy, it makes good business sense.
THAT IDEA MORPHED INTO A PROGRAM CALLED HEALTHLINK. CLAIRMONT SAW THAT PATIENTS WITH LITTLE OR NO INSURANCE WERE DISCONNECTED FROM THE SYSTEM. THEY CAME IN ONLY WHEN THEY WERE VERY SICK, AND THEN IT COST A LOT TO MAKE THEM BETTER. SO HE DECIDED TO EXPAND AND FORMALIZE THE CHARITABLE WORK HOSPITALS AND DOCTORS TYPICALLY DO. CLAIRMONT RECRUITED A NETWORK OF DOCTORS. THEY AGREED TO SEE LOW-INCOME PATIENTS FOR A SLIDING SCALE FEE.
the fulfilling part of helping to organize that program was I didn?t have to make any real arguments. having worked with the physicians, having recruited many of them here, they were really conscientious about wanting to take care of all.
HEALTHLINK IS HOUSED OUTSIDE THE HOSPITAL, BECAUSE SOME PATIENTS FIND THE BIG BRICK HOSPITAL BUILDING ITSELF INTIMIDATING. CLAIRMONT WAS A LITTLE PAINED TO THINK THAT HIS INSTITUTION, WHICH IS AFTER ALL DEVOTED TO HEALTH, COULD ACTUALLY MAKE PEOPLE FEEL BAD. BUT HE CAME TO UNDERSTAND THAT PERSPECTIVE BETTER WHEN HE HIMSELF BECAME A PATIENT. CLAIRMONT WAS TREATED FOR THROAT CANCER EIGHT YEARS AGO. SINCE HE HAD INSURANCE, HE DIDN?T GET COLLECTION LETTERS FROM THE HOSPITAL. BUT HE COULD IMAGINE HOW HE WOULD FEEL IF HE WERE WORRIED ABOUT PAYING HIS BILL.
in medicine the whole creed is to do no harm. as an administrator there are things you can do that cause harm. Certainly emotional stress and all the scars that go along with treating people unkindly. so my take-away from my experience was make sure the do no harm transfers into everything you do.
BUT IF CLAIRMONT SOUNDS LIKE A SOFT TOUCH, HE?S ALSO EVERY BIT THE HARD-NOSED ACCOUNTANT. HEALTHCARE COSTS MONEY. CLAIRMONT SAYS EVERYBODY ? BUSINESSES, TAXPAYERS, AND THE GOVERNMENT ? HAS TO COME TO GRIPS WITH THAT FACT.
its all a "who?s gonna pay" game and nobody wants to pay. people say healthcare is an entitlement and everyone should have it. and what they?re really saying, and it shouldn?t cost me anything is what?s usually left out of that discussion. it has to cost someone something.
CLAIRMONT SAYS THE GOVERNMENT AND TAXPAYERS NEED TO BE REALISTIC ABOUT THE COST OF CARE. LAST YEAR, HIS HOSPITAL LOST OVER 7 MILLION DOLLARS JUST THROUGH TREATING MEDICARE PATIENTS. HE SAYS ANY TALK ABOUT EXPANDING GOVERNMENT PROGRAMS, AS SOME PRESIDENTIAL CANDIDATES SUGGEST, HAS TO OVERCOME A BIG CREDIBILITY GAP.
the experiment of medicare at least from where we sit in new hampshire is a failure. the promise is still out there but the funding for that promise isn?t. and you can?t build on that lack of success
Nor is the patient exempt. Clairmont feels everyone who can pay something toward his or her care should have to.
NOR IS THE PATIENT EXEMPT. CLAIRMONT FEELS EVERYONE WHO CAN PAY SOMETHING TOWARD HIS OR HER CARE SHOULD HAVE TO.
the saying goes, if you don?t pay for something you don?t value it. people, if they have to spend the money for a service, they?re going to be making sure it?s the right decision.
CLAIRMONT BELIEVES THERE ARE SOME HOPEFUL TRENDS IN TERMS OF CONTROLLING HEALTH COSTS. FOR EXAMPLE, THE GROWING FOCUS ON IDENTIFYING AND USING THE MOST EFFECTIVE TREATMENT FOR EACH DISEASE. ALSO, TECHNOLOGY, WHILE IT?S EXPENSIVE, CAN EVENTUALLY CUT COSTS BY GIVING DOCTORS A MORE ACCURATE PICTURE OF A PATIENT?S ILLNESS. NONETHELESS, CLAIRMONT SAYS AMERICANS ARE GOING TO HAVE TO TAKE THEIR MEDICINE ? AND FACE THE FACT THAT HEALTHCARE IS EXPENSIVE. FOR NHPR NEWS
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