Where Does It Hurt?: An Entrepreneur's Guide To Fixing Health Care Download Free (EPUB, PDF)
A bold new remedy for the sprawling and wasteful health care industry.Where else but the doctor’s office do you have to fill out a form on a clipboard? Have you noticed that hospital bills are almost unintelligible, except for the absurdly high dollar amount? Why is it that technology in other industries drives prices down, but in health care it’s the reverse? And why, in health care, is the customer so often treated as a mere bystander—and an ignorant one at that?The same American medical establishment that saves lives and performs wondrous miracles is also a $2.7 trillion industry in deep dysfunction. And now, with the Affordable Care Act (Obamacare), it is called on to extend full benefits to tens of millions of newly insured. You might think that this would leave us with a bleak choice— either to devote more of our national budget to health care or to make do with less of it. But there’s another path.In this provocative book, Jonathan Bush, cofounder and CEO of athenahealth, calls for a revolution in health care to give customers more choices, freedom, power, and information, and at far lower prices. With humor and a tell-it-likeit- is style, he picks up insights and ideas from his days as an ambulance driver in New Orleans, an army medic, and an entrepreneur launching a birthing start-up in San Diego. In struggling to save that dying business, Bush’s team created a software program that eventually became athenahealth, a cloud-based services company that handles electronic medical records, billing, and patient communications for more than fifty thousand medical providers nationwide.Bush calls for disruption of the status quo through new business models, new payment models, and new technologies that give patients more control of their care and enhance the physicianpatient experience. He shows how this is already happening. From birthing centers in Florida to urgent care centers in West Virginia, upstarts are disrupting health care by focusing on efficiency, innovation, and customer service. Bush offers a vision and plan for change while bringing a breakthrough perspective to the debates surrounding Obamacare.You’ll learn how: • Well-intended government regulations prop up overpriced incumbents and slow the pace of innovation. • Focused, profit-driven disrupters are chipping away at the dominance of hospitals by offering routine procedures at lower cost. • Scrappy digital start-ups are equipping providers and patients with new apps and technologies to access medical data and take control of care. • Making informed choices about the care we receive and pay for will enable a more humane and satisfying health care system to emerge. Bush’s plan calls for Americans not only to demand more from providers but also to accept more responsibility for our health, to weigh risks and make hard choices—in short, to take back control of an industry that is central to our lives and our economy.
Hardcover: 240 pages
Publisher: Portfolio; 1 edition (May 15, 2014)
Language: English
ISBN-10: 1591846773
ISBN-13: 978-1591846772
Product Dimensions: 6.4 x 0.9 x 9.2 inches
Shipping Weight: 10.4 ounces (View shipping rates and policies)
Average Customer Review: 4.3 out of 5 stars See all reviews (54 customer reviews)
Best Sellers Rank: #34,639 in Books (See Top 100 in Books) #6 in Books > Health, Fitness & Dieting > Diseases & Physical Ailments > Skin Ailments #12 in Books > Business & Money > Insurance > Health #36 in Books > Politics & Social Sciences > Sociology > Medicine
Unarguably, America's medical care is technologically the best in the world; however as a health care system it falls short, lying somewhere at the bottom ranks of "first world", and even some "second world" countries.The system, like another behemoth (the IRS), mismanaged by government's confusing and often contradictory regulations, should be scuttled and restructured to fit a twenty first century culture and economy.The core of medicine is the relation between patient and physician, which can be even more intimate than family; it has been disrupted by layers of administrative record keeping, obfuscated payment/reimbursement policies, threat of multi-varied and unpredictable litigation as well as undertones of disruptive audits and arbitrary disciplinary actions for perceived or real accounting/billing errors.To most physicians, medicine is a vocation and life ambition, worthy of the significant sacrifices made learning the science and practicing the craft. Their families learn, early on, to cope with the absentee husband and father because always "the patient comes first".But in today's environment, the physician is expected to be a businessman, a manager, an expert on health care law, an accountant, and an insurance coding & reimbursement specialist. By the end of the day the provision of medical care becomes secondary and the most important component of the system (THE PATIENT) is reduced to an entity for generating codes (ICD-10 & CPT) for billing. Patient care is upended by medical chart documentation.No wonder the media reports that 42% of physicians are unhappy with their profession and 59% would not recommended it to others. The real numbers are much higher; also since the year 2000 more 50+year old physicians have retired than ever before.
This is a useful book to understanding how to improve the healthcare system. Clayton Christensen who wrote the Forward labeled it a ‘bottom up’ view as opposed to the ‘top down’ view from the “The Innovator’s Prescription”. This feels accurate.The book is an easy read, a narrative in 4 parts written in colloquial language with personal anecdotes. Below are the principal ideas. Apologies for license in choice of words, omissions, or misinterpretations.I Observations from the front- general waste from underutilized high capital equipment (e.g. hospitals) vs specialist businesses that can employ continuous use for diagnosis or treatment (e.g. MRI in hospital vs MRI shop)- high capital based treatment options vs low capital options (not obvious high capital solutions necessarily produce better end results)- lack of market competition for procedures with patients sharing in any savings- no/limited treatment and insurance availability across state lines (e.g. analysis by expert radiologists or dermatologists via Internet … must travel to another state for expert services)- care organizations ownership can dictate type of treatment (e.g. home vs care facility for dialysis in doctor owned businesses)- system preserves profits for incumbents as opposed to allowing for alternatives (e.g.
With apologies to Ronald Reagan, who might have liked this book, here we go again. Bush just repeats the libertarian /conservative Republican dogma that markets are if not perfect, are almost perfect. If only we could get pesky regulations out of the way, health care system would be so much better. Bush and his intellectual ilk constantly use the flawed comparison of health care services to other consumer goods: groceries, consumer etc. But they're not equivalent. The major differences, without going into too muchdetail, are the following:1.asymmetric information (patients, a.k.a consumers) do not have the knowledge of medical procedures that trained medical professionals do. To expect them to shop around for the right surgeries/tests like looking for a new TV or washing machine (yes, he uses that exact example) is absurd. Even Bush (p.65) concedes, albeit reluctantly, that this won't work in cancer therapies2.The people who have the most trouble obtaining need health care--mostly seniors and the disabled-- are those who need it the worst.The market is and in fact must be, a failure in providing this help. The only reason seniors today have access to health insurance, is Medicare, which Bush reluctantly concedes is here to stay for a while. I imagine if it were politically possible he would do away with that.3.The costs of health care are often or even usually unexpected-- the major illnesses that are tremendously expensive to treat can happen at anytime. Insurance is necessary for those of us without millions of dollars.Still, as much as i disagree with Bush's premise, he does get a few things right: 1.he explains the concept of ACOs to the reader (similar to Medicare Advantage, see more details on page 71), 2.
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