Alice and The Committee 1

Alice and The Mad Steering Committee

Alice came within sight of the administration building. She knew it was the right building because it was festooned with slogans, and over the door there was a large sign proclaiming:

"Great Things Are Happening Here," and
"MISSION PLANNING AND FORWARD-LOOKING LEADERSHIP" .

She entered the building and wondered where to turn. Various people were milling around looking busy, though it was hard to tell to what purpose. She timidly approached what looked like a receptionist's window, but there was nobody there. She turned to a man who was swinging a broom across the floor--at least he looked as if he worked there. "Excuse me," she said, "would you tell me, please, which way I ought to go from here?"

"That depends a good deal on where you want to get to," said the man.
"I was invited to attend a committee meeting," said Alice.
"Everybody does," said the man. "Whichever door you enter, you'll find a committee in progress. It's all crazy. You must be crazy to want to join. We are all crazy." Having said that, he returned to his back-and-forth sweeping.

Alice picked the corridor on the left. In the middle of it there was a set of important-looking double doors. There was a large conference table in the middle with chairs all around it. The March Hare and the Mad Hatter sat at the table, shuffling papers. A Dormouse was sitting between them, fast asleep. All the other chairs were empty. "Come in! come in!" they said. "You must be the consultant. You are late. Bring in a chair from the next room and sit down."

"But," said Alice, "there are plenty of unoccupied chairs," and she sat down. "Oh," said the March Hare, "someone from this committee must be absent. Do you vote for or against? "

"For or against what?" asked Alice.

"How should I know?" said the Hatter. "And what difference does it make, anyway?"

"It should make a difference," said Alice. "One should always learn what the question is, before giving an answer."

"That would be a breach of confidentiality," said the March Hare. "Mind your own business!"

"Then you should not have asked for my opinion," said Alice. "You are not very civil."

"You mean, if you knew the question, you could find out the answer?" said the March Hare.

"That is exactly what I mean," said Alice.

"Then you should say what you mean," the March Hare went on. "I usually do," said Alice.

"Don't!" said the Hatter. "Opinions undermine the team spirit. Next thing, you will start thinking."

"I think, therefore I am," quipped Alice, who was very proud that she knew who Descartes was, and she added, "I am, therefore I think."

"I am, therefore I sleep," muttered the Dormouse. The Hatter lifted a paper from the pile before him and said, "What day of the month is it?"

Alice looked at her watch and said, "The Fourth." The Hatter looked at his sheet of paper, shook his head, and said, "Two days wrong. I told you that getting the agenda from the horoscope column would not work. We have been at this for three days now."

The Hare became indignant. "It was a most popular column," he replied.

"Yes," said the Hatter, "but the planets must have misaligned," and he dipped the agenda in his coffee cup, adding, "What's the difference? We sit in committees forever anyway." Then he sharply elbowed the Dormouse.

"Our mission is to do good," declared the startled Dormouse.

"Good! Where, to whom?" asked Alice.

"Let's have a new Table of Organization," said the March Hare. "That always makes us look productive."

"I want a new title," said the Hatter. "Everybody move one place clockwise," and he moved to the seat next to him. They all moved to the seat to their left. Alice found herself behind a tag that declared her DIRECTOR OF COORDINATED ORGANIZATIONAL FACILITATION. The notepad in front of her was covered with donut crumbs, coffee stains, and doodles. Some of the doodles seemed like illegible writing, or perhaps it was illegible writing that looked like doodles. "But I don't know what DIRECTOR OF COORDINATED ORGANIZATIONAL FACILITATION means," complained Alice.

"What makes you think you are so special?" retorted the Dormouse.

"This is the stupidest committee I have ever sat on," said Alice.

"Then you haven't sat on many committees," replied the Hatter, and to Alice's relief he added, "Meeting adjourned. On your way out, collect your

'I HAVE PARTICIPATED IN BUILDING THE FUTURE' lapel buttons."

The Cost of Administrative Waste In American Hospitals

"No matter how brilliant the elite group of planners, no matter how great their intuition, and no matter how much data or how many periodic evaluations they can amass, they cannot possibly substitute successfully for the function of the free market. Forcing residents into different subspecialty training programs to ensure their future ability to “obtain meaningful and gainful” employment is doomed to failure. Workforce and trainee planning should be abandoned immediately as an idea that is outdated, unworkable, and out of touch with reality." Jerome C. Arnett Jr, MD, FCCP ¹ and Jane M. Orient MD, FACP

http://infomotions.com/etexts/gutenberg/dirs/1/8/9/4/18948/18948.htm

"Hospitals ...........spend and waste money profligately.

Hospital boards are supposed to provide oversight, but in reality the members are either well meaning but naive community leaders, or doctors whom the hospital can play like a violin because it tosses them some special perks...paid directorships, etc. There is little if any real oversight, and anyone who believes the 990's provide an accurate accounting of hospital revenue and spending is naive. There is some value in the 990...but only if you sit down and read several consecutive 990's from a single institution and start looking for patterns.

The real name for all these euphemistic slogans is...corporate medical practice. The hospitals deploy the line that they provide all this charity care and who will provide it if they are gone. If you actually look at the so called charity care, you will discover that what they claim is not the actual cost of providing the care, but is the retail, marked up chargemaster price...meaning, if it actually costs $20 to take a chest XRay they will claim $100 or more dollars. Sort of like marking up the value of underwear donated to goodwill for the tax deduction.

Also, the dirty secret is, with few exceptions, there is not so much genuine charity care these days. Pretty much anyone has access to something...generally medicaid...and the hospitals pay from the government is figured on a formula for each hospital which makes allowances for non payment........ . the hospitals never mention the care doctors provide in hospital and out of hospital to these same people, but we don't get any credit or tax deduction.

The observation hospitals are also reimbursed more is correct. In my state, BC/BS pays 94% of Billed hospital charges! Doctors take a 45% hit on our fee schedule from BC/BS relative to other private payers with less market share. However, who is called greedy.....?Hospitals are biggest threat ...The government is creating Accountable Care Organizations...which will pay the hospital the money for the care doctors provide, and then doctors will be paid by the hospital. This is about as bad a model as one could construct, yet the AMA seems to be pushing it.................It will take public comment and education but that is long term. Short term, the state boards of medicine should start looking at the implications of having hospitals employ all doctors, or having doctor's economic livelihoods dependent on hospital administrators who...hate us................virtually no talk of the conflict of interest inherent in employed physicians and hospitals. Sham peer review has already been used to get rid of doctors who express concerns about patient care, and since the doctors who will be judging those who speak out, or dare to economically complete with a hospital and have sham charges brought before the employed doctors...whose paycheck is being signed by the hospital CEO...what chance are you going to have?"

"No matter how brilliant the elite group of planners, no matter how great their intuition, and no matter how much data or how many periodic evaluations they can amass, they cannot possibly substitute successfully for the function of the free market. Forcing residents into different subspecialty training programs to ensure their future ability to “obtain meaningful and gainful” employment is doomed to failure. Workforce and trainee planning should be abandoned immediately as an idea that is outdated, unworkable, and out of touch with reality." Jerome C. Arnett Jr, MD, FCCP ¹ and Jane M. Orient MD, FACP

Physician Workforce and Trainee Planning: Click here.

The death of strategic planning

Special Article: Costs of Health Care Administration in the United States and Canada. Click here.

Costs of Health Care Administration In The United States. Click here.

Is there anything accountable about the Accountable Care Organization, unless it includes numbers in its plans? Please click here.

Please click pictures.

We all pay for this waste.

Please click pictures.

Costs of Health Care Administration

Alice and The Mad Steering Committee

Alice came within sight of the administration building. She knew it was the right building because it was festooned with slogans, and over the door there was a large sign proclaiming:

"Great Things Are Happening Here," and
"MISSION PLANNING AND FORWARD-LOOKING LEADERSHIP" .

She entered the building and wondered where to turn. Various people were milling around looking busy, though it was hard to tell to what purpose. She timidly approached what looked like a receptionist's window, but there was nobody there. She turned to a man who was swinging a broom across the floor--at least he looked as if he worked there. "Excuse me," she said, "would you tell me, please, which way I ought to go from here?"

"That depends a good deal on where you want to get to," said the man.
"I was invited to attend a committee meeting," said Alice.
"Everybody does," said the man. "Whichever door you enter, you'll find a committee in progress. It's all crazy. You must be crazy to want to join. We are all crazy." Having said that, he returned to his back-and-forth sweeping.

Alice picked the corridor on the left. In the middle of it there was a set of important-looking double doors. There was a large conference table in the middle with chairs all around it. The March Hare and the Mad Hatter sat at the table, shuffling papers. A Dormouse was sitting between them, fast asleep. All the other chairs were empty. "Come in! come in!" they said. "You must be the consultant. You are late. Bring in a chair from the next room and sit down."

"But," said Alice, "there are plenty of unoccupied chairs," and she sat down. "Oh," said the March Hare, "someone from this committee must be absent. Do you vote for or against? "

"For or against what?" asked Alice.

"How should I know?" said the Hatter. "And what difference does it make, anyway?"

"It should make a difference," said Alice. "One should always learn what the question is, before giving an answer."

"That would be a breach of confidentiality," said the March Hare. "Mind your own business!"

"Then you should not have asked for my opinion," said Alice. "You are not very civil."

"You mean, if you knew the question, you could find out the answer?" said the March Hare.

"That is exactly what I mean," said Alice.

"Then you should say what you mean," the March Hare went on. "I usually do," said Alice.

"Don't!" said the Hatter. "Opinions undermine the team spirit. Next thing, you will start thinking."

"I think, therefore I am," quipped Alice, who was very proud that she knew who Descartes was, and she added, "I am, therefore I think."

"I am, therefore I sleep," muttered the Dormouse. The Hatter lifted a paper from the pile before him and said, "What day of the month is it?"

Alice looked at her watch and said, "The Fourth." The Hatter looked at his sheet of paper, shook his head, and said, "Two days wrong. I told you that getting the agenda from the horoscope column would not work. We have been at this for three days now."

The Hare became indignant. "It was a most popular column," he replied.

"Yes," said the Hatter, "but the planets must have misaligned," and he dipped the agenda in his coffee cup, adding, "What's the difference? We sit in committees forever anyway." Then he sharply elbowed the Dormouse.

"Our mission is to do good," declared the startled Dormouse.

"Good! Where, to whom?" asked Alice.

"Let's have a new Table of Organization," said the March Hare. "That always makes us look productive."

"I want a new title," said the Hatter. "Everybody move one place clockwise," and he moved to the seat next to him. They all moved to the seat to their left. Alice found herself behind a tag that declared her DIRECTOR OF COORDINATED ORGANIZATIONAL FACILITATION. The notepad in front of her was covered with donut crumbs, coffee stains, and doodles. Some of the doodles seemed like illegible writing, or perhaps it was illegible writing that looked like doodles. "But I don't know what DIRECTOR OF COORDINATED ORGANIZATIONAL FACILITATION means," complained Alice.

"What makes you think you are so special?" retorted the Dormouse.

"This is the stupidest committee I have ever sat on," said Alice.

"Then you haven't sat on many committees," replied the Hatter, and to Alice's relief he added, "Meeting adjourned. On your way out, collect your

'I HAVE PARTICIPATED IN BUILDING THE FUTURE' lapel buttons."