Close the Hospital, Fire the Physician: The Case For Harshness in Healthcare

Compassion is upheld as a central virtue in healthcare. But what the $2.8 trillion industry that fatally harms upwards of 440,000 patients per year might need is a good dose of mercilessness — toward itself.
Subpar hospitals will need to close. Bottom-tier physicians (if hospitals even know which ones those are) need to be fired, or their contracts should not be renewed. Patients and their families should stop donating money to hospitals, especially if said money will fund something like an expanded waiting room.  
These were some of the ideas brought up at the Aspen Ideas Festival last week during a panel discussion featuring Toby Cosgrove, MD, CEO of Cleveland Clinic and Jonathan Bush, CEO and co-founder of athenahealth. There is plenty of talk about healthcare becoming more accountable, but Dr. Cosgrove and Mr. Bush explained what that really looks like. (And it has nothing to do with an ACO.)
The first issue? We have too many hospitals. This has been raised by a few different thought leaders (Dr. Zeke Emanuel’s take was especially interesting). Our volume-driven system extends beyond tests and procedures ordered. We’ve come to think that a country with more hospitals is a healthier one, which is faulty logic. Mr. Cosgrove threw out some statistics: The hospital occupancy in the United States right now is 65 percent. There were a million hospital beds 20 years ago. “Now there are 800,000 and we still have too many,” he said.
Mr. Bush agreed, saying the weak links in healthcare need to go on and become something else. It’s easier said than done, of course. It will hurt, and communities will feel the pangs. It’s analogous to America’s sensitive problem with end of life care: Are we keeping something or someone surviving rather than thriving? Is it time to let nature run its course?
Mr. Bush said yes, and he brought up another ruthless idea: Patients and families should stop donating money to hospitals. “I don’t care if they name a pavilion after you,” he said. “You’re a murderer if you donate.”
It’s some provocative language, but I think what he’s saying is this: If a hospital can’t stay open and offer high-quality care by its own merits — if a patient’s donation is somehow involved in the likelihood of such — maybe it deserves to close. Donations may keep subpar, even low-quality hospitals on life support. Patients go to these places for care, but also for medical errors and patient safety issues, which can ultimately kill them. (There’s where the murderer accusation comes in.)
Another harsh reality? “When the nuns or the community hospitals come to Washington to ask for a bailout — because they will, because they will close, because they must — do not let your congressman bail them out,” said Mr. Bush. “It’s going to be very painful for your congressman, because they have tons of jobs and they’re not exactly sure where those people in the hairnets and the smocks are going to go next. And they’re terrified. But they must go somewhere else, because they are hurting their patients, they are shortening their lives, they are dehumanizing and they are making the product too expensive.”