5 rules to kill in 2021

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Healthcare is a changing landscape, and its rate of change has only accelerated in recent years. Whether it is shifting cultural values, utilizing new technology or recognizing better ways of doing things, some longstanding rules eventually need to be changed or removed altogether.

Becker's Hospital Review asked healthcare leaders around the U.S. which rules they'd kill, and below are their answers.

Note: responses have been lightly edited for style and clarity.

Question: What is a rule in your company, or a common rule in the industry, that has outlasted its usefulness? 

Jim Stidham. President, Healthcare Management Associates (Chicago):

I believe the certificate of need process is outdated, expensive, cumbersome and is designed to hinder the growth of the ASC market as well as other alternative health initiatives. Most CON states are slow to react to the changing market. 

An example of this is the shift of cardiac care to the ASC. The American College of Cardiology and the Society for Cardiovascular Angiography and Interventions, along with CMS, have all acknowledged that the ASC is the appropriate facility, given appropriate patient selection. However, states are slow to recognize this expansion, causing excessive unnecessary expenses to the already burdened system.

In my experience, there are a limited number of experienced ASC representatives on the CON boards, and they are often hospital controlled, which [produces] conflicts, manifests as anticompetitiveness and blocks the growth of ASCs.

Robin Meter. Chief administrative officer of St. Charles Healthcare (Bend, Ore.): 

Utilizing relative value units to gauge provider productivity. CMS's value changes in 2021 only accelerated changes that have been long in the making. My business partner and I recently published an article [in the American Association for Physician Leadership's Physician Leadership Journal] on this phenomenon. The RVU still has much to offer, though — in terms of cash yield analysis, expense management and ambulatory staffing — but has reached almost total obsolescence as a valid measure of provider productivity. That being said, the development of [the resource-based relative value scale] in 1985 at Harvard, and subsequent implementation in 1989, was positively brilliant. Who would have believed at the time that it would become the equivalent of the Dewey Decimal System for healthcare?

Thomas Graham, MD. Chief innovation and transformation officer, Kettering Health (Dayton, Ohio):

The broadly defined "rule" of exhaustive due diligence before rendering a decision is outlasting its usefulness. Stated alternatively, "paralysis by analysis" is evaporating and our level of comfort with the rapid prototyping of solutions, piloting alternatives and accepting reasonable risk is mercifully replacing the unproductive drag that can result from too much data, lack of role/responsibility clarity or unrealistically narrow risk tolerance. 

The tradition of "kicking the can" — deferral of issue resolution (or opportunity embrace) — can hamper an enterprise immeasurably in the complex healthcare milieu. Institutional agility is a competency that we seek to manifest. "Smart" does not have to be synonymous with "slow." 

I'm not suggesting that we are any less dedicated to quality, safety or responsible resource allocation. I simply believe that as we emerge from the pandemic, we have an enhanced respect for the decision cycle that is moving our organization to make better decisions faster. 

Q: Looking ahead, what company rules will be antiquated in the next five, 10 years?

Michael Leone. CFO, Liberty (Mo.) Hospital:

[The old] paid-time-off buyback rules. Hospitals have been asking nurses to work extra shifts throughout [the pandemic]. They are not able to use all of their PTO. The old rule was to discount the employee's PTO rate when they sold back unused PTO to the hospital. The new rule is to pay 100 percent so that nurses, and all employees, don't feel penalized for working more shifts and not using their PTO.

Mr. Meter: Any rule or principle that takes geography into account. The combination of current and emerging digital and asynchronous technologies make physical proximity in almost all dimensions in healthcare a diminishing requirement. Not only is clinical care transitioning to the cloud at warp speed, but all levels of administrative and executive support for typical healthcare business and operational functions are no longer bound by physical proximity to the work at hand.

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