GPHA Clouds

Healthcare – Treating People in a Fee-For-Service World

Great Plains Health Alliance

Clinicians are funny people. In general they are very kind and caring individuals who have spent a good many years training for their professions. By the way, what is and is not a profession is somewhat of a grey area; you might not think everything is a profession, but each job can, and is, treated that way by the person doing it. These are professionals. Whether or not people regard the job as one of the “professions,” is a topic for another blog entry.

Clinicians will talk from time to time about a “good” case. However, the deal is, YOU probably don’t want to be the subject in a “good” case, because this translates to interesting or challenging… where we win or lose. We do our best in every circumstance, and we really do care about winning (life) and losing (death). Even in cases where death is imminent, in our hearts we wish it could be different. We provide care. We care. We are totally on your side.

Honestly, we wish you didn’t have to come see us in the first place. Even while administrators and boards lament for more volume, no one really wants anyone to be sick or injured; it’s just an unavoidable fact of life that they will be. We also know they will have to go somewhere, and we want to be that place, not for the money, but because we strive to have the best services, providers, and care. We want to be able to be there to care for the sick and injured when they have reached a point that they have to go somewhere because we care that everything possible be done for them.

With all this going on, it is easy to see why clinicians are excited about quality. We don’t need a stick to make us care about doing the right thing. We already want to do the right thing because the person we care for is another human being, worthy of care for that simple fact alone; which is why we pursued the profession to begin with. Only in extremely rare and lamentable exceptions, pretty much everyone has someone who cares about them. And even in those cases, many people will tell you that God cares for them. A brother, sister, parent, child, aunt, uncle, husband, wife, or significant other (I wish there was a better term than significant other), people tend to have at least someone who cares for them, and is greatly concerned with their care and its outcome.

The issue is that care givers are paid. They make their living by intervening when someone is sick or hurt. That is another fact of this industry. It is an exchange that is marked by a person with special training who will either be paid for what they do or what they know. If we can’t pay them, they will have to learn and do something else in order to survive in our society. Meanwhile, there is no changing the fact that people will continue to need care; there would just be no one there to provide it. No one really wants to be sick or injured, and the care giver doesn’t want anyone to be that way either, but when an unavoidable situation meets a much-needed profession, we have to figure out how to keep them in balance. That is where our pay-for-service model comes from.

The hospital is a business that is paid for the services it provides, understanding that a big portion of the cost is really a readiness cost, or being prepared for what MAY happen. People are on call, meds are on the shelf, equipment is in place and ready to go, the lights are on 24/7.

It’s a crazy, mixed up system that we have. We don’t want anyone to be sick or injured, but are only paid when we help those who are. We want to be there for them. What a novel concept in health care to perhaps consider caring for well and active people, helping them to stay well and active; and perhaps even being compensated for it.

We will always have the sick and it’s just a fact that people will get hurt. A big portion of the field is beginning to understand that things could be different; in fact they will be different. For now, we live in our fee-for-service world, knowing that things are changing, and we’re just along for the ride. We are looking for ways to make the transition we face safely and efficiently so we can be there to meet your needs when you visit us. We are innovating and trying new techniques, and when you come to us, we hope everyone wins.

Les Lacy is a Regional Vice President for Operations at Great Plains Health Alliance. You can reach Les with any questions at

Posted by admin on June 5, 2014 in GPHA Hospitals, Healthcare Improvement, Our People.


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