As our elected officials continue to debate about the financial risk corridors on the national stage, it would be wise to understand the downstream ramifications of their decisions on the real physical corridors in a hospital.— Chandrakanth Are, MBBS, MBA, FRCS, FACS
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It was mid-morning, and I was walking along one of the long corridors in our hospital, attending to clinical duties. From a distance, I noticed this elderly couple walking in the opposite direction. As we got closer, it became obvious that the elderly gentleman appeared winded and was looking around to rest. Fortunately, there was a bench along the corridor, and he managed to sit down with some help before the occurrence of any untoward incidents. After inquiring about their destination, which was quite far from the current spot, it was clear they needed help to get there. We were able to secure ancillary help with which came a wheelchair, and with some goodbyes, he was carted off to his destination.
These days, it is not uncommon to see patients of all ages, shapes, and sizes wandering along the long and labyrinthine corridors of any hospital trying to reach their destination. Some appear lost and utterly bewildered of the maze of corridors they are meandering through. So many of us at work are routinely giving directions to these patients, many armed with a map in hand but still appearing lost, and others frail, tired, and completely exasperated. This does not make up for a particularly pleasant experience, considering the anxiety they are already facing due to their illness.
Were it not for the friendly and helpful hospital staff, one can only imagine the plight of these patients and their families. Similar to airports and shopping malls, hospitals have become so large these days that patients sometime end up walking long stretches to make it to their appointments. Although valet parking is a convenience, it serves little purpose if the sick and their attendants still need to walk far across unfamiliar buildings, which sometimes even confuse employees. Conveniences such as colored floor linings or attendants stationed along the way may be of some help but will still not make the long corridors in any large hospital less confusing or shorter.
Regionalization of Health Care
Buoyed by data supporting the concept of better outcomes with regionalization of health care, we have witnessed the mushrooming of large health-care complexes. In addition to the benefits of regionalization, several other causes are contributing to this trend. By nature of economies of scale and scope, these large health-care systems are expected to provide high-quality care and are supposed to be well cushioned to absorb or reduce the costs of caring for complex patients. The changing federal regulations also nurtured the environment to the growth of these large hospital systems. Although the intentions are good and may also be supported by science, the law of unintended consequences rarely steers far away from good intentions. What giveth in one hand, it taketh away by the other.
It is becoming increasingly clearer now that, although regionalization has many benefits, it is not without its disadvantages. One such disadvantage is the difficulty experienced by patients in navigating through these large hospital complexes. We hear several complaints from numerous patients of the inconvenience and difficulty in visiting major hospital systems. Some of our older patients also express fear of visiting such large hospitals that it almost deters them from keeping their appointments. Gone are the days when you could park in front of your doctor’s building and take a few steps to be inside the office. Many hospitals have morphed into mega-complexes with multimillion-dollar gleaming buildings connected by a complex array of corridors, bridges, and tunnels. Some or many of these mega-hospital buildings look far glitzier and are more expensive than many of the highly rated hotels in town. As the mergers of major hospital systems continue, it is likely the size of hospital complexes will only grow further.
National Debate Over ‘Risk Corridors’
As we discuss how to facilitate the transport of an individual patient along the corridor of an individual hospital, there is much debate on the national stage about another type of corridor. These corridors, named “risk corridors,” were implemented as a part of the Patient Protection and Affordable Care Act (PPACA) in 2010. Multiple discussions were held with the major stakeholders (insurance companies, pharmaceutical industry, etc.) to enable and entice their participation in the PPACA. Many of these entities are for-profit or publicly traded companies, whose primary aim is to deliver value to their investors, who remain their major stakeholders. The major insurance companies were enticed to participate by creation of the new risk corridors to offset any losses for participation in the PPACA.
The risk corridors constitute a public pool, where theoretically funds are contributed by companies that make a profit to offset any losses incurred by other insurance companies. This concept of sharing the benefit of profits and cushioning the burden of losses through these risk corridors was essential to convince insurance companies to participate, as they were asked to increase the pool of insured and not raise premiums or penalize patients for preexisting conditions.
The risk corridors started in 2014, and it soon became clear that they were evolving. The Department of Health and Human Services accrued less than $400 million in the 2014 risk corridor—a small fraction (12.6%) of the $2.9 billion that is owed overall. The debate continues unabated on how to make the reinsurance and risk corridor payments, as major insurers are declaring losses and leaving market segments entirely. It is likely that this debate these about risk corridors will continue well past the November election.
Ramifications on Actual Hospital Corridors
As our elected officials continue to debate about the financial risk corridors on the national stage, it would be wise to understand the downstream ramifications of their decisions on the real physical corridors in a hospital. Although their decisions may or may not help insurance companies or other large stakeholders, they sure have the potential to affect the individual patient who needs to navigate through the increasingly convoluted physical, digital, and virtual corridors of our rapidly evolving health-care system. Decisions made by these same elected officials guided by academic health-policy experts in the past have led us to where we are now in health care. The results of their policy decisions have led to the creation of these mega-hospitals with administrative behemoths, which scare and deter the same people their policies were intended to help.
There is something to be said of simplicity: the simplicity of parking right in front of your doctor’s office, walking a few steps to be inside it, without wandering along a long corridor; not having to fill a rain forest worth of paper work that is confusing even to health-care workers; and not having to deal with more than one person before you can be seen by a physician who is likewise not constrained by time limits or administrative checks.
As we look at the future of health care in America, we are not entirely certain which corridor will dominate the debate. But we surely can be certain which corridor will affect individual patients and the comfort of care they receive. ■