I would prefer not to get into Mr. Orszag's record at his two posts. As the head of O.M.B, his job was decidedly more political and mostly consisted of selling--or spinning---the health care reform efforts by Obama and the Democrats and its putative effects on the long-term fiscal picture of the US economy. He ended up being the first member of Obama's cerebral economic team to leave his job, and he was last seen on the pages of the New York Times arguing for an extension of George Bush's tax rates.
Being a newly minted hospital administrator, I decided to give Mr. Orszag's columns a look this evening. He writes an article entitled "Health Care's Lost Weekend," a cheerful overture to doctors and how they need to about their work schedules and consent to some oversight of their work.
The article mentions New York University's Langone Medical Center as a case study for the first idea.
"First, weekends. It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.
One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization"
I can't really quarrel with the numbers in the study. I would like to see these numbers replicated a few more times in other hospitals, but let's assume they are right.
"And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms"
The first response I have to this article is: how much is the hospital really closed on weekends? After reading this article I had the impression that hospitals would have a big "CLOSED" sign on the front with the doors locked, the lights out, and no one but the weekend security guard on the premises. That was not my impression of hospitals growing up in the home of a neurosurgeon, whose weekend rounds and emergency cases seemed to have no discernible monday-thru-friday regimen.
But why would a $750 billion/yr sit idle on the sidelines on weekends if it could be put to better use 7 days a week? Why have decades worth of hospital CEOs, administrators, and department chiefs not thought of this idea before.
Hospital resources sit idle on weekends because its a cost-effective way of keeping the hospital services flowing. Mr. Orszag does not say how much more it would cost to keep the hospital open on weekends. He makes the incorrect assumption that the marginal cost of hospitals being open on weekend would be zero, or negative. Wouldn't you have to pay for people to work there? Nurses? Scrub nurses? back office staff? electricity? Pathology? Maintenance for instruments?
Or do all those employees work for free on weekends?
Also, Mr. Orszag discusses the reduce health outcomes for patients admitted on weekends, a fact which may be true. But what about having doctors work 6 or seven days a week? Same thing with PAs and nurses?
What effect would keeping the hospitals open on weekends have on the staffs' family lives? Social lives? Morale. Mr. Orszag does not say. Having doctors, residents, and physician assistants on call while spending time at home is a great way to use their leisure time wisely.
My point is not to hand down a harsh verdict on this column. I think his analysis is incomplete, yet the Passing Scene Cafe anxiously awaits a follow-up to this.
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