The Physician’s Weekly #PWChat series continued with another insightful discussion on Thursday, Aug. 26, focusing on on why hotels and hospitals shouldn’t necessarily be compared to one another and how global budgets can help avoid the comparison.

It was co-hosted by Joshua Sharfstein, MD, and inspired by his TEDx talk Hospitals, Not Hotels, as well as the newly published report, “An Emerging Approach to Payment Reform: All-Payer Global Budgets for Large Safety-Net Hospital Systems,” from the Commonwealth Fund.

You can view our upcoming schedule, or read our other #PWChat recaps here.

Below are the highlights from the chat. You can read the full transcript here.

Question 1

Q1: What’s the problem in touting/focusing on the unique customer service of the US healthcare system?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

That’s a nice way of putting it. US system costs so much more and delivers, in many ways, much less. cc: @RosenthalHealth #pwchat https://t.co/s5WOM1aS0E

— Joshua Sharfstein (@drJoshS) August 25, 2017

A major reason is that we reward hospitals like hotels, for keeping the beds filled. What if we rewarded hospitals differently? #PWchat https://t.co/TBLbJzEhYJ

— Joshua Sharfstein (@drJoshS) August 25, 2017


Question 2

Q2: Why do so many hospitals resemble hotels?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

Differences between hospitals and hotels: hospitals much much more expensive. And generally not a stay to look forward to. #pwchat

— Joshua Sharfstein (@drJoshS) August 25, 2017

So it makes sense to think about paying hospitals differently from hotels. If hospitals prevent illness –>reward, not punishment. #PWchat https://t.co/YD3dWuN07D

— Joshua Sharfstein (@drJoshS) August 25, 2017


Question 3

Q3: Is paying hospitals based on filled beds good for the country?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

A3. No. Patients in hospital at risk for nosocomial infections, complications. Better to keep out unless absolutely needed. #PWchat

— Linda Girgis, MD (@DrLindaMD) August 25, 2017

Great point. And yet we generally pay hospitals more when more patients are admitted. | Global budgets drop acquired infections. #PWChat https://t.co/l04JifZtYR

— Joshua Sharfstein (@drJoshS) August 25, 2017


Question 4

Q4: Why is life expectancy in the US ranked 31st in the world but for costs we’re ranked #1?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

Just read An American Sickness by @RosenthalHealth — horror story about how much we pay and how little we receive #PWChat https://t.co/Zh3q1q6qUu

— Joshua Sharfstein (@drJoshS) August 25, 2017

A4 Definitely costly but can we truly compare US to other countries w/different climates & other differing factors? #PWchat https://t.co/exKhEG2y2R

— Lisa Davis Budzinski (@lisadbudzinski) August 25, 2017


Question 5

Q5: Should hospitals be encouraged to invest in the health of their communities? What are the benefits?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

Here’s the key: hospitals should have the *incentive* to invest in the health of their communities — not just the encouragement #PWChat https://t.co/fDShpWRPM8

— Joshua Sharfstein (@drJoshS) August 25, 2017

A5. Absolutely! Healthier patients are easier and less costly to treat. #PWchat https://t.co/sm4cVDgdL0

— Linda Girgis, MD (@DrLindaMD) August 25, 2017

Sadly, under fee-for-service, hospitals with healthier and less costly to treat patients may do worse financially. #whoops #PWChat https://t.co/Anaq725N9n

— Joshua Sharfstein (@drJoshS) August 25, 2017


Question 6

Q6: What exactly are global budgets for hospitals? #PWChat #GlobalBudget

— Physician’s Weekly (@physicianswkly) August 25, 2017

A brief summary, from this article: https://t.co/fO0h1sDDH8 pic..com/W4488E9xKO

— Joshua Sharfstein (@drJoshS) August 25, 2017

A6 Link for explanation https://t.co/QzdOVDNWLE #PWchat

— Lisa Davis Budzinski (@lisadbudzinski) August 25, 2017


Question 7

Q7: What are the benefits of a #GlobalBudget for hospitals?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

Among global budget advantages … 1. Incentives aligned for transformation. 2. Improved community health 3. Revenue stability #PWChat https://t.co/sgOCOolR2z

— Joshua Sharfstein (@drJoshS) August 25, 2017

A7 PDF Link for benefits & weakness for #GlobalBudget for hospitals https://t.co/GhJ1GaOi3g #PWchat https://t.co/N6QXbhu6X1

— Lisa Davis Budzinski (@lisadbudzinski) August 25, 2017


Question 8

Q8: And Conversely, what are the disavantages of a #GlobalBudget for hospitals?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

To be successful, a global budgeting system must be administered fairly and with credibility. Cannot reward shirking patients. #PWChat https://t.co/N51k1gB0g6

— Joshua Sharfstein (@drJoshS) August 25, 2017


Question 9

Q9: What’s stranger: a #GlobalBudget for hospitals or paying hospitals more the more they treat/see patients?#PWChat

— Physician’s Weekly (@physicianswkly) August 25, 2017

#PWChat How would you distinguish a #GlobalBudget from a #BlockGrant, @drJoshS? The latter was a reviled part of healthcare reform proposals https://t.co/kasqjJmXBL

— Michael Sinha MD JD (@DrSinhaEsq) August 25, 2017

Thanks for asking. Apples v. oranges. What we said in @commonwealthfund report. #PWChat pic..com/N7h1brMeJb

— Joshua Sharfstein (@drJoshS) August 25, 2017


Question 10

Q10: What real-world experiences are there with global budgets for hospitals?#PWChat #GlobalBudget

— Physician’s Weekly (@physicianswkly) August 25, 2017

Maryland, and potentially coming soon to other states. See https://t.co/JbZ3mYXXTk to hear from a wide range of MD-ers #PWChat https://t.co/BQ3pTg1TM3

— Joshua Sharfstein (@drJoshS) August 25, 2017

Also to note: MD-style global budgets differ from those in other countries, especially in how constructed to reward prevention #PWChat https://t.co/BQ3pTg1TM3

— Joshua Sharfstein (@drJoshS) August 25, 2017


Question 11

Q11: Has the use of global budgets for hospitals taken hold? Are any other states/hospitals jumping on board?#PWChat #GlobalBudget

— Physician’s Weekly (@physicianswkly) August 25, 2017

I would file this one under “Something to Watch.” Thanks for inviting me to participate in the #PWChat tonight! https://t.co/cZOitPyvcW

— Joshua Sharfstein (@drJoshS) August 25, 2017