Why your Website is Killing Patient Satisfaction

Hospitals probably have more than one hundred points of contact with each patient.  These points of contact (POCs) begin before the patient is admitted and continue after the patient has been discharged.

The first contact may come by a visit to one of the hospital’s clinics, a 3 A.M. call to a primary care physician, or browsing the hospital’s website.

Yesterday I assessed whether the website of a large hospital group was functional or whether it was just a website window-dressed to look like a customer portal. I assess functionality based on whether I was able to accomplish what I set out to accomplish.

I counted dozens of different phone numbers to call. Along with the list of numbers were links for physician and employee portals, links to the board, a link for donors, wellness, specialties, medical professionals, and dozens more, all on the front page. 

There was even a link, albeit not a portal for patients—a rather important link since the number of visits by patients and prospective patients probably greatly exceeds the combined number of visits by all other visitors to the site.  Unfortunately the patient link was imbedded with six other equally weighted links.

I clicked the patient link and was greeted by two-dozen new links, each displayed as being of equal importance.  There were links for patients to use before coming to the hospital and links for them to use once they were home.  Points of contact with your hospital.  Points of satisfaction or dissatisfaction. 

I clicked some more.  Schedule an appointment.  There are actually two links for scheduling an appointment.  The first link gave me a phone number I could call M-F between 8 and 5:30 P.M.  What number do I call at 6 PM I wondered?  I tried the second link; it took me to the same place. Could I schedule an appointment online or through a mobile device?

What did I learn? There are 168 hours in a week.  Their scheduling service operates for 47.5 hours a week, 28% of the week’s hours. If I dialed that number after hours would I get a recording telling me how important my call was?  If my goal was to schedule an appointment using their website, or to schedule an appointment at any time on any device not only did the hospital not meet my expectation, it did not even offer me an alternative. A dead-end.

If it costs the hospital thirty dollars to schedule an appointment by phone and nothing to schedule an appointment online, why not complete the task correctly, the first time, and for zero cost?

I next looked at what I could do when I was home, more POCs, more chances to be satisfied or dissatisfied. 

Manage my medical records. Using the website I was able to print and mail, two very non-electronic processes, a request to have my records printed and mailed to me.  There was no way to submit my request using their website.  If I did not own a printer or did not have access to a printer my expectation was not met, and was I not offered an alternative.  Some people, a whole lot of people, actually like to complete tasks using a tablet or smart phone. Another dead-end.

Let’s try billing. For Medicaid patients there are two numbers to call for help understanding your bill. That means understanding Medicaid bills is a nontrivial exercise.  That tells me that if I asked the same Medicaid billing question of three different people I might expect to get three different answers.  Why not design the sight so that it provides one right answer to whatever question is asked?  Why not include an online chat feature? Why not create a link to a YouTube video, produced by the hospital that explains Medicaid billing?

Medicare.  No link to prequalifying, not even a phone number for questions.

How to pay your bill.  Perhaps the most difficult and least desirous task a patient must do. There is no link explaining the various components of the bill, and nowhere on the site is a copy of a sample bill explaining or highlighting the various sections of the bill.

There is also no link to understand how to file a dispute or a claim with a payer.  Maybe it is not possible to do this for every payer, but using the 80:20 rule there must be ways to help the majority of patients understand what they are up against rather than having them face down the evil empires on their own.

Patients come to the hospital’s website with expectations.  Patient satisfaction is repeatedly won or lost at your hospital’s website and on the phones.  POCs.  Having a tool that proposes to help patients with their bills that not only does not help them but that adds to their frustration will crush patient satisfaction.

Hospitals want patients to pay their bills and to pay them on time.  Patients who do not understand their bill will not pay more completely, nor will they pay faster.

The next time you look at your hospital’s website ask yourself how different it would look had someone asked a patient how it should function.

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Patient Experience Management is abi-normal

I remember the first time I entered their home I was taken aback by the clutter.  Wet leaves and small branches were strewn across the floors and furniture. Black, Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.

There came a time however when I simply had to ask, “Why all the buckets? What’s the deal with the leaves?”

“We try hard to keep the place neat,” she replied.

“Where does it all come from?” I asked.

“The open windows, the stuff blows right in.”

I looked at her somewhat askance. “I’m not sure I follow,” I replied as I began to feel uneasy.

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.  And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

Trying to assume the role of thought leader I asked, “Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked at me like I had just tossed her cat in a blender.

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives.  Sort of like Patient Experience Management (PEM). The normal has been subsumed by the abnormal, and in doing so is slowing devouring the resources of the hospital.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid daily. When I talk to people about a statistic that indicates that 500 people called yesterday about their bill, and everyone looks calm and collected, it makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

If I ask about the high call volume they always have an answer, the same answer.  “Billing calls are usually around 500 a day.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid. It’s gotten to the point where no matter how bad things get, as long as they are consistently bad, there not bad at all.

This is the mindset that enables the PEM manager (I know you don’t have one—I am being facetious) to be fooled by his or her own metrics. When is someone going to understand that repeatedly having thousands of people calling to tell your organization you have a problem, means you have a problem?

It would probably take less than a week to pop something on your web site, and post a YouTube video explaining how to read the bill.  Next week, do the same thing and help patients understand how to file claims and disputes—granted, you may need more than a week for this one.

Healthcare Social Media: How to put it to work for you

A cold wind is blowing in from the north, blowing so hard that at times that the rain seems to be falling sideways, echoing off the windowpanes like handfuls of pea gravel. The leaves from the walnut trees, that had prematurely yellowed, dance a minuet as they slowly make their way to the ground in the woods. It feels like the first day of fall, a day for jeans, a long sleeve shirt, and a pair of long woolen socks. The temperature has nosedived. On a normal day, the first indication of sunrise would have begun to push the darkness from the sky. But today is not a normal day. The clouds are hanging low and gray against the dark sky.

The garage door creaked and moaned as it rose along the aluminum track. Halogen headlights pierced the darkness. Its driver, an unkempt and rather rotund woman in her 40s eased the car down her driveway and proceeded through the still slumbering neighborhood. She was a friendless woman, who along with her husband and daughter kept to herself. The neighborhood children were afraid of her, too frightened to retrieve a ball if it fell into her yard and certainly too scared to Trick-or-Treat at her home.

“Were those your dogs barking? I was asleep,” she screeched at me as she exited the car wearing her oversized pajamas. The site alone was enough to frighten children and a few grown men. “I’m going to find out whose dogs were barking,” she chided. “And when I do, someone will be hearing from me. I took my last neighbors to court because their dog barked. I don’t like children. I don’t like dogs. I don’t like yard work, and I don’t want to be invited to any community activities.” I feel pretty confident she won’t have to worry about being swamped by invitations.

It was actually almost ten in the morning the day she registered her complaint—dawn to some people I guess. Three days later, the letter arrived in the mail. The return address indicated it was from a homeowners association. The letter stated that if we couldn’t control the barking of our dogs that we would be reported to the community board of directors. For second, we didn’t know how to react—then we started to laugh. The reason for the laughter was simple; my wife is on the Board of Directors. It’s like the East German Stasi are alive and well and living in Pennsylvania. I can picture this woman hiding behind her drapes, her little steno pad in hand, recording each and every bark that disrupts her bliss.

She’s a tattletale, a 40-something whose problem solving skills never grew beyond that of a third grader. She lives right next door, 100 feet away. We’ve only seen her three times in the 28 months we’ve lived here. Six months ago she sent us a fax, complaining about something or other. A fax, mind you. To her next door neighbor. This is too easy. It’s social networking run amok. She has become my poster child for bad manners, a benchmark against which all subsequent social networking commentaries will be measured.

There are many good social networking opportunities, especially for large healthcare providers.  Such as?  Do you record the number of patient calls you get each year by call type?  The fully loaded cost of each call is probably somewhere around twenty dollars.  It costs a lot of money each time you answer the phone; do you spend it effectively?

What percentage of those calls are resolved the first time?  What percentage of those calls could be answered  more effectively without the phone? How do you answer a call without a phone?  By having the caller get what they need from some form of social media site.

Imagine that in less than a few months you redesign part of your web site and you develop several YouTube presentations to explain your bills better than any single person could explain it on the phone.  You could provide a similar service for patients who need help contacting their insurance company, and need help filing a claim.  The ROI on social media is significant, and it’s nicer than sending a fax.

Well, that’s it for the moment. I’m off to the store. I think I’m going to buy a third dog.

Dinner’s warm, it’s in the dog–Patient Experience Management

Let’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen.  “Dinner’s warm—it’s in the dog.”  She walked out of the kitchen.  I think that’s one of the best lines I’ve ever heard.

He was one of my mentors. We spent a lot of time consulting on out-of-town engagements. I remember one time I took out my phone to call my wife when he grabbed me by the wrists and explained I shouldn’t do that. We had just finished working a 10 or 12 hour day of consulting and had stopped by a bar to grab a steak and beer. I remember there was loud music playing. When I inquired as to why I shouldn’t call he explained.

“When your wife is chasing three children around the house and trying to prepare dinner, she doesn’t want to hear music and laughter and clinking beer glasses. She needs to know that you are having as bad a night as she is. So call her from outside, and make it sound like tonight’s dinner would be something from a vending machine.”

“But it’s raining,” I whimpered. Indeed it was, but seeing the wisdom in his words I headed out and made my call.

So, back to the dinner and the dog, and the steak and the phone call. In reality, they are both the same thing. It all comes down to Expectations. In healthcare it comes down to patient expectations.

PEM can be a number of things; Patient experience management, Patient equity management, and Patient expectation management. In this instance, we are discussing the latter. A set of expectations existed in both scenarios. One could argue as to whether the expectations were realistic—and one did argue just that—only to learn that neither of our wives considered the realism of their expectations to be a critical success factor. In that respect, the two women about whom I write are a lot like patients, their expectations are set, and they will either be met or missed.

Each time expectations are missed, their expectationbar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next? Patients leave. They leave and go somewhere they know will also fail to meet their expectations. However, they’d rather give their money to someone who may disappoint them than somebody who continued to disappoint them.

Patient Experience as experienced by the patient…

…is not a pretty picture.

At least that is how it seemed to me today during my son’s visit to a specialist at a renowned children’s hospital.  The hospital uses and equally renowned EHR–you can substitute the name of your favorite EHR and the story remains as relevant.

Actual face-time with the doc–30 minutes.  The clinical side of the patient experience was perfect. It could not have been any better–I awarded her bonus points.

Here’s the part I think most hospitals are missing.  There is another part of the Patient Experience which has little or nothing to do with the patient. It is also the part which lingers most in my memory and the one about which I am quick to repeat to others.  What part is that? It is the part that involves all of the non-clinical processes associated with the visit, such as:

  • Complete the forms-could have been done online
  • Provide the insurance information-was done the last two visits
  • Wait
  • Schedule the next appointment
  • Wait
  • Print out the results of this visit
  • Wait
  • Settle the charges
Total time spent on the non-clinical patient experience–30 minutes.
Any time a patient visit requires another family member or guardian to be present, Patient Experience Management by definition becomes Family Experience Management. Instead of poor processes wasting one person’s time, the time of two people are wasted by being inefficient and ineffective.
“How was the visit?” Asked my wife.
“Fine,” I reported. And then I spent two minutes telling her about the bad experience I had dealing with the non-clinical processes, those processes involved with running the business.
So, it was great to know my son is healthy, but we sort of knew that going in. It wasn’t great to be subjected to the inefficiencies and ineffectiveness of their processes and systems.  What will I remember about that experience as I am driving him to his next appointment? Will I remember how well he is doing and how professional the doctor is?  Or, will I remember to plan for an additional thirty minutes to allow the staff to perform all of the automated business processes to check us in and out?
The purpose of this post is to get us thinking that Patient Experience Management and Family Experience Management has to do with everything that happens from the time the person enters the facility until they leave it. If the only good part of the experience occurs during the examination, then the overall patient experience as experienced by the patient can be no better than mediocre.

The Spandex Insecurity—the Ego has Landed

Now before you get all upset about the sexist picture, at least read a little bit of this to see why I selected it. Yesterday morning, five miles into my run, I was feeling pretty good about myself. I had passed seven runners, had a nice comfortable rhythm, no insurmountable aches, and Crosby Stills & Nash banging away on my MP3. I don’t like being passed—never have. Some people say I’m competitive. They say other things too, but this is a family show.

I’m a mile away from my car when I see a slight blurring movement out of the corner of my left eye. A second later I am passed by a young woman wearing a blue and yellow, midriff revealing spandex contraption. Her abs are tight enough that I could have bounced a quarter off of them. She is pushing twins in an ergonomic stroller that looked like it was designed by the same people who designed the Big Wheel. I stared at her long enough to notice that not only was she not sweating, she didn’t even appear winded. She returned my glance with a smile that seemed to suggest that someone my age should consider doing something less strenuous—like chess. Game, set, match.

Having recovered nicely from yesterday’s ego deflation, today at the gym I decide to work out on the Stairmaster, the one built like a step escalator. I place my book on the reading stand, slip on my readers—so much for the Lasik surgery, and start to climb.

Five minutes into my climb, a spandex clad woman chipper enough to be the Stepford twin of the girl I encountered on my run mounts the adjoining Stairmaster. We exchange pleasantries, she asks what I’m reading, and we return to our respective workouts. The first thing I do is to toss my readers into my running bag. I steal a glance at the settings on her machine and am encouraged that my METS reading is higher than hers, even though I have no idea whether that is good or bad.

Fifteen minutes, twenty minutes. I am thirsty, and water is dripping off me like I had just showered with one of Kohler’s full body shower fixtures. I want to take a drink and I want to towel off, but I will not be the first to show weakness. Sooner or later she will need a drink. I can hold out, I tell myself. Twenty-five minutes—she breaks. I wait another two minutes before drinking, just to show her I really didn’t need it.
She eyeballs me. Game on. She cranks up her steps per minute to equal mine. Our steps are in synch. I remove my hands from the support bars as a sign that I don’t need the support. Without turning my head, I can see that she’s noticed. She makes a call from her cell to demonstrate that she has the stamina to exercise and talk.

When she hangs up I ask her how long she usually does this machine—we are approaching forty minutes and I am losing feeling in my legs. She casually replies that she does it until she’s tires, indicating she’s got a lot left in her. I tell her I lifted for an hour before I started; she gives me a look to suggest she’s not buying that. I add another ten steps a minute to my pace. She matches me step for step.

Fifty minutes. I’m done toying with her. I tell Spandex I’m not stopping until she does. She simply smiles. Her phone rings and she pauses her machine—be still my heart—and talks for a few minutes. I secretly scale down my pace, placing my towel over the readout hoping she won’t notice. She steps down from the machine. My muscles are screaming for me to quit, but I don’t until I see that she’s left the gym.

Victory at any cost. What’s the point? For what was lost, for what was gained (McKendree Spring). Men and women. Customers and companies. Most parties will deny they are competing, yet neither will yield. The customer is always right–Turns out it makes a better bumper sticker than it does a business philosophy. Nobody’s business policies reflect that attitude. If anything, were you to listen to what CSRs are instructed to do for the callers and compare that with what they are instructed not to do for the callers, it’s clear that their mandate is to minimize the negative impact to the firm, without regard to the negative impact to the customer. Remember the last time you tried to dispute an insurance claim?

Patient Experience Management: For Adults Only

This post is the first in a series that may make you rethink everything you think you know about Patient Experience Management.

Last week I checked in to a hotel for three days; seventy-two hours.  I was at the hotel for an event that required ninety minutes; one-and-half hours.

A few weeks prior to my stay someone told me where I had to be, how long I would be there, and what I would be doing.  My reservation was made, and I sorted out how I would get to the hotel.

The check-in process was flawless.  My room was ready.  My wakeup calls were timely. The room was serviced daily.  Plates with food arrived.  Plates without food departed.  The requirements for my ninety minute event were met and I was escorted to the correct room.

On hour seventy-two I checked out of the hotel and I received a copy of my bill.  The last thing I encountered was having someone asking me how my experience was.

Try thinking the remainder of this discussion through with me.

Of the seventy-two hours I was at the hotel only two percent of it (1.5 hours) had to do with my reason for being at the hotel—the presentation I was giving at the HFMA.

So, you may ask, how did it go?  The speech or the stay at the hotel.  Two different experiences.  Let us say that my speech tanked, or that people couldn’t find the room, or that the projector did not work.  If someone asked me, how “was your speech,” I might conclude by saying, “The speech was awful, but the hotel was great.”

On the other hand, what if the hotel lost my prepaid reservation, was only able to give me one night instead of two, made me sit in the lobby for two hours because my room wasn’t ready, could not get the air conditioning working in my room, and then billed me for two nights instead of one.

If that was the case I would conclude that my experience was awful, and I would go out of my way to let everyone know about it.

To those who want to argue that a hospital is not a hotel I will concede the point.  However, I will argue that for those who actually wish to significantly improve patient experience management that much of the improvement can be made by treating it as a hotel, and by treating your patients as guests.

For the time being, let us agree to have this discussion separate and apart from the Emergency department—we will address the ED in a later post.

The patient experience, which many claim to be managing, may be grouped into two parts—the treatment, and then everything else that happens to you from the time you schedule your visit to the time when you finish paying you bill.

Most patients fully expect their experience of their treatment will be very positive—that is why they came to the hospital.  Patients know that for treatable issues they will leave the hospital better than when they entered.  Therefore, it is a given that they will rate their treatment experience as a positive one.  A positive treatment is considered de rigueur.

However positive, the patient often views their treatment experience as the result of the procedure they underwent.  If they came in for their gall bladder and leave without their left leg, no amount of explaining how well the amputation went will convince them their experience was positive.

Both inpatients and outpatients spend the bulk of their time in the hospital undergoing non-patient experiences and suffering through ineffective and impersonal processes.  All patients spend most of their time simply as visitors, as customers, as guests of your facility.  Unfortunately, few hospitals spend much time improving those processes that are common to all patients.

To improve in the area of patient experience management, break the person’s experience into two categories; clinical and non-clinical.  While there is merit in reengineering the processes around a hip transplant, doing so does nothing for everyone who did not have a hip transplant.

Over the next several posts I will suggest what can be done to improve the non-clinical patient experience in a way that can change how people view your hospital.

What my daughter taught me about healthcare IT

The other night as I’m sitting on a hard bleacher watching my seven-year-olds baseball practice I noticed the mom sitting next to me looking a little forlorn. Being naturally inquisitive, I asked if everything was okay.

“I lost his glove,” she replied.

Noticing a glove on her son’s hand, she saw my look of confusion. “Not his. My husband’s. I had it with me last Thursday, and I left it here.”

“I don’t suppose this was a new glove. Judging by the look on your face I’d say this was his favorite glove, and was probably handed down from his father. Autographed by Mantle and Maris in 1961.  Fifty years old, supple, broken in, fold flat as a sheet of paper.”

“Fifty-five years,” she corrected as she lowered her eyes.

“It’s rained the last three days,” I told her, which caused her to grimace even more. Having nothing better to do, I flayed her emotions. “I bet that glove meant the world to him. He probably planned on giving it to your son in a few years. The glove probably reminds him of the big events in his life, every scar, each stain on the leather, points to something important. You know, if it was outside for a few days, the field mice will have chewed on the leather.”

She brushed away a tear, and headed to the lost and found.

“Any luck?” I asked when she returned.  She shook her head in despair. “In some countries, if a wife does something life that, the husband can sever the relationship, literally,” I said as I made a slashing motion with my hand. She made the briefest of smiles. At least she knew I was pulling her lariat. Reeling her in, I continued.

“You’re not thinking of spending the night at home, are you? If you are, you should at least call someone and let them know of your plans. He’ll heal over time,” I told her. “But he won’t forget it. Twenty years from now the two of you will be watching something on TV, and something will remind him of the glove YOU lost.”

Fast forward to last Wednesday night. My daughter and I are getting out of the car so I can coach her and her softball team in the playoff game.

“Is your glove in the trunk?” I asked. This is after I spent several minutes grilling her at home about whether she had everything she needed for her game.

“I hope so,” she said shamelessly as I popped the trunk for her. “You hope so?” I repeated with an edge in my voice.

“It’s not here Daddy,” she said as she searched the trunk.

I left her with her friends and drove home to look for it. Ten minutes. Nothing. For some reason, I looked in the trunk. There it was. Death by 1,000 cuts.

Does it all come down to baseball gloves?  “I hope so.”  What kind of a response is that?

Will these EHR expenditures improve our operations? I hope so.

Can you confirm for me that Patient Experience Management won’t fall any further? I hope so.

Are we ready for the reform changes coming to the business model?  I hope so.

Will we meet Meaningful Use? I hope so.

Do you think we should continue to employ you? I hope so.

Are Customers Running the Asylum?

Below is a response I wrote to a blog on customer experience management. I would love to hear what you think. http://www.ceforprofit.com/2010/08/defining-customer-experience-implications-and-all/comment-page-1/#comment-3111

One thing businesses have been slow to realize is they have lost control of the customer conversation, and as such, at least from the customer’s perspective, have forfeited their right to control the customer experience.

Traditional customer relationship management (CRM) has always been a Push.  A manages B.  Organizations manage customers.  Sort of reminds me of cowboys trying to manage a herd of cattle into the cow-pen for slaughter.  Organizations have only been marginally successful at “managing” their customers.

Customer Experience Management (CEM), CRM’s big brother, is at least a thought in the right direction.  However, most firms still do not “get it.”  The ungotten “it” is that customers have taken over the sandbox and they are not going to give it back.  Customers are now managing vendors, and the vendors have yet to figure that out.

Most firms can print a report titled “My customers” or “Our customers.”  The single most important error with these reports is the use of the pronouns ‘my’ and ‘our’.  Firms no longer own customers.  More accurately, customers now hold the power.  Customers now have “My vendor” reports; vendors they have researched and hand-culled.

If a firm wants to check out how well they are managing the customer experience all they have to do is to Google themselves, or search for themselves on YouTube.  See what people are saying about them.  Not much of it is favorable, but much of it is viral.  Videos, blogs, Tweets, and chat rooms.

Manage that?  Too little too late.  Customers are issuing virtual RFPs.  Whether customers want a large screen television or a hip replacement, they go to the web.  They find out your pricing, how well you service your customers.  They make informed decisions.  Most organizations have a long way to go just to get back into the battle to make it a fair fight.  The first step is for them to learn how they are being managed by their customers and then to learn what to do about it.

Who should be able to answer these business questions?

Now that spring is in full bloom, I’ve been doing a little gardening. My dogs are the anti-gardeners. No sooner do I turn my back after planting something, there they are, happily digging away and ceremoniously digging it up. I don’t know if that’s because they don’t like the particular plant, or just happen to disagree with where I planted it.

Today I discovered the youngest dog uprooted a plant and replaced it with a Reece’s Peanut Butter Cup. Perhaps she wanted to grow a candy tree.

One thing that always confuses me about gardening is this: When I plant a one-gallon shrub, I dig a two-gallon hole. I place the gallon shrub in the two-gallon hole and proceed to fill the remaining one gallon hole with the two gallons of dirt lying next to it. Without fail, there is never enough dirt to fill the hole. Perhaps you can tell me what I am doing wrong.

Here is another area of confusion for me: When you walk or are wheeled into a hospital, neither you nor anyone else knows the answer to anything.

That is astonishing. Nobody can tell you:

* With whom you will interact.
* How long you will stay.
* What will happen to you.
* How it will happen to you.
* When it will happen to you.
* Who will be doing the happening.
* Exactly when it will happen.
* Whether it will need to happen again.
* What it will cost.
* What you will be charged.
* What will be covered.
* How much you will owe.

I am stupefied. How can anyone run a business like this? My daughter knows what her lemonade stand costs per cup. Wendy’s knows the cost of a bag of fries and a large Frosty. Porsche knows the cost of a Cabriolet, the cost of the shift knob, when the wheels will arrive at the factory, when they will be placed on the car, who will build it, who will inspect it, and who will sell it. They can tell you exactly who will touch the car, when they will touch it, and what those people will do to it.

The only thing anyone at a hospital may be able to tell you is whether HBO is billed separately. If I wanted to fly into space with the Russians, I would know the answer to each of those questions. The cost, for example: $50 million.

Why can’t a hospital do this? Because it doesn’t know the answers. It is not because anyone is keeping this information a secret–it’s because they really don’t know. The truly strange thing is that they seem to be okay with not knowing.

Recently, I reconnected with a good friend whom I haven’t seen in years. He is the vice president of finance for a large hospital. He used to be an accountant–a very detailed and precise profession, unless you’re one of the guys who used to do Enron’s books. (The only thing I remember about accounting is that debits are by the window and credits are by the door–if I’m in the wrong room, I’m at a total loss.) This business must drive him nuts!

And so I’ve been wondering; would hospitals be more profitable if:

* They had a P&L by patient?
* They had a P&L per procedure?
* The steps for the same procedure, say a hip replacement, were identical each time?
* They had answers to any of the questions you read above?

Of course they would!

Some areas of healthcare already discovered this tautology–Lasik, endoscopy, the Minute Clinic. Assembly-line medicine. Some people say those words with an expression on their face as though they’d just found a hair in their pasta. The office of my Lasik surgeon looked more impressive than the lobby of my Hyde Park hotel. It may leave a bad taste in the mouth of some, but for others, they are laughing all the way to the bank.