Nurses Take Back Health Care One Employer at a Time

By Jeanne Moore

Health care has changed dramatically since my days of wearing whites. For the past twenty years, the quality of care in the United States has steadily declined, while the costs have astronomically risen. Health care is, in fact, making us sick, and those paying the lion’s share for the highly dysfunctional system are American employees.&nb

• Language: English
• Publisher: Connections Healthcare Cost Containment
• Release date: Jun 15, 2019
• ISBN: 9781733196123

Book preview

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What They Are Saying

"There are (quite literally) only a handful of people in this country who have the unique capability to marry together the clinical AND financial components necessary to start solving the crisis in America’s healthcare system today. Jeanne Moore, RN, BSN, MBA is one of those people. When you add in her passion, her program development skills, her knowledge of the health insurance industry, and her dogged determination, you’ve got a combination that can’t be beat. In this beautiful book, you see the heart and soul of not only Jeanne, but of thousands of nurses across this country who are tired, frustrated, and even confused.

I doubt there is a single nurse in the field today who wouldn’t tell you a thousand similar stories, and not a single one who wouldn’t say, We have to be able to do something. Some of those nurses are joining the revolution by joining companies like Jeanne’s, and like mine. If you too are one of those nurses, know that by simply passing copies of this book on to those you encounter who have employer-sponsored health plans/health benefits/health insurance and asking them to give a copy to the owner of their company or the CFO of their company, they too can make a difference and begin fixing this problem we call health care…one employer at a time."

Deborah Ault,

RN, CCM,CCP, AATMC, BCPA, MBA, President, Ault International Medical Management

"Dear Jeanne,

I just finished your book! It was an enjoyable and educational read! I understand the healthcare system so much better now after reading through your book. Thank you very much for sharing it with me. American employees everywhere should read this book and have long talks with their leadership!"

Taylor Helmick,

American Employee

"Arnold S. Relman MD, former editor of The New England Journal of Medicine, coined the term medical industrial complex. It refers to the expansive network of companies and providers that supply medical services, drugs, products, insurance models and wellness programs for huge profits; representing almost 20% of domestic GDP. It also includes a virtual cottage industry that consumes another 10-15% of costs without improving quality. Unfortunately, as unsung heroes of American medicine, nurses are often left out of any discussion to re-engineer and reform these egregious participants; until now!

Enter, Nurses Take Back Health Care [One Employer at a Time]. This eleven-chapter text uses riveting first person narratives, case examples and protean points-of-view, to explain how the avaricious complex might ultimately be tamed. It replaces academic sterility, in favor of personal humanity, as the entire brobdingnagian ecosystem is exposed."

Most insightfully, and weaved throughout the book, is the ubiquitous need to bend the profit curve rather than the infinitely expanding cost curve. This concept alone will be an epiphany to most readers; but not the biased cognoscenti that continues to feed the beast-of-profits over patient centricity. Simply put, my recommendation is to read Nurses Take Back Health Care, become an informed employer or employee, and reap.

Dr. David Edward Marcinko ,

MBA CEO, Institute of Medical Business Advisors, Inc

"My world changed when I met Jeanne and her infectious passion around fixing healthcare for the American Consumer! In Nurses Take Back Health Care, you will see her passion firsthand around how to fix a broken system and how consumers can take control of their care. If you are a benefits consultant and are interested in doing what’s right for your clients, Jeanne will show you the way. Work with her. Listen to her. Trust her! Your world will change for the better."

Jim McCauley,

SVP Broker - Phoenix

Jeanne does a great job exposing the challenges faced by every stakeholder in the American healthcare system - patients, employers, healthcare providers, and taxpayers (who dutifully fund Medicare and Medicaid). Patients suffer while administrators focus on growing endowments, cutting unnecessary expenses, and improving their own compensation. The actual givers of care are stretched far too thin and Americans pay top dollar prices for sub-standard care, whether it’s the patient or the primary payer of the healthcare bill... the employer. Jeanne points out, through real-life stories just how easy (and cost effective) it could and should be, to deliver high quality care to everyone.

Kevin Schlotman,

Chief Operating Officer, Flume Health,

Chairman of the Board, Society of Professional

Benefit Administrators (2018-2019)

"Nurses are truly the keepers of the keys to patient safety, comfort, and protection. Writes Ms. Moore, ‘The American healthcare system produces substandard outcomes and is the most expensive in the world...It is perverse to witness the system created to care for us ultimately causing injury - emotionally, physically, spiritually, and financially.’ Further, ‘The hidden costs of health care can be attributed to both overutilization and pricing.’

This book is a most readable history of healthcare in America, how we got where we are and how to fix it. This is a great book written by someone who has seen firsthand the consequences of deteriorating health care in the US."

Tom Emerick,

CEO of Edison Healthcare, co-author of Cracking Health Costs and An Illustrated Guide to Personal Health.

If you or a loved one has ever experienced a significant medical issue, then you know how daunting it is to navigate the US Healthcare System. Whether you are an employer wrestling with the cost of providing your employees with meaningful health care coverage, or you are a participant in an employer-based medical plan trying to understand the system and absorb the out-of-pocket expense of accessing quality care, Jeanne Moore RN, BSN, MBA is a source of great insight.

Nurses Take Back Health Care, One Employer at a Time"provides a unique perspective from someone who has spent her career literally working the front lines of both the clinical and financing sides of health care. Ms. Moore’s first-hand account of the dysfunction and inefficiencies witnessed in the delivery of health care exposes how the system is increasingly producing substandard outcomes despite incredible advances in medical technology and treatment.

Further, her experience in the health insurance industry allows her to open the black box of perverted incentives which produce so much waste, fraud, and abuse in the financing of health care. Most importantly, as a Nurse, Ms. Moore identifies a workable model to increase quality, improve outcomes, and manage cost."

Steve Butz,

Executive Vice President, Certus Management Group

Copyright 2019 by Jeanne Moore

All Rights Reserved

Printed in the United States of America

No part of this publication may be reproduced or distributed in any form or by any means without the prior permission of the publisher. Requests for permission should be directed to [e-mail] or mailed to Permissions, 230 S. Dayton Ave. Ames, Iowa 50010.

Neither the publisher nor the author is engaged in giving legal or medical advice. Nurses Take Back Health Care is a concerted effort to teach employees and their employers the truth about healthcare finance. It is not meant to offer medical advice or treatment. Patients should refer to their trusted ARNP or physician for medical diagnosis and treatment advice.

The publisher and author shall have neither liability or responsibility to any person or entity with respect to any loss or damage caused directly or indirectly by the information in this publication.

ISBN: 978-1-7331961-2-3

Connections Healthcare Cost Containment

230 S. Dayton Ave.

Ames, Iowa 50010

Dedication

In loving memory of Bev Geppert RN, MBA - I miss you every day.

— Molly and Haley —

Keep the faith, and in everything you do, may your hearts be filled with joy.

Seems like everybody’s got a price. I wonder how they sleep at night. When the sale comes first, and the truth comes second, just stop for a minute and smile.

— Jessie J

Foreword

As the Quizmeister-in-Chief of Quizzify, I write healthcare trivia questions for a living, so it seems appropriate to start this foreword with one: What is the country’s most trusted profession?

I’ll give you a hint: it’s not workplace wellness vendor. (In case anyone is keeping score at home, workplace wellness actually has the lowest Net Promoter Score ever recorded for an industry, according to WillisTowersWatson.)

The answer? Nursing. When was the last time you saw a nurse involved in a financial scandal? When was the last time a nurse jacked up his or her prices by 1000%? Do contracts for nurses include opaque rebates and volume incentives? Of course not.

And yet until now, no one has ever asked the question: What do nurses think of the healthcare system?

Not much, as it turns out. Over time, nurse/patient ratios have dramatically increased, while the number of hospital administrators, insurance executives, middlemen, and, yes, wellness vendors, has skyrocketed.

Ms. Moore describes what nursing care used to be like…and what it’s like today. Everybody who has ever had any experience (their own or family members) with overnight hospital stays has a story… and many of those stories involve either the harm caused by inadequate staffing, or the heroics performed by a Florence Nightingale who turned around a situation that would have led to a bad outcome. Many such stories populate this book.

Yet despite the lack of nurses in many hospital settings, there is no shortage of white-coated healthcare techs waiting to descend upon healthy populations of employees to pry, poke and prod them because a wellness vendor snookered an employer into thinking this nonsense saves money. The idea that pry, poke and prod programs save money is so far from the truth that I myself offer a $3 million reward to anyone who can show that it breaks even.

And yet these programs are still popular. Ah, well, as Mark Twain said: It is easier to fool people than to convince them they’ve been fooled.

In this book, Jeanne recounts many examples of how we have all been fooled by suppliers who are supposed to be containing our costs and providing better care. In particular, she points out how the insurance companies have been feeding at the ACA trough for 9 years now, taking full advantage of its well-intentioned provision limiting profit margins to 15% or 20% of costs. Which of course, means that the only way to increase profit is to increase costs.

I’d be lying, though, if I said my second-favorite part of the book wasn’t her smackdown of the wellness industry. She started with the fraud that was Safeway (whose CEO eventually tired of wellness and moved on to his next bright shiny object, Theranos), which is credited with launching the ACA’s wellness provision despite not having a wellness program. Next, Jeanne moves point by point through the fallacies, harms, cluelessness and lies which formulate the industry’s business model. Her expertise in health care product development gives her a clear advantage. She knows where the smoke and mirrors lie and goes after them with a vengeance. (She is careful to exempt companies, like US Preventive Medicine and It Starts with Me, which have been validated by the Validation Institute.)

Further, despite the admitted trivial impact of wellness, these vendors nonetheless create massive savings out of whole cloth. How? They have many ways to lie, but the most common way to show savings is to compare active motivated participants to inactive, unmotivated non-participants – even though it’s been proven repeatedly that no matter what you do (including nothing at all, including telling diabetics to eat more carbohydrates), participants will dramatically outperform non-participants simply due to being motivated to begin with.

So when Jeanne talks about nurses taking back healthcare, these are the perps she wants to take it back from – the immensely profitable insurance companies, wellness vendors and other middlemen who are sucking resources out of the healthcare system while actual health outcomes continue to stagnate or deteriorate in the US, even as lifespans in other countries continue to lengthen.

Employers - join the movement. Enlist the services of the RIGHT nurses who have mastered two of the most complex ecosystems in America today: the health care delivery AND the health insurance industries. These are the nurses with both the clinical and financial expertise to get the job done. Employee experience and outcomes should improve because, let’s face it, they can’t get any worse.

Alfred Lewis JD, CEO Quizzify

Mr. Lewis is author of trade bestsellers Why Nobody Believes the Numbers, Cracking Health Costs, and Surviving Workplace Wellness

Contents

Dedication

Foreword

Introduction

Chapter 1: Nursing School

Chapter 2: Quality of Care in the United States

Chapter 3: Bedside Nursing to the Economics of Healthcare

Chapter 4: Healthcare Reimbursement and the U.S. Government

Chapter 5: The Hidden Costs of Health Care

Chapter 6: Healthcare Data

Chapter 7: The Road Less Traveled

Chapter 8: The Insurance Broker

Chapter 9: The Employer

Chapter 10: Benefit Advisors You Can Trust

Chapter 11: Closing Thoughts

About the Author

Acknowledgements

Review Request

Terminology

Introduction

Health care has

changed dramatically since my days of wearing whites. It is perverse to witness the system created to care for us ultimately causing injury - emotionally, physically, spiritually, and financially. For the past twenty years, the quality of care in the United States has steadily declined, while the costs have astronomically risen. Health care is, in fact, making us sick, and those paying the lion’s share for the highly dysfunctional system are American employees.

There are two complex ecosystems for which you