Healthcare in the Age of Pandemics: A Best Practice Guide to Patient Safety and Quality Healthcare

By Wesly Guiteau

The question is, what are the vulnerabilities? It starts with a simple recognition that we need to share our best practices with the rest of the world to help every country, especially the poorer states with the greatest vulnerabilities, create the necessary infrastructure for early detection, prevention, and management of future pandemics.

• Language: English
• Publisher: Balboa Press
• Release date: May 12, 2022
• ISBN: 9781982272821

Wesly Guiteau

We are told that we are lucky to be alive in this era of the greatest civilization humankind has ever known, with limitless potential. We have sent men to the moon and back, we have extrapolated as much knowledge from the cosmos as our machines have allowed us. The Hubble telescope, voyager, new horizon, all men made machines sent into the far and deep space to tell us what is out there. We are capable of building supersonic machines, traveling faster then the speed of sound. Yet, here we are in the deepest most backward economy the world has ever produced. I don’t mean backward in terms of productivity, I mean backward in terms of its lack of logic and reason as demonstrated by the growing income inequality and damages done to our planet.

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Copyright © 2021 Wesly Guiteau.

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The author of this book does not dispense medical advice or prescribe the use of any technique as a form of treatment for physical, emotional, or medical problems without the advice of a physician, either directly or indirectly. The intent of the author is only to offer information of a general nature to help you in your quest for emotional and spiritual well-being. In the event you use any of the information in this book for yourself, which is your constitutional right, the author and the publisher assume no responsibility for your actions.

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Scripture quotations taken from the Holy Bible, New International Version®. NIV®. Copyright © 1973, 1978, 1984 by International Bible Society. Used by permission of Zondervan. All rights reserved. [Biblica]

ISBN: 978-1-9822-7281-4 (sc)

ISBN: 978-1-9822-7282-1 (e)

Balboa Press rev. date: 05/11/2022

CONTENTS

Preface

About the Author

Introduction

IThe Legacy System

IIThe Pursuit of Perfection

IIIFrom Risk Management to Risk Transfer

IVBest in Class Risk Management Processes

VOne Healthy Nation

VIThe Case for Universal Access to Quality Care

VIIGene Editing and the new Bioscience

Sources

To my Father

Bazile Francois Guiteau,

1934 – 2018

For inspiring me

PREFACE

In December 2001, Saint Paul Insurance Company, the largest medical malpractice insurance carrier with over 25% of the market share, announced its decision to withdraw from the market effective immediately. This decision, coupled with the monstrous attacks of 911, would mark the beginning of a hard market, a period of a significant increase in insurance premiums due to limited capacity that would last all through 2006.

The hard market also had created the catalyst for significant changes in how healthcare providers would administer and deliver care to their patients. While many of these institutions were already engaged in proactive risk management to mitigate against the rising cost of insurance, many more needed to embark on this journey.

The conditions that led to St Paul withdrawals were very simple. They had been running at a 178% loss ratio for a few years, and their attempt to raise rates commensurately only slowed the bleeding but did not stop it.

For an insurance carrier to be profitable on any lines of insurance, they need to be running below a 100% loss ratio. By way of example, a loss ratio is a balance between the premium collected from the insurance policy holders and the cost to the insurance carrier. For example, for every dollar an insurance carrier collects, it needs to cover operating costs, including underwriting costs, and put away money to pay future claims from that policy. This means that at a 178% loss ratio, St Paul was simply bleeding cash.

Saint Paul’s decision to stop writing medical malpractice insurance and to non-renew their entire portfolio sent a shock wave to the industry. It forced many healthcare providers to rethink their approach to risk management, and identify and adhere to best practices. It also forced them, especially the larger institutions, to rethink how they buy insurance.

In the ensuing chaos, three things happened that helped to revolutionize the health care industry in many ways:

1. Identification of System-wide inefficiencies and pain threshold

2. Corrective measures leading to significant improvement in the quality of care and overall patient safety.

3. New risk financing approach as part of the solution

My hope in writing this book is to share what I have learned from two decades of working closely with all the protagonists of the system, including providers, payors, vendors and clinicians, and dozens of medical malpractice carriers.

Furthermore, I hope this book becomes a reference guide for hospitals and physicians, especially those serving the poorest counties in America and governments in third world countries. Hopefully, they will find support and guidance in this book to help them navigate the ever-changing risk profile of their industry as they continue to strive towards the goal of higher quality of care for all.

ABOUT THE AUTHOR

I have worked in the healthcare industry for 20 years, including 17 years as a medical malpractice insurance broker and 3 years as a medical malpractice underwriting manager. In my role, I was responsible for insurance procurement for some of the largest health care institutions in the country, from the largest for-profit systems to the smallest community hospital in rural America.

In 2004 I had an opportunity to work in Bermuda, and my expertise blossomed into a wider network of healthcare providers and carriers. By the time I became an underwriter, I had established a solid relationship with dozens of medical malpractice carriers throughout the global marketplace, including US, Bermuda, and London.

The sub-industry supports big pharmaceutical companies, such as clinical research organizations responsible for the research and development and the clinical trials before FDA approval. As a team, we also worked with life science companies, responsible for research and development and for the manufacturing of certain pharmaceutical ingredients, such as API (Active Pharmaceutical Ingredients).

We worked with the managed care insurance companies, which provide health insurance services to millions of Americans. These companies provide health insurance coverage for their members’ health care needs at a discounted rate based on volume. Their coverage is subsidized by patients’ employers, who receive a massive group discount based on the number of employees in a group.

Anyone who has been unfortunate enough to have been out of work for a while and tried to maintain their coverage through COBRA knows how expensive that coverage can be. This is because of the absence of the leverage that exists when buying as part of a larger group.

In my role, I had firsthand knowledge of these companies, working exclusively with their CEOs, CFOs, Chief Medical Directors, Corporate legal compliance officers, and Risk Managers. I had unfettered access to all relevant data required to negotiate these insurance contracts for these health care institutions.

I had firsthand knowledge of their modus operandi, thus enabling me to rate their operation based on national best practices across the industry.

As part of the underwriting process, I analyzed their financial and clinical performances by procedures. I searched for a broader understanding of their commitment to quality and patient safety through the investment and training of their clinical staff. I also knew their funding structure through commercial insurers, Medicare, Medicaid, which provided me with a broader understanding of their risk profile based on the patient population.

As a Broker, I needed this data to help mitigate the impact of the hard market and lower the cost of insurance. As an underwriting manager, I used the data to help rate each system on its own merit, according to its performance.

Evidently, two decades of access to such a treasure trove of information on this highly specialized industry has given me a unique point of view of the U.S healthcare system that I have tried to capture in this book.

INTRODUCTION

The Coronavirus was discovered in Wuhan, China, in December 2019 but did not become a full-blown pandemic until mid-February to early March 2020. I had recently joined an MBA program at Hofstra University and was attending a business class when the news was first announced.

Within a few weeks, I had to evacuate the school, and everything subsequently was shut down. I never returned to class after that as it became very difficult to attend class online.

Over a period of months, I watched the various problems with implementing a proper lockdown at the state as well as at the federal level. There was a delayed announcement from the President, who proceeded to downplay the virus, thereby preventing the roll-out of an effective prevention program.

By April, the hospitals were overcrowded with covid patients, and many of them were running out of ventilators and available beds.

I reach back to the early days of the Affordable Care Act (Obama Care). Over the years that followed the official rollout of the program, many great things came to light about how the law helped not only improve the quality of care at the bedside, but also by expanding access to a large number of previously uninsured patients, 30 million of them by some estimates.

The law faced strong opposition at the outset from various factions of society, including the newly anointed tea party and other factions of the conservative movement.

During the last twelve months of this pandemic, one wonders how different the responses would have been had this law not passed in congress in 2010. How would the system have responded to those 30,000,000 million Americans who were uninsured before the law, not to mention the more than 20,000,000 people who have lost their jobs due to the pandemic?

Moreover, how the law’s various provisions have effectively helped or hindered the clinical response to this pandemic.

This book evaluates the early gains of Obama Care, as well as its setbacks. It identifies a set of policy provisions that perhaps should be reconsidered to improve the law, chief among them is the level of consolidation that ACA has facilitated in the healthcare industry since 2010. At the time of its implementation, these provisions of the law were consistent with both the objective of reducing cost in the long run and its goal to improve both access and the quality of care to patients.

The idea that hospitals and other care providers should be fully responsible for improving patient health makes a lot of sense. This law simply modified their payment method to better align with the care incentive in the form of bundle payments. Care providers would be incentivized to maintain their patient population healthy. The healthier their patient population, the higher the profit, and inversely, if they fail at maintaining their patient population in good health, they bare all the additional costs incurred.

This aspect of the law forced a significant number of healthcare providers with the greater financial wherewithal to acquire other systems as a way to complement their services to be able to provide the full spectrum of care from inpatient to outpatient, laboratory services, home healthcare, primary care, specialty care, dialysis, rehabilitation and even some nursing care for their older population.

Since the law passed congress, there was a record number of mergers and acquisitions from larger institutions and regional networks to gain more and more market share.

This aspect of the law that we believe has had unintended consequences on the way care is being provided to covid patients. The consolidation took place across all levels of care, reducing a great deal of available beds. The consolidation had a greater impact on rural and urban communities, which saw many community hospitals either close their doors or merge with larger institutions to survive.

This book provides a detailed analysis of the state of the healthcare system before and post covid and provides suggestions on how to amend or reverse some of these structural changes. These structural changes may have cost thousands of lives.

Simply put, in the age of a pandemic, it is vitally important that we increase the number of available beds and do so in a way that is geographically dispersed to serve all communities, especially the minority communities, who are reporting significant disparities in access to both tests and vaccines.

A family tragedy, a humbling experience

Thousands of Americans die of cancer each year. There are all types of cancers, and while some can be treated if caught early enough, others are simply incurable.

I am one of the thousands of unfortunate Americans with too