Wednesday, July 27, 2005

Oakland 911

“Yes, please help me, a pit bull is eating my poodle.”
“Sir, you don’t really think this is a ‘police emergency’ do you?”
“Oh my God! He’s finished my poodle and is attacking the neighbor’s Labrador.”
“Sir, maybe you should call animal control or your neighborhood watch captain.”
“Please, just do something. What’s the animal control number?”
“Sir, this is 911, not 411. Click.”

“Hello, you’ve reached the City of Oakland’s animal control. We are unable to take your call at this time; if you need immediate assistance call the Oakland Police Department’s non-emergency number or you may leave a message after the sound of the beep. Beep. The voice mailbox you are trying to access is currently full. Click.”

“You have reached the Oakland Police Department’s non-emergency number all our operators are currently busy with other calls please stay on the line and your call will be answered in the order received. The current wait time is approximately 3 hours and 20 minutes.”

“Hello, you have reached the Oakland City Council.”
“There’s a marauding pit bull headed to a pre-school.”
“You know, we get so many calls about dogs and let me assure you that the councilperson strongly supports dogs and their owners. Let me suggest that you go to our website where you can see pictures of the councilperson and dogs and you can read about all that this district has done for dogs.”

“No! I need help, someone might get hurt.”
“Oh, I’m sorry we get so many calls about crime, there’s nothing we can do at this time. We did successfully pass Measures B and S and the new funding should be available in 2020.”

“No, my neighborhood is being terrorized by a marauding pit bull.”
“Well, I can advise you to join your neighborhood watch and get organized. If you can bring lots of people to meetings where the councilperson can talk about all they have done for your community, we might be able to help you more.”
“Please I just need one police officer.”
“Sir, this is a nuisance crime, if you give me your name and address I will send you a helpful brochure about policing yourself, home safety tips and 25 reasons to elect Jerry Brown as California Attorney General.”

Wednesday, July 13, 2005

Memo To Cambio Healthcare Solutions

Happy Holidays Homeless Shelter

Joe, “Hey Bob, you got mail from Highland.”
Bob, “Really, I didn’t think they sent mail to homeless shelters must be a bill. Open it for me.”
Joe, “Dude, it’s a bill for $190,000 dollars.”
Bob, “Wow, I hit the jackpot nobody’s ever thought I was worth that much.”
Joe, “You’re going to have to collect a lot of cans to pay that.”

Most healthcare consultants have problems with the fundamental premise of county hospitals, see the medical center’s mission statement says it will provide healthcare to the indigent and the uninsured. So let me introduce an important concept here, listen carefully and take notes fellas. Many of the medical center’s client’s are poor, by that I mean they have no money. Got it? Poor, no money. At the point that you’re sending out itemized bills to prisons, homeless shelters and freeway underpasses you got a problem.

Now that we have introduced the concept of poor, sick and homeless people being unlikely to pay hundreds of thousands of dollars in hospital bills, lets apply these concepts to hospital management. See the medical center has services that assist clients in getting functional enough to work or in getting disability benefits, they’re called rehabilitation services. I know it’s tiresome listening to hospital employees who keep saying you need to help the patients more. Still, the medical center has to get patients well enough to work or get them the disability benefits, it’s the only way to get paid.

The medical center has a whole rehabilitation center so people can get intensive therapy to return to their lives and assistance in getting disability benefits if they are permanently disabled. This keeps people out of the emergency room, gets them back at work or at least gets them some income and medical coverage so the medical center can get paid for the services they provide.

So, when you consultant dudes wrote this year’s budget you looked at rehabilitation services and chop, chop, chop! You looked at the data and correctly concluded that the uninsured get therapy. Then you cut the funding for about a third of the therapists because they mostly serve the poor. The problem is if you want medical center clients to get unpoor enough to pay these huge consultant generated bills you have to get them well enough to work. Denying cheap appropriate care just frustrates patients and drives them back to the emergency room.

I know this is lots of new information and you consultant types probably never met any poor people, but most poor people want to get well. They work hard, expect little and want to be healthy. Cutting the services that patients need to return to work and manage their illnesses and injuries is unlikely to improve the medical center’s overall fiscal health, but I’m sure it looked good in your report!