The Big Healthcare Challenges in FY 19

As the present financial year draws to a close, I am left reflecting on the challenges the private healthcare services organizations in the country face in the coming year. The present year has been a pretty tumultuous one. The regulatory environment threw up several challenges. The NPPA orders on price controls of devices such as stents and joints impacted the profitability of most private healthcare companies adversely. The DPCO’s orders on price controls on key drugs too are also likely to dent the bottom line of private hospitals. The media brouhaha triggered by two cases one at Fortis Hospital Gurgaon and one at Max Hospital, Shalimar Bagh, New Delhi created consumer distrust of an unprecedented nature. The private sector hospitals were called names and their doctors were addressed in the vilest of terms leading to all around despondency. Private hospitals are now limping back from this assault. The government of Delhi also announced a half-baked scheme for its citizens, which allows them access to private hospitals if the government-owned hospitals put them on a wait-list of more than a month. Finally, in the budget, the union government announced the path-breaking ”Ayushman Bharat”, which is supposed to provide a cover of INR 500000 to a million families across the country.

All these are expected to lead to some fresh challenges for the private healthcare providers in the next financial year.

Regaining Patient’s Trust 

If there is one thing, which ranks higher than any financial matrix of revenue, costs, and profits it has to be the effort to regain the patient trust. The reasons for the loss of trust are many, some genuine and some purely trumped-up, however, most private hospitals see the urgent need to regain the customer trust. Significant investments will have to be made to improve transparency, patient communication, and organizational culture, which will lead to patients trusting their hospitals. This too is a difficult task and will involve a lot of senior management time and effort.

Profitability

The government and the media have quite successively sold a narrative to ordinary citizens of the country that the private sector hospitals are profiteering and that they are out to cheat patients by over-prescribing, over-billing or worse. Thus, they have ascribed themselves the role of the guardians of the ordinary citizens against the rapacious, profit-hungry hospitals. The truth is far more prosaic and indeed worrying for the private sector hospitals. Most of them have seen a shrinkage in their profits, which to begin with were meager. The biggest challenge that private sector hospitals face in the coming year is clearly of ensuring reasonable returns for their shareholders. In an environment, driven by complete distrust between patients and the hospitals, with power-hungry politicians seemingly baying for their blood in what might be an election year, most private sector hospitals are staring at a bleak year ahead. The EBITDA margins are likely to contract. The hospitals will have to thus figure out a way of reining in costs, without compromising on patient care, safety, and outcomes. This is obviously easier said than done and will probably consume most of the bandwidth of the top management of the hospitals.

Managing the Changing Regulatory Environment

Healthcare is finally getting some attention from the government, which in itself is not a bad thing at all.  However, the controls being put on pricing and the schemes like the Ayushman Bharat and similar programs are not at all well thought through. The private sector, however, has no choice but to adapt to the changing situation. The National Health Protection Scheme (NHPS), will be rolled out this year. One is hopeful that it will be backed by suitable technology, which allows private hospitals to handle patients covered under NHPS. The hospitals will need to usher in change to be able to accommodate the large number of NHPS beneficiaries, which may flow into private hospitals. These changes may include modifying the bed configurations in the existing hospital, tweaking systems and processes and creating special areas to handle NHPS patients and create low-cost models, which allows the private hospitals to manage the NHPS patients in high volumes. Other regulatory changes in drug price controls, devices pricing controls and guidelines on re-usage will all lead to significant tweaks in hospital processes.

Managing Media and Consumer Activism

Consumer and media activism is here to stay. An unexpected outcome, a perfectly explainable error of judgment and sometimes a perceived lack of attention can trigger a media avalanche. Much as the hospitals may crib about being unfairly targeted, they will have to learn to live and cope with it. However, this does not mean that hospitals will not take a stand or push-back particularly when they are in the clear. They will have to learn to work with a partisan media and try their best to put out their side of the story. Speed will be of the essence and the communication teams of the hospitals will have to be beefed-up. Social Media too will throw up new challenges and the hospitals will have to learn to respond quickly and have a ready base of loyal supporters who will help defend them against motivated tirades.

These are all unique and new challenges. I am sure something good and lasting will emerge from these as well.

The views expressed are personal

 

 

 

 

 

 

 

 

 

 

 

 

The Destruction of Trust – A Media Trial and a Witch-Hunt

The last couple of weeks have been a difficult time for the healthcare services providers in the NCR of Delhi. The media have been busy reporting about how Fortis and Max Healthcare ill-treat their patients and how the only thing they care about is profits. Having worked in both the hospitals, I can only say that this is completely wrong. The media-houses in their zeal to sensationalise and chase TRP’s are doing a great dis-service to these hospitals and the the medical profession in the country. The reporting is biased, short on facts and the conclusions drawn are completely unwarranted even bordering on fantasy.

The stories pertain to two cases, one at Fortis Hospital, Gurgaon where a 7-year-old child died of complications related to Dengue and the hospital is accused of over-charging and being callous. The other pertains to Max Healthcare, which is charged with negligence as one of the twins born at 23 weeks gestation was wrongly declared dead at Max Hospital, Shalimar Bagh, Delhi. The false narrative being spun is that the hospital chains are negligent, money- making machines and do not care for their patients. The outrage is completely manufactured and the stories falsely amplified and one-sided.

To make matters infinitely worse the politicians too have jumped in. They clearly want to be seen as championing the poor masses, who mostly cannot afford the services of these hospitals. The hospitals are being subject to multiple enquiries and the police has been called in to investigate the ‘murders’. The hospitals are being threatened with the cancellation of their licenses. (Strangely, a few months ago when scores of children died at a government owned hospital in Gorakhpur because the hospital ran out of oxygen supplies, no one thought of cancelling the license of that hospital)

Lest, we forget, both these hospital chains are amongst the top 5 private healthcare services providers in India. Between them they run more than 40 hospitals, treating thousands of patients every day. They are amongst the most well equipped hospitals in the country, boasting of the highest levels of technology, processes and systems and have patient outcomes comparable to the best in the world. They employ the finest of clinical talent available in the country and provide them an environment to excel. The hospitals attract thousands of patients from all over the world, who travel from across the globe seeking treatment for the most complex of diseases. Having worked in both the organisations, I can confidently say, that while there are many differences between the two institutions, both are thoroughly committed to the highest standards of patient care.

In-spite of all this, the hospitals are not infallible. No hospital in the world is. They can only aspire to do better, keep improving themselves and always try to do the best they can.We need to ponder, how these centre of clinical excellence have suddenly become pariahs overnight basis two cases, where there have been lapses. Like in any other profession or sphere of human endeavour, errors are inevitable. Tight processes, technology support and intent to weed these errors out is far more important than the errors themselves. On these, I can say without any hesitation that the hospitals compare favourably  with the very best that we have in the country.

The line between genuine errors and negligence is very thin. Doctors, while racing to save lives are required to make split second decisions, which may mean the difference between life and death to their patients. Sometimes not taking a particular decision may prove fatal and at others taking a particular decision may lead to complications. We have to trust our doctors to take the right decisions based on their experience and judgement. We also have to accept the fact that their decisions might turn out to be wrong and that these decisions can have horrendous consequences. This is just the nature of medicine. An adverse outcome doesn’t mean that the surgeon or the hospital messed up. It mostly means that they tried their best and yet didn’t succeed.

This is something very fundamental to healthcare. As patients or care-givers, we must support the doctors as best as we can. We can question, we can ask but let us not blame, at least, not every time something goes wrong. If we believe that there is a case of genuine negligence, as consumers we do have options. We can lodge a complaint with the Indian Medical Council, approach the consumer courts or go to the police. We must use these options judiciously.

Getting back to the baby, who was born at 23 weeks of gestation at Max Hospital, Shalimar Bagh. It has now been established that the decision, not to resuscitate the child was medically correct as he had a very slim chance of survival. The prognosis in case of survival too was also very poor. The decision to declare the child lifeless, without fully ascertaining the fact of death was wrong. Failure to properly communicate this tragedy to the parents too was an error. Was this negligence? Was their any malafide intent of causing harm to the child or undue pain to his parents? In my view this certainly wasn’t the case. I am not an expert in these matters and various eminent clinicians are conducting an enquiry about what happened. My view as a layman is that someone made a mistake, it was a bad mistake to make, hopefully some lessons too would have been learned and this would never be repeated again.

Does this mean that the hospital, the doctors and the administrators be called vultures, cheats and murderers and have rampaging mobs running amok in the hospitals baying for their blood?

The views expressed are personal.