Who Puts The Hell In Healthcare

Who Puts the Hell in Healthcare?

That's a good question, I have been involved in some form or another in health care for over 20 years and I have yet to understand why things happen the way they do.

My most recent and involved experience came when I moved with my then boyfriend, now husband from Pittsburgh to Johnstown in 1993. That in itself was a culture shock! I thought I could find a job quickly and continue my paycheck earning ways. Again, another shock, there were no jobs to be had. I had experience in many aspects of hospital medical record management, physician office management, and billing, and of course I had my retail experience to fall back on. I left Pittsburgh making somewhere around $45K - $60K.

After a little research and a brief stint putting papers in numerical order for eight hours, for minimum wage at a local dairy company, I happened upon a position at Windber Hospital. The initial position I was offered was soon recanted because the former employee decided not to quit after all, but they did offer me the opportunity to interview for the Assistant to the Vice President of Finance position, well, I felt much better and thought okay, pretty good job, what does it pay? And the shocks kept on coming, $6.56 an hour, and they work 75 hour pay periods. Wow, how did people live on that?

I did interview and accept the position, because after speaking with several people, I found out that Healthcare was the largest employer in the area and usually you had to know someone to even be considered for a job. Okay, now I'm making less than $13K a year and the prestigious position of Assistant to the VP of Finance, meant SECRETARY! I have never been a secretary and I'm not one to work well when the boss tries to manage by intimidation. So I tried the best I could and tolerated more than I thought I was capable of and I learned everything I possibly could about our little Windber Hospital.

Windber Hospital and Wheeling Clinic was officially opened on January 15, 1906. The Berwind (get it, Ber wind - Wind ber ) White Coal Company built the hospital to take care of the thousands of miners it employed along with their family members. The town was a company town, it managed everything from a company store to the hospital. The miners rarely had to carry cash, each item purchased from the store was taken from their paycheck and a fee for healthcare was also deducted, fifty cents for a single miner, seventy-five cents for a couple and a whole dollar for the family. Sound like an early form of an HMO.

The more I knew, the more interested I became in how a little, then dingy, hospital could stand up to the competition of the two giants downtown. One of the first things I learned was that the current administration at the hospital was hired to get the hospital out of the red. There had been hiring freezes and wage freezes for more than four years. Employee morale was as low as I'd seen anywhere. The employees were paid 20-30% below national benchmarks. The physicians pretty much ran the show, they also practiced by intimidation. We fondly referred to them as the Good Ole' Boys. If they were not coddled to, they always threatened to take their patients elsewhere. The CEO was a nice little guy that did his job - I knew this because I worked in finance and I prepared the financial statements. He soon decided to move on to bigger and better things and leave Windber.

Enter capitated, or managed care. Probably the most dramatic realignment of the nation's health care system in recent years has been the development of managed care plans. Managed Care is a generic term that has evolved over the past few years to encompass a variety of forms of prepaid and managed fee-for-service health care. It is also often referred to as "Managed Competition." The number of managed health