Potential new Sparks owner has big ideas

Rick Jackson, a more than 30-year veteran of the healthcare sector who publicly espouses bold and likely controversial views about the future of healthcare, could soon be the CEO of the new CEO for Sparks Health System.

If the pending sale of Sparks to Alpharetta, Ga.-based Jackson Healthcare is completed by June 30, Jackson and his designated CEO of Sparks will have the opportunity to put some of their medical care theories and practices to a real-world test. Sparks will be the first hospital Jackson — through his subsidiary, Jackson Hospital Affiliates — has owned.

While the ability of Jackson and his officers to achieve a financial turnaround of Sparks may be uncertain, his opinions about the future of healthcare are anything but uncertain.

Jackson’s first of his proposed 8 “major components” to fix the U.S. healthcare system is to get rid of insurance companies.

“They need to be replaced with a more efficient system that significantly reduces unnecessary costs, passing those savings on to employers and patients,” Jackson notes in an introduction to his plan. “The new system must return physicians to the practice and control of medicine.”

THE BIG IDEAS
And he’s just getting started. His 8 major components are:

• Eliminate the middleman — the insurance companies
Jackson argues that 24 cents of every healthcare dollar is spent on insurance expenses.
"Before the technology era, the use of insurance companies made sense," says Jackson. "But with advances in computerized transactions and innovative smart card technology, insurance companies have become unnecessary middlemen that merely complicate and increase the cost of healthcare," he adds.

• Healthcare reimbursement system
Instead of carrying an insurance card, Jackson’s system would have users care a Personal Health smart card.
“Each time a patient is treated, they would present their PH Card and it would automatically verify eligibility, authorize pre-certifications and procedures of treatments, compute co-pays (taken out of checking account or charged to credit card) and transfer funds to a provider’s account through ACH (just like Visa/Amex).This system would ensure that the proper party would receive payment immediately with no costly billing or collection staff. All data would be downloaded to the System and accessible by all providers and payers. The total cost of all transactions should be no more than 10 to 25 cents.”

• Central Repository for all medical info
The info would be linked to the PH card, meaning doctors could get a broad look at a patient’s medical history in seconds.

• Healthcare Reimbursement Trust (a risk pool)
Jackson sees this fund as replacing what he considers the unnecessary costs of insurance companies.
“Actuaries would determine ongoing premiums based on desired coverage, with patients/employers permitted to pay more for increased health benefits. Actuary tables would reflect higher costs (out of pocket) for those whose lifestyles make them poor health risks.”

• National physician review panels
Such panels would wrest control of healthcare from insurance companies and place said control with doctors and patients, according to Jackson.
“We need to trust physicians again. … It’s not necessary to have $30,000 a year insurance clerks challenging a physician’s treatment.”

• Reduce malpractice and defensive medicine costs
Such costs are about 10% of today’s healthcare costs, Jackson notes, primarily because doctors order unnecessary tests to cover their legal backsides.
Under Jackson’s HRS Plan, malpractice claims would be reviewed by a regional panel of non biased, independent peers, to determine if negligence occurred and whether the claim should be litigated, thereby eliminating about 95% of all lawsuits.

• Eliminate PPOs and provider networks by creating a National Fee Schedule
Jackson asserts cutting the admin fees of provider networks will cut up to 2% from healthcare costs.
“This fee schedule would have modifications based on the cost of living in each geographical region. Physicians could still differentiate their income by service, efficiency, as well as customer care, and add other services that are self pay, such as plastic surgery, private rooms, anesthesia for colonoscopy, birthing suites, etc.”

INCENTIVES
The big component is providing incentives to doctors and the private sector
Jackson makes several points under this idea:
• "Private industry invested over $ 250 million years ago to develop the MRI, and its payoff has been significant," says Jackson. "But in today’s healthcare environment, MRI’s would be considered ‘exploratory’ by Medicare and other payers, with no assurance that it would qualify for reimbursement, thus making it a worthless purchase.”

• Doctors and surgeons who create a better financial model to cut the costs of medical care would be rewarded.

• The lack of control over their own practice, the hassle of billing and collections, the loss of the doctor/patient relationship and the overwhelming need to practice defensive medicine has taken "the bloom off the rose" for some doctors as they view their careers. according to Jackson.
"Physicians are leaving the medical profession, and if something isn’t done to resolve these problems, we will continue to lose the best and the brightest. And because of supply and demand, logic dictates it can only mean more costly healthcare."