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The bitter truth is that Mr. Jacobs is correct. With the increasing bad debt that hospitals are carrying year after year they must resort to this type of business policy.

Payment up front is not a new business strategy though, it has been used in hospitals for some time now. Rising healthcare costs and medical indigence has forced hospitals to pay more attention to business practices, financial status, and competition.

Reimbursement rates are much less than they used to be from insurance companies and the costs of providing services as we all know are significant.

It would be nice to point the smoking gun at a hospital but the fact remains that all healthcare organizations and businesses are attempting to protect their financial stability.

That being said, it would seem that several things need to happen in healthcare to improve our current status. Reimbursement rates, investor interests, some CEO compensation amounts, medical education tuition costs, healthcare manufacturing costs, to name just a few need to be looked at on both a macro and micro level to determine areas for either cost savings or cost avoidance.

Healthcare organizations exist in an imperfect market, solutions are going to be as complex as the problems. Mitigating today's healthcare issues is likely to be nothing short of contentious.

Dear Mike,

You are right on and that is why I feel conversations isolated to the hospital perspective today are a no win.

We need to create megacommunity partnerships and learn how to configure the use of philanthropy and government funds into a system of care that works.

I really appreciate your response. I was hoping this strong statement with evoke some respectful dialogue here rather than more of the same.

My practice is about creating those megacommunity partnerships and writing about the possibility.

The best case scenarios are not known widely enough and real working partnership that are working to join people through the UN are pilots that are now working that are not limited to the United States perspective.

I want to add here, that from a more personal persepctive--- I have been setting up my own health care in UTAH. Yesterday I went to a dermatology clinic that is cosmetically driven for high price clients. I was there because of the credentials of the dermatologist, her training and the fact that I wanted a woman doctor. I am prepared to pay with my cash in hand, not even credit. I have been planning for this for some time to repair a scar from a virus I had in my face a few years ago.

The support person without knowing me lectured me and told me the rules and said rudely this is cash and carry. I almost walked out and did not schedule an appointment. Instead I scheduled the appointment and with respectful manners, I wrote a letter this morning to the dermatologist describing my career and my needs as a patient to have a concise verbal conversation based on intelligent information so I can be in her care for the long term.

I told her that someone telling me if I did not have the money and that the doctors time was her own and she would do what she wanted did not assure me any motivation to spend my hard earned money with her and what I was looking for was quality of care and a client relationship that reflected respect.

We have alot to do right now to reorganize our health care and assure people at home the care they need that is not hospital based.

We are indeed going to a cash and carry mode and more and more I am convinced, I need to find a high deductible hospital policy and use my monthly cash to get that cash and carry care and select physicians and practices that give me the education and care I need.

We can't just keep talking about health care like it is an object that performs. It involves people, technology, science, facilities and management that I hope will become more about leadership rather than micromanaging or a lot of experts touting their beliefs, including me.

Now I will turn and be quiet. I have been trying to get Tony for 3 years now to plan an annual meeting of somekind for a megacommunity that is about people rolling up their sleeves and doing something rather than talking about it or promoting their consulting or hospitals.

A project of this kind not done on the run and fly can make a difference. What you do is gather people and then figure out the resources you need and apply for a grant.

Anyone interested in that can contact me at coregroup@workecology.com.

I have the resources that know how to make this work. It takes people who are willing to move beyond getting outside their box of normal day operation and giving it time to be intelligent and constructive.

Nick thanks for notifying me today how to reach you. Maybe someday we can connect in person or by phone.


I am giving quiet thought to how to link my program to hospitals. I am not sure where this reflection will take me.

Yesterday, I had a woman come to my door that I helped probono because the institution system of hospitals and clinics is not helping her. I have not seen her in 2 months. She is taking control over her life beyond anything I have seen in six months, so this was a great testimony for me to know that my program can work.

We are now organizing her in all treatment and support systems in the community outside the hospital.

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