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The Keckley Report

A 55-Hour Reminder

By July 28, 2014March 1st, 2023No Comments

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article. 

The past week, contestable elements of the Affordable Care Act (ACA) were once again in full view as two appeals courts reached conflicting opinions about the validity of subsidies for those who enrolled through the federal exchange earlier this year. At issue: Whether the letter of the law in the ACA stipulating subsidies through “state run” exchanges is to be followed or a broader interpretation of intent is to be accepted. Yet another chapter in the constantly unfolding and confusing saga of health reform in the U.S. system.

I saw this from an unusual perspective this weekend as a “guest” in a hospital for 55 hours: I had total knee replacement Thursday morning in Nashville. In the course of that episode, 39 different caregivers played roles in my care: Six were the nurses assigned by the Joint Replacement Center to coordinate my meds, attend to my needs and answer my questions. Upon departing, I was unclear as to what my episode will cost but confident my care was exceptional and prognosis favorable to the extent one can know.

On reflection, I have three strong impressions from my treatment—

Frontline caregivers don’t understand health reform nor are they well equipped to answer questions about its intent or status. My healthcare providers seemed to find systemic flaws, such as—inappropriate variability in care, unequitable access, lack of transparency and costs as abstracts. Frontline caregivers deal with circumstances in their own daily schedules and while possibly eager to understand the bigger picture rarely have time to study or research on their own. The 14.5 million healthcare workers in the U.S. system are its strength: But they are ill-prepared to deal with issues surrounding its future. As we interacted, solutions to systemic issues were not top of mind for the people who might be expected to know more.

The delivery of care is complicated. I watched intensely as my care team transitioned me from stage to stage. Monitors, needles, and constant queries are standard operating procedure, and it did not stop when I left for home. Our trade is not simply to understand: Our services are capital-intense, labor intense, scientific, and expensive, and how we diagnose and treat for optimal care changes by the day.

The outcome of my knee replacement will be substantially impacted by my attitude and behavior—follow-up with my physical therapists, adherence to my medication regimen, and ongoing communication with my care team. At the end of the day, it’s about the partnership between the care team and patient that makes the most difference.

My 55-hour hospital visit was not suspenseful: It was routine for my care team and hopefully uneventful in their recollection of our time together.

Healthcare employs good people who do important, worthwhile work. I was reminded of that again this weekend and regard it an honor to be among their ranks.


The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

 © 2014 Navigant Consulting, Inc.