What went wrong at Bernhoven hospital, the favorite of the insurers?

the latest tech news, global tech news daily, tech news today, startups, usa tech, asia tech, china tech, eu tech, global tech, in-depth electronics reviews, 24h tech news, 24h tech news, top mobile apps, tech news daily, gaming hardware, big tech news, useful technology tips, expert interviews, reporting on the business of technology, venture capital funding, programing language

What went wrong at Bernhoven hospital, the favorite of the insurers?

‘Look at Bernhoven’, hospitals at the negotiating table with insurers have been told time and again in recent years. “There in Uden a lot less can be treated and operated on. They can.”

the latest tech news, global tech news daily, tech news today, startups, usa tech, asia tech, china tech, eu tech, global tech, in-depth electronics reviews, 24h tech news, 24h tech news, top mobile apps, tech news daily, gaming hardware, big tech news, useful technology tips, expert interviews, reporting on the business of technology, venture capital funding, programing language

The advocates of ‘sensible care’ – a movement against the needless treatment of patients – were dealt a blow this week. On Wednesday it was announced that the Bernhoven hospital is in crisis. It must reduce its workforce by 100 to 120 people. In order to make the hospital healthy, there will have to be a €20 million “turnaround” over the next two years – by cutting back and generating more revenue.

Until recently, Bernhoven in North Brabant was the showpiece of health insurers, because the hospital managed to shrink, despite the aging population. What got it into trouble?

Global Tech News Daily

Bernhoven’s idiosyncratic story began when Peter Bennemeer became a hospital chief in 2011, after a career of 27 years in the food industry. Bennemeer was surprised about the differences between the business world and the healthcare world, as he would later describe in the book The procedure. He saw a culture of “congealed mistrust.” Between doctors and the board, and between the hospital and health insurers, with the annual contract negotiations as the lowest point.

In business, Bennemeer was used to thinking from the perspective of account managers who maintain relationships with large customers. CZ and VGZ are responsible for 80 percent of Bernhoven’s turnover. All the more reason to build up a good relationship with them.

Global Tech News Daily

Bennemeer also saw perverse financial incentives in the hospital. “An open secret in the sector is that towards the end of the year, even in hospitals, directors are calling for more turnover – just like in regular companies,” he writes. High turnover gives hospitals a strong negotiating position towards insurers. “Medical specialists are able to produce the necessary turnover – as if it were magic.” Examples abound: “Deliberately not referring patients back to the GP; perform keyhole surgery to see clearly what is going on; reducing the outpatient time from 30 to 20 minutes to allow for larger numbers.”

At the same time, much care can actually be provided just as well (and cheaper) by the general practitioner or other care providers outside the hospital. Bennemeer realized: “what society needs from hospitals is that less care is provided.”

Bennemeer set to work with this insight. He strengthened ties with CZ and VGZ, which concluded very generous five-year contracts with him from 2015 due to the promise of contraction, so that they no longer had to come to the negotiating table every year.

Doctors started having other conversations with the patient. For example, if it was an inguinal hernia, they took the time to explain the pros and cons. As a result, many patients decided against the procedure.

The doctors were employed. Because their income was no longer partly determined by the number of admissions and operations, the incentive to treat too much disappeared. Bennemeer chose a pricey tactic: doctors received the salary they also earned as self-employed.

In a joint study by IQ Healthcare, the CPB and the Dutch Healthcare Authority, it appears in 2020 that turnover in Bernhoven fell by 13 percent in five years, but that patients did not move to other hospitals. In other words: care has evaporated.

Health insurers applaud Uden’s story and screen with the example during contract negotiations with other hospitals. The success is also a source of inspiration for national agreements that hospitals may no longer grow in turnover from 2022. If other hospitals were to follow ‘operation Bernhoven’, Bennemeer writes in his book, that would save at least 3 billion euros annually.

Declare less turnover

But over the years, the hospital slowly headed for financial problems. They have several causes.

First of all, because of the favorable agreements with health insurers, doctors and nurses are less and less concerned with the claims they submit. It was once the custom in Uden, as elsewhere, that the costs charged were added up via the nationally agreed reimbursement system. The more surgery and treatment, or the more severe the diagnosis, the higher the declaration value.

In the hospital, for example, it happened that the medical specialist briefly entered a conversation that was actually being conducted by the nurse. Handshake consultations, it was called indoors. That was part of the game to drive up the fees.

In Bernhoven, doctors and nurses were no longer concerned with the claim value of the treatment they gave, or the diagnosis they made, thanks to the trust and generous reimbursement of insurers.

Thanks to the strategy of sensible care – more prevention and consultation, less treatment – the hospital was able to declare less turnover in the first place, says Hans Feenstra. He was hired as an interim director to get the hospital back on track financially. “Doctors, for example, come to the conclusion that instead of surgery, physical therapy is sufficient. That takes more time in the consultation room and results in fewer interventions, fewer follow-up treatments and therefore less money.”

The Dutch Healthcare Authority and the Healthcare Institute, authoritative bodies in the healthcare world, also see these wrong incentives in healthcare. In 2020, they wrote in a report that the payment system has made healthcare too much of a revenue model.

Foot too big

But not only did the system fail in sensible care, there was also enough going wrong on Bernhoven’s side. According to Feenstra, doctors and nurses have stopped keeping track of exactly what is being done per patient and therefore too little was declared.

Due to the comfortable arrangement with insurers, the hospital also started living too much. Operating costs were high compared to other hospitals. Too much overhead was attracted for a small hospital, for example for (research) projects related to meaningful care.

In addition, a disadvantage of less production is that the fixed costs – such as the expensive new construction by Bernhoven, the secretaries and innovative equipment – ​​do not fall. Those fixed costs are high. The direct, patient-related costs per treatment, such as nutrition, bandages and implants, are relatively low. It turns out that the hospital cannot be left with much less money if less treatment is given.

When the generous contracts with insurers expire, Bernhoven’s financial starting point is not good. Operational management is expensive, the declared production is low.

In October 2021, the then CEO Geert van den Enden will complain in the Zorgvisie trade journal about the attitude of insurers. It was no longer possible to reach a new long-term agreement with VGZ. CZ succeeded in doing so, through an ambitious contract. For example, it has been agreed to reduce the number of doctors in hospital and to have more done by general practitioners.

“But then the corona crisis came in between cycling,” says Van den Enden in the trade journal. That is why more doctors and care providers are needed. Another plan to spend less on medical devices also falls through the cracks as the prices of face masks and protective equipment skyrocket. Van den Enden: “According to the agreements in the multi-year contract, health insurers do collect the agreed reduction in turnover.”

Corona regulation worked poorly

The corona regulation for 2020 that is being agreed nationally to keep hospitals afloat also turns out badly for Bernhoven. This is based on financial support based on production, for which the hospital does not declare much.

In 2021 Bernhoven will eventually lose. How much exactly is not yet known, says interim director Feenstra. With the help of consultancy firm KPMG that Bernhoven has screened, he is now busy putting things in order. The reduction of the workforce by 100 to 120 FTEs is expected to have an impact mainly on the support services.

Bernhoven will remain a fully-fledged hospital, Feenstra says, the emergency departments will remain open, for example. It does, however, want to collaborate intensively with a larger hospital in the area. And from now on, staff must better register for insurers which actions are performed, even if this does not necessarily benefit patients.

The intervention is by no means the end of sensible care, says Feenstra, that remains the starting point for the future.

Peter Bennemeer has been away from the hospital since 2017. He sees the problems from the sidelines “with some disappointment”. He certainly does not want to exonerate Bernhoven, because too many people have been hired. “But we now mainly see that sensible care is not rewarded in the way in which healthcare is financed. I hope that instead of having a good strategy killto correct the system.”

What went wrong at Bernhoven hospital, the favorite of the insurers?
Source link What went wrong at Bernhoven hospital, the favorite of the insurers?

News Related

OTHER NEWS

Philippe Coutinho's agent has already revealed his thoughts on Liverpool transfer return

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Araujo taken in ambulance after sickening clash of heads with Barcelona teammate Gavi

Barcelona defender Ronald Araujo was taken off the pitch in an ambulance during their match against Celta Vigo and rushed to hospital. The Uruguayan was involved in a sickening clash ... Read more »

Aston Villa vs Liverpool: Report and player ratings Sadio Mane gives Reds a Premier League title boost

A much-changed Liverpool side came from behind to win at Villa Park to keep the pressure on league leaders Manchester City Read more »

Liverpool vindicated Jurgen Klopp’s risky rotation policy by doing just enough to beat wasteful Aston Villa

Klopp demoted Mo Salah to the bench and Andy Robertson from the squad but Liverpool had enough to reserve to bounce back from Saturday’s disappointment Read more »

Gary Lineker offers solution to Coleen Rooney and Rebekah Vardy 'Wagatha Christie' case

Gary Lineker has offered a funny solution to the “Wagatha Christie” court case between Coleen Rooney and Rebekah Vardy. Coleen is being sued by Rebekah for libel at the High ... Read more »

FIFA chief Gianni Infantino announces plans to create football game to rival EA Sports

FIFA are planning to create their own football video game after it was announced their three-decade partnership with EA Sports is coming to an end. EA Sports have confirmed FIFA ... Read more »

Fabinho injury: Liverpool midfielder suffers suspected hamstring issue ahead of FA Cup final against Chelsea

The Brazilian pulled up as he sprinted after Philippe Coutinho and had to be replaced by Jordan Henderson at Villa Park Read more »

Man Utd youth coach assesses club's "exciting" kids and his own rise ahead of cup final

Justin Cochrane started his coaching career while a teenage player at QPR when he placed an advert in his local paper for juniors to teach. It didn’t make big news ... Read more »

One year on from football's social media blackout - what's changed?

More than one year on from the social media boycott aimed at tackling discrimination and vile abuse online has anything really changed? You'll remember that at the end of April ... Read more »

European transfer news: Real Madrid up stakes for Kylian Mbappe plus Casemiro exit

Real Madrid have long been linked with Paris Saint-Germain striker Kylian Mbappe and despite speculation the France star is set to sign a new contract with the Ligue 1 giants ... Read more »

Sadio Mane's 'childhood dream' comes to light as Liverpool star linked with summer exit

Sadio Mane 's dream destination has come to light amid links of a summer transfer to Bayern Munich. The Liverpool star is yet to sign a new contract with the ... Read more »

Jadon Sancho's Erling Haaland plea falls on deaf ears as he ignores Man Utd star's wishes

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Edu 'steps up' Arsenal transfer efforts for £17m Scotland star to replace Nuno Tavares

Arsenal have reportedly stepped up their attempts to sign Scotland star Aaron Hickey as a replacement for Nuno Tavares. After laying out the Gunners' transfer plans, technical director Edu is ... Read more »

Newcastle prepare summer transfer cull with as many as 10 stars 'facing axe'

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

5 Man City casualties from Erling Haaland transfer including brand new signing

The sight of Erling Haaland arriving at Manchester City will send tremors of terror throughout the Premier League – and perhaps to his team-mates as well – as the champions ... Read more »

Chelsea ace Antonio Rudiger signs Real Madrid contract with huge release clause

Chelsea defender Antonio Rudiger has now penned a bumper pre-contract agreement with Real Madrid to bring his five-year stint at Stamford Bridge to an end, according to a new report. ... Read more »

Ole Gunnar Solskjaer was spot on about Erling Haaland after revealing thoughts on Man Utd

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Fifth senior Man Utd figure leaves club as chief strategy officer exits in reshuffle

Manchester United have told their employees chief strategy officer Hemen Tseayo is stepping down from his position. A new era began at Old Trafford in February when Richard Arnold became ... Read more »

7 flops who cost more than Erling Haaland after bargain Man City transfer announced

The capture of Erling Haaland has sent pulses racing amongst Manchester City fans as the Premier League prepares to welcome the Norwegian hot-shot. The champions have agreed a £51million deal ... Read more »

Arsenal desperate to prevent Eddie Nketiah exit with six Premier League rivals keen

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Pep Guardiola reacts to uproar over Liverpool comments after Jurgen Klopp response

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Brighton starlet attracting transfer attention days after returning from loan

Highly-rated Brighton goalkeeper Carl Rushworth is back training with the Premier League club after his loan at Walsall ended. Rushworth made 43 appearances for Walsall keeping 11 clean sheets for ... Read more »

Lazio president responds to Man Utd's transfer 'interest' in Sergej Milinkovic-Savic

Lazio president Claudio Lotito insists Sergej Milinkovic-Savic is not for sale amid rumours linking him with both Juventus and Manchester United. The Serbia international, 27, has impressed for Lazio this ... Read more »

Cristiano Ronaldo's seven-year prediction on £30m Arsenal transfer speaks volumes

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Gary Lineker hits out at Patrice Evra for talking "utter nonsense" about Pep Guardiola

Gary Lineker has responded to Patrice Evra's claim that Pep Guardiola doesn't want any leaders at Manchester City due to his management. The former Manchester United defender believes the Spaniard ... Read more »

Stats show Antonio Conte justified in hitting back at Jurgen Klopp's Liverpool 'excuses'

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Borussia Dortmund immediately name Erling Haaland replacement amid failed Man Utd attempt

Borussia Dortmund have already replaced Erling Haaland by snapping up RB Salzburg hotshot Karim Adeyemi – despite Manchester United's late attempt to hijack the deal. Dortmund have been braced for ... Read more »

Patrick Vieira selects best players he played with and against during legendary career

Patrick Vieira has named Zinedine Zidane, Dennis Bergkamp and Thierry Henry as the best three players he played with during his illustrious playing career. Vieira, who is now the manager ... Read more »

Ralf Rangnick's 4 most controversial Man Utd remarks as Rio Ferdinand calls him "distasteful"

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Roy Hodgson responds to angry Watford fan backlash after his "snub" at Crystal Palace

Roy Hodson has apologised to Watford fans for failing to acknowledge them in the dark hour of relegation but insisted: “I didn't snub them deliberately.” As their relegation to the ... Read more »

Jesse Marsch quotes Gandhi, JFK and Mother Teresa in bizarre Leeds survival team talk

It is hardly “we’ll fight them on the beaches” stuff, but Jesse Marsch is using sayings by Gandhi and Mother Teresa to fire up his Leeds players for their relegation ... Read more »

Birmingham could sign ex-Atletico Madrid and Chelsea striker if Maxi Lopez buys club

Former Argentine footballer Maxi Lopez wants to sign free agent Diego Costa if he gets control at Birmingham. Birmingham’s Chinese owners are ready to sell a stake in the club ... Read more »

Jose Mourinho demands "explanation" and "respect" in furious Roma outburst

Jose Mourinho has demanded that Roma receive an “explanation” for decisions that went against them in their bruising 2-0 defeat to Fiorentina on Monday. The Giallorossi, not so fresh from ... Read more »

FA Youth Cup final 2022: Man Utd stars to watch vs Nottingham Forest, from Alejandro Garnacho to Joe Hugill

United take on Nottingham Forest at Old Trafford on Wednesday bidding for a record 11th competition triumph Read more »

Antonio Conte taunts Jurgen Klopp with strong response to Liverpool boss' dig

Antonio Conte has hit back at Jurgen Klopp's analysis of his Tottenham side, insisting that Liverpool were lucky to escape with a point from their weekend meeting at Anfield. Spurs ... Read more »

5 free agents Erik ten Hag could target with Man Utd summer transfer budget in question

jQuery(function(){ if (typeof jwplayer_load == typeof indefined) { var jwplayer_load = 1; jQuery(window).load(function(){ jQuery(".sc_video_shortcode_jwplayer").each(function(){ var _this = $(this); jQuery.get(jQuery(this).attr("url"), function(data, status){ if (typeof data.split("\n") !== typeof undefined) { var src ... Read more »

Man City confirm sensational Erling Haaland transfer to sign Europe's hottest property

Manchester City have announced the stunning capture of Erling Haaland after meeting his release clause at Borussia Dortmund. The Norway international, 21, has arguably been the most sought-after player in ... Read more »

Man Utd 'prepare formal bid' for Portuguese youngster who impressed Bruno Fernandes

Manchester United are reportedly preparing a 'formal proposal' for Sporting Lisbon centre-back Goncalo Inacio. Inacio, who came through Sporting's youth ranks, made his senior breakthrough in the 2020/21 season after ... Read more »

Jack Wilshere in Denmark: How Arsenal hero has fared as he provides vital assist

11 years ago this month, Jack Wilshere was fulfilling media duties for England ahead of the Three Lions Euro 2012 qualifying clash against Switzerland. Not one reporter in the room ... Read more »

Erling Haaland transfer: Man City confirm agreement in principle to sign Borussia Dortmund striker for £64m

City are still finalising terms with Haaland, who passed a medical in Belgium on Monday Read more »