hospital impact

by Tony Chen

Here's a couple of deliciously controversial items that I saw in the news recently:

- I just read an insightful report from Deloitte on the Medical Home concept. Though the conceptual model is an old one, Deloitte presents a nice case (complete with financial ROI) for the U.S. healthcare system to move in this direction. Basically, PCPs as we know them would change into true care leaders/managers/navigators, coordinating all of our care (everything from IP hospital stays to dental care to coaching/behaviorial modification). And instead of seeing 5-7k patients/year, they'd be responsible for 1-2k. Sounds crazy, I know, but the model does address the impending chronic disease explosion no one has solved yet.

- Nanotech has received a lot of buzz lately for its amazing potential for good and for evil. Read a great article here that looks beyond the hype/controversy and gets at what the potential really is. Not surprisingly, medical applications will be huge - wire-to-nerve interfaces, coatings to reinforce osteoporic bones, and "labs on a pill."

Bottom line: as strange as this sounds, I'm betting nanotech will hit our healthcare system before the medical home concept sees the light of day.

by Tony Chen

At HIMSS today, MSFT announced that it's setting up a $3MM Be Well fund. It'll award approximately 20 proposals (of ~$150k) that "should make use of shared health data and connected home health devices to improve the potential for positive health outcomes for patients."

Of course, this probably doesn't come as a huge surprise. Microsoft is essentially accelerating their ecosystem vision (and of course, HealthVault would be central). But nonetheless, it is a strategic and smart move that brings in talent & expertise that they don't have internally.

From their press release, they are specifically looking for:

Microsoft is soliciting proposals from areas that include, but are not limited to, the following:

* TRACK 1: Primary Prevention Applications

Proposals targeting primary prevention could help people and caregivers create and maintain strategies that prevent or delay onset of disease by reinforcing healthy lifestyle factors and addressing modifiable risk factors such as hypertension and weight.

* TRACK 2: Secondary Prevention Applications

The identification of major modifiable risk factors (such as dyslipidemia, hypertension, smoking, obesity and inactivity) is a prerequisite to the implementation of preventative interventions — known as secondary prevention. Proposals in this category could help people and their caregivers measure things such as blood pressure, lipid profile components (LDL and HDL cholesterol and triglycerides), diet and nutrition, weight, smoking, and activity level to create the optimal plan to prevent or delay morbidity and acute care.

* TRACK 3: Acute Care Applications

Certain conditions require immediate diagnosis and treatment, whether at the doctor’s office or in an urgent care setting. Proposals targeting acute care scenarios might track progress, improve communication and share data between the silos in the healthcare system, providing caregivers with a longitudinal view of a patient’s health history that ultimately may lead to superior outcomes.

* TRACK 4: Juvenile Disease Management Applications

Health conditions in children often require specialized detection, diagnosis and treatment. Parents typically become eager partners in the plan of care, and seek information specifically related to their child’s condition. Proposals focusing on juvenile disease management might provide age-appropriate tools to help children, parents and caregivers understand and manage their conditions.

* TRACK 5: Women’s Health Management Applications

Women’s health issues can be complex and are often influenced by biopsychosocial and environmental factors. Proposals targeting this track might choose to create online tools or services that help manage health within the context of lifestyle and family.

* TRACK 6: Community and Social Health Applications

Patients and caregivers dealing with illness or people interested in wellness are increasingly sharing information and support with each other through various Web-based social applications. Proposals targeting this category might include applications for health in areas such as collaboration, communication and the use of social relationships to improve care.

Alright, all you wired up hospitals and health solutions start-ups, start your engines!

by Nick Jacobs

Renee Cree, a writer for the Temple Times of Temple University, wrote an article entitled “School of Medicine creates new pipeline for future doctors,” in which she explores the “Silver Tsunami.” Inadvertently, this is a topic about which I have obsessed for over twenty years, and a topic that will be wedged sideways in the gullet of our culture as the nearly 80,000,000 Baby Boomers prepare for their transition.

It was the professional futurist, Ken Dychtwald who tapped me on the head with a 2x4 in the late eighties as he began to point out the nuances of aging and what they would eventually do to our country and world. He wasn’t a sooth sayer, but he did project our idiosyncrasies into the upcoming decades.

Ken, the President of an organization called “Age Wave,” pointed out the frailties of our system. “After all,” he said, “when the majority of our buildings were designed, the average age that they embraced was the 30’s because the average person was dead before their late sixties.

When Germany's Chancellor Otto von Bismarck designed a system of social security for industrial laborers late into the 19th century, he knew exactly what he wanted to achieve. Not only could he consolidate the strategic position of his party, but also he could bring those workers under the control of the State. He knew, too, that most of them would be dead before they ever reached Social Security age. We, though, are heading toward economic challenges generated by overspending in our government for decades, and are significantly surpassing the targeted pension years.

All of this was food for thought, but what else was common sense? The chairs in our waiting rooms were too deep and difficult for the elderly to get in or out of. The lighting was that horrible fluorescent style that pulsated and virtually blinded cataract challenged visitors. The steps were designed to accommodate someone without arthritis. Finally, the life style to which the typical Baby Boomer had become acclimated was more sophisticated than that of their parents.

We weren’t depression babies. We weren’t used to reusing our tea bags, and, heaven knows, we had no interest in being Plutoed*. ((Plutoed, according to BuzzWhack.com means to be unceremoniously dumped or relegated to a lower position without an adequate reason or explanation.)

So, here we are with not enough doctors, nurses or hospital beds to go around. Oh, and lest we forget, there’s not enough money either as our deficit grows into the trillions and our ability to generate our own income will soon begin to reduce exponentially.

Well, the Temple Times says that Temple University is about to introduce pathways for new doctors. The School of Medicine will be providing programs to address either those undergraduates who didn’t take the appropriate courses to get into Medical School, or will be providing programs for those individuals who did take the right courses but are not sure of their ability to pass the Medical College Admission Test, MCAT. These students are classified as either “career changers” or “career enhancers.”

Having done physician recruitment for over twenty years, there is no doubt in my mind that these steps should be taken. On the other hand, it sounds like a Band-Aid solution.” The word Tsunami is absolutely the correct word. This fix is clearly like sending a gallon of water to the hundreds of thousands of victims to share.

Our medical schools are currently unprepared to deal with the shortage of physicians, techs and nurses that we are already facing on a daily basis. Not only are the schools not responding, government seems to be doing all that they can to discourage physicians to come to or stay in Pennsylvania.

Maybe it will all go back to the wisdom of indigenous man. We will have midwives and medicine men that we can pay with chickens and crops.

by Nick Jacobs

"Compassion is not weakness, and concern for the unfortunate is not socialism." (Hubert H Humphrey)

Each and every day hospital executives are faced with the reality of the sometimes overwhelming responsibility of ensuring that life is carefully delivered, maintained and eventually transitioned. We are ultimately responsible for the appropriate management of resources, allocation of funds and commitment to excellence that allows all of these life transition situations to be addressed appropriately.

In addition, we face the challenges of probability and statistics as we attempt to deal with whatever the odds parse out. Some days the chiller stops and the house heats up. Some days we have a crush of sick people who all hit the emergency room at the same time, and each time we think the day is running smoothly, a piece of equipment breaks or one of our twenty plus regulatory agencies shows up with a check list. It's all part of the day.

When you think about running a $50M, $100 M or $1B business with 500, 1000 or 30,000 employees, consider that each one of them typically represents a family of four. Consider the fact that each and every one of those family members in some way, shape or form also come under the umbrella of your responsibility.

If that isn't enough for you to consider, then consider this one. Think about what it would take to look into the eyes of a family member who's loved one died because of something that one of your physicians or employees might have either done or failed to do. That would be my most dreaded experience.

The burdens of leadership are all put to task when the added responsibility includes life and death situations.

Because of the intensity of this role, quality assurance, risk management, and six-sigma perfection are all realities of our day to day activities. There also is a tendency, however, in this world of health care to create protective mechanisms, to insulate, to attempt to limit access and to prevent pain to oneself. This is achieved in many ways by self-talk. Rationalizing of each and every situation to create the space needed to keep it unreal.

We do this by becoming the sun around which the planets are forced to orbit. We become the center of the universe, and we completely strip the power away from those for whom we have been hired to protect and nurture. That is Employee Centered Care.

It has been my philosophy to have an open door policy, to provide transparency in every way possible, to reach out with compassion.

Interestingly, the most difficult part of leading such an organization with compassion includes development of the skills necessary to cope with the social fabric present and with the previous training of the employees and other stakeholders. In our current world order where tough is a daily requirement; compassion is many times interpreted as weakness. Instead, compassion needs to be a daily requirement. Do unto to others as you would have others do unto you.

by Nick Jacobs

From the 1976 movie “Network,” Howard Beale, the news anchor who was verging on a meltdown said: “I want you to get up right now, sit up, go to your windows, open them and stick your head out and yell - 'I'm as mad as hell and I'm not going to take this anymore!' Things have got to change.”

While recently visiting a friend at a nursing home, she looked up at me and said, “Why do you think the people who work here feel the need to come into my room at 5 AM, throw on the overhead lights and say, “It’s time to wake up!”

As a patient, I once asked a technician why she needed to take my blood at 2:30 A.M., she replied, “I have to because your physician comes to see you at 4 AM, and he gets very angry when he doesn’t have your blood tests and lab results.” When I asked her why the doctor makes rounds an hour before most musicians return home from their night time job, she smiled and said, “He doesn’t like to talk to the families, and they’re never here that early.”

If you’re a physician, your response is, “If I don’t make rounds early enough, I can’t see enough patients during the day to even begin to meet my financial obligations for staffing my office, for medical school loans or for my daily living,” but what about those docs who do come at a descent time? How do they do it? Here’s a better question. Do you avoid talking to the families?

Of course, if you work in the medical profession, your immediate knee jerk reaction to my other example is going to be, “We have to get them up and give them their medicine. We have a dozen patients and only so much time to get them ready for the day.” Yet, someone on that list has to be your first wake up and someone the last. What goes into that decision making process? Is it YOUR decision based on YOUR wants and needs?

There have been hundreds of cases of which I have been made aware in my health care career where the convenience to the patient was the very last priority on the list. The concept of Patient Centered Care is actually considered revolutionary in this field, and the fact that someone believes that you should focus on the patient, their needs, their convenience and their wants is revolutionary tells you how very upside down this system is.

When the radiologist takes an hour and a half for lunch while a patient languishes in an operating or waiting room waiting for the results of their tests; when the nurse, nurse’s aid or therapist builds their schedule around their breaks, and looks at the lighted call bell as an inconvenience, the system needs changed. Insensitivity toward the customer is rampant.

One of my favorite stories was of a local luminary who had joint replacement surgery. He rang the alert bell and began a two hour wait. Finally, he picked up the phone, called the outside number for the facility, asked the operator for the nurse’s station on the floor where he was a patient, and then said, “This is Mr. Blank. I’m a patient here on your floor. Could you please send someone to my room?” It was the only way he could get their attention.

This is not an indictment of the medical profession. It is an indictment of every profession. If you are a patient, a customer, a client or even a citizen interacting with a bureaucrat, remember one thing; without you, they have no business, no income. So, go to your window and yell, “I’m mad as hell, and I’m not going to take it anymore,” and then hand them a copy of the movie, “The Doctor,” it shows how uncomfortable the shoe can be on the other foot.

by Nick Jacobs

A few months ago in an article in the New York Times by Alex Berenson, he discussed the obviousness of the widening gap between those who have and those who do not have in our country. The Centers for Disease Control and Prevention reported that growing dental problems among U.S. citizens, untreated cavities, have reached a higher level than any time in the last 27 plus years. What does this have to do with health? Well, take one of those tests about how old you really are, and check NO when it asks if you floss regularly. Then do it again, and this time check YES. It’s creates a fairly dramatic difference in the years to live category.

Over 100 million Americans, nearly 30% of our population, do not have dental insurance and two children died of untreated cavities last year. Even though it was only two, it’s a very sad statistic. This represents a reversal of earlier trends in dental health in our country. Berenson additionally explored the trend of dental practices that do not accept Medicaid patients and have imposed significantly higher rates for their services. Of course, just like the primary care physicians who have pursued this same route, they are now enjoying booming financial times. Their professional organizations have also fought the use of dental hygienists and other allied health, non dentists to provide basic care.

This development leaves those uncovered individuals waiting in lengthy lines for access to public dental clinics. Sadly, clinics like this are not always available in many areas. The ones that are forced to use the clincs, however, have as much as a six month waiting time for patients to be treated.

Fifteen years ago I worked to help secure funding to provide health care through medical missions to the people of rural Honduras. Upon initial examination of the most pressings needs, we discovered that the single greatest medical crisis faced by the native Hondurans was the lack of potable water and proper dental care, and our teams of mission oriented medical people pulled hundreds of teeth on each visit. This work literally saved the lives of scores of people.

As the article stated, the right to have straight, white teeth in the United States among the middle class and above appears to be a God given expectation, but, once again, as we fall behind in care of our citizens in the industrialized world, we see the plight of those individuals who do not have their own advocates or financial safety nets falling deeper into a world of financial, physical and mental despair as they face more and more life threatening.

by Tony Chen

Check out this link for some examples of how hospitals are using the popular wii game console for their rehab/PT patients.

by Christopher Cornue

A continuing look at the Commonwealth Fund’s recent report, Bending the Curve: Options for Achieving Savings and Improving Value in US Healthcare Spending finds us reviewing their second area of focus – that of Promoting Health & Disease Prevention. By lowering the incidence of disease through increased public health initiatives and improved care, significant cost savings can be realized in our health care system. Chronic disease is their primary focus, making the assertion that prevention of continued dependence upon healthcare will curb costs significantly. Research conducted by the Centers for Disease Control & Prevention suggest that medical costs for individuals with chronic disease represents 75% of total health care expenditures. Their three primary areas of health promotion & disease prevention are:

• Reducing Tobacco Use
• Reducing Obesity
• Positive Incentives for Health

Reducing Tobacco Use – tobacco usage, including cigarette smoking, is arguably the single most avoidable cause of death in the US. Lung cancer, respiratory disease, heart disease and stroke have all been associated with tobacco usage. During the late 1990s, the CDC estimated that cigarette smoking led to $75 billion in health care expenditures and close to $100 billion in lost productivity. The Bending the Curve Report recommended the increase of the excise tax on cigarettes from $0.39 to $2.39. The additional revenue would be funneled to: 1) CDC’s national tobacco control programs; 2) development of grants to states for their own programs, providing they adhered to minimum tobacco control standards such as banning smoking in workplaces and enclosed locations.

Reducing Obesity – obesity has become an increasing problem in the US over the past several years, with the share of national health expenditures related to obesity falling in the 5-9% range. This presents a significant opportunity in reducing costs and combating this issue. The report recommends establishing a new tax on sugar-sweetened beverages at a rate of $0.01 per 12 ounce serving. These revenues would be used to create grants for states to develop individualized obesity prevention programs, providing they met specific minimum obesity control requirements. Additional suggestions offered in this report: 1) requiring restaurants to display nutritional information; 2) requiring schools to ban sugar-sweetened soft drinks; and 3) enforcing requirements for healthy meals in schools.

Positive Incentives for Health – it has been suggested that our own personal behavior (i.e., smoking, diet, physical activity, etc.) has a significant impact on our health and mortality. Therefore, if we take ownership and change these behaviors, our health can be improved and the costs related to treating disease can be reduced. Disease management and wellness programs which encourage individuals to embrace healthy behaviors are becoming increasingly present in our society. Federal grants to states to develop and promote these programs and encourage insurance companies to incentivize individuals to participate are examples of policies in Bending the Curve. Additionally, broadening the rules for Flexible Spending Accounts to allow for participation in programs to quit smoking or control weight would encourage participation.

On a side note, it’s important to state that these activities don’t need to wait for approval at the Federal or State levels. Action can be taken community by community. An example of this is a developing initiative in Chicago. I had the fortunate opportunity to attend a kick-off meeting this week, hosted by the American Medical Association and the Chicago Department of Public Health – “Building a Healthier Chicago.” Though in very early states, experts and concerned groups assembled for a day-long discussion about necessary efforts to create a healthier Chicago. Many of the initiatives and policies brought forth by the Bending the Curve report were discussed as plausible initiatives that a community can tackle. More information about this will be provided as it develops. Stay tuned …

by Tony Chen

No, it's not just retail clinics in drug stores. Check out this post on hospitalbusinessdevelopment on other potential retail opportunities that hospitals should be assessing.