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January 27, 2010 -- Hospital Impact has been ranked one of the top 50 healthcare blogs by Wikio.
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by Dr. David Blumenthal
The Recovery Act called for the creation of two new committees--the HIT Policy Committee and the HIT Standards Committee. Created in May, 2009, and operating under the Federal Advisory Committee Act rules and regulations, the meetings and deliberations are open to the public. To date seven HIT Policy Committee meetings and eight Standards Committee Meetings have been held. Each committee has heard testimony from the public.
These committees have a lot on their plate, and from the outset, we knew that in order to accomplish the scope of work set forth by each committee in a timely manner and be responsive to legislation, workgroups would need to be created.
Second of a two-part series.
By Emily Paulsen
Last week, we brought you Part I of this two-part series on the recent discussion we had with Lucian Leape, MD, a leader in the national patient safety movement. Currently, he is a health policy professor at Harvard School of Public Health, and chair of the Lucian Leape Institute, part of the National Patient Safety Foundation.
Hospital Impact: Why haven't we made more progress on the patient safety front? Is it just because culture change is so hard or is there another impediment?
Lucian Leape: There's no question that we're moving up hill in terms of the culture, but, in addition to that, the whole financing of healthcare works against us.
by Joseph Ingemi
President Obama's appointment of Howard Schmidt as the nation's new cyber-security chief illustrates the importance of cyber-security in protecting us from what Schmidt called "great dangers to national security, public safety, economic competitiveness, and personal privacy."
Health IT is not immune from these dangers. So as we move forward with connecting our healthcare system electronically, we should not forget about the importance of security.
by Paul Roemer
The national EHR market is ripe for the taking by a big three like Microsoft, Google and Oracle. Heck, I'll even go so far as to suggest that when the dust settles in about five or seven years, the National Health Information Network will be a regulated combination of a handful of those firms.
As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario: Let's say I am in charge of Google's somewhat non-existent healthcare line of business. One of my goals would be to have more users of my PHR than any other firm.
Why does this model make sense? Two ways, both of which come from the cable/telco business model.
by Emily Paulsen
Part I of a two-part series -- In November 1999, the Institute of Medicine released its groundbreaking report, "To Err is Human," which found that medical errors were to blame for 98,000 patient deaths every year. The report was met with shock and some disbelief and brought the issue of patient safety to national attention. To get a perspective on the progress of the last decade, and a glimpse of priorities for the next few years, we spoke with health policy analyst Lucian Leape, a co-author of the report and a leading force in patient safety. Dr. Leape is currently an adjunct professor of health policy at the Harvard School of Public Health and chair of the Lucian Leape Institute, part of the National Patient Safety Foundation.
Hospital Impact: Looking back, what do you see as the most important development in patient safety during the past decade?
Lucian Leape: When the Institute of Medicine report came out in 1999, it got national and even worldwide attention. That's when the true conversation began, and we went through a period of increasing awareness. It has been very much like the grieving process: denial, outrage and anger, and gradually acceptance. Now patient safety is on the agenda of every healthcare organization.
There has been a tremendous increase in the science in the last 10 years. In the IOM report, we said, "It's not bad people, it's bad systems," and we advised healthcare organizations to redesign their systems. We had principles and concepts using human factors principles in the design of processes, but we didn't have specific solutions.
In the interim there has been research and development and validation of a number of safe practices.
by Anne Zieger
Right now, if a patient has a large deductible plan--particularly those tipping the scales at $5,000 or more--your odds of collecting that money aren't great.
Realistically, those who buy high-deductible plans are largely those who don't have much money in the first place, and they're not likely to have thousands to give you on the spot.
What's worse, as any revenue cycle manager reading this knows, once they walk out the door the odds of collecting get smaller by the day. At that point you're lucky to get a portion of what you charged.
by Paul Roemer
Can being an 'early adopter' save your hospital millions of dollars? We both know the answer depends on what you're adopting. Suppose we are discussing the adoption of an idea. Can that be analogous to not adopting another idea? I think it can. Allow me to explain.
Many providers are in the process of making a very expensive, highly complex, and wide-ranging decision regarding their healthcare information technology strategy (HIT) for their electronic healthcare records system (EHR) -- a non-trivial moment, to say the least.
Careers will be made and lost as a result--I'm betting more will be lost. Why? By making a bad choice on the EHR, on how to implement it, and on how to modify your organization.
As some of you might recall, we recently published a list of nine of our favorite healthcare bloggers. While many of you liked our choices, you also noted that we didn't include any female bloggers on our list. Touche!
Today, we're sharing a list of some of our favorite healthcare blogs written by women in an effort to make sure we give credit where credit is due. On these blogs you'll find hands-on operational discussions, public policy analysis, visions of healthcare's future and more--written by women who have a great deal to say.
Just before Thanksgiving, I spoke at a gathering of 180 physicians about how physicians can overcome their frustration -- not just their frustration over losses in reimbursement, but also in authority and autonomy.
Part of the reason for these losses is that we lack training in such process skills as communication, negotiation, and conflict resolution that facilitate leadership and the implementation of sustainable solutions.
In general, our leadership skills are skewed too much toward command and control to actually contribute to high-performing teams. In fact, our teamwork and communication practices resemble those of the airlines in the 1970's.
But I do remain hopeful. The reason? I've worked with physicians who have overcome frustration and skepticism to establish themselves as leaders who make their time count. Three examples follow:
by Paul Roemer
Ever wonder how the billions of dollars in healthcare IT came about? I imagine it went something like this:
DC Wonk 1: Email those fellows over at HHS and tell them we should just make the doctors install Electronic Health Records (EHR)!
DC Wonk 2: While we're at it, how about we pay them a bonus to do it?
DC 1: Yeah, and we could penalize them if they don't. We'll give 'em money with one hand and take it back with the other!
As many of you know, in 2008 I accepted the position of CEO of McKee Medical Center in Colorado. It was a wonderful opportunity, one I hadn't necessarily been seeking, but one that I was excited about and happy to accept.
What many of you may not realize is that my wife and young children (ages six and three) were unable to make the move from Chicago to Colorado due to the health of my wife's father. During the course of my time in Colorado, we attempted to make this transition happen but in the long run, were unable to do so.
by Nancy Cawley Jean
For years, we've relied on the carefully crafted one-way message, distributed through the traditional advertising, marketing and media relations channels, to communicate what we wanted to tell the consumer about our brand.
We've spent months conducting research, polling focus groups, writing marketing plans, and developing new advertising and branding campaigns to support an overall strategy with clear priorities. That's all well and good, but if you're not including social media as part of that strategy, the message just doesn't matter.
by John Cunningham
With the ongoing debate on the cost of healthcare and the myriad of proposals to "fix" it, it's easy to become distracted from the daily operational issues that acute-care hospitals face in managing one of the fastest growing expense lines; physician preference items.
Physician preference items can end up accounting for a sizable portion of a hospital's total supply expenses. In 2008, the FDA reported that 3,370 new items were submitted for FDA approval and that number continues to climb. In fact, by 2011, the Healthcare Advisory Board predicts that 35 to 45 percent of all procedures will use an implantable device.
I have been thinking a lot about the 2009 ACPE Doctor-Nurse Behavior Study, which surveyed 2,124 physicians and 696 nurses. It found that nearly 85 percent of respondents experienced degrading comments at work, including yelling (73 percent), cursing (49 percent) and refusing to work together (38 percent).
As I wrote in my first book, Better Communication for Better Care, confronting a physician creates fear, but in retrospect, we all benefit from early intervention to avoid lapses in patient care suffers and even burnout. The reason why I use the term "in retrospect" will become apparent after I relay my own humbling experience (from a previous century):
Cornell University economist Robert H. Frank, in a New York Times editorial, argues that even without a public option, any of the current healthcare reform bills will eliminate the underlying conflict of interest that has caused costs in the U.S. to skyrocket. Actually, "argue" may be too strong a word, as he devotes the entire article to a very lucid explanation of the problem. Does he contribute to the debate? You be the judge. Article
I recently learned about an online medical practice that uses the Internet to connect with and take care of patients. I was intrigued by what I heard, so I researched the site further and found it to be a very interesting concept.
Through the site, patients use the Internet as a primary means of communication with their healthcare provider. They create an account where their healthcare information will be stored and then have access to multiple physicians at a click of the mouse.
by Anthony Cirillo
FierceHealthcare recently reported on the latest report that identifies the best-performing hospitals that offer the highest quality of care. The research firm that came up with the list says it's the "first comprehensive index to compare the value of care that hospitals provide."
They measure quality, including CMS's Core Measures, patient safety, mortality and readmission rates; efficiency, including the relative measure of the cost to the hospital for providing services; affordability, a relative comparison of prices charged for inpatient and outpatient services; and patient satisfaction as measured by CMS' patient satisfaction survey (known as HCAHPS).
by Wendy Johnson
The CEO of a Cambridge, Mass.-based hospital recently wrote a great blog post about how his own health issues have impacted his views of healthcare reform.
"The true promise of health care reform is a transformation to a system that prevents disease more than it treats it," Dennis D. Keefe, CEO of Cambridge Health Alliance, writes for WBUR, a Boston-based National Public Radio affiliate. "There's plenty of money in the system, we just aren't spending it correctly, or aiming it at the programs that produce the best results."
Noting how the proactive steps he has taken to control his diabetes has resulted in fewer medications and trips to his doctor's office, he writes that while "it may seem strange for a hospital CEO to be envisioning declining patient volumes...that's the point. If we are to really succeed with reform that lowers costs as well as improves outcomes, physicians and other clinicians will have to become health educators and hospitals and clinics will be wellness centers."
You can read the rest on WBUR's website.
by Nancy Cawley Jean
If you work at a hospital, you know these institutions are pretty traditional when it comes to modes of communications. And now there's the brave new world of social media thrown into the mix. If you've already dipped your toes into the water, bravo!
If your organization is still on the fence, you'll likely meet up with a few nervous naysayers who, understandably, have concerns. Here are a few ways to alleviate their apprehension:
by Joe Ingemi
In my last post for Hospital Impact, I spoke of the possibility of standards-based meaningful use criteria, and performance-based meaningful use, such as recording the number of smokers enrolled in cessation. Hidden beneath these regulations are a whole other set of compliance standards that are yet to be discussed: internal controls.
Florida hospitals had a front-row seat to the genesis of the Recovery Audit Contractor program due to the Sunshine State's participation in the three-year RAC demonstration project. FierceHealthFinance recently spoke with Bruce Rueben, CEO of the Florida Hospital Association, to find out what his member hospitals have learned from the RAC program so far.
FierceHealthFinance: Based on the experiences of your member hospitals, what is your global forecast for hospitals nationwide in 2010 as the national RAC program ramps up?
Rueben: Florida, like New York and California, served as the initial testing ground for the Centers for Medicare and Medicaid Services to develop the RAC program.
In Part II of our Q&A interview with the CEO of Boston's Beth Israel Deaconess Medical Center, Paul Levy shares how Massachusetts' mandatory insurance coverage law has impacted his institution, and his thoughts on how healthcare reform should play out at the national level.
FierceHealthcare: Do you have a prediction, or even a personal preference, as to what type of insurance model is going to work?
Paul Levy: The approach we're using in Massachusetts which, I think works pretty well, basically requires people to have insurance--in other words, there's a personal mandate that you have to have insurance, and then the state has created an insurance exchange. The insurance companies in the state have to live by the rules of that exchange and provide the insurance coverage, and then subsidies exist for the lower income people. I think that's a pretty practical way to do it.
"We have some issues here," a CEO of a mid-sized community hospital told me.
"We have a pluralistic medical staff of employed, contracted, and independent doctors who are in revolt. After our residency was put on probation several years ago, we set up a hospitalist teaching service, where a third of unassigned patients went, which angered the private doctors.
"Also, we have adopted a more hands-on policy with our case managers, to meet state and federal core-measure guidelines, which physicians feel interferes with their autonomy to care for patients. And we just divested a service line that lost over $2 million in the past five years, which meant that some physicians who've been with us for more than 30 years lost their jobs.
by Wendy Johnson
Every once in a while, a hospital error comes to light that's so tragic and egregious, it makes national news headlines and holds our attention: Josie King, the child who died at Johns Hopkins Hospital due to severe dehydration and a medication error; Jesica Santillan, who died after receiving organs with the wrong blood type at Duke University Hospital.
This month, we learned of the latest shocking error; massive radiation overdoses at Los Angeles-based Cedars-Sinai Medical Center.
As many of you know, Paul Levy, CEO of Boston's Beth Israel Deaconess Medical Center, is an avid blogger who advocates for more transparency in healthcare (he even disclosed his own compensation package and asked folks to comment on whether they think he's overpaid).
Anne Zieger, FierceHealthcare's senior editor who named Levy as one of nine people to watch in healthcare, recently talked with Levy about how his views on blogging have evolved over the years.
FierceHealthcare: So what do you think has been the net benefit to the hospital--or you--with having this ongoing relationship with the blog?
Paul Levy: I'd be hard-pressed to say that it's had any benefit to the hospital, per se; at least it's hard to measure that kind of thing. My only hope in the blog is that it would be interesting for people to read, and that it would promote some debate and maybe educate some people as to the issues that are going on. That's all it is. It's kind of a news magazine from my point of view.
by Neil Versel, FierceEMR
While dozens of media outlets picked up on a Kaiser Permanente-led study, published in the American Journal of Managed Care, about how a "bundle" of two low-cost medications could prevent heart attacks, nearly every report I saw missed out on one major detail of the report: The researchers would never have found a link without the help of EMRs and predictive modeling technology.
Kaiser mined its KP HealthConnect EMR--its name for the Epic Systems installation across all nine Kaiser regions--to find patients at risk for heart attack or stroke to participate in the study. Once the program started, the EMR helped Kaiser clinicians track their patients' adherence to the recommended treatment.
by Joseph Ingemi
Compliance will be a central issue, for HHS and for providers, once the Office of the National Coordinator (ONC) releases its meaningful use criteria for physician practices and hospitals. (It's expected to be published in the Federal Register by the end of the year.)
To receive federal funding, each entity will have to comply with the criteria. Translation: All providers will need to set up quality assurance programs to ensure compliance. That's where skilled, thorough IT auditors will come in handy. But even the most experienced IT auditor will be charting new territory in evaluating meaningful use compliance.
Based on the current work of ONC, here's where an auditor's system evaluation might take two approaches:
by Paul Roemer
I built a deck one day simply because I wanted to build it. I called Home Depot, told them what I thought I needed, and the next day they delivered the necessary supplies to my house. Twelve hours later, I had an 800 foot multi-level deck with a railing and benches. Prior to that day, I'd never built anything. I had no plan, just and idea. I got lucky.
Several years later, my friends and I climbed two 19,000 ft. volcanoes in Mexico. We had a detailed plan, talked to people who'd climbed them, read about the climbs, practiced climbing on glaciers, and practiced using crampons, ice axes, and ropes. We even spoke with a doctor about how to deal with some of the health dangers we might encounter. Good thing: We almost died from pulmonary edema. Had we not planned, we would have died.
I've been thinking a lot about why projects fail. My most demonstrable failures can be traced back to two things: a lack of leadership and a lack of planning. Planning doesn't guarantee success, but I like my odds a whole lot better with it than without it.
by Nancy Cawley Jean
Do hospitals need to enter the world of social media? That's the exact question we asked ourselves last year at Lifespan, a large, Rhode Island-based health system comprised of a parent and five affiliated hospitals. We started to realize that communication as we know it has changed dramatically in the last five years alone, giving consumers more of a voice than ever before.
No longer are disgruntled customers (or patients) left with the sole option of writing a letter to the editor of their local newspaper to get their voices heard. Now they can blog about it, tell their friends through Facebook, or even share their experience with the entire world through Twitter. Unlike the past, consumers now expect to be heard.
by Paul Roemer
Those I've had the pleasure to meet online know one thing about me: I view the selection and implementation of an electronics health record (EHR) system to be a very non-trivial event. What makes it so difficult?
Hospitals typically spend more money on EHR than they may have spent on adding a new hospital wing. And yet, many hospital leaders make EHR decisions without clearly understanding their business need or their business requirements. Sorry, but obtaining ARRA money is does not count as a "business justification."
It's no wonder, then, that 70 percent of large IT projects--those in excess of $10 million--fail. Failure is defined as missing the budget, the timeline, or not meeting the desired functionality.
by Anne Zieger, FierceHealthcare
As any web user knows, there are thousands of healthcare bloggers out there. But of course, all blogs are not made equal. Some offer that soupcon of personality, great insider insights or just the ability to make us laugh at ourselves in a way few of their peers do. And those are the blogs (and tweets) worth putting on your must-read list.
We've compiled a list of nine of our favorite healthcare bloggers and tweeters, a diverse mix with a wide range of information and commentary to share. We hope you enjoy them as much as we do. Start the slideshow
by Anthony Cirillo
I recently had an engaging conversation with Kellyann Curnayn, author of A Good Day in Hell: The Flatlining of Nurses Across America.
Yeah, that title gets your attention. So does Kellyann, a dedicated, practicing nurse. She shared with me her view that nurses do not get paid to take care of patients--they get paid to fill out paperwork. She shared with me some insights on the level of lateral, nurse-on-nurse violence that occurs in healthcare across settings every day. Much of it is based on the need to cover your you-know-what.
by Paul Roemer
I've never been mistaken as one who is subtle. Gray is not in my patois. I am guilty of seeing things as right and left and right and wrong. Sometimes I stand alone, sometimes with others, but rarely am I undecided, indecisive, or caught straddling the fence. When I think about the expression, 'lead, follow, or get out of the way,' I see three choices, two of which aren't worth getting me out of bed.
I do it, not of arrogance, but to stimulate me, to make a point, to force a dialog, or to cause action. Some prefer dialectic reasoning to try to resolve contradictions; that's a subtlety I don't have--like the time I left the vacuum in the middle of the living room for two weeks hoping my roommates would get the hint. That was subtle and a failure. I hired a housekeeper and billed them for it.
Take healthcare information technology, HIT. One way or another, I have become the polemic poster child of dissent, HIT's eristical heretic.
by Anne Zieger and Dan Bowman
Now, more than ever, healthcare is a topic that is being talked about at every water cooler and dinner table in the U.S. Between hospitals struggling to stay afloat and a reform effort that seemingly has the nation divided, what happens over the next few months and years will have a lasting impact on healthcare in this country.
FierceHealthcare decided to take a look at a few of the movers and shakers in healthcare today, to get a better understanding of where healthcare is now, and where it is going. Whether we're talking about bloggers, doctors, business professionals or politicians, the following people represent the present and future of healthcare.
by Dr. Kenneth H. Cohn
Last weekend, I was a speaker and mentor at the SEAK Non-Clinical Careers for Physicians Conference, which was attended by approximately 250 physicians. My topic was "Practical Strategies for Transitioning to Non-Clinical Careers," in which I described part-time hospital administrative work, locum tenens coverage, and creating and sustaining a personal brand using Internet technology.
The experience that I will never forget was serving as a mentor to more than 50 physicians who signed up to see me in 15-minute blocks throughout the weekend. I met people from a variety of specialties (ED, cardiology, primary care, radiology, surgery) and many states, from Florida to California.
by Wendy Johnson
Publisher, FierceHealthcare
We've heard lots of interesting ideas since then. Some were a bit Mickey Mouse, others focused on nothing short of a complete turnaround. The common thread throughout: Hospital Impact has been your water cooler--your place to sound off, share ideas learn from each other. That's still true today.
by Dan Bowman
Associate Editor, FierceHealthcare
Bill Frist has been keeping busy these days. Between chatting up former colleagues on both sides of the aisle about healthcare reform and heading up the acquisitions, divestitures and portfolios for his Nashville-based investment firm, Cressey & Company, the cardiac surgeon and former Republican Senator from Tennessee is also promoting awareness of atrial fibrillation. He has also been an advocate for children's health around the world, pushing for investments in such resources as clean water and vaccines.
FierceHealthcare caught up with the ex-Senate Majority Leader yesterday and asked him to elaborate on some of his efforts, as well as his views on healthcare reform.
Of the 15 acute-care hospitals in the nation with the highest gross-patient revenue, only seven are located outside of the states of California and Pennsylvania. Only three of the 15 recorded a financial net loss last year. But which facility tops FierceHealthcare's list, based on 2008 statistics compiled from the American Hospital Directory? Is it Cedars-Sinai Medical Center? Massachusetts General? The famous Cleveland Clinic? Read on to find out. Click here for the slideshow
by Anthony Cirillo
I love to stir the pot and my last post on why patient and person-centered care is not working did just that. I should first qualify my contention from that blog. True, person- and patient-centered care is working in some instances, but honestly, it is taking hold in just a fraction of the health care universe. I may have implied that it is not working at all, and that was not the intent.
by Anne Zieger, FierceHealthcare Editor
Readers, as most of you probably know, tonight President Obama went on live national television to make a pitch for his health reform vision. Unfortunately, given the Administration's track record of intellectualizing, inside baseball and changes in direction, it's not likely that most Americans walked away saying "Wow! I understand health reform perfectly. Give me some of that!"
The thing is, most of us, both in and outside the industry, agree that there are many reforms that need to be made, some of which President Obama has been working hard to communicate.
by Tony Chen
Well, the day has come for my last post here at Hospital Impact. After transitioning this blog over to FierceHealthcare, and after I was laid off from my hospital job, I'm now focused full-time on a few new start-ups in the healthcare and Web 2.0 arenas. You can still follow me on twitter @hospitaltony and read posts from me at the sg2.com community website.
by John Cunningham
Healthcare is one of the very few industries where there is a high dependence on the performance and effectiveness of the supply chain, and low level of engagement within senior management. Although hospitals have begun to elevate the supply chain leader to a seat within mid-level management, very few have brought them into the c-suite. Why?
by Christopher Cornue
As we continue to explore what our future healthcare may look like, I'm recommending a site that does an excellent job summarizing the various plans, and progress made. The Kaiser Family Foundation (http://healthreform.kff.org/) provides great trending information, polls, and a wonderful side-by-side comparison of the various reform proposals.
If you're looking for one place for updates on what's going on out there with the reform debate, I'd suggest bookmarking this the Kaiser Family Foundation healthcare reform site, and check back frequently.
by Dr. Kenneth H. Cohn
The purpose of this post is to summarize conversations that I have had with three physicians this summer about healthcare reform. I feel blessed to have a group of friends from medical school who rent a house on Cape Cod every July and to their spouses for making it happen.
As baby boomers who still view the practice of medicine as a calling, we recognize that many Gen-Xers do not see the world the same way.
by Dan Bowman -- Associate Editor, FierceHealthcare
FierceHealthcare recently got the opportunity to talk with Dr. Jason Bhan, a practicing family physician co-founder of Ozmosis: The Trusted Physician's Network. Prior to starting Ozmosis, Dr. Bhan served as a consultant and medical adviser to Medsite, where he helped develop the company's core strategy for e-detailing and online physician retention. Dr. Bhan also served as the Medical and Technology Officer for VirtualMed, Inc. and helped launch MiamiHealth.com, which provided physicians with an online presence.
We asked Dr. Bhan about the early days of Ozmosis, as well as his opinions on physicians migrating online and healthcare reform.
FierceHealthcare: Please briefly explain what Ozmosis is for people who might not have heard of it.
Jason Bhan: The concept behind Ozmosis is that physicians need a place where they can exchange medical, clinical, practice management and policy information, discuss cases, review journal articles or any other information on the web in a trusted environment; somewhere where there aren't other eyes looking in, and they can be assured that the other people they're talking to on the site are, in fact, physicians, peers or colleagues.
by Christopher Cornue
Many of you have probably already seen "10 Steps to Better Health Care," the Op-Ed in The New York Times printed last week by Drs. Atul Gawande, Don Berwick, Elliott Fisher, and Mark McClelland. If you haven't, it deserves a read.
Whether or not you support the ongoing efforts by President Obama and Congress to create Health Care Reform, this op-ed makes a very striking point: that all healthcare/medicine is local. In reflection, I believe this is one of the fundamental differences of our healthcare system here in the United States compared to the rest of the world.
by Anthony Cirillo
There is a movement afoot. Some call it culture change. Hospitals call it patient-centered care. The long-term care industry calls it person-centered care. Whatever you call it, for the most part it's not working. Everyone has an opinion. Here is mine.
by Christopher Cornue
I had the opportunity this week to meet Stephen M. R. Covey and talk with him following his presentation in New York about the importance of Trust. It was an amazing presentation where he described the impact trust has in organizations...specifically healthcare organizations.
During his talk, he discussed some very sobering statistics about those of us in healthcare. Specifically, he quoted several studies that demonstrated we have significant trust issues.
by Dr. Kenneth H. Cohn
One of the wonderful privileges of being a guest blogger on Hospital Impact is that any time I need inspiration, I have always been able to find it in someone else's posts. So it was with Christopher Cornue's insightful, "Where did all the strategists go?"
Chris makes the point that as a result of the recession, people who plan strategy have become an endangered species, as hospitals focus on cost-containment and daily survival. His comments have prompted me to tell my own story. Like a news reporter who warns the audience before showing graphic footage, I apologize ahead of time to anyone who finds the edgy content or language offensive.
by Christopher Cornue
Over the past several months, I've noticed a significant shortage of a very important role in hospitals--that of the strategist or planner. These are the folks that understand the market dynamics, the new innovative approaches to care, niches that may exist for evolving technology and are able to collaborate with leadership to develop a vision for the organization's future.
I believe this type of individual is absolutely necessary for the success of an organization, especially during this "economic downturn"--what better way for a hospital to stay ahead of their competition and leverage ripe opportunities for growth, new service development and revisions of current services than to have dedicated folks remain one step ahead of everyone else.
With the recent release of Apple's iPhone 3G S, FierceMobileHealthcare decided to take a brief look at 15 commonly used free healthcare apps for the iPhone according to sites like apptism, iAppHealth and Apple.
Click here to get started.
by John Domansky
Marketing and promoting a hospital or health system is not just a marketing department's responsibility these days--I believe that it is the responsibility (and obligation) of all of the employees. In other words, a "Village" is needed to market and promote the great things that are going on in hospitals on a daily basis.
by Nick Jacobs
Frontiers of Health Services Management published its summer 2009 report on Bullying in Healthcare recently. In this edition, they took an in-depth look into the problems of bullying in the workplace. As many of you know, I have been pontificating about the devastating impact of bullying for a dozen years now, and between the Joint Commission's stand and features like this one, the topic is finally beginning to get the attention that is needed to address the absolutely horrible outcomes prompted by those individuals in healthcare who have long lived as bullies.
by Toe Knee Chin*
If you have been following my twitter feed, you'll know that I was laid off from the business development director role at my health system about six weeks ago. I was called into my boss's office and the HR professional was also sitting at the table. Even though I had prepared for this moment and I knew it was coming, my heart was still pumping when I heard, "Unfortunately...Your position was one of the ones that has been eliminated."
Thousands of times over, this is happening in hospital offices across the country. In fact, just in Chicagoland alone, there's probably been 1,000-plus layoffs. As such, this is obviously a pretty touchy and raw subject for many. Nonetheless, for me, at the risk of sounding a little insensitive or overly positive, I've taken this whole situation as a great opportunity, and am looking at it as great timing.
I don't get philosophical too often here at Hospital Impact, but maybe this topic deserves a bit of just that. Here are some things I've been thinking about:
In March of this year, WellPoint and Availity announced a strategic partnership with Availity--a health information network that connects health plans and providers. Anne Zieger, Editor of FierceHealthcare, recently chatted with WellPoint Vice President of Healthcare Management John Jesser and Availity CEO Julie Klapstein about the collaboration, what it means for both parties, and what it could mean for the future of healthcare. Click here for more...
Scott Shreeve, MD, Senior Health Advisor at The X Prize Foundation, has asked the healthcare blogosphere to take part in this blog rally in order to raise awareness about the Healthcare X Prize Foundation competition and encourage public participation in the prize design. Pass the word around and feel free to post this to your own blog if possible.
We are entering an unprecedented season of change for the United States healthcare system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don't harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.
We believe there is a better way.
by Nick Jacobs
"Good news," my new physician said. "You passed your cardiac stress test." "Yes," I thought. "That is REAL good news; no open heart surgery, no angioplasty, no more stents. Yeah, that is great news." Even though I know that thallium stress tests are only about 70 percent accurate, I'll take that piece of information and hold it tight while I smile a little.
"Well," he went on, "Your HDL is not where it should be, and you do have mild kidney failure. We’ll just have to keep an eye on that."
"Mild kidney failure?" I said out loud. "Wow, that was unexpected," I sighed. What did mild kidney failure mean?
by Dr. Kenneth H. Cohn
We usually know him when we see him: Tightly wound, a product of pedigreed training programs, a high achiever, used to getting his way. Most healthcare organizations have at least one of him. He may be the cornerstone of an institute or service line. He is the alpha doc.
The question we face is, how do we capitalize on his expertise and charisma without dreading to work with him?
Based on my 500,000 mile journey working in 40 states, I offer the following strategies from healthcare professionals who face this challenge.
Welcome to the first annual FierceHealthcare review of health plan CEO compensation.
Despite the trials and tribulations of the past year, there are several executives still raking in quite a few dollars at the end of the day. This is a look at some of the top total compensation packages from 2008 based on information gathered from the U.S. Security and Exchange Commission.
by Christopher Cornue
During the past several weeks, I was one of the folks who thought we were overreacting to this strain of flu. Its symptoms were similar to other flu strains, it didn't seem as virulent as others, and we had identified a drug that could combat it (until it developed a resistance to it).
However, I actively participated in efforts to ensure my hospital, as well as regional and county organizations, were well prepared for the potential outbreak we could have experienced--one can never be too prepared, and we did take these actions very seriously. It was the education and preparation for a potential outbreak that I believe was either a direct (or possibly indirect) outcome of what we've experienced that past few weeks.
by Joe Wasserman
In recent months, our industry has experienced unforeseen financial pressures as a result of the economic downturn impacting our patient volumes, operating income and investment income.
The proper response is to lower our operating expenses. This is not likely a transitory situation, and ultimately we need to learn how to operate profitably under our Medicare reimbursement.
The lack of a well planned and executed expense reduction plan may well result in catastrophic financial and operational difficulties.
What to do? Consider these perspectives:
by Dr. Kenneth H. Cohn
In Hospital Competition: The Unusual Suspects, Tony Chen wrote that in addition to physicians, other areas of competition--such as insurance companies, pharmaceutical manufacturers, drug stores, wellness providers, and hotel--are broadening competition for healthcare dollars.
In the comment section, Ron Whiting wrote, "A complete alignment of interests particularly between hospitals and physicians is required to effect real change in hospital care." As a practicing surgeon, I remain mystified over the operational definition of "complete alignment"; in Collaborative Mentality, I wrote about mindset differences between physicians and hospital leaders.
Nevertheless, my cluelessness about how to achieve the state of complete alignment will not stop me from pointing out a few ways that we can collaborate better to improve financial and clinical outcomes for our communities:
by Christopher Cornue
I've written before about the unique opportunity we have in the United States to pilot many solutions to our healthcare needs and challenges. We have 50 unique laboratories in which we can try these solutions...and hopefully some wonderful and innovative strategies will emerge to help us all.
Tuesday saw the culmination of many long and tireless hours of work in Colorado with the signing of the Colorado Healthcare Affordability Act. While this act isn't unique in the United States (approximately 22 other programs exist in other states, under other titles such as "Provider Fee" or "Provider Tax"), this particular act has some unique aspects to it, which I'll describe in a second.
by Tony Chen
I'm very excited to announce our newest blogger at Hospital Impact: Mr. Joe Wasserman.
Wasserman is the President and CEO of Lakeland Healthcare, a three-hospital system that includes two long-term facilities, an assisted living center, 3,500 associates, and 325 physicians located in Southwest Michigan. He has been in this role since 1985.
Joe received his Masters of Health Services Administration from the University of Michigan - Ann Arbor. He is also a Fellow of the ACHE.
Joe: Welcome to the community and the team, and we look forward to working with you.
by Nick Jacobs
The other day I received a phone call from a newspaper. One of its employees had heard me speak at a leadership conference on transformational leadership. She then went to her publisher and described all of the nontraditional things that had been instituted at my former place of employment in Windber, PA. The call was to ask me to make a presentation to the employees of that newspaper about re-inventing their organization. Interestingly, I had recently returned from a print-related company that had done just that some 15 or so years earlier. Today it has more engineers working for it than pressmen, and the result of its journey into the creative process has been success beyond anyone's wildest dreams.
by Dan Bowman
Associate Editor - FierceHealthIT
By all indications, this year's HIMSS09 show in Chicago will be extremely thought provoking--11 sessions are dedicated to the economic stimulus package and the effects it will have on the healthcare landscape.
What's more, healthcare technology seems to be coming of age rather rapidly. Between the push for mandatory adoption of electronic medical records and the expanding efforts by physicians and organizations to be relevant in a Health 2.0 world, the healthcare of yesterday is being swept aside to make way for the practices of tomorrow. Compliance issues for new technology and physician-oriented social media networks were among the hot topics of FierceHealthIT's preview webinar, which took place this past Tuesday.
Count us, at FierceHealthIT, among those who have jumped on the bandwagon. Both Anne Zieger--Editor-In-Chief of FierceHealthIT--and I will be sending out live updates from HIMSS09 via Twitter; furthermore, we'll provide you with in-depth stories from various keynotes and educational sessions. If you're unable to attend this year's conference, we've got you covered.
by Debora Hendrickson
The Institute of Medicine estimates that nationwide, preventable medical errors in hospitals unintentionally kill the equivalent of one jumbo jet crashing each day. While preventable medical errors are the last thing a patient should have to worry about when he or she is admitted to a hospital, it might surprise most people to know how much time hospital administrators and clinicians spend with their colleagues, consultants and medical agencies to work to eliminate all preventable medical mistakes.
I am the Executive Director of Professional Services at Eden Medical Center, one of the Sutter Health hospitals in the San Francisco Bay Area. Our hospital treats approximately 1,000 in-patients per month. I chair our Medical Center’s Patient Safety Committee, which was formed almost a decade ago. I spend many hours each month working with our physicians, managers, nurses and virtually all members of the medical center team impacting our patient’s environment of care to develop and implement best practices for our health care teams so that we never have a "never event"--an error that should never happen in a hospital.
by Christopher Cornue
"The physician must be able to tell the antecedents, know the present, and foretell the future--must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm." – Hippocrates
Today we celebrate our trusted colleagues, friends and medical leaders. Each March 30, our country recognizes the significant accomplishments of our physicians...from the simple prevention of a disease to the saving of a human life. Their accomplishments and daily acts are to be praised and thanked.
Some quick facts and information about this day of recognition:
by Tony Chen
Follow Hospital Impact on Twitter. There, I'll be providing daily links, "recently heard" quotes, & commentary on the news of the day.
What is twitter, you ask? Well, think about it like a blend between a blog and an instant message. Entries are limited to 140 characters and show up on your "followers'" homepage. See wikipedia's explanation of Twitter.
At the end of the day, twitter is basically a new communication tool. You can blast information out, you can interact with like-minded followers and readers. And you can learn more about your market - real-time. Every day, I'm getting at least a couple of hospitals who sign up for twitter and start following us. More on how hospitals can use twitter in a later post.
In the meantime, head over to twitter.com/hospitalimpact and tell me what you think. Waste of time or useful communication tool?
by Dr. Kenneth H. Cohn
A cherished friend and mentor who lives in Atlanta described her recent spring weather as, "It’s just pollen now. All the beauty is gone because of a frost. Just as the buds begin to emerge, living things are the most vulnerable."
As I read Tony Chen's latest post, "TIME's 10 world-changing ideas and healthcare," his last line--"It's chaotic times like these where new leaders can emerge"--triggered thoughts of emergence again.
by Tony Chen
Recently, TIME magazine (is it still an actual magazine?) came out with the 10 big ideas that are changing the world today. As I read through this mostly fantastic (and maybe fantastical-sounding?) list, I couldn't help but think about the impact on health care for six of those big ideas.
by Christopher Cornue
McKinsey & Company have launched a new product simply titled "What Matters." According to McKinsey, they have created this site to provide "knowledge derived from convening some of the best thinkers from around the world."
There are many topics, but of most interest to me (and probably most of you) is the one on healthcare. It's a very interesting read and I encourage you all to take a quick look (and a deeper dive, if your curiosity gets the best of you...like it did with me).
The link is here. Enjoy.
by Nick Jacobs
Periodically, my life crashes into certain realities that did not seem to be even a consideration days earlier. For the past six months, my consulting has directed me toward a project that had been ruminating in my mind for over five years, and that project involved the networking of approximately 20 rural hospitals via dark fiber. The purpose of the network was to create a virtual health system that was not dominated by one super tertiary power, the normal system that typically takes the "Community" out of community health care.
During my explorations, a very savvy facilitator appeared on the scene that worked with a stable of consultants responsible for telemedicine efforts in military medicine, the originators of these technological advances. Through her, I began to learn about the unlimited possibilities represented by this connectivity, ranging from telepharmacy to telepsychiatry. Of course, as a virtual health system, all of the less subtle and far less challenging aspects of centralizing finance and billing also were on the table for consideration, and eventual implementation.
by Tony Chen
Here's a few things I've been hearing from other hospitals on the impact of this recession.
"Bad debt is going through the roof."
"Even administrative employees are being asked to take unpaid time off, go on furloughs."
"Merit increases are frozen. So are open positions."
"Surprisingly, volumes are up 5 to 8 percent from last year. It's just that we're not getting paid for the services we provided."
"We are actually having one of the strongest years in the hospital's history."
"We're actually doing okay, though we are reconsidering a major capital project."
One thing to recognize is that while we like to look at national numbers, our hospital systems all operate in local environments. Yes, all of our investment incomes were smashed, but each market (some folks say it's probably 250 to 300 local markets around the country) will have unique dynamics to deal with.
by Tony Chen
Think back just a year ago, to February 2008. Oh, things back in the "good ole" days of 2008 were so much simpler. Consider the headlines of the day brought news such as Mitt Romney winning the Maine Caucus and Ralph Nader entering the 2008 presidential campaign. The Dow was down to 12,000 from high of 14,000, while the NASDAQ vacillated around 2,500.
At the risk of sounding insensitive, let's all step back and take a deep breath for a second. Most experts agree that in 12 to 18 months, this recession will be over. Things won't go back to normal--whatever that means--but things are going to be a whole lot better than they are now, psychologically and otherwise.
by Christopher Cornue
This story has been around for a few weeks, but in case you haven't seen it: take a look at this incredible story with horrifying examples included. Let's keep these examples in mind when we're talking about our own issues stateside.
by Dr. Kenneth H. Cohn
I am writing this post in the moment as I cover surgery at a rural hospital in New Hampshire over the weekend.
Yesterday, I had the humbling responsibility of telling a patient brought in by ambulance with severe abdominal pain that she needed an operation, and that I did not know what caused her pain. Her white blood count was elevated (over 17,000), and her computerized tomographic (CT) scan showed a large amount of fluid around the liver and in her pelvis, with a non-visualizing appendix. I told her that the source of her problem could be anywhere from her stomach to her rectum--including her reproductive organs--and asked a gynecologic surgeon to be on call to see her preoperatively and assist me in surgery.
by Nick Jacobs
Last week it was my privilege to spend a few hours with an entrepreneur who compiled every quality indicator published by all 20 organizations that list themselves as having a mission that is directed toward "healthcare quality." I can't remember if there were 20 or 30,000 of them, but it was a boatload.
The entrepreneur then had a software expert create grids and graphs and quantitative tables in relational databases that would compile all of the related indicators, cross reference them, and pull them together into the appropriate job descriptions. This system was constructed to enable employers to objectively quantify these job descriptions and thus to evaluate the employees in a more appropriate, efficient, and comprehensive manner.
All of this would lead to higher quality care, reduce costs normally created from employee turnover, and lead to a better workplace and better patient care.
by Tony Chen
Since we've blogged extensively in the past about hospitals and social media, here's a quick note: Henry Ford Hospital will be sharing a live kidney cancer surgery on Twitter on Monday.
From their PR team:
Dr. Craig Rogers will lead a surgical team from Henry Ford Hospital as they perform a robotic partial nephrectomy. The public will be able to receive updates and information from OR 25 at Henry Ford Hospital, and communicate with the surgeons via the Twitter microblogging service. Henry Ford is a teaching hospital.
Also, check out Ed Bennett's tally list of Hospitals using social networking tools. Can you believe that there's 60 hospitals on twitter already? Yes, that's only about 1 percent of the all the hospitals in the country.
by Tony Chen
If this didn't already start in your hospital three months ago, it will start soon enough. In order to survive the coming year or two of increasing bad debt, increasing charity care, other reimbursement cuts, declining elective surgery volumes, more complex delayed-care stuff showing up in the ER, and decreasing philanthropy, it is time for the serious business of cost-cutting.
What is your hospital planning? Where do you look first to cut costs? The real question is, where do you look that you haven't already?
by Dr. Kenneth H. Cohn
I heartily recommend Abigail Zuger’s provocative article on Dissatisfaction with Medical Practice (Zuger A. 2004. "Dissatisfaction with Medical Practice."New Engl J Med 350(1):69-75). I learn more each time I reread it.
In the article, Dr. Zuger points out that the golden age of health care, which lasted approximately two decades after the passage of Medicare in 1965, was an anomaly. For example, she mentions that in 1913, the American Medical Association estimated that no more than 10 percent of physicians were able to earn a comfortable living.
She also quoted Dr. Kenneth Ludmerer from Washington University as saying, "One of the virtues of medicine...is its self-critical nature...Intrinsic dissatisfaction can lead to significant social good." As a nurse executive counseled me, "It's the sand in the oyster that creates the pearl."
by Nick Jacobs
The fundamental charge of a hospital administrator is, and always should be, patient care. All too often, however, we immerse ourselves in the daily tedium of trivia that deals with mundane issues that can only be described as the fundamentally messy drivers of day-to-day life among human beings. We deal with those issues that cause our in-baskets to bulge, our voicemails to fill, and our Blackberries to show memory overload; but, for the most part, they are not essential issues that contribute directly to patient care.
The vast majority of these problems are very similar to those that were part of my daily challenges as a teacher some 30 years ago. They often deal with egos, with jealousy, or with seeking ways for the individual employees to save face after engaging in confrontational behavior. There is also one very true description as well that states that "the problem is never really the problem." If you look under the surface, you will find the reality of every situation.
by Tony Chen
2006 was the year of consumer-driven health care. Two years ago was the year of retail clinics. Last year was the year of health IT (with Google and Microsoft making big splash entries). So, what will 2009 bring? Here are some predictions sure to go wrong:
1. The number of uninsured and underinsured will increase dramatically.
Think about it: Unemployment was once close to 5 percent. At some point in 2009, it could get up to 10 percent. Add to that the many businesses that will be cutting healthcare coverage for the sake of business survival, as well as the folks who will decide to forego buying individual health insurance to make ends meet.
by Christopher Cornue
As part of an ongoing series reviewing my first 100 days as a CEO, I spent the first 45 to 60 days assessing the current culture, operations, strategy and environment at my new hospital. My initial (and lasting) assessment: I'm working for a wonderful group of individuals--the employees, physicians, board, community, etc.--everyone has been so welcoming and positive!
Safety TipHospital facilities built today do not include asbestos, but many older buildings still have asbestos components in them. Steam pipes, boilers and furnace ducts were often insulated with an asbestos blanket or asbestos paper tape because of their fireproof and insulating properties. Resilient floor tiles were made from vinyl asbestos. Asbestos cement was employed in roofing, shingles and siding materials. The hazard of this carcinogen increases when the fibers become airborne, and untrained contractors can inadvertently increase risks by cutting, tearing, sawing, scraping, or sanding asbestos materials. Elevated asbestos levels can occur in hospitals where old materials are damaged or disturbed. It is best to leave undamaged asbestos material alone if it is not likely to be disturbed. Inhaling asbestos fibers is known to cause mesothelioma and other diseases. Be sure to use an experienced asbestos removal contractor when you need to get rid of old materials that might contain asbestos. |
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