by Nick Jacobs

As a 40ish rookie in health care management, the common conversation around the board table in the late 80's was a chorus of woeful sobs directed toward the good ole days of cost based reimbursement. That was a time when hospital CEO's could pretty much count on getting checks equal to their costs to pay for services rendered. In fact, a book entitled, The Hospital That Ate Chicago, was a good example of how hospitals could actually make a profit from the government from building projects.

Ah, to have been an Executive Director or Superintendent in that era. If you didn't golf several days a week, you were not considered competent enough to be an administrator. One of my early mentors used to say, "Son, If you want to survive and thrive in this field, you are obligated to learn to golf and play a good game of bridge."

Needless to say, I sometimes drive over a bridge, on my way back from Washington D.C.this week, I actually filled up at a Gulf station?

Today, we are seeing the beginning of an end of another era. As the tide begins to sweep the post WWII generation closer to retirement, it is clear that the System is about to change. It is about to change or die, and, once again, the ole timers will wish for better days when they actually got reimbursements that, for at least a small amount of time, would allow them to pay the bills and make a little profit for the organization.

One problem with writing a blog like this is that it's easy to criticize, easy to point out, and easy to suggest, but it will take an engaged group of hard working, deep thinking leaders to set the path for the future, a path that pays attention to the infrastructure, that will work to ensure the bridges don't collapse, the discoveries aren't curtailed, and the future becomes all that it can be. That path should be inclusive, comprehensive and for the good of mankind. Hopefully, we can help make the directional signs for that journey because, our future depends on it.

By Nick Jacobs

Literal translations . . . BLACK and WHITE interpretations. It all started out with HIPAA.

I'm sure that the legislators behind the HIPAA (Health Insurance Portability and Accountability Act) were well intentioned. I'm sure they wanted to protect us.

The result, however, has taken us into a world that can be absolutely maddening. Compliance officers, HIPAA experts, the protectors are everywhere, and, interestingly enough, they have fallen into the trap of enforcing and interpreting every detail as if it were absolute black and white.

My heart yearns for situational ethics again.

Worse than that, not unlike the inspector who, after four days of not finding anything wrong at our facility, went into the furnace room with a flashlight and found a cigarette butt in a concrete block that had been there since 1974. They will look and look until they find something that can be interpreted in a BLACK AND WHITE fashion.

A year ago on the morning of my heart cath, my experience prior to the procedure was a typical hospital experience. The nurse carefully placed me in an outpatient bed to wait for my procedure and to collect my health history. Beside my bed was a curtain, and behind that curtain was another patient. Believe me when I tell you, I know every intimate detail about that patient, everything.

That's when it hit me that, although the HIPAA police are always lurking, trying to get us to build walls and separators, there is no real privacy in any hospital that has semi-private rooms. NONE. There is NO HIPAA behind that curtain.

So, try as we might to protect our patients, once your doctor comes into the room to tell you what's going on, the word is out.

A post by Andrew Barna

Here is an interesting issue coming out of Georgia. According to this story in the Atlanta Business Chronicle, there have been a number of bills in the state legislature granting additional rights to non-physician practitioners. This is a very sensitive subject for physicians, as it touches on the very definition of their profession. State medical boards, comprised mostly of physicians, have traditionally defined the scope of practice for all sorts of providers. This is a bum deal for non-physician providers, as they don’t have a “seat at the table” when their profession gets defined.

It is obvious that physicians have an economic interest in defending their professional borders (and I have rarely begrudged anyone for defending their economic interests), but the arguments given by physicians for not expanding scope of practice for other providers are often based on education and training. I don’t find this argument convincing. It is hardly scientific to propose that a nurse practitioner or chiropractor or pharmacist couldn’t perform some medical activity because they didn’t attend medical school. These practitioners are highly trained in their particular disciplines and there is nothing to say that they couldn’t receive sufficient training in the medical activities that they seek to provide. Indeed, these providers often seek to expand their practice in areas where they believe they have unique insight into the patient’s condition or treatment based on their particular training and approach. For this reason, expanding their scope of practice improves patient care.

I actually see physicians’ response to the expansion of other providers’ scope of practice as a moral response. From the beginning, physicians have been ultimately responsible for the care of the patient. The physician makes the hard decisions and they have to live with the consequences. This responsibility has conveyed (a duly earned) sense of moral authority. However, healthcare has changed. There is a wider array of practitioners that are providing care and they bring valid, specialized modes of healing to patient care. They should be given the latitude to perform their disciplines.