by Nick Jacobs

Tony asked me what I would miss as a hospital CEO? Let me begin by saying that I left teaching at age 31, and thirty years later I still very much miss the interaction with the students. Just yesterday, I received another E-mail from a 50ish year old IT executive telling me that my teaching had been one of the greatest influences on his life. That was the third similar E-mail that I had received in the last five months from that work of 30 years ago.

From teaching I miss helping the students find themselves, teaching them to fly, and saving those borderline kids who were hanging by a thread. My life as a teacher was completely built around being a care-giver and a mentor.

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by Nick Jacobs

Penn and Teller, magician-comedians, have a cable TV show that basically explores all aspects of life in America with the intention of exposing those areas that are not valid. I'm not sure why the noble bull has suffered this indignity of their show's title, but, when it comes to making fun of the nontraditional, these magic men hold nothing back. They look at topics like integrative medicine, snake charming, and sensitivity training through their sarcastic, unprofessionally trained eyes and do all that they can to rebuke the topics being explored.

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by Tony Chen

All this talk about health care policy, healthcare blogging, and hospitalk, sometimes it's easy to forget that we are talking about real people, real sons, daughters, fathers, mothers, wives, husbands, and loved ones.

Yes, we have to run tight ships financially to ensure the long-term sustainability and advancement of our hospitals. Yes, we need to learn the business of healthcare. Yes, we have to think aggregate in numbers. But let's always remember that we are serving individual people, many who are in the most scaring, vulnerable moments in their lives.

I ran across this story at Blog, MD about Derek Madsen, a 10-year patient who had a rare childhood cancer. Please take a moment today and go through these 20 gripping Pulitzer prize photos of his journey.

Also, we've collected a few other patient stories here.

by Nick Jacobs

Back in 1963 my philosophy professor challenged me to prepare an analysis of intrinsic (taking) versus altruistic (giving) behavior. My conclusion at that time was that there clearly was no such thing as altruism. No one did anything unless it was good for them. Even those individuals who so generously gave of their time, money or wisdom, did it because it made THEM feel a little better about themselves.

Interestingly enough, that sophomoric knowledge (I was a sophomore.) did not keep me from embracing a life in not for profit management. Throughout my career in the various nonprofit organizations with whom I have worked; education, arts, economic development, and healthcare, it has been clear to me that there are two types of people who volunteer, the givers and the takers.

When questions are raised regarding how much is personally too much to those individuals who are the takers, the answer is obvious, “You can never have too much.” But when the same question is posed to the givers, the answer is entirely the opposite, “We enter with nothing, and we should leave with nothing. We are here to serve mankind.”

Well, over the last thirty plus years, it has also become clear to me that controls are necessary in order to keep the takers in tow because, many of them have no boundaries in regards to their material needs, and not for profit organizations are not the appropriate setting for pursuing those endless needs.

After Enron there appeared to be a glimmer of hope relating to controlling these takers, and there also appeared to be a strong movement toward a Sarbanes-Oxley-type legislation for nonprofit's. That proposal has now evolved into a new proposal called the Nonprofit Accountability Bill. Unfortunately, it does not yet have enough teeth to be really meaningful.

Let’s examine carefully the rolls of our nonprofit board members and simply track back the amount of business done by their companies within the nonprofit corporation for which they volunteer. Then check to see if bids were solicited, if influence was not placed on executives in charge through board compensation committees and if the business/member excused him or herself from the meetings when these issues were being decided. The Nonprofit Accountability Bill proposed certain limitations regarding the amount of business that actually constituted a conflict of interest, but, it is relatively clear that those numbers have also not been activated.

Bottom line? Ask questions about your nonprofit boards. Thankfully, for the past ten years I have worked for a board that is free of conflict, but this clearly is not the norm.

The difficult proposal that requires you to buy board member products, embrace their services, and use their consultants in order to ensure that they will be good board members is not acceptable behavior in a world that needs our help.

A post by Andrew Barna

So we are all on board with price transparency in healthcare, right? Well maybe it is not so simple. Apparently, a John’s Hopkins study has found that specialized cancer facilities have higher costs at the time of service, but they “yield lower cost per quality-adjusted life year” in the long-run. That is a mouthful, but in a nutshell, it means you are going to pay more for cancer treatment at a Sloan Kettering or a M.D. Anderson, but you will probably live longer and with a better quality of life. I think this would make sense to most Americans – you get what you pay for – but the picture is not so clear when you look at hospital/physician comparison websites.

Most of the websites I have seen have been pulling quality data from the CMS quality demonstration project. This is not a bad start. The CMS measures cover some of the highest volume procedures and they draw attention to practices that promote better outcomes. And by “better outcomes,” they mean you are more likely to leave the hospital alive. I am not knocking the CMS measures. I think the CMS Demonstration project, as well as the IHI campaign, have created systematic improvements in patient safety and outcomes… but…these measures do not necessarily give consumers an indication of the long term value of the services they are purchasing.

Let’s go back to our health economics class. The value of a healthcare intervention is measured in terms of lengthened life or improved quality of life. Indeed, this is how a lot of medical research is done. One treatment is shown to have better long term impact than another. But by their very nature, the CMS measures focus on short-term outcomes that can be measured during your hospital stay. So on one of the hospital comparison websites you could find out that the in-hospital mortality rate for your heart procedure is lower at Hospital A rather than Hospital B. OK, easy choice go with Hospital A. But what does that outcome mean relative to cost. Are you willing to pay an extra $5,000 for less of a chance to die? Or could you save a $1,000 and take a tenth of a percent in additional risk? Now the decision is not so clear. We aren’t typically equipped to make such a call.

Americans are expert consumers and we want to know every detail about what we are buying. I won’t even buy a CD until I know how other people who like similar music like that CD. When we have the right information about what we are purchasing, we make better choices (I should say that we make choices that we are happier with). Granted that purchasing healthcare is not equivalent to purchasing a CD, but it is not different on this point. The more that hospitals can demonstrate their overall and long-term value, the more consumers will make better choices.

Post Script: I just received the spring copy of Frontiers of Health Services Management and the featured topic is “Price Transparency: Meeting the Market Demand for Clarity”. So as I read the articles, I am sure I will be writing posts retracting the comments above. Hey Tony, your old boss Richard Clarke wrote the lead article. It looks good from the summary.