December Praises…and Holiday Wishes

‘Twas the day before Christmas and . . . I was catching up on details.

No unusual calls, but some very nice correspondence received via e-mail, letter and voicemail messages. For instance, Angela K. wrote of past reluctance to seek therapy [due to hearing horror stories about such experiences] and her dread in attending therapy sessions. To her delight, she found that the stories were all wrong and that the therapists helped make her feel very comfortable and didn’t make her do anything she was unable or uncomfortable doing. Another caller described our ACH Therapy Colleagues as “friendly, courteous, and very team oriented” ... saying that they were all especially attentive to her specific needs. She said she has been other places and was particularly impressed with the attention paid to small, yet important details, (such as cleaning the exercise equipment) here at ACH.

Thank you, Maintenance, for another job well done. Security recently returned a wallet that was found by one of our Maintenance Colleagues. The wife of one of our patients thought she had dropped the wallet somewhere between her home and the hospital as she was rushing her husband to our ER. When he was admitted to his room, a member of the Security department was already there with the missing wallet and all of its contents were in tact, including several hundred dollars in cash. The patient and his wife wanted to let us know how much they appreciated our Colleagues; not only for their kindness, but for the care they give to all patients.

To all our great Colleagues, physicians, volunteers, Board leadership… here’s wishing everyone a very Merry Christmas and Happy New Year. It is indeed a pleasure and an honor to be part of the ACH family.

Stan

Health Care Reform, Our Community Hospital’s Not-for-Profit Status

After reading about many of the national Health Care Reform proposals being discussed, it seems the one thing that everyone agrees on is that our system is broken. My top three suggestions for areas to focus on are:

1. A single payment system. I believe one of the most efficient providers of care is Medicare, through which roughly 3% of the health premium dollars go toward administrative costs and the rest is allocated to direct care expenses. Compare that with monetary allocation process used by a majority of insurance providers, through which about 30% of healthcare dollars are used toward administrative/marketing costs and the complicated expense payment system. The Medicare system provides price transparency for consumers; trying to get the same information from your insurer, hospital or doctor on non-Medicare coverage and is nearly impossible. Potential savings: 27% of 1.1 trillion dollars. A good start.

There are several not-for-profit insurance models that operate on a breakeven philosophy, such as Aultcare in Canton, Ohio. This means that out of every healthcare premium dollar collected –except for administrative expenses—those monies, go toward the actual care provided. This translates into more money for the providers of care and lower costs to the healthcare consumers.

2. Hospitals and doctors focus on quality and service transparency. Assuming a single payment system, prices would clearly be defined. Insurers, whether governmental or private payers, would earn their customers through service, value and performance.

While we are working on #1(single payment system), all providers, doctors and insurers should be required to post their actual rates and payments. Under the present system, consumers who are paying about 13% of out-of-pocket expenses receive much better information through a car purchase than they do regarding their own health care. Quality and service indicators are easily understood and actual dealer costs and mark-ups are available on such website as consumer reports.com. Many insurance provider contracts prohibit the sharing of this information. But, consider this: Who shops for cars at list price? Currently these are the prices you see from providers on our healthcare websites -- list prices. Right now, there are only a few hospital systems that are advocating for publication of healthcare services provided.

3. Consumer accountability. The bottom line is, consumers need to be more directly involved with the purchasing of their own care and the financial consequences related to their actions. Consumers who don’t actively work on preventative health measures should be paying more of premium dollars for their coverage. Smokers should pay more than non smokers. Individuals who are proactive about managing chronic conditions should pay less of a premium than those who don’t. Hospital and other employers should continue to redefine our benefit package to encourage this.

Now that I have been able to vent, let me move on to some concerns I have as a local hospital administrator. Our not-for-profit status is being questioned by many: do we deserve it? Let me begin by stating the obvious, we do get a tax break of about $2 million dollars a year. As expensive as it may seem, there are several critical services that community hospitals provide that still don’t cover their expenses and lose a lot of money. At our hospital, maintaining our Emergency Department through physician coverage loses about $500,000 a year, while our OB department, on average, loses close to another $1 million a year.

Overall, how do we? As a not-for-profit we still need to make money to remain viable, but instead of sharing those profits with shareholders, we use them to pay for services that are not justified on a financial basis. Below is a copy of our Community benefit report for 2005 and 2006, which includes a summary for Ohio hospitals.


-- Stan

Impacting Healthcare Reform at the National and Local level

When I first started my blog I had good intentions of writing at least weekly if not more, I apologize for not keeping up. In the future, I will try and do better.

It has been a month since my last blog and certainly there has been much to write about. Before I dive into one of my favorite topics these days, Reform of our Health System, I'd like to mention that this was a very good week for me personally. I just returned to work after the wedding of my daughter Amy to Eric. While I was away, I had five phone messages from customers; four were compliments and the fifth was a very good suggestion on how we could improve services. I want to send Compliments to our Community Care and Rehabilitation Center, Imaging, Physical Therapy, and ER departments, each of which was mentioned favorably in the complimentary calls.

Now, onto the issue of Health System Reform. If you go to Forbes.com website and type “ Solutions: Health Care” into its search engine, you will see some great commentary from political leaders, professors, government employees , physicians and many others calling for reform of our national healthcare system. If we would just take some of their inspired, mutually-agreed upon suggestions and start implementing change, it would be wonderful. The payment system is archaic and cumbersome and the barriers to real price information are thwarted by it complexities and the confidentiality agreements between payers and providers.

At the local level, we are continuing with our efforts to collect meaningful price information from customers in the marketplace. We will reach out to service organizations and others to collect information from individual E.O.B.s(explanation of benefits). From this information, we hope to be able to explain to our marketplace that Alliance Community Hospital and the Independent Hospital Network (Aultman, Dunlap, Joel Pomeren and Union Hospitals) are one of the best consumer values for acquiring health services in the USA. Another advantage we hope to garner from compiling this information, is to determine whether or not we are being fairly compensated.

Internally, we will be studying the design of our health benefits package. We want to do more to foster accountability for changes in health habits of Colleagues. An example might be: Colleagues who smoke may pay more in the future for their health insurance. Our Pharmacy department is exploring a better way to manage chronic ailments and illnesses that are a major part of our colleague expense budget. In addition, we are examining better use of our internal data to be help shape better prescription drug purchases.

We will keep you informed about our progress in these areas. In my next blog, I hope to touch upon the issue of Community benefit and our not-for-profit status.

Stan

Competition, but on a level or even playing field…please talk with your local legislators regarding house bill SB120

Competition is a very good thing. If you have read some of my past blogs relating to transparency, our hospital and doctors feel we can compete with anybody in providing great services at a valued price.

Why am I so concerned about this legislation and the expansion of niche or specialty hospitals? More services and choices mean more competition, right? WRONG!

These specialty hospitals usually target the most profitable services that are typically part of a Community-not-for profit hospital, like ACH. Yes, we too (like the for profit hospitals) need to make money otherwise we wouldn’t be here. However, the profits we make get plowed back into all the services that aren’t self supporting and sometimes lose a great deal of money; services that are vital to our Community like having an Emergency Department available 24 hours a day, seven days a week that never closes; or OB Services or Cardiac Rehabilitation.

At our facility our not for profit status entitles us to tax advantages to the tune of about 2.3 million dollars a year. We still make a profit but, we provide just under $8 million of Community benefit dollars to support services that otherwise would not be provided or scaled back greatly.

One of two things should occur if specialty hospitals are allowed to proliferate in Ohio. The first, which is addressed in the proposed legislation, is that these hospitals should also provide emergency support to the Communities that they are in. This levels the playing field and shares the burden of providing much of the Community’s uncompensated care. The other is unlikely to occur. Without inclusion of this type of provision how services are paid for must change. Insurance companies and the government must shift some of the payment away from the profitable services and pay more for services like OB, ER, and Cardiac Rehab. If that doesn’t occur we will have more competition, more fragmentation and most likely higher costs. That is my opinion, what’s yours?

Health Consumers We Need Your Help

At Alliance Community Hospital we are trying to learn how to be better shoppers of health care. How can you help? By sending me your comments and questions as they relate to shopping for health care services. Hospitals, doctor offices, and free standing centers are not very well prepared to answer many of your questions. Probably the most frustrating is not knowing in advance how much you will pay for a service, the amount of your co-pay or out of pocket expense. So, what information do you need to become better shoppers of health care services?
Looking forward to hearing from you.
Stan

Is the Customer/Guest Always Right? And Kudos Again

Kudos Again

Being a backwards thinker sometimes gets you where you want to be faster. So I will begin with the end of this blog first…I have been getting more and more compliments about Colleagues who work here. Here are two, one from the end of the summer that missed being passed on and the other from last week:

Sharon writes “…In E.R. Susan was the shining star. She was patient, kind, caring and quite knowledgeable…she more than goes the extra mile. She is a great asset…And in same day surgery, Dotty went the extra mile as well…she was kind and had a wonderful sense of humor. She puts the patient at ease and has a wonderful smile. Please let both individuals know how much they are appreciated.

Debra called to recognize Dawn and Tricia part of our therapy team. They were both so kind and professional. I will always recommend Alliance Community as the place to go.

The above comments are wonderful. I look forward to the calls regarding staff because I usually can get more of what our colleagues exactly did to make such an impression.

Is the Customer/Guest Always Right?

So is the customer or guest always right? I guess it is a matter of perspective. When a customer takes the time, or initiative, to share a comment you can either receive it as free consulting/advice or you can view it as a complaint. Most people usually don’t express their dissatisfaction because they don’t want to get anybody in trouble; at least those are the words I hear most often as it relates to healthcare. Many of our customers and guests at Alliance Community Hospital listen for the following words, “Is there anything else I or a fellow Colleague can do for you?” as their cue to let us know if we haven’t met their expectations; and they can do so without getting anyone in trouble. During a patient's stay or visit with us a Colleague may offer a business card. On the bottom of their card is the leader of the department in which they work. If the Colleague can’t respond to the request directly their boss is available to help. If for any reason they are unable to respond, the patient is free to turn the card over and contact me directly. My business, cell and email are listed. In the past when I would be responding to what customers would say is a "complaint" and went to follow up with a Colleague or department manager often the first words I would hear were, “You have to hear my (our) side of it." This doesn’t happen too much anymore. Most times it goes, “Let’s look at what happened and see if there was a way to meet the customer’s expectations.” It isn’t a right or wrong issue anymore.

Last week a patient’s wife called in to express concern over the discharge process related to her husband’s care. Although she was very concerned about her husband, she wanted to make sure if there was anything that could have been done better that we investigate, and if so help avoid some of the things they went through.

We will be getting back to her and her husband and we were very thankful for her call. Certainly when things go well we love to hear from you; however we care just as much when they don’t or we haven’t met your expectations so please let us know how we are doing.

Thanks. Stan

P.S. (Just recieved this comment!) Virginia writes regarding our transport services sponsored by local physicians and the hospital: “I want you to know how important your transport service is to me….I ….and most of my friends are in our eighties and don’t like to drive…It is a wonderful service”

Hillary, Rudy, Ted in Ohio et al….please help!

In a recent meeting with several physicians, we were discussing all the changes that health care providers must deal with that are non-clinical in nature. As frustrating as it might seem to patients, it has been increasingly so to doctors as well.

More than half their time seems to be spent on non-clinical matters, helping their patients navigate the health care system maze or on billing activities trying to get paid by insurance companies. This last Friday on 20:20, the final segment showed a primary care physician who dropped all insurances and would only accept cash. He lowered his overheads, seemed to have more time for his patients and his income stayed the same. In a recent seminar that I attended material was presented on a RAND study done in Ohio several decades ago. This study found that when patients paid a greater percentage of their health care costs they used 31% less care with no significant outcome differences.

So, let’s design a system of caring and health that lets doctors practice and doesn’t require them to get another degree in accounting or information systems to get paid for their work. Next, make sure patients have enough incentives to learn to be good buyers of health care services.

So what’s next? Transparency. Health consumers need information on actual out of pocket expenses in advance of service. Sorting out value will be a bit more complicated; however, the quality information that hospitals, doctors and insurance companies possess needs to be shared in ways that help patients purchase health services. We also need to get this information into the hands of doctors and other health professionals who can assist their patients in determining the best value.

Now here is where we could use help from our legislators. Last time Hillary tried to get more information out there the insurance industry had a lot of lobbying money, and the Republicans turned her plan into waste material. Of course I am on dangerous ground here because I too didn’t like the plan. My point here is that the governor of Ohio has a task force working on these issues and I am not sure that any doctors or hospitals are on it. I hope Ohio can take the lead in developing something that both Ohio Democrats and Republicans can get behind because, the big picture for Ohio and the U.S. is for us to be a lot more competitive, after all our health care costs are killing us. Being too idealistic? It never hurts to dream big.

With all these pressures it was refreshing to hear comments from local doctors last week as they were discussing their own frustrations in running their practices; whatever they do they agreed the bottom line was to do whatever it takes to care for their patients. After that they would focus on running their practice or how to work better with a hospital.

Not there yet but we are getting closer…building our dream of becoming the best Community Hospital for the State of Ohio

Last Friday, several hospitals from the Cleveland Clinic network visited us and I had a chance to reminisce about changing the culture at our hospital. To borrow a line from W. Edwards Deming, “America has the greatest and most productive workforce in the world, all it needs is leadership who believes in them."

The culture of an organization certainly is a leadership issue. Well at ACH/Planetree I have gotten a lot of credit for many of the wonderful things we have achieved and do everyday, but I will be the first to admit we just have a great team of talented individuals who get to practice their professions in an environment that they helped create. What we have done as an organization is create an atmosphere of shared beliefs and values that makes us feel good and is appreciated by our patients and guests. What was wonderful to hear was how our guests perceived our colleagues and their level of genuine engagement.

Postscript to my very first blog. I was saddened to learn that the physician practice decided to discharge Susie’s mom from their practice. Even in the movie, Miracle on 34th Street, Santa sent a customer to Gimbels for the one item they were searching for because Santa cared about the value to the customer. There is an old expression, "let the buyer beware.” Well the new expression will be “let the seller beware.” The end result for Macy’s, they are still around today. Hospitals and doctors, the world is changing quicker than ever; let’s help educate our customers and serve them well. What has always made us special in the eyes of our patients is their trust. There are rough times ahead and as long as we continue to keep that trust of “patients first” we will all be better off.

What do you get when you mix transparency, with support from the government, hospitals, and doctors?

Answer, a possible cure for managed care, a boost for an ailing economy and more knowledgeable healthcare consumers.

In an article by Robert Pear that was published in the New York Times January 9, 2004:

• Health spending was 15 percent of the nation’s economy
  
• 1.55 Trillion
  
• Projections put health spending at 17.7 percent of GDP by 2012
  
• Spending for hospitals and prescription drugs seemed to be tapering off
  

On August 12, 2007 in the Huckabee Roundup summarizing some of the presidential candidate’s views:

• The health care system in this country is irrevocably broken, in part because it is on a health care system, not a health system
• Health care spending is close to 17% of our gross domestic product
• Our health system is making our businesses non-competitive in the global economy
  

Well, it is only three years since the earlier prediction of 17% of GDP. Gosh we are five years ahead of schedule. Unfortunately, I expect that there will be lots of good ideas bantered about throughout the next 15 months and little change until 2009 or beyond.

In Media Beat there was an article by Kip Sullivan (8/14/2007):

• The call for rationing became audible in the late 1980s It got louder in the early 1990s as universal health insurance rose to the top of the nation’s agenda
• Five years even louder as it has dawned on pundits that HMOs are incapable of reining in health care inflation The U.S. system may be wasting up to 300 to 400 billion dollars a year It would cost 40 billion to cover the uninsured with insurance
• A conservative estimate of the cost of excessive administration spending and excessive prices alone comes to 15 percent of total health care spending
• Excessive administrative spending refers both to the administrative spending of insurers and medical providers
• The issue is whether we could spend less than a fourth of our health care dollar on clerks, HMO police, ad writers, lobbyists, merger specialists, and a host, of other functions who do not provide health care to patients
• Administrative spending grew rapidly as managed care spread. Because HMOs hire people to supervise doctors and hospitals and because doctors and hospitals hire people to deal with HMOs
• If you give a dollar in premiums to an insurance company it will keep 15 to 30 cents for overhead and pay out 70 to 85 cents for medical services
• The GAO found that U.S. providers would enjoy administrative savings equal to 4.5 % of total health care spending primarily because billing for physicians is so much easier when they have to bill just one insurer

Where do we start?

Since the health care system is sick we, who work in the system, should start the process. Modern Healthcare’s August 27, 2007 issue recently ran the article, “Religious Experience” by Cindy Becker in which she quoted Sister Carol Keehan. Sister Keehan is leading us in the right direction. She says, “A good (healthcare) system is not necessarily only one way…On the balance we are not looking for the perfect system…So we’re say as opposed to advocating your plan vs. my plan, we have been working to develop principles so we can say any healthcare reform plan should be measured by these principles.”

Let us begin with the transparency on the information we have; we need to figure out how to share it. We get quality data on how we compare to other hospitals from the insurers. It is only for internal use. Let’s agree to share it. If we are low and it is shared maybe we will work harder to change it. Let’s ask our customers for their EOBs (explanations of benefits paid) so we can see how others are being paid for the services they provided. Let’s share our pricing with our consumers. They need to know before their service what their co pays will be, not after. If we are not efficient, competitive or can’t explain the value difference in price or service then maybe we don’t deserve the business; isn’t that what today’s free market is all about?

For those who don’t take care of their own health insurance when they are capable of doing so, they should bear greater out of pocket expenses. I’m usually not in favor of more government control, but I can vote on tax increases (force those of us in healthcare to reallocate what we do) so why not a single payer system, with true transparency on how hospitals and doctors are actually performing and let knowledgeable consumers decide for themselves.

As bureaucratic as it may be, the fragmented system of managed care is far more difficult a course to navigate. It is a shame with all the wonders of medicine available to us that we don’t have a better system. Sister Carolyn is right. “Until we have that critical mass of American people saying, ‘WE WANT IT,’ things won’t change.” Let’s keep educating those we serve.

-Stan
Writen: August 28, 2007

The Good, the better, the best…Well actually they are all good!

When I got my messages today, my first message was from a patient and it went something like this, “You know I have been there before (to the hospital) and haven’t been very pleased, but I had to use your ER recently and that Dr. G. and that nurse (He couldn't remember her name) were just great… I got first class service and the nurse that attended to me was just super nice, thank you."

The second message I got was from a visitor to our Community Care Center who had never been to our nursing home/short stay rehab before, and was just delighted to see some of the things that make our facility so warm and welcoming. I, of course, am prejudice and think the best part about CCC, the part that really differentiates us, is our team of dedicated Colleagues…However, a new facility with private and semi private rooms, an enclosed garden area with a waterfall and picnic area, our easy street therapy area , the fact that we are attached to the hospital (that has a great restaurant which features some of the best food at low prices), physicians offices attached to the hospital (No more ambulette rides!), an emergency room right down the hallway and 8 wonderful medical directors. This is such a great place to work and practice, I know this sounds like an advertisement so hey I guess it is. I am very proud of all we do and what happens here everyday.

Last call of the day was from a physician on staff. Yesterday he had a special need for one of his patients that needed attention within the next 48 hours, some special type of drug therapy. Actually, this call was to let me know that this request was taken care of today and not only did he get what he asked for but, it was personally taken care of by Paul who leads our Pharmacy team. It was an unusual request and our physician just had to let us know that he and his patient really appreciated the attention to service. These details make ACH/Planetree a special place on an everyday basis. For us service is routine, but these unexpected calls of thanks were a very nice way to end the week.

The Next Joint? Regulator or Consultant

My first experience with the Joint Commission was as an administrative resident. I was responsible for organizing all the materials for the reviewers. I remember how proud I was the survey went well and we received our accreditation. Everyone seemed relieved that we wouldn’t see the Joint Commission for another 3 years. Several years later I remember my friend’s hospital did not receive one Type I recommendation; in other words a perfect score. Were they indeed perfect? Finally I decided to voice my criticism. My organization had again been surveyed and again we received accreditation. What bothered me most were my discussions with the Joint Commission at the outset of the process. Did we have any issues of concern that were quality related? We responded yes and proceeded to ask their help and to even cite us. I am sure many of us have used the line with our staff that we must do it because the Joint Commission says we have too. My last experience that I dare talk about was a few years back in another hospital, we had 17 Type I recommendations. I told our team Pass /Fail was good enough and we passed. Of the 17, several were significant, but most were trivial and corrected within several minutes.

Most of my colleagues in the field, if asked, probably would not invite Joint Commission as a consult, nor pay for their services.Sounds like I am going to recommend we only use them because we have too, but that is not the case.

A recent article in Modern Healthcare discussing Mr. O’Leary’s retirement and all the recent problems attracting national attention in Joint Commission Accredited hospitals certainly raised a lot of eyebrows. It is certainly not the Joint Commission’s fault. Could some of the stories been avoided, possibly and if only one then there is value. Of the 4 recommendations I remember how a critical crash bar didn’t work on an emergency exit. We, as hospitals and physicians, do need to keep raising the bar and change the way we practice. I believe more than ever we need both a stick and a carrot or in this case both a regulator and a consultant. If history serves me right it was the College of Surgeons and others that originally founded the Joint Commission. Several years back when continuous quality improvement became popular the Joint Commission backed off on pushing process (CQI) because of many voices from the field or at least that is the way it appeared. We hospitals and physicians need a partner and advocate who understands healthcare. Having selected Dr. Mark Chassin it seems the Joint Commission believes the same thing. Consumers need better information and knowledge and until we figure out ways to increase our transparency those of us within the field need to push even harder regarding safety and quality.

The following is from Modern Healthcare, cover story, by Andis Robeznieks; Dr. Chassin said he hopes to accelerate change by wider and more aggressive dissemination of proven methodologies for quality improvement. “To help accelerate improvement, you can’t have each individual hospital and health system invent it’s own improvement programs one after another”. Even if successful, there’d be a lot of wasted and duplicated effort.

A good read is Wall of Silence by Rosemary Gibson and Janardan Prasas Singh. Telling the stories is not enough. Let’s partner with Dr. Chassin and his colleagues to keep the things about the accreditation process that make sense and really help, drop the things that don’t and accelerate the sharing process.

-Stan

Measure Success by the number of lives we touch….

Two of our Therapist Colleagues received a note today which read:

“If we measure success by the number of lives we touch and the ways that we reach out to others and truly make a difference, then it’s hard for me to imagine a richer life than yours”.

This is why most of us in health care chose this profession. For most of us patients truly come first.

Kudos go out to Walter and Dan, the two Therapists that received this note. I know each day at ACH-Planetree our Colleagues do touch lives. This note certainly made my day as I hope it did theirs. For me it came at a time when I learned of some incredibly difficult caring and compassion that had taken place by other members of the staff, only to have that experience diminished because parts of a health delivery system where people debate over money and time while patients wait… however that will be a story for another day.

- Stan

Following in our footsteps? Cleveland Clinic and ACH/Planetree

Last week Wendy, our Planetree coordinator at the hospital, e-mailed to let me know we are no longer the only Planetree hospital in the State of Ohio. Cleveland Clinic is going to be a member hospital. Alliance Community joined Planetree in November 2002. Welcome aboard to our fellow health care Colleagues at the Clinic.

Yesterday was orientation for new Colleagues at the hospital. We were expecting 12 new staff members and when we needed extra chairs for the 15 that showed up we were ready to go. I always look forward to meeting with individuals that want to be a part of the ACH family. I get to talk about our culture (more of that in a minute) and I also get to hear how people heard about us and why they wanted to join our team. This morning’s comments were fairly typical, but very encouraging .One new staff member heard about what a great team we had in Pharmacy, another talked about comments they heard at church and being new in the Community checked us out and found what they liked, a third who had been here before talked about nursing and our strides we were making in patient safety.

Years ago I asked the Colleagues in our organization to help me write a book by creating real stories and special moments. I never did get to write that book, but over the years the Colleagues certainly have done their part. I have more stories to share about what helps us bring our mission and values to life everyday. Here are a few I shared at yesterday’s orientation.

“A young lady and her mother walked to the hospital for service; they live about 10 minutes away. They expected to be here about ½ hour for an outpatient procedure. After the procedure one of our staff members noticed the young lady crying and asked her mom how she could help. Mom went on to explain, the procedure went fine, but they didn’t realize it would take closer to an hour and a half from check in to check out. The problem was her daughter who had trained all year for the Special Olympics had just missed the school bus taking them to the event and they had no transport. Fortunately, another ACH staff member who knew exactly where the games were being held was introduced to mom and daughter and drove them the 30 minutes to the event. Several weeks later we received a nice note saying not only did she get there, but she also won a medal.

When we first joined Planetree there were a lot of questions from the staff. How could we do more for our patients than we were already doing? Wasn’t it going to cost a lot more money? For those of you interested in what a Planetree hospital is all about go to one of my favorite links www.Planetree.org and read the tribute to Laura Gilpin. Laura assisted with our first Planetree Colleague retreat and when she was asked the above questions she politely responded “How much more time does it take to be nice versus not nice” and went on to share example after example of how she practiced as a nurse. Laura, Planetree is alive and thriving. You will always be in our hearts.

Stan

24/7 Access

Okay, it is the 1970’s. I remember how cool it was to get a beeper (pager) back in the 1970’s. I was the administrative resident at a 1000 bed hospital and I was now sharing call with 10 other senior administrators at the hospital. This was my week. I looked important. Maybe people would think I was one of the medical residents. I just prayed it wouldn’t go off. All I remember is that one day it did. Something bad was happening, a SWAT team was called and they needed the administrator on call…I thought they were looking for someone to sacrifice…I survived. On another on-call incident, our computer system, a singer something with 23k that ran 23 hours a day to do payroll, couldn’t print checks for our 3000 plus employees. My last memory of the early on-call days, is a bit more personal (sorry Nancy.) Yes, as luck would have it, I’m on call and my wife goes into labor. There we are in the delivery room just moments away from the arrival of one of our daughters… No, the beeper didn’t go off…a person from the admitting office knocks, comes in and announces my wife had not signed the admitting form and could she have a signature…I am not sure Nancy remembers what she said, but I do remember the doctors' words…Get me the damn administrator on call right now… and now flash forward.

This morning my phone rings and I answer. A customer of the hospital wants to voice two concerns about services received; the first at a private physician's office, the second regarding a clinic at the hospital. Both are non-clinical in nature. Actually, it will be a simple matter to follow up on and allow us and the physician’s office an easy way to customize and enhance our services. The real reasons I chose to write about 24/7 access are about to be told. This individual told me that one of our Colleagues at the hospital had given her their business card. All Colleagues who work here have one (we should probably make sure all volunteers do, too). Their name is written on the front along with their Director's name and contact information. On the back of the card is our most important strategy regarding service and service recovery, the key question.. Below that is my personal e-mail address and cell number. You guessed it. I am available 24/7 to back up our Colleagues and their Directors. It used to be at the hospital years ago that when the administrator showed up to follow up on a complaint someone was going to get in trouble. Now, Colleagues are inviting us when they can’t resolve the matter on their own and we are there to back them up. So, today, we got some free consulting advice from a loyal customer. The call ended with the following comments…You know on my last visit to the hospital I needed rehab…a friend of mine recently decided to try the new CCC, so I did, too…they spoiled me rotten…the nurses, the food (special ordered room service when I wanted it), and the compassion and caring. One young lady, after I had made a mess and we had cleaned everything up, hugged me and meant it… I felt like I was with family…This is good, and that is what ACH Planetree is all about… more to come soon.

Stan

Public Trust, taking the High Road, more Knowledgeable Healthcare Consumers

Since this is my first ever blog, I wish it was one of the healthy stories I could be proud of, but it is not. I want to address several points that I believe are important in helping consumers be better buyers of health services. We want you, the consumer, to trust your hospital and doctor; but you need to do more of your own research and hold us accountable. The more you are involved, the better it is for all. Hospitals, doctors and insurance companies make it very difficult for you, the consumer, to have the same information we have on quality and out-of-pocket expenses and the real value of what you get for what you pay for. Sure, there are legal, antitrust, and lots of others reasons why…so with all that being said let me get down to the knitty gritty.

This is Susie’s* story. I will also be polite when I get to the doctors involved who are excellent physicians. Susie went to an appointment with her mother to see a specialist located off campus. Her mother is a resident in the nursing home attached to our hospital. After the visit, the nursing home contacted Susie to let her know the specialist had ordered an MRI and EEG at an offsite imaging center. Susie then contacted the doctor’s office to request that these tests be done at our hospital. Two of the individuals at the doctor’s office told Susie they could not write test orders for Alliance Community Hospital. Susie assured them that if they just sent her an order for the test, she could schedule it at the hospital. They again disagreed, but Susie persisted and indicated to them if it were written on a doctor’s script it was no different than a script for a prescription which could be filled at any drugstore chosen by a patient. So as long as this physician group was licensed to practice medicine in Ohio, Alliance Community Hospital would also accept the orders for the MRI and EEG. Susie told the office staff the reason she wanted them done at the hospital is because the nursing home is attached to the hospital and did not feel she should have to pay the extra expense of an ambulette ($50 round trip) versus a wheel chair ride down the hallway. In addition her mom gets confused when leaving the building and it takes time to get her reoriented.

The office finally returned the call and said they would fax the order for the MRI, but not for the EEG, because the doctor cannot read that test if it is done at the hospital. Susie then requested that they cancel the order for the EEG at the specialist’s office and she would contact her mother’s primary care physician’s office to order the EEG and then have the results forwarded to both her mom’s primary care physician and the specialist who wanted to do the EEG in his office. Susie added we need to find a better way to educate patients and their families.

A couple of final comments. Obviously, the physician specialist could read the test results done at the hospital, but would not get the facility fee for doing the procedure in his office or the professional reading fee. In addition, the patient would have another $50 ambulette fee.

A year or so ago I, the CEO, gave an exclusive reading contract for another service that impacted this group of specialists. They immediately dropped all privileges at the hospital. I only mention this because both we the hospital and this group of physicians want your business in areas we compete in. Many of my friends seek care from this specialty group and I support that. They are good docs.

The key here is when a patient or one of the 1200 colleagues or volunteers I work with request to have services here at the hospital, or for that matter anyone that prefers our service, it should be respected. Too many times over the past year I have personally called primary care physician offices on behalf of patients regarding this same issue. The specialist would often refer these patients to a surgeon in Canton where, in many cases the surgeon would request a repeat MRI at the hospital because the quality of the test results from the facility where the specialist had ordered the test was not adequate. I would hope that this group would start taking the high road and respect their patients’ requests.

Susie, you are right! We need more knowledgeable consumers. Hospitals and doctors must do a much better job of educating and disclosing all the facts of why we recommend where procedures are done, what is the overall quality and value of the service, and definitely consider the cost and service factors important to patients and their families, or we will certainly lose their trust.

Stan
*Susie's name has been changed for confidentiality reasons