Wednesday, August 29, 2007

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.

Writen: August 28, 2007

Friday, August 24, 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.

Monday, August 20, 2007

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.


Friday, August 17, 2007

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

Tuesday, August 14, 2007

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 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.


Monday, August 13, 2007

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.


Friday, August 10, 2007

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.


*Susie's name has been changed for confidentiality reasons