Health Views: The Good, The Bad and The Ugly

Fix Health Care, Don’t Destroy it.

2010-04-08T10:41:00.003-04:00

This is something I wrote just before the Congress voted to pass the health care reform bill. It ran in the local Alliance newspaper and I wanted to share it more globally.

Everyone agrees the current Health Care System is broken.

It is dying and without reform will be financially
unsustainable in 6 to 8 years, but it AIN’T DEAD YET! It
can be fixed, but the current bill being considered is not
the answer.

In earlier blogs last Fall I wrote I came away encouraged
after going to hear President Obama speak on health care
reform and I wanted the change process to begin as quickly
as possible.

Why? I believed it would take an extraordinary
effort and everyone working together over the next six
years to keep it from dying. I must admit I was terribly
naïve to think that our elected leadership (both Democratic
and Republican) could actually work together on something
so vital to our economy and our well being. Sadly, it seems
that there is some type of epidemic infecting our leaders
upon arrival to their offices in Washington D.C.; instead
of trying to work together to bring about change
benefitting everyone, the current process seems to be more
about posturing and manipulating who may get elected or
kicked out of office.

Most of the national media hasn’t
helped much either; instead of helping understand what is
broken and the merits and consequences of needed changes,
they too are focused on how it affects political fortunes.
I am ticked off and feel helpless. I am only one vote and
one voice and admittedly biased... but I love our
healthcare system-there are too many of us –doctors,
nurses, volunteers, and healthcare workers who really care
and are wonderful at caring for people. Before you end up
with health care you will not recognize, you will not like,
and health care that over time you will not be able to
afford as a taxpayer, I need to speak out.

Overview:
Today’s healthcare system is a combination of private
not-for-profit (the majority of hospitals in the country),
governmental, e.g. VA hospitals, Federally Qualified Health
Clinics, and County Hospitals etc, and private for–profit
Hospitals or individual practicing physicians and nursing
homes. I believe most Americans would choose to have their
care in the USA rather than go to another country, even if
their health care funds were unlimited. As imperfect as
this system is, people have more access to care in this
country than anywhere on the planet. The major problem is
how it is financed and how care is paid for, and who can
pay. All I know is Americans have some of the biggest
caring hearts and we usually are at our best when
responding to a crisis and challenge. We have a tradition
of helping those that couldn’t help themselves, whether it
is peace keeping, natural disasters or large challenges
here at home, like the crisis in health care. The
healthcare system is in crisis and what we need now are
leaders and statesmen, not political solutions.

The “political fix” (tampering with a very complicated
system that is about to happen in Congress) will be far
worse than doing nothing. The current system is still
fixable but you can’t fix something if you kill it, which
the present bill will do. We do need government
intervention because “we” that are all part of the system
need a target and direction. This should be our
government’s role in my opinion.

What are we about to destroy? Well in Ohio the healthcare
system represents about $66 Billion of the Ohio Economy and
hundreds of thousands of jobs. One of the greatest “safety
nets” for those who can’t afford to take care of themselves
are not-for- profit community hospitals. In Ohio we
provide just under $4 Billion of care to those that can’t
afford it.

For simplicity let’s address the three major points of the
current health care bill now being considered:

1) You can’t be denied coverage if you have a pre existing
condition(I am actually very much in favor of this,
just concerned with how it will be implemented).

2) Everyone will have coverage.

3) A lot of money will be taken away from the private and
not for profit insurance companies by the government
not reimbursing them as much (roughly $500 billion). In
return, the insurances companies will turn around and
pay less to the providers (doctors and hospitals) for
senior’s health care.

So how do I see this playing out for a Community Hospital
like the one I practice at (similar to about 3000 other
Community Hospitals in the USA)?

1. People with pre-existing conditions can’t be denied
coverage? Does this bill really address how to properly
afford this not only for tax payers, but for people who
keep their current insurance like President Obama said they
could? The way it is structured in the current bill under
consideration will cause all insurance companies to build
in additional premiums to cover pre-existing
conditions—your insurance costs or taxes will go up. How
will all these plans and a government rate commission pay
hospitals and doctors—I can only guess as it appears to be
a secret. Today our hospital is paid only part of our costs
(Medicare pays us about 89 cents out of every dollar of
costs and Medicaid pays us about 78 cents of our costs).
The impact we assume will have to be more increases in
price shifting to those individuals with any type of
employer or private insurance. Again, the premiums for
those with this type of insurance will have to go up. This
will also cause more administrative costs for insurance
companies. Many community hospitals will be left with no
bottom line which means less safety net care and more job
losses.

2. Everyone has coverage. The same patients will be coming
to our hospital as do now. Does this mean less people
coming to our Emergency room for care? Will more doctors be
opening their practices to more patients?
Presently, we have a federally qualified health clinic in
our community which offers free primary care or a sliding
scale of payments based on what patients can afford. So
why do so many more people come to the emergency room for
care? You don’t have to make an appointment and you don’t
have to provide financial proof to determine what you will
pay. You may have better access to a specialist and you can
still sue (most people don’t, but try suing the federal
government clinic.) I don’t mean to be cynical but only
make another point. One of the reasons ER care is so
expensive is to be able to defend lawsuits that you did
everything that was appropriate; you don’t get sued for
usually doing too much, although you may get denied
payment. Bottom line, in my opinion, is more people will
be coming for care in the ER, which is more expensive. Why
isn’t the federal government fixing the problems with these
clinics if there is an access problem to primary care? The
public who have access to these free services still prefer
the private system. If you give them coverage with no more
reason to change going to the ER (which they prefer and is
easier to use) we have only encouraged more use. If the
hospitals were already providing much of the care through
the ERs, why not turn over the federally qualified health
clinics to be run by not-for-profit hospitals next to our
emergency rooms?

3. Take a lot of dollars away from the insurance companies
and force them to create an even more bureaucratic system,
and they will in turn cut payments to doctors and
hospitals. The insurance companies have billions at their
disposal and will not be hurt as severely as doctors and
hospitals. Doctors and hospitals, where profits are less
than insurance companies, will suffer far more. Doctors
and hospitals will take big hits and we now provide the
biggest safety net for those presently without healthcare.
I feel this proposed bill will kill the not -for- profit
hospitals and destroy the current safety net of providing
care for those that can’t afford it.

Final thoughts:
Why can’t a free market exist that is competitive and
encourage best practices of both hospitals and doctors?
There is little economic alignment between most hospitals
and doctors, most hospitals are at a tremendous
disadvantage in negotiating with insurance companies for
how we are paid–we don’t have the leverage. There is
virtually no real transparency (the patient does not know
the out of pocket expenses) on actual costs to health
consumers before they seek care. Where else would you buy
something and find out how much it costs later? Here is
where we could use government intervention and the best
ideas of all concerned.

The way we are paid doesn’t seem to allow for that. Paul
Levy, an administrator in Boston of Beth Israel Hospital
and the CEO of St. Lukes, who runs the most cost effective
hospital in Toledo, knows insurance companies set the price
and many hospitals are paid far less than others, even if
they provide the exact same service.
Insurance companies put in our contracts that we can’t
disclose the price they negotiate with us for services. Out
of pocket expenses are a much greater part of an
individual’s health expense today. How can consumers
actually shop and compare price? Doctors and hospitals can
compete and lower or bend the cost curve. We need a level
playing “field” and competition and transparency and
consumers with a stake in the game.

Medicare is not broken; most seniors I know appreciate it
and the care they receive. The funding mechanism is broken
and there are too many boomers who are looking forward to
Medicare (me included but they are already talking about
means testing and raising the age limit on eligibility).

There are pilot projects around the country to start
working on economic alignment between doctors and
hospitals. This has the potential for stimulating a free
market response to best practice. Why does it take the
government years to implement this...because it is a very
complicated system that is government run? I wish our
government leadership would follow this path to challenge
us in the system to compete with each other and redesign
our system. It would happen much quicker in the private
sector.

We need Leadership and Americans working together. We have
sent good people to Washington. Please STAND UP AND BE
HEARD. You represent us. For god’s sake and ours start
working together. We can’t afford for you not to!!
Please call your Congressman and tell them doing nothing is
not an option, tampering with a system without fully
understanding the consequences is far worse, so start
working together with the best ideas of those of us who
work in the system each and every day.

Sincerely,
Stan W. Jonas
CEO of a Not-For-Profit Community Hospital
Alliance, Ohio

This Advertisement was paid for by Stan Jonas.
It expresses his personal opinions and not necessarily that
of the hospital, its doctors or staff.

April 5th

2010-04-05T21:12:00.002-04:00

Last week I received a call from Eileen, a recent patient in our therapy department. The following words were used in her voice mail regarding her 16 trips for service: “very professional . . . everything was first rate . . . everyone was knowledgeable . . . if not for them, I wouldn’t be walking around and feeling good.”

I wanted to let our therapy department know that our patients are constantly calling in to express their thanks.

My thanks again to our team of dedicated colleagues for what you do each and every day.

Stan

Words Say A Lot

2010-02-08T11:21:00.000-05:00

February 8th, 2010

A very satisfied customer…Words say a lot

I can’t say enough good things about everyone. You could tell it was a good environment. Mostly worked with Linda and Tricia, also Aaron and Tiffany…felt could always ask them anything…they were just outstanding. I chose to come to ACH Therapy and will definitely recommend them.

Last Blog of the Year

2009-12-31T17:22:00.002-05:00

December 31, 2009

To All Our ACH Colleagues, Physicians and Volunteers…and Board of Trustees

I haven’t blogged as often as I would have liked this year but I definitely wanted to end 2009 year by saying how proud, fortunate, and blessed I am because:

1) I have the opportunity to work beside/with so many dedicated and passionate people.
2) I am graced with such meaningful work; to actually be paid to do something I truly love to do.
3) I have my family and my health,

Bearing all this in mind, I'd like to share some comments from a letter that was sent to several of us here at ACH from the family of a patient:

"…thanks and love to all those who participated in the recent care of our father and for all the kindness shown to our family as a whole…"

"Over the years Dad had been hospitalized at several of the area hospitals where he received great care … but here at Alliance Community Hospital, we received much more than health care and it all started at the front door…"

"We want to thank all the Ambassadors, the pink ladies and gentleman, and the cafeteria staff for their words of encouragement and keeping us fed…"

"To Security who watched over members of our family who left the hospital late into the night…"

"Our gratitude to all the technicians from the Lab and the Respiratory department and everyone whose skills and kindnesses were shared with our father…"

"We want to thank Housekeeping who worried and cared so much about us…"

"To all those behind the scene who are many times overlooked -- may we thank you for your expertise and kindnesses…"

"And lastly we want to extend our love and most heart felt thanks to the Nursing staff … your care, concern, and compassion went beyond measure…”

As for me, I can only add what I observed as someone who wanders about the halls of our organization… it was a total team effort!

Thank you, Dr. K and to all ACH team members, for reminding me, as always, what caring is all about -- and for inspiring me.

Stan

First E-Mail of the Day

2009-11-09T15:53:00.000-05:00

November 9th, 2009
Great way to start a Monday…First email of the day

Comments: I would just like to say that I have never had a better experience with any facility/hospital as the experience that I had with yours. My boyfriend's mom was there - the hospital stay was short n sweet - she had a hip fracture - 87 years old - it was within the rehab facility that our experience was so awesome and words cannot express the feelings that we came away with after her stay was over.

First of all, Becky RN - Brandi PT - Amy PTA - Lana PTA - Rachael OT - just a hand full of employees that I would love to give them endless thanks and praises for their continued effort, kindness, and professionalism - and so much more.

I worked in a hospital for 4 years and would have loved to have had the opportunity to work with a group of individuals as great as these. Everyone, including Samantha, Elisabeth, Kathy (from hospital), and a couple of the other social workers were there for us also. His mom is supposed to get in home PT and OT - and we are so disappointed that they won't even measure up to the group you have working for you.

We really do miss them as they not only helped - but enriched our lives as well.
Thank you for them - please let them know that we really did appreciate...

Way to go team.

Stan

2009-10-29T16:18:00.001-04:00

October 30th, 2009
This says it all !!!! Here's a recent comment I received.

"Dr. Kuentz, the nurses, and nurse aides on 3 east, and the respiratory therapists treated Dad as if the best part of their day was when they were in his room…"

Thanks to our ACH physicians and colleagues for what they do each and every day.
Stan

Inspiration - - An ICU Wedding at ACH

2009-09-29T12:14:00.002-04:00

September 28th, 2009

I haven’t written a blog for quite sometime and have been gathering my thoughts to continue to write about health reform and make the case for why change is so desperately needed.

Somehow after receiving an e-mail from Amy (one of our nursing supervisors) that subject --although important-- needed to take second seat to a more important story.

This past weekend many of our colleagues helped create a beautiful experience for the family and friends of one of our ICU patients. Amy did such a nice job of describing what occurred that I want to share her words with you. She and I both are so very proud of our team, their compassion, and how they choose to go about their work in service to others in such a special way. Here's Amy's summary:

We currently have a patient in our ICU who has been with us (in some capacity) for nearly two months. She is from the Youngstown area and initially came to our facility as a patient of Dr. Hudzik. Unfortunately, her health has continued to decline and her chances for survival.

(Over the time she's been with us ) the nurses in ICU have bonded not only with her, but, also with her family. Her daughter is scheduled to be married sometime near the end of October. As time goes by, it is becoming apparent that she won't be able to attend the wedding, and may not even survive until then. So, the family asked if they could have a ceremony in her room in ICU for their immediate family. (Critical Care Director) Deb Clemens got the go ahead from all the necessary folks and the date was set for 9/26 at 9:00pm.

The nurses in ICU stepped up and began planning an informal celebration for the bride and groom. I can't even begin to list all the things they did, but, some included: cake, many, many decorations, food, balloons, punch, music, and even a dress for her to wear. All the patients in ICU were informed (of our plan to host a wedding) and, if they chose not to participate, their curtains were shut during the activities.

Most of the families visiting other patients participated and one family even bought a second cake! Many of the ICU nurses and secretaries even came in on their day off -- on a Saturday night.

A little after nine, the couple was married in her room with their minister and then had a small celebration in the conference room. I'm not sure how much (the patient) absorbed, as she was getting worse throughout the day, but her family could not have been more appreciative and I could not have been more proud of the ICU staff and our hospital.

This probably isn't listed on any Planetree pamphlet as a service we offer, but it was, without a doubt, a very Planetree effort.

August 12th, 2009 - More on Health Reform

2009-08-12T12:33:00.002-04:00

Ever since I came back from the health care forum recently held in Shaker Heights, I have been wishing the momentum begun there would continue and that leadership would step up and work together. Well, obviously that is not the case. We are losing sight of why change is necessary and confusing the general public. Right now, we are witnessing democracy at its worst. We need out leaders to rise to the occasion and stop making this a win/ lose situation. What is missing?

Those of us in health care leadership need to remind our patients and their families what is really broken in the system. We need to explain that the system we have in place now is unsustainable. We need straight talk. As more “Baby Boomers” enter and lose health insurance (from their employers), we are finding that: 1) the current system, if not improved, will implode in about six years, 2) the ranks of the ever-increasing number of unemployed people is exacerbating the situation even more, and 3) doing nothing is not an option.
The government is tackling this mess with the same old political process, with likely the same old political results: someone will win or lose based on votes -- or worse yet, we will get a compromise. Merely tinkering with the system is the worst thing we can do. In this case the end doesn’t justify the means and how we get to where we need be is vital. We didn’t get to the moon or develop the means to perform transplant surgeries through political processes. Where are the best and brightest who understand our health care system and why aren’t they working together under the direction of the current leadership? This issue is too important for all Americans for this overhaul to fail because of stereotypical politicking. And there is a huge difference between keeping a political promise and doing the right thing.

We in health care are forced to ration our services every day in one form or another. We over-utilize in some respects, in order to protect our selves from lawsuits. We compete with each other to make the claim of “full service.” The way we receive monetary reimbursement (which allows us to be able to afford to function) often relates more to negotiation skills rather the basis of our true costs as a health care provider. The public can’t decisions on what is best (even from a price standpoint) because of an unseen “middle man” who negotiates on their behalf. They are not allowed to know rates for health care services in advance of receiving them. They learn their out-of-pocket expenses after the fact. How do the insurance companies really help manage care? Let’s face it, everybody wants the health care we are capable of delivering. It’s just that, more and more over time and due to this broken system, we just can’t afford to offer it. So where is there value added? Where is the waste? With all these supposed and proposed changes, will we have an affordable system? If not, do we redefine the old economic question: “Do we produce more guns or butter?” or to put it another way: “Do we produce health care the same old way or not save our economy and our future?” Sadly, that is our choice at the moment.

Health Care Reform

2009-07-29T22:00:00.003-04:00

July 27th, 2009

Health Care Reform…

What is Being Said; What is NOT Being Said - and Why We had Better CHANGE

Last week I went to hear President Obama speak while he was visiting Shaker Heights. I came away from his speech inspired and even more focused on looking at our own health care costs in our hospital and our community… and in consideration of what are we doing to change ourselves and our system.

At ACH, we are just a microcosm of what is happening on a national basis. Compared with larger cities in Ohio and to other health care facilities in the region, the cost of care in Stark County is far less than in most places, yet, it is getting more expensive all the time. We are self-funded in terms of health coverage for our hospital employees. If the current trend continues we will drive ourselves out of business because our own health care costs are simply too high.

The most important message I heard President Obama give is this: all of us should be demanding change and the quicker, the better. Health care is hurting the economy big time and just because we haven’t experienced job changes here at ACH yet, it is a fact many Americans have and many more will. I believe the President should keep pushing the issue. I wish he would appoint a group of objective experts (with no political agendas and who are simply inspired by the desire to do the right thing) as the team to take a fair plan to Congress and urge them to get it passed. Now that would be real change.

It wasn’t long ago I heard Tom Daschle and Tommy Thompson’s recorded comments agreeing on almost 80% of the things that should be done to fix health care. Why not start with that list?

What happens when the stimulus dollars for Cobra-assisted health insurance runs out? Many hospitals have already had layoffs.. Fortunately, we have been able to avoid this at ACH to date. Yet, how much will laid-off employees be spending for their Cobra plans? At our hospital, we offer three health plans. For those employees utilizing our highest level of coverage, it would cost $22,000 for family coverage. The least expensive option plan at ACH (which includes an HRA) would still be $9,000 a year. Both plans are extremely costly, particularly if you are receiving only an unemployment salary.

Somehow, we have heard so much about the uninsured that many of us with coverage haven’t really taken a close look at what is actually happening to both us and to the health care system as a whole. What is not being said is that there really isn’t enough money around to make the current system work and that we all are going to have to pay more, expect less, and assume more responsibility for our own health care costs and our own individual health, period.

I can’t change what is happening on the national level but I can begin at home by trying to impact change here at the local level. I want to double check our statistics, but a few years ago the hospital was paying about 70% of the cost of family coverage and 94% of the health care costs for single coverage for full time employees. Today those numbers are 85% and 88%, respectively. Our costs of care have skyrocketed, so our employees are paying more for family coverage even though their share of the costs is actually down from just a few years ago. Similarly, singles are paying more of their costs on a percentage basis and yet, there is less money for wages and needed investments today.

It is clear that we need to redesign our health benefit plan to include incentives for taking better care of individual health (and that of dependent family members). We need to promote transparency so that people can know what their out-of-pocket expenses for health care will be PRIOR to receiving services. We are part of the health care system, so we need to teach ourselves and others how to shop for health care smarter.

At one time in my career, I was in favor of a single payer system that was not necessarily public or private. I was just trying to simplify the paperwork and bureaucracy. But perhaps the most useful single payment system would be one that is not entirely unlike the one I hear the President suggesting. With an ideal single payment system, pricing should be known in advance of service. As it stands, billing and the payment of insurance claims are far too bureaucratic and costly and the buyer is too disconnected to be able to determine the best way to spend their health dollars. Transparency and competition in health care care will benefit all consumers. It will help ensure accountability -- either by forcing us to pay more for health care services services by choice or by forcing us to take better care of ourselves -- or both.

I want to give President Obama 100% of my support for demanding that the system change and I wish that he would not relax his timetable. Hopefully he will find a way to get something done in Congress without having to bargain for it. Let's hope he will be able to encourage his peers (i.e. fellow politicians) to do the right thing.

-Stan

P.S. There is very little with which I could disagree in President Obama’s Shaker Heights presentation, but there were two comments he made which gave me extra consideration. One such statement was a remark about how people in unions are not actually receiving pay increases because their health care costs are going up faster than their salaries. The truth is, this problem is affecting all employees, both union and non-union. Likewise, I agreed with his assertion that the Cleveland Clinic is a world class health center, but I am unconvinced that it is the model of efficiency for our own health system. If you drove down the road an hour (within Stark County), the cost of your open heart procedure could be almost $100,000 less than it might be at the Cleveland Clinic. That is why we need known pricing and transparency. Our health system is ready to compete -- we must change our manner of educating consumers so that our businesses outside of health care can compete globally.

2009-07-13T15:47:00.001-04:00

July 8th
Headed off for some vacation, but before taking off, wanted to play some catch up from a few stories from 2009…

From JC: Miracle Workers

Summary from 55 days of ER/ICU/Community Care/Rehab:

I could go on forever…but let me summarize:
~Dr. Catalano and the ER staff were so helpful
~I equate the care I received at CCC to ICU and ICU to the best
~CCC/rehab colleagues are miracle workers. I am confident that my husband would not have walked again without Mike,Amanda,Maggie and Carol
~Outpatient therapy continued to work their magic

From CB:
Three surgeries this past year, the last from Dr. Palutsis, he was excellent. The whole hospital, atmosphere was just unbelievable.

Just wanted to recognize certain people. Bob Mick night shift, the rest of nurses on # East and Lori in Nuclear medicine, she was right there by my side and she was wonderful.

Anonymous: Thank You to my doctors. Dr Kolb, Dr. Byers, Dr. Johnson and Dr. Singh

It Has Been A While

2009-07-07T15:45:00.002-04:00

July7th
It has been awhile… but my inspiration to Blog was triggered by a card received from a patient. It made my day and I am sure it will make others'. It was that simple reminder why we are all here. In the midst of all the distractions and interruptions that divert our focus, a reminder that the patient should be at the center of all we do was and is a good thing.

In her card, M.D. writes:

“I have been to the hospital and to several doctors' offices many times…recently I became very ill and visited the ACH emergency (department)…I was treated with compassion and kindness and felt so comfortable with my care…I never met a doctor who made me feel he had all the time I needed to answer all of my questions and really cared about me, as (did) Dr. Bosch…I will always be grateful…the nurses couldn’t have been more attentive and their kindness will always be appreciated…a special thank you to Rhonda and Debbie…I am so proud to let others know what a great emergency room and hospital we have in our community."

Great work. Glad to be part of the ACH family.
Stan

The Planetree Difference

2009-04-08T11:54:00.001-04:00

April 8, 2009

Haven’t blogged for a while, so might as well start off with a really good one.

As I was walking through the Café this morning a good friend of mine stopped me to say “Hi.” Although she was here on community business, she wanted to talk about her family’s experience of being in a Planetree Hospital. She asked me to pass on comments to all of the appropriate personnel and colleagues --- especially those in our ICU.

Her father recently passed away here and she said that the total support and care given to her dad and entire family and all the accommodations that were made, left her feeling that there was literally nothing more that we could have done. She wanted to make sure our colleagues knew how much they were appreciated by all of the members of her family. Obviously, she said she could see the differences of being in a Planetree Hospital and how our staff seems to know just how to demonstrate their compassion and caring.

Recently, I had the privilege of attending the National Healthcare Conference in Chicago. There were many relevant sessions that I attended that will assist our organization, but the most rewarding and beneficial part of experience was the chance meeting I had with the author of “Why Hospitals should Fly,” Mr. John Nance. His book should be required reading for all who are interested in patient safety and quality in hospitals. Although some may view it as being farfetched and idealistic, I feel we need more writings of this nature that are transparent in a very meaningful way. It clearly identifies a very necessary cultural change that is needed in many of our hospitals.

Hopefully, it will inspire our organization as well as many others.

Going from Good to Great

2009-03-17T12:38:00.004-04:00

Going from good to great….all it takes is a willingness to want to be the best.
March 16th, 2009

Today was a good day. A colleague told me about a personal health caring experience regarding herself and one of her family members. Overall everything was really, really good….but yes; there was a but.

Treatment in the ER was appropriate and comforting…her relative was admitted and the family was advised that the surgeon would be in very early in the morning to meet with patient. Expectations were set and the whole family organized themselves to help. All their planning didn’t work out as well as expected and many things had to be rearranged because the surgeon’s and hospital's timetable changed by almost five hours. I am not sure whether the timetable could have been adjusted. Perhaps the only thing which might have helped would have been an explanation about the reason for the delay as soon as it could have possibly been communicated, so that the patient and their family would have been expecting the delay.

Is there a learning lesson here?

Having this discussion reminded me about something that is special about the way we practice here at ACH.

What is interesting to me is how often patients and members of their family use the words “I really don’t want to get anyone in trouble” and truly, they don’t. However, they do want someone to understand what dissatisfied them and didn’t meet their expectations -- or why their expectations were not met. Just as often when I follow up on a complaint (which I consider a great opportunity to do something better), I here these words from a colleague or a physician: “You have to hear my side of it”. Usually they are a little startled when I say that I don’t.

Then I go on to explain why. I let them know the reason I don’t have to hear "their side," is because I believed whatever they were doing, they were trying to do the right thing. The point is the customer, or in this case the patient, is always right. What is most important is that we have an opportunity to figure out what we could have done to meet or exceed their expectations.

Time is critical, especially if the patient is still at the hospital -- and the focus should always be on how could we make it better. If we are willing to accept constructive criticism, knowing that no one will get in trouble, and focus on what could we have done differently rather than worrying about explaining what happened, we are well on the way from going from good to great.

Below is a message we give to patients when they come into our facility. I think it is worth repeating. We actually tell our patients our expectations of them. We encourage them to express their complaints to us.

A Welcome To Our ACH/Planetree
Customers and Guests, Families and Friends
We, the Colleagues, Physicians and Volunteers are striving to help Alliance Community Hospital (ACH) become the Premier Community Hospital in the State of Ohio, which means:

The Best People Providing the Best Service and the Best Place To Work

As a Planetree Hospital our models of “Health Caring” are cultivating an environment and service philosophy that combines the best of hospitals with the best of spas and hotels…where just being here begins the comforting or healing process.

Our Expectation of You, our Customer and Guest
We can only achieve this vision with your help. Throughout your visit or stay here you will constantly be asked “Is there anything else I or a fellow colleague can do for You?” This is your cue to let us know how we could go from being good (in your eyes) to being great, or if we haven’t met your expectations, how we might do so. Other hospitals may view your advice or suggestions as "tattle tales" or getting someone into trouble; we view them as free consulting advice.

So please when you are asked, let us know the little things that you would appreciate to make your stay or visit with us special or more comforting.

Every department or service you visit or use has their Vision and Health Caring Standards posted or published. Please look for them and read them. We know we are not perfect and there are times when if you were rating our service you might not be able to say it was excellent. Please take the next opportunity when one of our colleagues asks “Is there anything else I or a fellow colleague can do for You?” to let them know what would help you or perhaps the next customer or guest. We thank you in advance for helping us help others.

During your stay or visit with us any of our colleagues may offer you their business card. On the bottom of their card is the leader of the service or department with whom the colleague works. If the colleague can’t respond to your request directly, their boss is available to help back them up. If for any reason they might not be able to respond to your need, feel free to turn the card over and contact me directly, Stan Jonas, CEO, Alliance Community Hospital. My direct business and home numbers, along with e-mail, are also listed. We know every one of our customers and guests are individuals and everyone may have different needs.

Again, we value your opinions and suggestions and for helping us to continually improve and pay attention to the things that are most important to you our customer and guest.

Sincerely,
Stan W. Jonas, Chief Executive Officer
Alliance Community Hospital

Sometimes people still are hesitant to express their dissatisfaction until after they have left the hospital. So, if the patient or the family member is hesitant to express their feelings, how might we encourage that?

The easiest way is to always ask our strategic question. "Is there anything else I or a fellow Colleague can do for you?" It is what differentiaties us from our competition each and every chance we get.

Thanks for listening.
Stan

Catching Up . . .

2009-02-11T15:01:00.002-05:00

February 11, 2009

Catching up… an opportunity and two letters from January.

Yesterday one of our out patient guests called to suggest we do something about improving the
parking for patients and visitors of our professional office building on Arch and State. The good news is, it is very busy with many patients and visitors coming and going… the bad news is, sometimes the folks who shouldn’t walk far (particularly in inclement weather) are parked in spots that are the farthest away from the entry doors.

Although we hand out information throughout the campus about our Shuttle Service, many of our patients and guests are still not aware of how to take advantage of that service. Dan, who is the most frequent driver of our shuttle (which is a white Toyota Scion), carries a cell phone,330-417-5454. If you call him from your parking spot, he will pick you up and drop you off at the entrance which is most convenient to you. At the conclusion of your service, you can ask an ACH colleague to call Dan and he will bring you back to your car.

In January, one of our patients (J.W.) wrote, “Dear Mr. Jonas: During the night my temperature rose to a disturbing level and my nurse called a 'rapid response'…a team brought me back to normal with compassionate and loving professionalism…I ask that you express my appreciation to all the registered nurses, aides, and clinical technicians who treated me with great respect and skill…also commend your housekeepers who were also very friendly and caring. I would be remiss not to include Dietary who accommodated my special needs…(what a) wonderful hospital staff for the Alliance Community."

Also in January, our nursing supervisor received a call from the wife of one of our patients. She wanted to tell us about the excellent care that was received in the ER, "especially Dr. Kolb and the nurse that assisted… Dr. McNally picked up with Dr. MkParu.." She wanted all to know how grateful she was.

Hope to talk with you soon.
Stan

Thanks to All

2009-02-09T11:56:00.000-05:00

February 9th, 2009

C.T. writes:
"During a recent visit to my family in Ohio I became very ill, necessitating a visit to the ER…from the first person who I encountered …to the last person that discharged me, everyone was professional and kind. Lynn was very efficient and so caring…the radio logic technologists were also very professional and used two patient identifiers…I am sorry didn’t catch their names. They were instantly by my side when I needed them due to my medications……the doctor, nurses, and ancillary staff that took care of me were exemplary. Please convey my thanks and praise to all of them."

More Comments about Therapy Services

2009-02-09T10:45:00.002-05:00

February 6th, 2009

Once again therapy saves the day! Here are some other positive comments I received:

~D.P. called in to say he was going through a very bad situation until he got to our therapy services…All he could say was "excellent…couldn’t thank Tiffany and Gail enough…they were just super…P.S. what a great laugh Tiffany has!"

Say What You Mean & Do What You Say

2009-02-05T23:01:00.003-05:00

February 6th, 2009

Say what you mean and do what you say … touched and inspired by words of support.

("Everyone can shave a little if they have to...")

Just prior to Christmas 2008 we held special Colleague forums at ACH. Usually, every month for the last 12 years, I have held communication forums through which I update the staff and anyone who works or volunteers at the hospital can ask me questions.

The intent of this special forum was for me to ask people to be conservative in their personal spending as well as watch our hospital expenses. I wanted to share my concerns that 2009 and 2010 may be tough years as we try and turn our economy around. I really didn’t want to have layoffs in the future and wanted to let everyone know that we may need to take actions that would affect people’s incomes, in order to keep Colleagues employed through the tough times ahead.

Personally I told them --as a leader who might be asking them to take time off each month (without pay)-- that I would begin January 1st by voluntarily reducing my income by just under 7%.

We will watch our monthly performance and I will first ask management to take off one day per month. I will give them 30 days notice of putting that into effect. I wanted all staff members to know that leadership needed to step up.

The above is just one example of what we may have to do in 2009. I also stressed that this is a great time of opportunity for us, as well, because of the culture in our organization and the way we practice. We need to be thankful for every time a patient or customer chooses us and puts their faith in our hands with regard to their healthcare needs.

Several weeks after this presentation I was deeply touched by a message I received from one of our Colleagues. They told me they appreciated my actions and they, too, wanted to help. This Colleague makes around $20,000 per year and told me that "everyone can shave a little here and there if they have to," so they wanted to give back $50/month. They said how very much they appreciated their job here and felt they needed to help. too. I told them when the time comes I will take them up on their offer but for the time being, hold off.

As I was writing this blog today I was interrupted by a call from one of our outpatient guests…more to come tomorrow.

Stan

A Look Back, A Look Forward; Some Old & Some New

2009-02-05T14:10:00.002-05:00

February 5th, 2009

2007 and 2008 have proven to be very challenging years for hospitals and health systems, particularly for those with variable rate municipal bonds and for those seeking access to new capital to continue to replace and upgrade equipment and facilities.

In 2007 the phrase "sub-prime" took on special meaning as many of the risks associated with variable financing that had never previously occurred -- actually happened. For some, interest rates on millions of dollars worth of debt hit double digits (in some cases, going as high as 20%). Fortunately for us at ACH, our rates (not quite) doubled from 3.5% to over 6% and only for about four months. Again in October 2008, for only 9 days, our rates hit 9% and then returned to normal. While many organizations were fully invested in the market, we have been financially conservative (earning our 4-7%) and we have learned to operate on what we make. So, while the market has been devastating to others, we were very fortunate to complete our new campus in 2006 and avoid huge losses in the market in 2008.

I remain optimistic about our future for several reasons:

First and foremost is the spirit of cooperation with our medical staff in terms of finding new ways to support each other and to serve our patients even better. We know in the future there will be shortages of primary care physicians and we have been able to recruit three additional family doctors to serve in Louisville, Alliance, and in new markets to our north. In addition, we have signed two new radiologists and will have, for the first time in a while, a total of three serving our community. We have a great team of dedicated colleagues and volunteers who exemplify the meaning of patient-centered care every day. Below are summaries of some comments from patients or their families that were received before I started my Blog, as well as some very recent ones from this past fall and our winter season:

OLDER SUBMISSIONS ~

A pat on the back, a hug and a handshake, who could ask for more…
One of our colleagues was seen walking an elderly gentleman to the lobby. Another colleague overheard the patient say, "You’ve been very kind to me. Thank you so much.” As usual our colleague asked “Is there anything else I or a fellow colleague can do for you?” The patient said no, but as they left he patted our colleague on the back, hugged him and then shook his hand. I was wondering what he might say about his health caring experience, but didn’t have to wonder long because as he was leaving he was already sharing his story with his wife.

A touching moment...
Dear Stan:
I had to write and tell you about a touching moment I had with an elderly gentleman that I discharged from PCU. Before he left the floor, he told me he received excellent care here and that all the nurses were excellent. He wanted me to pass on those words to all the PCU staff. He requested accompaniment down to his car, so I went with him and his two daughters to the car. As he was getting in I shook his hand and thanked him for letting us take care of him and how much we appreciated the opportunity. He looked at me sort of funny and then asked him why I would thank him? I told him that of all the hospitals in the area, he chose Alliance Community Hospital to provide his care. He took my hands(he had tears in his eyes) and he said, "I never looked at it like that, but that is a sweet thing to say and now if I ever need care Ill be back for sure.” Now I know I will not forget to say thank you to my patients.

A donation…December 23, 2004...
Dear Stan,
The enclosed check is in appreciation for the wonderful care I received from your exceptional staff during my recent stay at ACH. Enclosed was a very generous donation to our Foundation.

Health Caring Nurse...
"Kudos to the health caring nurse who [probably didn’t see me observing her as she greeted the person she was caring for with a warm and friendly, "Hi Mrs.____., I am here to help you with your medications." All I saw was an individual who had so much to do on a very busy floor, yet gave an impression of not being rushed at all. She stayed by the bedside and sat for a very brief moment, her patient smiled and thanked her and in the next moment she was off to take care of someone else. How you do things sure does make a difference."

The following was presented to our colleagues early on in our Planetree journey and judging from the comments above, it is the way most of us choose to practice each and every day...

Your Role (As a Member of the ACH Team) is to Create a Great Health Caring Experience;
Find that next right answer to do the extraordinary for just one person, be it a patient or by assisting a fellow colleague

I. All of our patients expect good clinical care.
They come to us because they or their physician have determined they need to be in a safe, comforting environment to receive more medical information or treatment.

II. What most patients are not expecting, and it is surprising how few hospitals still don’t provide them, are the simple courtesies of our five Health Caring Standards:

· Acknowledge their presence in a warm and friendly way
· When appropriate, address by name
· Provide a friendly, timely and comforting discharge or departure
· Thank them for allowing us to care for them
· And most important of all asking them, “Is there anything I or a fellow colleague can do for you?”

III. Think of your role at ACH as a cast member in a play that performs three performances every day, 365 days a year. You have been selected because you possess job skills and knowledge to perform in that role. Every day you’re blessed with an audience; many are new and some audience members are returnees. The best actors on Broadway do what they do each and every day … create special moments - they take their daily routine, which they do over and over again, and make it special over and over again for every audience. Each one of us possesses special talents to go with our job knowledge and skills. Your role is to find a way to express this talent either in your job or on a Planetree Caring Committee and to do something extraordinary for at least one patient/customer or guest a day.

Thanks to all who are making a difference each and every day.

-Stan

MORE RECENT SUBMISSIONS ~

Missed meal...
This past fall, one of our patients was very disappointed the afternoon of their discharge. When asked why they responded that "my favorite meal was ordered for dinner and now I will miss it." Speaks pretty highly regarding our nutritional services department. When our supervisor in the department found out, they contacted the husband and wife and arranged to have their favorite meal delivered to their retirement villa several miles out of town a week later. Now that is service the ACH way.

Jan. 19th, 2009...
Mr. Jonas:
This is a belated and remiss thank you and kudos to all your staff that served my wife and me last June. Carol, one of the nurses and Dr. P. our physician, especially. At any rate, we were continually amazed at the service from each and every department. The office and financial staff answered all our questions about costs and (in advance) worked out a pay schedule. Pre-op informed of what was going to happen and answered our questions very patiently. Jennifer met us in the lobby and was very sympathetic and helped ease our anxieties. Nursing and the therapists were attentive and gentle, yet assertive with their expertise and still flexible in working with us. The chapel, outdoor gardens and lobbies were peaceful. Our room was clean and full of amenities. And yes, the cafeteria food was diverse, well prepared and delicious. Of all the services (and perhaps the most surprising) welcome was the Concierge service. The concept of welcoming and orienting the clients could not have been executed more faithfully. Our stay exceeded our expectations in every way and could not have been better. The quality and depth of your facility’s mission was evident in every aspect of the facilities and services. We have raved about our exceptional experience that eased a health crisis into a very good and memorable time of challenge. Please pass this thanks on to all.

Cardiac Team...
I am writing to compliment two members of your Cardiac Rehabilitation Team, Kelly and Dave. My interaction with them has been very positive and I wanted to make sure you knew how important they have been. Kelly’s sincere interest in my personal medical situation put me at ease…She went out of her way to explain details…her medical knowledge was impressive…Dave was awesome when it came to the physical aspect…thanks to his personal attention I was able to stop all pain meds within a month and am now pain free…they genuinely practice “quality patient care” in every aspect of what they do.
Sincerely,
B.

Dear. Dr. M:
First of all, I just want to say thank you. I deeply appreciated your expertise and good judgment. Would you also thank your associate Dr. H. for he helped me assuage my fears by his kindness… overall my experience at Alliance Community Hospital was 5-star…a wonderful staff.
From G.M.:
Don’t want to name any one person since everyone has been great! You know, (I had)an experience many years ago was not that favorable but I must say I can’t find one thing to complain about…you can always improve something but this visit and stay has just been great.

From J and M:
My husband was scheduled for a knee replacement in October. We arrived at the hospital at 6am and were met by Jennifer and you thought we were checking into a 5 star hotel not a hospital! J’s room was 373 and the nursing staff was wonderful, Lois, Natalie, Emily, and Debra. All the CT’s were great. You would have thought these ladies were family instead of someone assigned to take care of you. It didn’t matter what you asked they always took time to answer and help. If I ever need another hospital visit I wouldn’t hesitate to come back or recommend your facility.

An anonymous call...
Please thank big time Bob, John, Kristen, Cathy, Tiffany and Gail! (Although the caller didn't identify an area, my guess is this person was referring to therapy services.)

There's a slice of the kind of feedback we've been receiving.
Thanks team,
Stan.

Phone Call

2008-08-04T14:46:00.001-04:00

I just returned a phone call to the husband of a recent patient and found that you can learn a lot from the way people describe their experiences. According to the caller, he and and his wife are new to Ohio and they have visited hospitals in many other areas. Here’s what they had to say about Alliance Community Hospital:

“Wonderful stay, keep it up. Don’t know what you are doing but the caring attitude from groundskeeper and maintenance crew to everyone we met…made us feel like we were in a hotel. And that one male nurse on PCU--he was really concerned and caring and so attentive…Usually (in a hospital setting), you find someone having a bad day-we never did. We will be writing a letter to the colleagues here.”

I look forward to hearing more from them.

Talk with you soon-
Stan

July 28th Note

2008-08-04T14:01:00.002-04:00

Well, I certainly can’t say it any better than was stated in a note written to me on July 28th by one of our patients. It read:

“Thank you so very much for your services. Joann in out-patient is AWESOME!! Our time at Alliance Community has been above and beyond our expectations. Dr. Mitchell and Dr. Hudzik are the best! Again thank you ACH team.”

Thanks for taking the time to share-
Stan

Happy Birthday to Me!

2008-07-28T16:17:00.001-04:00

Today is my birthday…and aside from getting many birthday wishes I received two great compliments regarding our Colleagues and the caring Planetree environment and great services we provide. What a nice present; way to go team!

First up, another compliment for our Therapy team. Whatever they are doing in Therapy Services, it seems a week doesn’t seem to go by in which someone calls me to talk specifically about Therapy Services and their very special team.

1) Therapy…
A Therapy patient called in today to discuss what a wonderful experience she had in our Therapy department. “Everybody was so nice & friendly. Thank you!” she said.

Secondly, I got a visit from a Colleague regarding Planetree.

2) So Proud to Work at ACH…
One of our Colleagues came in to talk to me about how proud she is of our hospital and how much she enjoys working here. She said her mother is a currently a patient at another local hospital and she cannot believe how unfriendly the staff is. Some of her comments included, “They do not offer to open doors or assist you in anyway as we do at ACH. The food is terrible and the hospital is dirty.” She went on to say that her mother commented, “These rooms need cleaned.” The Colleague said that the room her mother is in is a makeshift ward with two beds stacked atop each other. “You can hardly get through they are crammed so close together. The staff does not pay attention to patients,” she said, noting that one day her mother needed to get up but nobody would help, so her mother was trying to get out of bed by herself. This Colleague said she spends a lot of time at the hospital with her mother because she does not feel safe leaving her there alone, adding that when her mother was a patient at ACH she never worried about leaving her.

Is our hospital better because of Planetree? Absolutely, because our Colleagues practice in a way that makes all of us proud to be on the ACH team.

Thanks for making my day a great one.

Stan

Calls from Patients and Guests

2008-07-25T14:49:00.000-04:00

I am always amazed at how many calls I receive from our patients and guests. Most just want to let us know how much they appreciated a special moment that had been created for them (through the compassion of our staff) or to voice appreciation for a response they received from one of our Colleagues or physicians.

There a few calls expressing dissatisfaction. They are usually surprised that they can get the CEO on the phone so easily and they also appreciate the knowledge that our staff receives feedback from me in order to improve processes and/or better handle a patient’s or guest’s specific needs. Here is a recap of comments from a call I received today:

“Just received a call; ER was very busy. Patient knew she was bottoming out and requested OJ; something she usually kept with her. Without hesitation one of the staff members immediately responded and genuinely seemed glad to help. They were busy with so many others and just wanted to express thanks for this moment. It was an act of kindness and service she felt should not go unrecognized. Sometimes it is just the little things that can mean so much. Way to go team. It says a lot about practicing in a Planetree Hospital.”

Stan

It has been a while...

2008-07-16T14:58:00.003-04:00

It has been a while so my last sign off …..”talk to you soon” was a bit of a long stretch.

Today we welcomed Brenda, Tamara, Brooke, Terry, Sue, Casey and Kelly as new Colleagues to Alliance Hospital. Three members of the group shared their thoughts about working at ACH. What was great to hear is that one of them will drive more than 30 miles to work --passing several of our competitors’ facilities along the way-- because she wants to work in a Planetree environment. Another was drawn here because she did some of her training at our place and really appreciated the mentoring and support of her preceptors. The third said she was glad to be at ACH because she had heard so much about us from friends who enjoy working here. I enjoyed my time as a presenter during the new Colleague general orientation process and discussing our dreams and the expectations for our organization with these newcomers.

As part of my presentation this morning, I discussed the importance of listening to our customers. Interestingly enough, immediately following my presentation I received a call from the wife of a recent patient. Part of the call had to do with the rudeness of one of our staff members, but the majority of the call was very positive. The caller asked me, “How do you find such wonderful people to work here?” The more I thought about it, I remembered what our new Colleagues were telling me this morning about why they came here. People join us because they know they will have the freedom to practice their passion in a proud manner – or because they know that coming here will afford them an opportunity to learn and grow -- and possibly find new passions upon which to build their strengths.

The caller ended our conversation by saying that what disappointed her husband the most during his stay here was that he was not able to stay for dinner the day he was discharged -- because he really loves our food and was looking forward to what he had ordered for dinner! Hopefully sometime soon he and his wife will just drop by for dinner since our Café restaurant is one of the best choices for a great meal at a great value in this area.

Better sign off with a thank you for listening.

Stan

Life Stories of our Community Care Center Residents.

2008-05-07T14:55:00.000-04:00

Yesterday I had the pleasure of attending and listening to the presentations of Professor Nancy Pine’s freshman class of Mt. Union students. Dr. Pine is an Assistant Professor of English and her students were sharing their essays based on the conversations that each student shared with a resident partner from our Community Care Center. In attendance were all the students, many of their partner residents, family and friends, and Colleagues from the hospital staff. As promised there were recollections of happy and joyous moments, hardships, some shedding of tears, much laughter and many of life’s lessons to be shared. You could tell that what started out as part of a course curriculum evolved into much more. For most there seemed to be a true bonding not only of different generations but of friendship.

Thank you to all for this moment of sharing. I hope that Dr. Pine and her students appreciated the experience as much as I did and will consider coming back next year.

Talk to you soon.
Stan

Follow up to April 17th blog….

2008-04-30T15:53:00.001-04:00

Well I lucked out because the hospital in Toledo was willing to take a cash payment for the allotted amount stated by our insurance company of $109; remember their list price was $249. If only I could have convinced my daughter to have her x-ray done here before she went back to school; our list price for the same exam is $91 before any adjustment.

If John McCain is going to be successful with his healthcare strategy of less regulation I sure wish he would figure out how to level the playing field for consumers; so that hospitals, doctors and insurance companies had to disclose in advance what services will actually cost out of the consumer’s pocket. I realize for many services it might be a range but for many services it can be an exact price.

Talk with you soon
Stan

Wanted to share some patient compliments I received yesterday…

2008-04-25T15:46:00.001-04:00

Wanted to share some patient compliments I received yesterday…

Robert called in to talk about Therapy Services. He said that Erin, the person who took care of him was great and that he was more than satisfied with his care. If he ever needed such services again, he said this would be the first place he would come.

Kathleen wrote regarding our E.R. She said of her first visit to the ACH ER, “Each one (of the staff members) was friendly, caring and most professional. My husband and I were very impressed. A note has been sent to the E. R. also.”

What a great way to end the day.

Stan

A Must Read

2008-04-25T15:43:00.001-04:00

April 24th, 2008

“The Third Path…Systematic Change Will Focus on Returning Value” is an article written by Greg Poulsen, SVP at Intermountain Healthcare that appears in Modern Healthcare’s, April 21st issue on page 26.

It is a must read; one of the most insightful, clear, forward-thinking approaches to health care…I hope all of the presidential candidates and their teams start listening, - and that whoever is elected stops listening to the special interest lobbyists.

In his article, for those of you who might not have access to it, he clearly points out that neither a consumer-driven approach nor the concept of universal insurance coverage addresses the core health care challenges we face: that of providing quality and value.

The core flaws, as he points out, are:

1. A fundamental flaw is not one of access or insurance – but rather, one of cost issues, structure and the need to align incentives.

2. Patients who lack complete medical histories must navigate a sea of provider settings. Poor communication increases the chances for errors. There is also a lack of real peer accountability.

3. The current system has powerful incentives to increase utilization; physician fees are affected by treatment decisions. Physicians can substantially increase their incomes by performing procedures versus providing consultations. Patients often request more expensive testing and medications. Finally, physicians with ownership in delivery systems such as ambulatory centers or imaging have their utilization incentives greatly magnified. Most physicians do what is right because they take their professionalism seriously; otherwise we would find our problems to be much greater.

Suggestions:

1. That the payment system move away from the fee-for-service structure to a more bundled approach.

2. Patients need to be motivated to opt for a high value approach.

3. The regulatory environment should change to better facilitate cooperation and coordination among the providers, doctors, hospitals and others.

4. Health information technology and EMRs need to be expanded.

Talk to you soon.

Stan

Become a Knowledgeable Buyer of Medical Services = www.bakboms.com . . . Our New Website!

2008-04-17T13:37:00.002-04:00

Last week the health system of which I am pleased and proud to serve as CEO started an ad campaign to help provide consumers with access to pricing information. Our motivation was simple: a win –win situation.

For many of the services we provide, our prices charged to both our insurance companies and consumers have been kept lower than those of many of our competitors for the past several years.

As a Community hospital struggling to make more than a 2% operating margin, we hope to drive more business here, particularly in the areas in which we offer some of the best equipment and prices around -- yet people don’t know how, nor do they have the information they need to shop. Once they experience the value ACH offers and they meet the colleagues who practice and provide the services here, I am confident we will create even more loyal customers.

How ironic: Today I look at an Explanation of Benefits (service) on an x-ray for one of my immediate family members. Of course, this service was performed out of town in one of the most expensive areas of health care in the state, Toledo. The list price here in Alliance is $91.00 for that service, while, at the hospital in Toledo, it’s $249.00. Naturally, my family member’s deductible is not any where near being met, so what will we end up paying?

Well according to my EOB, if the service had been provided here, my plan would have covered 100% of the charge at an in-network facility -- it would have paid the full $91.00. But, with regard to the out-of-network facility, I will find out later. My plan did inform me that the usual and customary charge would be $109 – which means that $140 of the list price in Toledo would not even have been paid. I sure wish I’d have known, in advance, which outpatient center to send this family member to --since we will end up paying cash.

Please email me or comment on my blog if you have questions on how to become a knowledgeable buyer of medical services -- and let us learn together.

Everyone that’s taken care of me….the whole bunch…they worked him so hard, it was what he really needed…three stories. It’s what keeps me coming back

2008-03-10T13:55:00.003-04:00

“Everyone that’s taken care of me, the whole bunch…you have very special people working here…because of all of them, they have given me a great deal of comfort and peace of mind…I am just not used to seeing that in other places I have been. This is just a very special of caring where everyone really cares.”

As CEO of this hospital, hearing comments from patients and their family members, such as the above words recently used to describe the team of health care professionals and colleagues comprising the ACH family, makes me feel proud to be part of the team.

Every so often things don’t go perfectly, but that too is what makes this place so special. Many of the colleagues I work with, including the physicians who practice here and the volunteers who give us their valuable time, are constantly talking, discussing, and listening to help us deal with all the imperfections and frustrations that our patients and guests deal must endure…for as good as we are, things happen.

Mr. James G. called this week, saying, “The ER team was great…I went to therapy for two weeks, every other day…the passion of the whole bunch taking care of me was obvious.The whole bunch was at it again in therapy.”

I thanked Mr. G. for taking the time to call me and let me know how he felt about the Colleagues caring for him.

I applaud our medical leadership because they are pushing administration and the board to be more public and proactive about Quality issues; encouraging what we do well and highlighting what we need to improve upon. They are working hard at looking at the way medical staff itself conducts it business and have embraced evidence-based medicine, which is not an easy thing to do.

Mrs. R. called to talk about her son’s therapy, saying, “We were so very happy with the services our son received. He had a terrible accident and was treated at Akron Children’s Hospital, but we wanted to be closer to home so we chose Alliance Community. Gail, Erin, Walt, Tiffany. All who called for our son worked him so hard and got him doing things we could not get him to do...he is now able to go back to school. We just felt so very welcome when we came…believe it or not but our son actually looks forward to going back and seeing his friends at therapy. A truly great experience. Thank you for giving us our son back...”

It takes a very special person to admit you could have done better, to apologize sincerely, to show that you care, to be open and honest, to want to improve, to accept constructive criticism, to hold others accountable for trying to be the best, to want to be better…to truly put the patient at the center of what we do. Because of all of you do, thank you for inspiring me to do the same.

Talk to you soon.
Stan

Healthcare is the Economy:

2008-03-05T14:34:00.001-05:00

I read, with great interest, Todd Sloane’s editorial entitled “The New Insurance Backlash” in the February 25th issue of Modern Healthcare. To me, one of the most telling lines was, “On January 23, the day Wellpoint reported a 8% gain in 2007 profits (to $3.35 billion), its share price fell by $2.90 because it also reported that it spent almost two cents more of each premium dollar on –wait for it- patient care.”

I truly believe one could make a good argument that healthcare is the number one issue in this year’s election. It is the biggest challenge affecting the ability of both big and small businesses to compete.

Below, I offer my own assumptions or definitions that are necessary to frame my conclusion for a combined Hillary/Obama/Huckabee/McCain plan – one that would fit well with Bernake’s suggestions for stimulating economic growth. So how would this work?

It would work, I believe, in a free market, competitive system. One with a fair and level playing field and--let’s face it-- the consumers of healthcare don’t have the information they need on quality and especially on price (i.e. money they will spend out of their own pockets). We have been preaching transparency, but truly have done very little about it because of all (issues posed by) the special interests; primarily insurance companies. Hilary and Obama would like to limit the amount of premium dollars that go to insurance companies. Under that theory, hospitals and doctors certainly could perform better and if healthcare consumers knew what they had to pay for in advance of many of procedures/tests they would certainly shop around for the best price.

We have been working on quality data for years and if we truly want peer review to work, we must do something about malpractice. However, I am encouraged that some doctors and hospitals are sharing their complication rates and mortality statistics with other key information on their websites. We don’t need a single payer system but we could certainly use a single payment system that is much simpler and makes individuals more accountable for themselves; we do need more of a wellness system than our current sick care system.

There is a lot that could change and bring both parties together and provide the stimulus for doctors and hospitals to improve as well; let’s quit talking about transparency and do something about it.

Two Great Valentine Gifts

2008-02-15T08:08:00.003-05:00

Received a very nice note from several colleagues today, on Valentines Day, thanking me. I guess I just want to share that thanks with our leadership team at the hospital because of what the note said.

It read: “Thank you for the new equipment and for always trying to make sure we have everything we need to do our jobs”. Reading these words was a great gift, as were the three enclosed gift certificates for the ‘CAFÉ, one of my favorite places to eat.

Several minutes later, I received a thank you in the mail from a new patient (from Doylestown) praising our service, our Planetree environment and our compassionate caring of our colleagues. They wrote, “Through the reputation of Dr. Palutsi, we were introduced to your hospital. First impressions are always important and we were bedazzled ….as a patient and family we received wonderful care…special thanks to Barb and Dottie in Same Day care…your volunteers are also to be commended”. Sincerely S&L P.

Couldn’t ask for a nicer day.

Talk to you soon
Stan

Interesting Articles on Health Insurers and Health Reform

2008-02-06T09:08:00.000-05:00

Thursday, January 31
By Bill Toland, Pittsburgh Post-Gazette
Insurer’s CEO Says Blues Deal Could Hurt Competition

Some big insurance companies in Pennsylvania are fighting for position, but what I found most interesting was the comments from James Buckley, President of the Delaware Valley Health Care Coalition, a multi-employer health purchaser. He said “he protested the lack of transparency among health insurers, saying true, healthy competition isn’t possible until the Legislature compels insurers and hospitals to be more open and accurate about the cost of procedures. The savings being touted in the IBC-Highmark wedding would be irrelevant if a transparency model is established, setting standardized hospital reimbursement rates. Instead of allowing the major health insurers to use their oligopoly power to receive preferential pricing and profits, health care providers should be able to charge reasonable prices to all health care customers.

I couldn’t have said it better.

DATA BRIEF
THE PRESIDENTIAL CANDIDATES’ HEALTH REFORM PLANS
Katherine K. Shea, Sara R. Collins, and Karen Davis
The Commonwealth Fund
January 2008
HEALTHCARE OPINION LEADERS’ VIEWS ON
THE PRESIDENTIAL CANDIDATES’ HEALTH REFORM PLANS

Typically I am pretty much a free market person, however I just don’t believe this has worked in healthcare. A majority of the public agree with the democratic position summarized below from the article.

Mixed Private–Public Proposals Favored
Most healthcare opinion leaders (61%) believe that the mixed private–public group insurance system reform proposals put forth by Democratic candidates are an effective approach to achieving universal healthcare coverage, with nearly two-thirds (65%) of academic leaders and half of business/insurance/other healthcare industry leaders voicing support for universal healthcare. Proposals relying on tax incentives for the individual market, however, are seen by the same experts as an ineffective method for achieving that goal, with 59% of respondents saying they were not effective. Twenty percent of polled business leaders (20%) think tax incentive-based reforms are more effective than do academic (4%) or healthcare delivery leaders (4%).

I was happy to see that most of my healthcare colleagues agreed with this position, at least in this poll.

Talk with you soon.

Stan

The Health of our ACH Colleagues and the Economic Health of the Alliance Community and Eastern Stark County

2008-01-31T10:44:00.000-05:00

The Ohio Hospital Association challenged all of its members to promote wellness in our hospitals and encourage our communities to do so as well. Today we initiated our GET FIT campaign. It began with registration for those individuals who want to participate in our version of “The Biggest Loser.” We are organizing teams and have received a lot of help from Mt. Union College regarding the personal trainers. We will let you know how we do in May.

We keep hearing that we are transitioning to a service economy and in many school systems vocational programs are the first programs to be cut. Well, in Alliance we had to make some tough cuts regarding the school budget that impacted these programs. There are many more students graduating from Alliance High School who won’t attend college than those who will. Interestingly enough, in Alliance and many of the surrounding communities, local business owners are saying they need more skilled workers in the trades; they would be most interested in interns, and work-study students.

Well, we are very fortunate in Alliance to have a superintendent of schools with a vision of how best to match the needs of our business communities with those of our students. Dual credits could be offered that might inspire those who thought they could never enter college to do so. If most of the students graduating have hope of a good career path, then we could help local businesses grow; with more and better jobs, we could help stabilize the housing market, which needs all the help it could get right now.

Very shortly, local citizens will get the chance to vote on a school levy Issue 20, which is focused on achieving the vision described above. A healthy local economy and investing in our kids’ collective future is a great way to GET FIT Alliance.

Talk with you soon.
Stan

As promised, here’s some closure to my last Blog

2008-01-21T14:56:00.000-05:00

After hearing from our candidates, I must say I was encouraged. Although I am personally not a fan of Dennis Kucinich’s all-public governmental approach to healthcare and the elimination of all for-profit healthcare entities, he spoke well and was much more likeable than I had expected.

Mitt Romney has already shown he can make change happen. Even if Massachusetts isn’t the perfect approach, you have to start somewhere. Of course, it would be nice to know in advance where we are going to end up before we begin our journey and Romney seems to at least have a plan. I was impressed because he was the only candidate that actually asked for my vote.

John McCain’s free market approach is one I usually prefer, but you need a level playing field in healthcare and in my opinion, we, like the government, need a lot more checks and balances.

John Edwards was certainly the most likeable of those present. His accent sounded more Cantonese than southern and his story about encouraging his daughter to attend Mt.Union College instead of Harvard University was perhaps one of the lighter moments of the day - and it was very well-received by the audience.

Not to be out done, Barack Obama showed a sense of humor as soon as he entered the room by asking the crowd, "Can you smell it in the air? Change is coming and much of it is good. Out with the bad odor of stagnant old time politics; in with the good. BO is for Barack Obama and I want to be leading the good changes that we need.”

Our audiences voted only on the merits of each of the candidates’ healthcare platforms.
Hilary and Obama combined for about 32 %( 16% each) of the vote. John McCain and Mitt received the most Republican interest with 23% and 18%, respectively.

My hope is that whoever is elected will implement the best ideas of all the candidates, in order to actually change the system -- even if those ideas came from former competitors.

Talk with you soon.
Stan

Presidential Candidates Address IHN Leadership Summit Conference

2008-01-14T16:06:00.000-05:00

Canton, Ohio - Eight candidates seeking to be the next President of the United States were present to speak before the Independent Hospital Network Leadership Summit Conference in Canton on Friday, January 11.

Here’s a summary of the events from a roving reporter’s first-hand perspective.

Taking time out before heading off to the primary in Michigan, four of the leading Democratic and Republican Presidential hopefuls presented their Healthcare Reform Plans to delegates from the Independent Hospital Network.

Hillary Clinton opened, and clearly let her emotions of the campaign process show when she started talking about the strain of campaigning and then quickly regrouped to focus on a hardluck story about how our healthcare system failed a man whose life was destroyed by the current system. She said that what he had worked a lifetime to achieve, was ruined after he lost his job and then suffered a heart attack; both of which ultimately led to the loss of his life savings. Hillary said that because of our flawed health system, this man, yes, is still alive, but everything that he has worked for is all gone.. Hillary, like two of her fellow Democratic colleagues, is pushing both a private and public platform of change.

Rudy Giuliani, on the other hand, said he prefers a market place approach to fixing our nation’s health woes. In a lighter moment, he said he really had to question why our legislators seem to be spending more time worrying about sports and steroids than healthcare. He asked that we focus more on the health of the nation and a little less on the well-being of the Yankees.

I believe “Huck” was up next,(by the way, I failed to mention that none other than Chris Matthews from NBC’s Hardball was our MC). I must admit I liked Mike Huckabee’s remark that people need to be more responsible for their own health and that a consumer- driven model makes a lot of sense.

More to come from this reporter on today’s events, but that will have to wait until tomorrow…I have some scheduled meetings and our team is working on gathering consumer information… a story for another day.

At the end of today, however, we did take a straw vote-- just based on the Healthcare Reform issue. I will share those results in a future blog.

Talk to you soon.

Stan

December Praises…and Holiday Wishes

2007-12-26T12:12:00.001-05:00

‘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

2007-12-14T11:12:00.000-05:00

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

2007-11-26T08:09:00.000-05:00

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

2007-10-19T16:01:00.000-04:00

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

2007-10-10T09:31:00.000-04:00

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

2007-10-09T15:36:00.000-04:00

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!

2007-09-19T11:34:00.000-04:00

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

2007-09-07T12:37:00.000-04:00

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?

2007-08-29T12:34:00.000-04:00

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!

2007-08-24T15:35:00.000-04:00

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

2007-08-20T15:19:00.000-04:00

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….

2007-08-17T15:52:00.000-04:00

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

2007-08-14T12:46:00.000-04:00

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

2007-08-13T09:57:00.001-04:00

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

2007-08-10T15:02:00.000-04:00

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