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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where do we start?

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

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

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

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

-Stan
Writen: August 28, 2007

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

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

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

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

The Next Joint? Regulator or Consultant

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

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

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

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

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

-Stan

Measure Success by the number of lives we touch….

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

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

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

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

- Stan

Following in our footsteps? Cleveland Clinic and ACH/Planetree

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

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

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

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

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

Stan