December Praises…and Holiday Wishes

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

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

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

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

Stan

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

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

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

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

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

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

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

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

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


-- Stan

Impacting Healthcare Reform at the National and Local level

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

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

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

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

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

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

Stan

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

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

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

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

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

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

Health Consumers We Need Your Help

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

Is the Customer/Guest Always Right? And Kudos Again

Kudos Again

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

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

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

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

Is the Customer/Guest Always Right?

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

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

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

Thanks. Stan

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

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

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

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

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

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

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

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