MedWorm: Health Managers

Huskies are top dogs in entrepreneurship

Running a hospital — Tue, 07 Feb 2012 15:22:00 +0100

More and more colleges and universities are promoting themselves as hotbeds of entrepreneurship, creating courses and even degree programs in this field. I think one measure of the fertility of a college campus for this discipline is the extent to which the students take it upon themselves to create a club to support potential and budding entrepreneurs in their midst.In that regard, I want to pay tribute to one local entrepreneurship club, at a university that might surprise some of you who immediately think of the Ivy Leagues or high technology schools. In a recent ranking by FledgeWing, the Northeastern University Entrepreneurs Club was listed as number six in the world. Among other things, the club holds Get Togethers, which attract over 100 students every week and inv...

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Gisele misses the ball

Running a hospital — Tue, 07 Feb 2012 12:20:00 +0100

I suppose we can understand why a supermodel, who lives in the dog-eat-dog world of fashion design, would blame someone other than her husband for the Patriot's loss against the Giants in this last weekend's Super Bowl match. We can understand her loyalty to her man. But she sure does not understand how to create effective teams. And she probably also doesn't understand how her remarks could potentially undermine the leadership role of the man she so clearly wants to extoll.As reported in the New York Post:Gisele Bundchen ripped into the Patriots receivers for the failed plays she believes cost her quarterback husband Tom Brady a fourth Super Bowl ring.The Brazilian supermodel was caught on camera lambasting No. 12's teammates after Sunday's game in Indianapolis."You [need] to ...

Acquisitions in the offing?

Managed Care Matters — Tue, 07 Feb 2012 05:00:00 +0100

Word is the recent flurry of acquisitions and mergers in the work comp services industry isn't likely to taper off any time soon. Genex is reportedly up for sale, Injured Workers Pharmacy has seemingly been in play for months, a... (Source: Managed Care Matters)

The virtues of peer-to-peer assessment

Running a hospital — Mon, 06 Feb 2012 20:34:00 +0100

This article proposes creating and implementing a structured prospective P2P assessment model in health care, similar to that used in the nuclear power industry, to accelerate improvements in patient safety. The article notes that there has been a lack of progress in patient safety, merely 1% between 2000 and 2005, despite major efforts by many advocates and participants. Health care also lacks safety-related performance measures in most clinical areas. "Most errors result from good clinicians working in complex and hazardous systems." Thus, we need to recognize the fallibility of people redesign systems and the manner in work is done to "anticipate and mitigate inevitable human error."The authors note that other high-risk industries have recognized sim...

Looking for lucrative customers: Hospital marketing gets serious

Health Business Blog — Mon, 06 Feb 2012 18:52:00 +0100

Are you commercially insured with cancer, heart disease or an orthopedic problem? If so, you are a juicy marketing target for hospitals, which drool over the prospect of high fee for service reimbursements. USA Today (Hospitals mine patient records in search of customers) explores how hospitals are combining their own data with information from consumer marketing agencies to pinpoint likely customers for their services. The article is a little vague on exactly what aspects of the hospital’s own databases are being tapped. It appears that some elements of financial and medical records (such as insurance status) are being used, but others (such as whether someone is a smoker) are not. Outside consumer marketing agencies can match the hospital’s data up with all sort of other pote...

Employment, Economic Recovery, Workers Comp and Group Health

Managed Care Matters — Mon, 06 Feb 2012 05:00:00 +0100

Friday's news that the nation added over a quarter-million private-sector jobs in January [opens pdf] was good news indeed for health plans, workers comp insurers, service companies. But January wasn't the only bright spot; the report indicated a lot more... (Source: Managed Care Matters)

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Flying blind in hospitals

Running a hospital — Sun, 05 Feb 2012 20:03:00 +0100

A recent article in Bloomberg Businessweek reminded me about the Commercial Aviation Safety Team, coming out of a commission established by President Clinton, who charged it to come up with a process for reducing the rate of airline accidents by 80% over ten years. The result:By 2008 CAST was able to report that by implementing the most promising safety enhancements, the fatality rate of commercial air travel in the United States was reduced by 83 percent. What's the current goal?Reduce the U.S. commercial aviation fatality risk by at least 50 percent from 2010 to 2025 and continue to work with our international partners to reduce fatality risk in world-wide commercial aviation. The methodology is pretty straightforward: Analyze data; propose process or equipment improveme...

Kristina writes a story from the Islands, and more

Running a hospital — Sun, 05 Feb 2012 01:19:00 +0100

You never know where you will encounter writing talent. My most recent experience in that regard was while getting fitted for sandals at the most famous -- and longest lasting -- provisioner of custom made sandals, Zora of St. Thomas. A visit to the shop is an experience that can last quite some time as your measurements are taken and a mock-up is made of your sandal. Then you come back another day for the final fitting, which includes walking around the shop until you have taken 5000 steps to stretch out the leather.Before meeting Zora, I was assisted by one of her folks, Kristina Diaz. Kristina has been in Charlotte Amalie for a while but -- much to Zora's dismay -- is leaving soon to get an advanced degree. She notes:I started writing stories in the third g...

5 tactics for your patient experience strategy

hospital impact — Sat, 04 Feb 2012 18:10:57 +0100

by Jason A. Wolf Hospitals cannot focus their efforts to improve the patient experience on only a checklist of activities, but rather make them part of a broader strategic direction. In a recent Hospital Impact blog post, I offered four strategies for addressing patient experience as the new healthcare reality to reinforce this point. Yet, while no two hospitals follow the same plan (and I encourage you not to be fooled by a one-size-fits-all solution), there are a few common practices to consider. In the 2011 study, "The State of Patient Experience in American Hospitals," we asked the question: What are your organization's top priorities for improving the patient experience? The responses were not surprising, as many related to domains comprising the Hospital Consumer Assessment of Heal...

How our hospital uses social media for customer service

hospital impact — Sat, 04 Feb 2012 18:10:57 +0100

by Ginger Anderson At Scripps Health in San Diego, we've been actively using social media since 2009. Our goal in the space is to build relationships with the San Diego community and position Scripps as a leader in healthcare. A large part of the work is actively listening and responding to customer service inquires and problems on Twitter, Facebook and Yelp. Have you heard the saying, "Perception is reality"? Our patients are spreading their opinion of us on the internet, and chances are good that their friends and family are going to believe what they say. It's our job to find customers who are talking about us (both bad and good) and make sure they get answers, feel heard, and are satisfied that their feedback results in appropriate action and changes within the system. Not only do...

Layoffs in Central Massachusetts

Running a hospital — Sat, 04 Feb 2012 13:46:00 +0100

UMass Memorial Health Care is a five-hospital system anchored by Central Massachusetts' main academic medical center. It announced this week that due to declining volumes and poor reimbursements it will eliminate between 700 and 900 positions. With the following words, CEO John O'Brien inadvertently proved a point made by Clay Christensen in the The Innovator's Prescription:We are having confidential discussions with a potential buyer regarding the sale of our Hospital Labs Outreach Business. Reimbursements for lab tests have been falling dramatically for quite some time and insurers are directing their patients and physicians to use labs that are lower cost than our service.And, in still another separate decision, UMass Memorial will seek a potential buyer for our Worcester-based H...

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UPDATE - SWIF, MedRisk, and the PA Auditor General's report

Managed Care Matters — Sat, 04 Feb 2012 05:00:00 +0100

UPDATE - In response to a query, MedRisk informed me that my savings figure was misstated. MedRisk reduced SWIF's medical payout by $28.9 million below fee schedule from January 2009 to December 2012; the earlier post (below) indicated the reduction... (Source: Managed Care Matters)

Medicare Quiz from Kaiser: almost everyone can learn something

Health Business Blog — Fri, 03 Feb 2012 22:28:15 +0100

Kaiser Family Foundation has posted one of the most informative and well-packaged pieces I’ve ever seen on Medicare. I’d encourage everyone to have a go at the Medicare Quiz. It comprises 10 quick multiple choice questions. The questions are reasonably challenging without being esoteric. You get your score right at the end of the quiz, along with the correct answer (if you missed it) and an explanation of the answer. I’m pretty savvy about Medicare but did miss two questions (share of low-income Medicare beneficiaries and share of beneficiaries with multiple chronic conditions). At least I got all the policy questions right. One nice thing about the quiz is that the answers provide direct links to Kaiser resources where you can learn more. Well done Kaiser! I’d like...

Time for FDA to hire some pharma marketers?

Health Business Blog — Fri, 03 Feb 2012 03:42:08 +0100

Turns out the Food and Drug Administration doesn’t achieve the impact it’s looking for in communications with physicians. That finding is drawn from a new paper that evaluates the impact of FDA warning labels and public health advisories over the past 20 years. Some disappointing examples are noted: FDA recommended diabetes monitoring for patients taking atypical antipsychotics, but testing did not increase Warnings of drug/drug interaction weren’t heeded –at least for 18 months When FDA warned about prescribing drugs in certain populations (e.g., atypical antipsychotics for dementia) there was an across the board reduction in prescribing As I read the article, it occurred to me that FDA could learn best practices from big pharma about communicating with physician...

Volunteers improve care and save money

Running a hospital — Fri, 03 Feb 2012 03:09:00 +0100

An article in the Journal of the American College of Surgeons documents the clinical improvements achieved by a collaborative of surgeons from 10 Tennessee hospitals. The group hypothesized that using the National Surgical Quality Improvement Program (NSQIP) system to share surgical process and outcomes data would bring about changes in patient surgical outcomes. They did the work, analyzed the results, shared stories, and made good progress. Here's part of the summary, comparing about 14,000 cases in one year to a similar number in the next year:-- A 19% reduction in superficial surgical site infections;-- A 15% reduction in being on ventilator longer than 48 hours;-- A 60% reduction in graft/prosthesis/flap failure;-- A 25% reduction in acute renal failure; and-- ...

Landon lands on the major issues about capitation

Running a hospital — Thu, 02 Feb 2012 13:47:00 +0100

Bruce Landon offers an excellent summary in today's New England Journal of Medicine about the necessary conditions for a capitated, or global, payment regime to be successful. He notes:The fundamental questions become how ACOs will choose to divide their global budgets and how their physicians and other service providers will be reimbursed. Thus, this system for determining who has earned what portion of payments — keeping score — is likely to be crucially important to the success of these new models of care.Under ACOs and many commercial global payment products, providers will continue to receive traditional fee-for-service payments, and hospitals will receive their usual contracted payments, through either the diagnosis-related-group (DRG) system or per diem payments. All spend...

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Scoping it out

Running a hospital — Thu, 02 Feb 2012 12:53:00 +0100

I have often expressed my annoyance at technical medical journals that restrict access to articles of public interest. I understand their need for revenue, but I don't see that they would lose income if they had a policy of publishing a few articles each month that might have a broad audience. The New England Journal of Medicine, for example, does this, with no loss of readership. Indeed, you can argue that its status is enhanced by the practice.But beyond the convenience factor, when articles only appear in abstract form, they can raise more questions than they answer. Here's an example from the journal Forensic Science, Medicine, and Pathology. I reprint the entire abstract:Fiberoptic endoscopy is utilized to diagnose and treat a wide variety of gastrointest...

Health Wonk Review is up at Colorado Health Insurance Insider

Health Business Blog — Thu, 02 Feb 2012 10:22:58 +0100

Check out the Campaign 2012 edition of the Health Wonk Review at Colorado Health Insurance Insider. Share (Source: Health Business Blog)

Health Wonk Review - upcoming hosts

Health Wonk Review — Thu, 02 Feb 2012 07:59:26 +0100

Submit entries to Blog Carnival 2/16/12 - Jason Shafrin at Healthcare Economist Submission deadline: 9 am on Wednesday, 2/15/12 3/1/12 - Joe Paduda at Managed Care Matters Submission deadline: 9 am on Wednesday, 2/29/12 (Source: Health Wonk Review)

Primary edition of Health Wonk Review

Managed Care Matters — Thu, 02 Feb 2012 05:00:00 +0100

From the Rocky Mountains comes this edition of Health Wonk Review; the always-erudite Louise Norris. Delightfully illustrated and well written, this edition deserves your vote.... (Source: Managed Care Matters)

More thoughts on having less benchmarking

Running a hospital — Thu, 02 Feb 2012 01:19:00 +0100

Following up on Catherine Carson's comment on the inadvisability of using benchmarks for certain patient safety goals, another person on the the National Patient Safety Foundation's listserv pointed out that the Institute for Safe Medication Practices has always maintained a position against benchmarking for medication errors. Here are excerpts from the ISMP website, responding to the questions, "What is the national medication error rate? What standards are available for benchmarking?" A national or other regional medication error rate does not exist. It is not possible to establish a national medication error rate or set a benchmark for medication error rates. Each hospital or organization is different. The rates that are tracked are a measure of the number of reports at a given i...

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Repeal and Replace or Repeal and do nothing?

Health Business Blog — Wed, 01 Feb 2012 23:00:42 +0100

Remember how opponents of the Patient Protection and Affordable Care Act (PPACA) vowed to “repeal and replace” the measure? It was and is a great slogan (I’m a sucker for alliteration, assonance and consonance) but it’s no surprise that the sloganeers have been slow to follow through on the replace part –even as they retain enthusiasm for pushing repeal. PPACA presents a fat target for opponents of an active federal role. It’s complex and ambitious, and even though at heart it is a very moderate (or even conservative) law, there are lots of hot button provisions to demonize. Health care is such an important emotional, personal and financial issue that people are justifiably nervous whenever something happens, and ready to listen to all kinds of claims....

The Scoop #4 – Best Practices in Healthcare Social Media

Fox ePractice — Wed, 01 Feb 2012 22:57:19 +0100

This article on RHIOs is worth reading: http://t.co/kq5LvoHm comments here: https://t.co/Iv2yjcS0 I’ll respond nex … RT @mHIMSS: RT @ludlowerehab: Bring your own device to work – should we even go there?: #mhimss survey was neck and neck. http://t.co/ … RT @iHealthBeat: "Thinking About @BPC_Bipartisan Policy Center Report on #HealthIT" by @healthythinker on @THCBstaff | http://t.co/QflQSD43 Twitter Revealed Epidemic Two Weeks Before Health Officials [STUDY] @mashable To conduct the study, the researchers created a timeline by searching for the term cholera and the #cholera hashtag on Twitter from Oct. 20 to Nov. 3, 2010. Read more… Facebook IPO: Test Your Knowledge [QUIZ] http://t.co/HcBeAhxD Smartphone Sales Overtake PCs for the First ...

Blogging Ideas for Physicians: Your Commentary on Medical News

Fox ePractice — Wed, 01 Feb 2012 21:57:22 +0100

Blogging Ideas: Medical News Your commentary on medical news is a great source of blogging ideas and some of the most useful information you can share with patients. Your physician or hospital blog is the perfect vehicle to address what your patients may be seeing or reading about in the news. By providing your commentary on your healthcare blog, you provide your own valuable point of view on information desired by patients. By addressing general questions concerning medical news on your blog, your office time becomes much more efficient and concentrated on the patient’s own specific questions. A great example of healthcare blogging is Dr. Wendy Sue Swanson, also known as @seattlemamadoc on Twitter. Dr. Swanson is a pediatrician whose blog, Seattle Mama Doc™ , can be found o...

Healthymagination quiz

Running a hospital — Wed, 01 Feb 2012 16:37:00 +0100

I usually don't sign into apps on Facebook, as they are thereby empowered to search through and receive all your data and files, but this one intrigued me. I read about it on Twitter from GE's Healthymagination (@gehealthy). It is a quiz about lifestyle habits that gives you a "ranking" of how you compare to others who have participated on Facebook (everyone, people with your first name, and your friends.) Here's the link.Then, it asks you questions in a number of categories, and you click on one of the two answers. Here's an example:And, finally, it gives you your ranking:It's fun, and if the competition provokes people to eat better and exercise and the like, no harm done. (Source: Running a hospital)

Hairy follow-up

Running a hospital — Wed, 01 Feb 2012 15:44:00 +0100

Do you remember my story from a few weeks ago about finding a human hair in my breakfast at a hotel in Mississippi? When my photo was taken to "prove" that the offending hair did not come from my head, etc? If you recall, I was told that I could call the risk management folks in a few days to find out the disposition of the case. The security guard left me with this card:I had a few free moments, so I called yesterday. The gentleman reported that the head of room service had been told about the situation. I asked what they might do to keep it from happening again to another guest. He said that he expected they would reinforce with the staff the need to keep hairs out of the food.My regular readers, familiar with hospital process improvement, will immedia...

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Understand CEO burnout to improve employee wellness

hospital impact — Wed, 01 Feb 2012 14:18:04 +0100

by Dr. Kenneth H. Cohn In "Hospital CEO burnout on the horizon: Look for successors now," Karen M. Cheung describes the challenging conditions healthcare leaders face as they move forward in an uncertain environment. According to the September/October issue of Healthcare Executive, there was a 17 percent CEO turnover rate in 2009, compared to 14.6 percent in 2001. I am pleased to see reports like this, because we need to bring attention to burnout at all levels in the healthcare profession to make it better. As I wrote in a previous Hospital Impact blog post, burnout affects physicians as well--often with devastating consequences for patient care outcomes and for nurses and allied healthcare professionals who may feel caught between working with angry, overworked healthcare professi...

Catherine says "Zero is the benchmark." Gets an A+.

Running a hospital — Wed, 01 Feb 2012 13:51:00 +0100

I've been following the National Patient Safety Foundation's listserv for a few weeks. As suggested by Dr. David Lawrance, at University of Illinois at Urbana-Champaign, the conversations and interchange are professional, thoughtful and helpful.A great comment came through yesterday from Catherine Carson, Director, Quality & Patient Safety at Daughters of Charity Health System. The topic was benchmarking, and the initial question was "Are you willing to share your falls benchmarks?"After a number of answers were submitted, Catherine replied:A thought for this email stream: When the goal is zero – as in zero hospital-acquired infections, or falls – why seek a benchmark? A benchmark would then send the message - that in comparison to X, our current performance level...

Israel Journal of Health Policy Research

Running a hospital — Wed, 01 Feb 2012 11:56:00 +0100

There is a new health journal called the Israel Journal of Health Policy Research. An important feature is its open access. Here's the link, and here's the summary of purpose:Israel Journal of Health Policy Research (IJHPR) seeks to promote intensive intellectual interactions among scholars and practitioners from Israel and other countries regarding all aspects of health policy, health services research, public health, health promotion, health economics, health care management, and the ethics, sociology, and political science of health care in Israel. The ultimate aim of these intellectual interactions is to contribute to the development of health policy in Israel and around the world. (Source: Running a hospital)

Hello, North Dakota!

Managed Care Matters — Wed, 01 Feb 2012 05:00:00 +0100

An open letter to the press, business community and people of North Dakota: The authors of this letter are journalists, columnists, bloggers and content publishers for the workers' compensation industry across the United States. We are a politically and professionally... (Source: Managed Care Matters)

Return of the pigs! This time in Vancouver.

Running a hospital — Tue, 31 Jan 2012 22:36:00 +0100

It is a great kick for me to see some of my older blog posts resurface from time to time, especially when they are indicative of a new Lean training program in one hospital or another. The most popular in that regard is the June, 2009 three-part series about drawing a pig as an introduction to designing standard work. In that regard, thanks to Tim McMahon of Westfield, MA, who has summarized the exercise beautifully on his blog, A Lean Journey.This week, all of a sudden, I received a bunch of hits on these posts from Vancouver General Hospital. If anyone out there is reading this, please comment on what you folks are up to. I would also love to get comments from others elsewhere who have used this exercise as part of their Lean training. Thanks, too, to Alice Lee, th...

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Should TakeAway be a give-away?

Running a hospital — Tue, 31 Jan 2012 22:10:00 +0100

I came upon this tent display in my local CVS last night, and it left me wondering. I like the idea of giving people a mailer with which to dispose of unused medicine. After all, it is good to have substances like antibiotics not enter the ecosystem. And as noted here, unused and expired drugs pile up in home medicine cabinets, which increase the likelihood for teenagers, elderly, pets, or others to misuse or abuse them.But are people willing to pay an extra $4 for the privilege? (Walgreen's also charges the same.)In Iowa, there is no charge to consumers:Iowa’s TakeAway program has been funded by the state, approved by the legislature in 2009 and 2010. Through these funds pharmacies receive TakeAway systems at no charge and patients can return unused m...

Small businesses and the Affordable Care Act. What do they need to know?

Health Business Blog — Tue, 31 Jan 2012 22:04:29 +0100

Small business is an essential part of the American economy and a key focus of the Patient Protection and Affordable Care Act (PPACA). Only 57 percent of companies with under 50 workers provide health insurance, compared to 92 percent in the 51-100 range and 97 percent with more than 100 employees. Despite what you may have heard, PPACA (aka ObamaCare) is not a radical government takeover of the health care system. Instead, it seeks to preserve and extend the employer-sponsored health insurance model and extend it further into the smaller employer realm. PPACA was crafted to encourage smaller companies to provide insurance for employees by regulating the insurance market, establishing health insurance exchanges, providing tax credits for the smallest employers, providing grants for wellnes...

IHI Conversations in March

Running a hospital — Tue, 31 Jan 2012 15:08:00 +0100

Speaking of office practices, please check out this IHI conference on March 18-20, the 13th Annual International Summit on Improving Patient Care in the Office Practice & the Community. It is especially geared towards health leaders and professionals working office practice and community settings.My pals at IHI tell me:Over 60 sessions will address the latest thinking and practices on topics that are crucial in today's environment. This year’s theme is “rediscovering conversations” – the kind of real, human conversations that are at the heart of transformational care … and help create a higher standard of care that is not only patient-centered, but is truly person-centered.Keynote speakers include:Maureen Bisognano, President and CEO, IHI; Donald Berwick, MD, MPP, Forme...

This is no bull!

Running a hospital — Tue, 31 Jan 2012 11:31:00 +0100

I would have been hard-pressed to imagine that two of my recent topics -- autism and process improvement -- could combined with animal husbandry. But check out this article from the Burlington (VT) Free Press. It is about Dr. Temple Grandin, an expert in sustainable agriculture and proper treatment of farm animals. During her 35-year career, Grandin’s work to improve humane handling of large animals, particularly during processing, has earned her much attention, from a spot on Time magazine’s list of “100 most influential people in the world” to an award-winning biographical HBO movie starring Claire Danes. The movie vividly brings to life the challenges that Grandin, now 64 and a Colorado State University professor of animal sciences, faced as a person with autism, starting with a...

Think your hospital bill was high?

Managed Care Matters — Tue, 31 Jan 2012 05:00:00 +0100

A hospital bill for $44 million showed up in Alex Rodriguez' mailbox a couple weeks back. Although Alex is a resident of New York, he's not "the" A-Rod, but even the A-Rod who wears pinstripes to work at Yankee Stadium... (Source: Managed Care Matters)

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Personalized medicine for the brain. A discussion with Brain Resource’s Evian Gordon

Health Business Blog — Tue, 31 Jan 2012 04:35:18 +0100

The Brain Resource Company (BRC) is a global leader in personalized medicine for the brain. In this podcast interview, BRC’s Executive Chairman Evian Gordon and I discuss: The similarities and differences between personalized medicine for the brain and overall The iSPOT study that focuses on biomarkers for depression and ADHD The importance of a standardized platform The business case for personalized medicine for the brain in pharmaceutical discovery and development How the next few years will unfold from a brain research standpoint If you want to hear more from Evian, you can check out a video of his recent conference presentation at Stanford. Share (Source: Health Business Blog)

Comparability doesn't matter

Running a hospital — Mon, 30 Jan 2012 14:28:00 +0100

I was talking about public reporting the other day with an MD colleague. He pointed out that hospitals often have different definitions for a variety of measures, like ventilator associated pneumonia (VAP). Therefore, he pointed out, public reporting of such measures can be problematic. I said, "No, it's not a problem."Why not?Let's look at what we are trying to accomplish. Simply put, we want the hospitals, doctors, and nurses to engage in systemic process improvement in their institutions. What are the elements of doing that? Brent James lays them out quite clearly, based on the concept of shared baselines:1 -- Select a high priority clinical process;2 -- Create evidence-based best practice guidelines;3 -- Build the guidelines into the flow of clinical...

$3 million and counting

Managed Care Matters — Mon, 30 Jan 2012 05:00:00 +0100

To date, Automated Healthcare Solutions and other companies owned by their principals have donated over $3 million to various politicians, campaigns, and political organizations. Automated Healthcare Solutions and their sister companies are heavily involved in physician dispensing to workers comp... (Source: Managed Care Matters)

Individual or systems error? Or, leadership lapse?

Running a hospital — Mon, 30 Jan 2012 01:01:00 +0100

Was Baltimore Ravens Billy Cundiff at fault for that missed field goal attempt last week, or was he the victim of a systems error? Or, was it the coach's fault? This is not about Cundiff trying to pass off the blame. He took full responsibility for the miss.Stefan Fatsis offered his view on Slate. An error on the Gillette Stadium scoreboard caused Cundiff to think he had one more down to prepare for his kick. Fatsis explains:Because the sidelines of an NFL game are crowded—scores of players, coaches, staff, and game officials, a tangle of benches, equipment, and cables, all crammed between the two 30-yard lines—the best way to follow down and distance, and to watch the plays, is on the scoreboard, which is how Cundiff coordinates his pre-kick routine. On Sunday, durin...

Something we could learn from changes in referral rates

Running a hospital — Sun, 29 Jan 2012 19:13:00 +0100

Michael Barnett and colleagues published an article in the Archives of Internal Medicine that documents a rather large change in the annual rate of referrals to other physicians from physician office visits in the United States. "Trends in Physician Referrals in the United States, 1999-2009" concludes that the probability that an ambulatory visit to a physician resulted in a referral to another physician increased by 94% (from 4.8% to 9.3%) during this period.The authors are not sure why this happened. One hypothesis they toss out for future study is that physicians are under pressure for time and therefore refer more. They note that "physicians are increasingly faced with more to do during the typical visit despite no meaningful change in appointment duration in 2 decades."Whatever ...

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What healthcare can learn from the car industry

hospital impact — Sat, 28 Jan 2012 22:39:03 +0100

by Frederick Southwick Too often, everyone assumes the work is being done correctly and that each person knows his or her role. Many customer-supplier relationships are undefined and dysfunctional, and caregivers generally assume they are not empowered to make changes to specific processes. In the absence of a standard model of healthcare delivery, medical errors sneak through the cracks of the disorganized care system. By modeling the healthcare delivery system after successful business practices, we can help prevent medical errors. Let's look at Toyota, whose Toyota Production System (TPS) uses three fundamental approaches for improving automobile manufacturing. TPS for healthcare organizations Set protocols: Define the work that needs to be done, how it should be done, and who is...

Help your physician inventors make a splash

hospital impact — Sat, 28 Jan 2012 22:39:03 +0100

by Keeley Wray Do your providers have an idea that can revolutionize medicine? Well, it is important they investigate what is currently on the market or in the development pipeline. A thorough analysis of competing technologies is essential to successful market adoption, a step that should follow the ideation phase but precede the building of a prototype or pilot-ready version. The reasoning behind my suggestion is, "You could remake the wheel, but would it be a valuable use of your time?" It's surprising how common it is for a physician inventor to stumble on a concept that has already been realized by someone else. Many times, a competing technology is better, or further along, rendering the inventor's approach obsolete. Or, the inventor is proposing additional features that only p...

A dad who missed the point

Running a hospital — Sat, 28 Jan 2012 20:01:00 +0100

Courtesy MA Futsal AssociationWinter brings indoor soccer in the form of futsal, and I have been refereeing those games. This is a fast sport -- a small-sized ball designed with very little bounce -- played 5v5 on a basketball court. Often lots of goals are scored. Since the game favors teams with good foot skills and passing, some matches are lopsided. That was the case today, with some Under-10 boys on the gray team pummeling those on the black team, most of whom were a year younger. At halftime, it was 9-2. By the end, it was 20-5. (For the official record, we only record a six-point spread.)In our league, a parent volunteers to keep score, and in this case, the man was father of one of the black team players. He was a clear Type A person,...

Nursing shortage. Is it a case of crying “wolf?”

Health Business Blog — Fri, 27 Jan 2012 20:21:23 +0100

How many times have you read about the staggering shortage of nurses? It’s routine to see numbers in the hundreds of thousands tossed around –representing the seemingly insatiable demand for nurses from an aging population. I’ve always been suspicious of these estimates. First, it’s not how the economy works. We’re not really going to have 260,000 unfilled nursing positions in 2025. Either supply will rise, demand will fall or there will be a substitution of other kinds of labor or capital. Second, these numbers often come from interested parties, usually advocates for higher nurse pay and benefit or people who are running nursing schools and would like them to expand. So I was struck by an article today that mentioned a glut of nurses, even in places like Cal...

Spear (Part 2) at MIT Webinar

Running a hospital — Fri, 27 Jan 2012 18:00:00 +0100

Creative Experimentation: Developing a Skill Critical for Managing Complex Operating Systems (Part 2)MIT SDM Systems Thinking Webinar SeriesSteven J. SpearSenior Lecturer, MIT Sloan School of Management; Senior Lecturer, MIT Engineering Systems Division; Senior Fellow, Institute for Healthcare Improvement; and author, The High Velocity EdgeDate: January 30, 2012Time: Noon - 1 p.m. ESTOpen to all Register A broad-based capacity for experimentation is critical for organizations to succeed because the systems in which people are embedded are increasingly complex and fast. For instance, medical treatment used to be accomplished by "going to the doctor," a sole practitioner supported by a handful of other professionals, who mastered a body of scientific knowledge through steady p...

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American Telemedicine Association Supports Medical Licensure Reform

MSSPNexus Blog — Fri, 27 Jan 2012 12:39:01 +0100

On Tuesday, January 31 the American Telemedicine Association will host an important Capitol Hill briefing entitled, “Physician Licensure Barriers to 21st Century Healthcare.” This public briefing is designed to inform Congressional offices, national organizations and other key stakeholders about how the current U.S. state-based systems to license and regulate physicians unduly restrict quality modern healthcare. Speakers will share constructive ideas for medical licensure reform. The briefing will be held in the Russell Senate Office Building Caucus Room (SR-325) on Tuesday, January 31, 10:00 a.m. – 11:30 a.m. This event is free and open to the public. To attend, please RSVP at http://www.americantelemed.org/briefing. The briefing is part of ATA’s larger effort to pro...

Broken escalator leads to a crisis

Running a hospital — Fri, 27 Jan 2012 12:30:00 +0100

A friend found this wonderful video in an article by Renskee Visscher at TEDx Maastricht, who notes: "It’s an exaggeration of our dependency on modern technology… at least I hope it still is."If you can't see the video, click here. (Source: Running a hospital)

How do we feel about hospitalists?

Running a hospital — Fri, 27 Jan 2012 01:49:00 +0100

I had missed this original MedPage Today column by George Lundberg back in November and so was pleased to catch it as a re-run over at Kevin, MD. George asks the question, "Are Hospitalists a Boon or a Bane, and for Whom?"A hospitalist, you will recall, is an internist who is the surrogate for your primary care doctor when you have been admitted to the hospital. Before the hospitalist movement started in the mid-1990s-- thanks in great measure to Lee Goldman and Bob Wachter at University of California San Francisco -- your PCP would be in charge of your care at the hospital. S/he would visit early in the morning before taking office appointments and then again in the evening to check in on you. If important issues came up during the day, someone at the hospital would call...

Reducing pre-term births; where public health campaigns can make a difference

Health Business Blog — Thu, 26 Jan 2012 23:07:27 +0100

Health plans have realized for quite some time that the widespread practice of scheduled C-sections and induced labor before the end of 39 weeks of pregnancy is an expensive proposition. Even babies born a week or two early have a significantly higher chance of being admitted to neonatal intensive care units, having difficult breathing and experiencing bloodstream infections. Such births are surprisingly common. In 2010 about 17 percent of babies were delivered at 37-39 weeks without a medical reason. The Leapfrog Group. March of Dimes and American College of Obstetricians and Gynecologists has taken the initiative to try to address this issue by getting the word out and having hospitals set performance. They’ve decided there’s no reason for hospitals to have more than 5 ...

Jonathan Byrnes on inventory optimization

Running a hospital — Thu, 26 Jan 2012 17:14:00 +0100

MIT's Jonathan Byrnes presented a terrific webinar last week. His topic -- inventory management -- has a lot to do with all kinds of businesses, including hospitals. I want to summarize some key points for you. (For those who want learn more, Jonathan has his own blog, which I highly recommend.)The major point of the webinar was that there is a huge difference between inventory optimization and inventory management. Jonathan puts this in terms of a paradigm shift:In the past, the job of the supply chain manager was to optimize the flow of goods into and out of the storeroom. For example, reducing the inventory of a SKU that lost money was viewed as success. But as Jonathan puts it, "If you optimize something that is stupid, the result is still stupid."He...

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Autism in France

Running a hospital — Thu, 26 Jan 2012 13:13:00 +0100

A friend, a doctor in the UK, wrote me this:Just back from France where I was horrified to learn that autism is treated only by psychoanalysis there because it is believed to be caused by lack of maternal bonding in the first year of life. I almost hit a senior pathologist as he held forth. Medicine isn't always as international as we would like it to be.Could it be, I thought? So I did a little Google searching on the topic. The first item was an article from The Lancet in 2007. Are you ready for this?In France, autistic children who have psychiatric problems routinely undergo a treatment that has never been tested in a clinical trial and that many parents regard as cruel. Psychiatrists who use the technique claim that it produces positive results, but critics argu...

Killing claimants.

Managed Care Matters — Thu, 26 Jan 2012 05:00:00 +0100

Over the last ten years, more than two thousand claimants have died as a result of drugs received as part of their "treatment' for their occupational injury or illness. That's the conclusion reached by Peter Rousmaniere in his latest column... (Source: Managed Care Matters)

End-of-life preferences on WIHI

Running a hospital — Thu, 26 Jan 2012 03:52:00 +0100

Have You Had The Conversation? Helping Loved Ones Discuss End-of-Life Preferences January 26, 2012, 2:00 PM – 3:00 PM Eastern Time Guests:Ellen Goodman, Columnist, Author, founding member of The Conversation ProjectIra Byock, MD, Professor, Dartmouth Medical School; Director of Palliative Medicine, Dartmouth-Hitchcock Medical Center Bernard “Bud” Hammes, PhD, Director, Medical Humanities and Respecting Choices®, Gundersen Health System Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare ImprovementMost of us, if asked, say we care a great deal about will happen to us when we’re at the end of our lives. And yet, because we’d also rather focus on just about anything but death and dying, especially if we’re young and healthy or aging well, we’re ...

Hospitals asking for payment upfront: generally ok with me

Health Business Blog — Thu, 26 Jan 2012 02:14:13 +0100

Hospitals in Northern New Jersey (and no doubt elsewhere) are a lot more likely these days to collect patient payments upfront rather than waiting to bill and collect later. Although it sounds a bit cold-hearted, it’s not a bad idea if done properly. In particular if a hospital can determine upfront what a patient’s co-pay or deductible is, it’s reasonable to try to collect it when the patient is there. That avoids the substantial costs of collection and dramatically boosts the percentage of patients who pay. In theory it may also lower the rates a hospital can accept from insurance companies, which ultimately could translate to lower premiums when there is less cost shifting from those who don’t pay to those who do. As I write this I’m well aware of the probl...

Heed these healthcare social media reminders

hospital impact — Wed, 25 Jan 2012 20:04:33 +0100

by Nancy Cawley Jean Today, roughly 20 percent of the nation's hospitals use social media. We're there because that's where our community is, and it's a medium that allows us to communicate important health and wellness information and build brand loyalty and awareness, among other reasons. Of course, these are all things you've heard before. Unfortunately, using social media is not without risk. You've probably heard that before, too. But sometimes, we need reminders. Last week, I received that reminder in the form of an email from our risk management department. It was passing along information from the ECRI Institute, a non-profit organization and evidence-based practice center dedicated to enabling improved patient care. ECRI recently issued a report, Social Media in Healthcare, whic...

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Zeno's paradox of hospital prices

Running a hospital — Wed, 25 Jan 2012 18:26:00 +0100

I apologize to my non-Massachusetts readers for having yet another column about the insurance company payment situation here in the Boston area, but I know there is a lot of interest around the country about the first state that put in place the kind of health care reform that was modeled at the national level. Many things are local in the health care world, but the issue of market power is one that is of interest everywhere. Indeed, there is substantial concern about whether the movement to accountable care organizations will lead to abuses of market power by providers and payers. The market structure issues that exist in this state, therefore, are of broader interest.A few days ago, I wrote about the falsity of so-called "rate reductions" negotiated between insurers and...

Building Bundling Business

Running a hospital — Wed, 25 Jan 2012 02:29:00 +0100

An intermediate rate design between fee-for-service pricing of medical services and capitated, or global, payments is the concept of bundled payments. Under this scheme, the health care organization gets a fixed fee for a given medical condition. A recent article from Medscape Business of Medicine by Kenneth J. Terry addresses some of this issues arising from this kind of payment scheme. It notes:There are 3 main types of bundled payment structures: Bundling of hospital and physician payments for inpatient procedures;Bundling of inpatient and post-acute care for a time-limited episode; andBundling of chronic disease care for a specific condition, usually for a year.In all cases, if the provider organization can deliver the care for less than the bundled payment, the...

Newt Gingrich and “conservative” hypocrisy on Medicare Part D

Health Business Blog — Tue, 24 Jan 2012 23:58:01 +0100

Newt Gingrich has positioned himself as the “true conservative” in the Republican Presidential primary. And last night he trumpeted his support for the Medicare Part D drug benefit program, which was spearheaded by Republican majorities in Congress and signed by Republican President George W. Bush. Sorry, but supporting Part D and being a conservative don’t go together. Gingrich said he supported the measure because it didn’t make sense to pay for kidney dialysis and open heart surgery but refuse to pay for insulin or heart medicine. That’s logical enough. But Medicare Part D was and still is a fiscally reckless program. Unlike Medicare Part A (hospital insurance) which is 84% funded by a dedicated payroll tax, Medicare Part D has absolutely no dedicated re...

Disease Hashtags on Twitter … the Healthcare Hashtag Project: Phase 2

Fox ePractice — Tue, 24 Jan 2012 18:00:02 +0100

“We are so fond of one another because our ailments are the same.” ~ Johnathon Swift _____________________________ The number of healthcare conversations taking place on Twitter is truly staggering. And, as many of you are aware, we’ve made an attempt to organize these conversations via the Healthcare Hashtag Project. Our initial launch of this ever growing list of health related hashtags for Twitter was focused on the “business of healthcare”. But we announced early on that it was our intent to add a section that would include disease hashtags to the mix. However, over the ensuing months a number of individuals began beating us to the punch, submitting disease related hashtags that we readily accepted (i.e., #autism, #diabetes, #rheum, and more). Patient...

Reporter's ABM helps shoot down medical armament in Utah

Running a hospital — Tue, 24 Jan 2012 14:26:00 +0100

In this world of medical arms races, it is refreshing to find a reporter who isn't taken in by the latest hype. It is brave when the story is about a hospital or doctors in one's own town. It is also refreshing to see a reporter who doesn't just parrot the press release, but -- like the journalists of a previous era -- finds alternate viewpoints.Kirsten Stewart at the Salt Lake Tribune wrote this piece. Excerpts:An independent group of radiation oncologists affiliated with hospitals throughout Utah is hyping the arrival of “the world’s most advanced radiation therapy.”But it isn’t new technology, nor is it new to the Salt Lake area. And whether the TomoTherapy brand is “a step above” other systems, as described by Gamma West’s founder and chief medical offic...

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Physician dispensing in Florida - Can money buy bad policy?

Managed Care Matters — Tue, 24 Jan 2012 05:00:00 +0100

One of the most powerful firms in the physician dispensing business is sending hundreds of thousands of dollars to elected officials in Florida. [sub req] The donations, to individual politicians and their affiliated organizations, come as the Florida Senate is... (Source: Managed Care Matters)

Doctor/patient email: Are we really still having this debate?

Health Business Blog — Tue, 24 Jan 2012 03:37:28 +0100

The Wall Street Journal devotes its Journal Report section today to pro/con debates on six health care issues. Five are reasonable and either timely or timeless: Should everyone be required to have health insurance? Should healthy people take cholesterol drugs to prevent heart disease? Should every patient have a unique ID number for all medical records? Can accountable-care organizations raise quality while reducing costs? Should patents on pharmaceuticals be extended to encourage innovation? But one –Should physicians use email to communicate with patients?– should have been settled more than 10 years ago. It’s almost a joke that it’s still being asked, and at first I thought the question was about whether doctors and patients should still be using email as oppose...

Rhode Island Quality Institute seeks help

Running a hospital — Tue, 24 Jan 2012 02:32:00 +0100

Laura Adams, President and CEO of the Rhode Island Quality Institute writes:The Rhode Island Quality Institute in Providence, RI is seeking its first Chief Medical Officer (CMO) and its first Director, Strategy and Development. Both of these positions report to Laura.Founded in 2001, the Rhode Island Quality Institute’s (RIQI) mission is to significantly improve the quality, safety, and value of health care in Rhode Island. RIQI is a non-profit and a collaboration of leaders in the Rhode Island community including CEOs of hospitals, health insurers, and businesses, along with leaders of consumer groups, academia, and government. This group is determined to significantly improve the healthcare system in the state by building on the availability and advantages of health informa...

The shamans knew

Running a hospital — Mon, 23 Jan 2012 20:55:00 +0100

Thanks to Kevin, MD for reprinting an excellent column by Joe Kosterich entitled, "There is scope for harm when ordering tests." Dr. Kosterich notes:Most symptoms that we experience are not due to disease. A cough may be a symptom of lung cancer but hardly anyone who coughs has lung cancer. Likewise with a headache and brain tumors.Most conditions we see today are not acute emergencies and hence can be given time to resolve themselves. You do not always have to run to the doctor at the first sign of any symptom. Listen to your body.Tests and treatments have an important role but are never free from potential harm. We must always balance the benefits against the risks.We need to get back to treating people and not numbers so as to please governments and academics.The process of settin...

The Joint Commission tries to lead hospital leaders

Running a hospital — Mon, 23 Jan 2012 13:13:00 +0100

I was intrigued to read of a new standard, effective July 1, 2012, adopted by The Joint Commission regarding the need for hospital leaders to create and maintain a culture of safety and quality throughout a hospital. Here it is:I do not know how to find the previous standard for this topic, so I don't know how different it is. But this one seems to reflect comments made in the past by JC president Mark Chassin that the industry needs to get better creating and maintaining a true culture of process improvement. For example, an article by him and Jerod Loeb in Health Affairs centers on this topic. In a town hall meeting back on April 13, 2011, Mark also noted:The first premise for taking on this new topic is that I believe we need to do something different in quality ...

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Genex is for sale

Managed Care Matters — Mon, 23 Jan 2012 05:00:00 +0100

Looks like the rumors are based in fact; case management/bill review vendor Genex is up for sale. The "official" news came yesterday (thanks to a good friend for the tip); "The Wayne, Pennsylvania-based company has EBITDA of USD 40m, the... (Source: Managed Care Matters)

Copperfield Research's CorVel hatchet job

Managed Care Matters — Mon, 23 Jan 2012 05:00:00 +0100

A couple days ago a shadowy equity "research" outfit that goes by the name Copperfield Research published what can only be described as a hatchet job, with CorVel the target. I'm no fan of CorVel - their business model makes... (Source: Managed Care Matters)

Let's move to real-time philanthropy

Running a hospital — Sun, 22 Jan 2012 23:55:00 +0100

I want to present here a somewhat radical view of how large non-profit organizations like hospitals might more appropriately use the financial reserves they have accumulated through philanthropy. In short, I want to suggest that virtually all gifts received by a non-profit of this scale should be considered spendable, to be used -- and used up -- for the strategic priorities for the organization over a short period of time, say five to ten years.*I offer this thought not in any attempt to be critical of the current policies of hospitals, but in the hope of stimulating some discussion. If this approach were to be adopted, it would require a different viewpoint by boards of trustees and a different approach with many prospective donors. Some background. Virtually all ...

Speaking personally: where to give voice to healthcare interests on the social web

Fox ePractice — Sun, 22 Jan 2012 18:38:49 +0100

The objective, therefore, is to promote our strategic objectives through the publication of the content that we wish to share by selecting the platform that we feel will show that material in the best possible light. The following suggestions are made on the assumption that users have clearly defined the role that Social Media is playing within their integrated communications plan, have alighted upon appropriate qualitative and quantitative measures to evaluate their success, have the tools in place to undertake such appraisals, and are willing to continually refine the activities they undertake and implement such learning as is forthcoming from their ongoing self-assessment. These are some of the fundamental precepts of social business development within healthcare, and whilst I will over...

Samsung's Smart Window

Running a hospital — Sun, 22 Jan 2012 11:57:00 +0100

A really neat invention. Thanks to Bertalan Meskó, MD (@Berci on Twitter), who notes, "Such windows would look great in hospitals as well. (Source: Running a hospital)

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Thanks for nothing

Running a hospital — Sun, 22 Jan 2012 02:11:00 +0100

I have been reading and listening to media reports about recent deals between Partners Healthcare System and insurers in Massachusetts and experiencing a case of cognitive dissonance. From the reports, you would think that PHS is reducing the rates it gets from the payers. Well, that just shows the power of PR spinmeisters. Let's start by recalling that PHS has used its market power for well over a decade to extract payments from insurers that are dramatically above those received by other hospitals and physicians. Those out-of-market rates were built into the contracts that were to extend a year or two into the future, and the annual increases included in those contracts were likewise out-of-market. So, what has happened is that PHS has agreed to lower the rate inc...

MCM's position on SOPA and PIPA

Managed Care Matters — Sat, 21 Jan 2012 05:00:00 +0100

I don't like these bills, and neither should you. First, my perspective. I'm a content provider and a copyright holder. I don't want anyone else taking my intellectual property without permission and/or compensation. This isn't just about MCM; I've also... (Source: Managed Care Matters)

Carrying a lot of baggage

Running a hospital — Fri, 20 Jan 2012 23:55:00 +0100

In contrast to the story below about treating airline priority customers well, let's turn to baggage handling. I recently traveled on American Airlines through Miami en route to Boston. The luggage from my first flight was to be shifted from that airplane to the Boston flight. I had used some mileage credit to get a first-class upgrade so my bags were tagged with a special red marker indicating "priority handling." According to AA, this would ensure special and expedited treatment: Immediately available system-wide, select American Airlines customers will experience Priority Baggage Delivery. Upon check in, your luggage will be tagged with branded Priority bag tags. And when you arrive at your destination, those bags will be the first ones delivered to the bag...

Airline priorities

Running a hospital — Fri, 20 Jan 2012 23:39:00 +0100

First impressions about service issues can sometimes be misleading, especially if you don't understand aspects of traffic flow. Here was my first impression, and then something I learned afterward.We start with this scene of a Delta airlines gate area. It happens to be at the Atlanta airport, but the same configuration is used elsewhere. (See the Memphis set-up below.) Note the sign indicating two lanes of traffic, "general boarding" and "Sky Priority." Note, too, the special carpet with "Sky Priority" printed on it. As you can see, the two lanes go to exactly the same door.Here's what happens. When a plane is being boarded, passengers who have the "Sky Priority" status are boarded first and directed to use the right-hand lane. Indeed, a ribbon is ...

Dental and medical benefits should be integrated

Health Business Blog — Fri, 20 Jan 2012 23:04:58 +0100

I find it really strange that dental care is excluded form health insurance, including commercial and government programs. It’s increasingly untenable in my view. Why? Neglect of dental issues due to lack of coverage causes higher medical expenses, for example as dental infections spread to other parts of the body Hospital emergency rooms are seeing many dental cases (representing as much as 2.7% of ER volume) and are not well equipped to treat the problems, according to USA Today. In any case the expense is high Even well-off people with medical coverage often don’t qualify for dental insurance –e.g., because they aren’t part of a group– and end up paying high fee for service rates to providers rather than benefitting from a plan’s purchasing power...

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Innovation Insight Through Healthcare Social Media

Fox ePractice — Fri, 20 Jan 2012 21:20:19 +0100

In this rapidly changing business environment, it has not been unusual to hear of healthcare executives smartly taking a step back from their big hairy audacious goals to revisit their innovation strategy. Chances are, they are looking for solutions beyond market presence, and cross pollinating industry segments to tap new knowledge – in other words looking for social inputs to expand their innovation vision. As an innovation is social enthusiast, social media is an excellent vehicle to identify strategic alliances and to generate ideas from both inside and outside company walls. Whether you are seeking random or more specialized insight, begin by choosing an effective model. The Four Lens of Innovation, by Rowan Gibson is an excellent starting place to harness fresh views: ...

Take control of your healthcare digital footprint

Fox ePractice — Fri, 20 Jan 2012 19:53:31 +0100

Treating patients, keeping up with the latest research and running a business means squeezing the most out of minutes. Adding social media into the mix seems a contradiction – it might seem like chitter chatter and time-wasting. There is also the question of mixing private use of social media with work – maybe you’re on Facebook – no way do you want patients to find you, or know anything about your private life, but you would like an easy way to stay up-to-date, and let people know what your professional expertise is. Or perhaps you keep meaning to ‘do something about that Facebook stuff’ (does anyone get Twitter anyway?), but you reflect that your world is not going to stop turning if you do not use it – it’s not like you are going to run out of patients. W...

Inventory Productivity Webinar from MIT

Running a hospital — Fri, 20 Jan 2012 12:55:00 +0100

Inventory Productivity: Missing Link Between Supply Chain Management and Sales MIT SDM Systems Thinking Webinar Series Jonathan L.S. ByrnesSenior Lecturer, MIT Date: January 23, 2012Time: Noon - 1 p.m. ESTOpen to all Register Traditionally, supply chain and sales have been managed relatively independently, despite the critical impact that each has on the other. Systems thinking provides the key to linking these two critical business functions. Inventory productivity, the return on invested capital in your inventory, is the single systems measure that links these two cornerstone functions. This webinar will: 1) explain the central importance of this critical metric; 2) describe how to measure inventory productivity in a practical way; 3) outline the levers that both sales and supp...

Routine or rote?

Running a hospital — Fri, 20 Jan 2012 11:31:00 +0100

I am reprinting one of my favorite columns, first posted here on April 26, 2007.A story for all who have been through the multiple rounds of medical histories upon entering an emergency department.A good friend found herself in a local ED with symptoms of appendicitis. The first medical history was taken by the triage nurse. Then, another nurse. Then, an intern. Then, a resident. Finally, the attending arrived, and he started the process again, writing while talking and making no eye contact.By this time, my friend had memorized all the questions, and she figured she could speed up the process by anticipating the next questions and giving the answers in advance of their being asked. "Have you ever had abdominal surgery?" "Yes," she replied, and proceeding to the next as yet unasked questio...

New Health Wonk Review at Workers' Comp Insider

Health Wonk Review — Fri, 20 Jan 2012 10:37:59 +0100

Julie Ferguson has posted Health Wonk Review's Look to the Future Edition at Workers' Comp Insider (Source: Health Wonk Review)

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Too little too late

Life in the NHS — Thu, 19 Jan 2012 23:04:39 +0100

So the RCN and RCM have withdrawn their support for the NHS Health and Social Care Bill. About time too in my opinion, but you have to wonder exactly why it has taken so long. It is 18 months or so since the Government first published their ideas for abolishing PCTs and putting GPs in charge of commissioning as well as a whole range of changes which will apparently increase competition and fix the mess that apparently is our healthcare system. Since then we have paused, given our views, seen some cosmetic changes and started the long weary process to change. The Bill still isn’t law but I suspect that will come soon. At the same time we are to save £20 billion, because after all the NHS is wasteful. I respect the RCN both as a professional organisation (I studied for my BSc through ...

The government takeover of health care that isn’t

Health Business Blog — Thu, 19 Jan 2012 22:05:30 +0100

Among the wide array of hyperbolic complaints about health reform, the phrase “government takeover of the health care system” has always struck me as an odd one. It makes it sound as though the government is taking over the means of production, which is far from the case. In researching this post I realized I’m far from the first to make the observation. Actually it was featured as the Lie of the Year for 2010 by PolitiFact. The government does play a major role in the health care system. It’s a big customer, financier and regulator. The feds own and operate VA and DoD hospitals, and there are various county, city and state facilities, but this is a small share of the total. Kaiser Family Foundation has an informative piece today (Betting on Private Insurers) that �...

Health Wonk Review is up at Workers’ Comp Insider

Health Business Blog — Thu, 19 Jan 2012 21:26:18 +0100

Julie Ferguson of Workers’ Comp Insider hosts the Look to the Future edition of the Health Wonk Review. Share (Source: Health Business Blog)

Empower hospital staff to boost workplace satisfaction

hospital impact — Thu, 19 Jan 2012 18:14:14 +0100

by David Musyj Seven years ago, when we asked our staff whether they "would recommend Windsor Regional Hospital as a place for their friends and family to work," we got an answer that made us gulp. Sixty percent of our staff answered in the negative. It is not a favorable culture if people are embarrassed to admit where they work. This is especially true for hospitals, where staff cares for the patients that come through your doors. At Windsor Regional, we knew the direct relationship between staff satisfaction and patient satisfaction; they feed off each other. Happy staff results in happy patients. Happier patients result in happier staff. It was one of those moments--if we did not want the answer then we should not have asked the question. Clearly, whether consciously or subconsciou...

Technology key to growing consumerism trend in healthcare

hospital impact — Thu, 19 Jan 2012 18:14:14 +0100

by Gienna Shaw, FierceHealthIT Consumerism in healthcare is one of those trends that has been "looming" for an awfully long time. When the experts first predicted that patients would start shopping for providers as if healthcare was any other businesses--making decisions based on price, quality, and brand recognition, for example--the idea was met with skepticism, to say the least. Over the years, the language used to describe the concept of consumerism morphed: the call for transparency gave way to talk of patient satisfaction to build loyalty, which in turn shifted to cries for a better patient experience to improve quality. And lately the focus has shifted, yet again, to patient engagement and e-patients. Meanwhile, with each change came more champions ... and the number of skeptics...

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How our hospital is making employee wishes come true

hospital impact — Thu, 19 Jan 2012 18:14:14 +0100

by Scott Kashman Recently I asked for our employees, volunteers and physicians to share their wishes. That is, share their wishes for their department, our hospital and health system. Of course, they listed items related to more staff, money, capital and space. Those we all expect and know they are ongoing balances we need to address. What struck me was the number of wishes without a cost including: recognition, acknowledgment and accountability. Some things we are doing towards making these wishes come true: 1. Recognizing team members for their efforts and contributions This can take place through leadership rounds, town halls, safety huddles, department meetings and personal letters. Use forums that encourage everyone to share their concerns and opportunities for improvement towa...

Healthcare Blogging 101: How A Blog Can Help You Engage And Be Found Online

Fox ePractice — Thu, 19 Jan 2012 09:29:10 +0100

Few things are as captivating as a good story. A blog is a vehicle to share stories. Sharing a relevant story is the 21st century way of engaging desired consumers, patients and stakeholders. Individuals in a practice or healthcare organization can build trust online through stories that share their knowledge and personal experience. Sharing your story also makes you “real.” Think of your blog as a hub for your online engagement. 69% of businesses attribute their lead generation success to blogging. Making sure your ideas can be found. Through blogging, you also increase your visibility online. A blog is the best way to provide the fresh content required by today’s search engines and valued by consumers. In 2012, understanding how search plus social works is crit...

Physician dispensed drug costs - progress in Florida!

Managed Care Matters — Thu, 19 Jan 2012 05:00:00 +0100

Earlier this year, I predicted Florida would pass a bill limiting reimbursement for physician dispensed drugs. This morning, we made some significant progress. Spent a good chunk of the morning watching the Florida Senate hearing on Sen Hays' bill that... (Source: Managed Care Matters)

New Year, New Health Wonk Review

Managed Care Matters — Thu, 19 Jan 2012 05:00:00 +0100

HWR's tech guru and all-around social media expert Julie Ferguson is this biweek's editor of Health Wonk Review. There are lots of predictions and insights, and much discussion of reform and the Supremes.... (Source: Managed Care Matters)

Costs of Care essay winners -- Part 1

Running a hospital — Wed, 18 Jan 2012 23:00:00 +0100

Do you remember my post back in September helping to publicize the Costs of Care essay contest? Well, the judges have acted and picked the winners. Organizer Neel Shah writes:Two of the winners are from Boston, including an internist who described how a pharmaceutical cost-shifting strategy left him unable to discharge his patient from the hospital, and a medical student who described how she was able to treat a patient in her clinic on a $100 budget by avoiding an unnecessary hospital admission. In all, we received more than 100 submissions from patients and providers all over the country that illustrate both challenges and opportunities to improve the value of care. We also plan to summarize the lessons learned from the stories we received over the last two years in the form ...

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Costs of Care essay winners -- Part 2

Running a hospital — Wed, 18 Jan 2012 22:58:00 +0100

Here are two more of the winning essays from the Costs of Care essay contest described in the post above. These are by patients.Renee Lux, ConnecticutPatient Cost Anecdote: an unnecessary CT scan raises a patient’s insurance premiumsOne morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an Advil before bed. By the end of that week, I was unable to comfortably move my head and I was feeling numbness down my left arm to my fingertips. I saw my doctor within 24 hours of calling his office. After a brief exam, he was sure of my diagnosis, but he scheduled me for a CT-scan at the hospital the next day, “Just to be certain.” A day after the CT-scan he diagnosed me with Radiculitus Cervicalgia- inflammation leading to nerve root impingement....

What to make of the “That’s What PBMs Do” PR campaign

Health Business Blog — Wed, 18 Jan 2012 22:50:44 +0100

The pharmaceutical benefit management (PBM) industry has apparently decided it’s time to buff its image. A new That’s What PBMs Do campaign has been launched by the Pharmaceutical Care Management Association (PCMA), which counts the big 3 PBMs and a few smaller ones among its members. Some articles speculate that the campaign is in response to scrutiny over the pending acquisition of Medco by Express Scripts. Although it seems a little bit unlikely that CVS Caremark would go along with that line of thinking, the pro-mail order and implicitly anti-drug store message of the materials does bear the handprints of Express Scripts/Medco. The print ads and video make the following claims: PBMs reduce pharmacy costs for employers, unions, and consumers PBMs play a key role in the Medi...

What would Richard do?

Running a hospital — Wed, 18 Jan 2012 17:54:00 +0100

When it comes to hotel service, I have a new standard by which I measure facilities: "What would Richard do?" Richard Caines, you may recall, is director of training at the Gaylord Palms Resort and Convention Center in Kissimmee, Florida. The hotel appropriately prides itself on a very high standard of service, based in turn on a respectful and congenial approach to its staff.So, today, I am at the Gold Strike Casino Resort, in Tunica, Mississippi, where I will be giving a speech to a group of health care finance people. Hearkening back to my years in Arkansas, I decided to start my day with a good old-fashioned Southern breakfast in the comfort of my room. Now, there was no way I was going to eat all 2000 calories, but I was looking forward to sampling the gr...

Health Wonk Review Archives: 2006-2011

Health Wonk Review — Wed, 18 Jan 2012 06:50:43 +0100

January 19, 2012 - Julie Ferguson at Workers' Comp Insider January 5, 2012 - Jared Rhoads at Center for Objective Health Policy December 22, 2011 - Gary Schwitzer at Health News Watchdog blog December 8, 2011 - Brad Wright at Wright on Health November 24, 2011 - Thanksgiving - no issue November 10, 2011 - Hank Stern at InsureBlog October 27, 2011 - Joe Paduda at Managed Care Matters October 13, 2011 - Christopher Fleming at Health Affairs Blog September 29, 2011 - Joe Colucci at New Health Dialogue Blog September 15, 2011 - David Williams at Health Business Blog September 1, 2011 - Avik Roy at The Apothecary August 4, 2011 - Joe Paduda at Managed Care Matters July 21, 2011 - Julie Ferguson at Workers Comp Insider June 23, 2011 - Tinker Ready at Boston Health News June 9, 20...

I shoulda warned you, Bob...

Managed Care Matters — Wed, 18 Jan 2012 05:00:00 +0100

Colleague Bob Wilson of WorkersCompensation.com has been delving deeply into the disaster that is North Dakota "justice", at least justice as applied in the Sandy Blunt case. Bob's efforts have uncovered some amazing stuff... For instance, the same state that... (Source: Managed Care Matters)

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De-Magnetizing

Running a hospital — Wed, 18 Jan 2012 01:45:00 +0100

One study does not a trend make, but this one has conclusions that are so direct that it is bound to attract lots of attention . . . and anger from certain quarters. This post, likewise, may prompt additional anger from some of my readers.C.J. Goode and others have published an article in the Journal of Nursing Administration entitled, "Comparison of patient outcomes in Magnet® and non-Magnet hospitals." You can view the abstract here. Let me give you the highlights: Non-Magnet hospitals had better patient outcomes than Magnet hospitals. Magnet hospitals had slightly better outcomes for pressure ulcers, but infections, postoperative sepsis, and postoperative metabolic derangement outcomes were worse in Magnet hospitals.What an indictment of a certification process t...

Inbound vs. Outbound Healthcare Marketing Strategies

Fox ePractice — Tue, 17 Jan 2012 19:55:17 +0100

This article was of great interest, being I led a discussion on the move to a more educated consumer, new buying behaviors and how social networking is a driving factor behind these shifts during my session at the Practice Management Institute national conference. Healthcare Social media and Inbound vs. Outbound Marketing With consumerism abound in healthcare, these same shifts in patient decision-making behaviors and choices in physicians/institutions are becoming increasingly difficult to ignore. With this adjustment in action, to be effective at reaching your patient (or referring physician, organization, etc) one must understand the difference between these two approaches to marketing. My friend and colleague Howard Luks, MD, does a great job of outlining these differences in h...

Getting veterans off Medicaid

Health Business Blog — Tue, 17 Jan 2012 17:47:53 +0100

As states grapple with growing Medicaid costs in an era of sluggish economic growth and antipathy to taxes, they are very pleased when they find a way to increase benefits to citizens while reducing their own expenditures. I predict many states will follow the example of Washington, which since 2003 has run a program to identify Medicaid enrollees who are eligible for benefits from the Department of Veterans Affairs. Surprisingly (to me anyway) there are numerous veterans who end up on Medicaid instead of turning to the VA system, which offers richer benefits. For example, some veterans qualify for the VA’s Aid and Attendance Pension, which helps low-income veterans and widows receive long-term care in their home or an institution. Medicaid may attempt to recover costs by going after...

The Scoop #3 – Best Practices in Healthcare Social Media

Fox ePractice — Tue, 17 Jan 2012 16:12:21 +0100

Attract Patients & Keep Them (Healthy) with Social Media @SoftwareAdvice Katie Matlack’s five steps aren’t necessarily intended to be an all inclusive guide to using social media in healthcare, but they do address some basics that will help any medical practice to establish a firm foundation. Follow her advice and you’ll be sure to not only engage with patients and the public, but you’ll help guide them to better choices in their pursuit of health and wellness. Read more… Distribution networks & #supplychains can minimize the impact of high fuel prices: http://t.co/1Q1q93t8. #logistics RT @CRMAdvice: It’s Monday! What better way to start the week than to dig into our latest article on #MA http://t.co/crz6EjME @josheac just posted a grea...

Wachter explains private practice in the UK

Running a hospital — Tue, 17 Jan 2012 14:55:00 +0100

Bob Wachter continues to offer thoughtful perspectives on the British health system. The latest is about the role of private insurance and private doctors operating in parallel to the National Health Service. Here are some excerpts:[F]rom the time of its founding in 1948, the British National Health Service has allowed – and, depending on which party is in power, promoted – a private insurance market. Private insurance in a single payer, government run healthcare system is a funny animal: one part incest, one part conflict of interest, and three parts strange bedfellows. And it’s infinitely fascinating. The action in the private world stems from occasionally poor access to specialty care in the NHS, both because of limited numbers of specialists and g...

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Why work comp pharmacy is nothing like group health

Managed Care Matters — Tue, 17 Jan 2012 05:00:00 +0100

Today's WorkCompWire has a great piece authored by PMSI CEO EIleen Auen on the differences between work comp and group pharmacy management. Among Eileen's points are: - "Group health benefits generally focus on sickness and illness while workers' compensation focuses... (Source: Managed Care Matters)

No, Mitt, you can't fire your insurance company

Managed Care Matters — Tue, 17 Jan 2012 05:00:00 +0100

Mitt Romney's comment " I like to be able to fire people" has been turned against him by his GOP Presidential candidate opponents, with Gingrich and Rick Perry (remember him?) using it to illustrate Romney's "out of touchiness" with regular... (Source: Managed Care Matters)

What to do with aging physicians

hospital impact — Tue, 17 Jan 2012 02:29:25 +0100

by Dr. Kenneth H. Cohn Last month, I had the pleasure to give a three-hour summary of my two-day seminar at the annual meeting of the Oklahoma Hospital Association. One question that I have mulled over came from a CEO: "I have an 83-year-old general practitioner that I just don't know what to do with any more. He has a long history with our hospital and has admitted many patients over the last five decades, but the question I struggle with is 'how do we persuade him to transition before he hurts someone.'" Nobody on his medical executive committee wanted to tackle the issue because they had no file of complaints to point to, yet they all sensed they were dealing with a ticking time bomb, when the informal monitoring systems they developed did not work. I suppressed the thought about ...

10 'must-do' strategies for hospitals this year

hospital impact — Tue, 17 Jan 2012 02:29:25 +0100

by Raymond Hino In September of 2011, the American Hospital Association (AHA) Committee on Performance Improvement (CPI) published a critically important report to its membership called "Hospitals and Health Care Systems of the Future." The 28-page report should be mandatory reading for every hospital leader today. It is based upon the evolving reality that hospital reimbursement in the United States is rapidly moving from a volume-based system to a value-based system. Is there anyone out there that doubts that premise today? In my home State of California, Blue Shield of California has announced that HMO members that require elective hip or knee joint replacement surgery as of Jan. 1, 2012 will be restricted to 16 hospitals in the entire state that have been designated by Blue Shield a...

Healthcare needs improved delivery, not more hospitals

hospital impact — Tue, 17 Jan 2012 02:29:25 +0100

by Kent Bottles Two recent articles tell me that some physicians and hospital leaders have not been paying close enough attention. When the rules change, you need to read the new rules and adjust your vision and strategies and tactics. In my experience, successful leaders do four things: They conduct an environmental assessment of their industry and create a vision that can inspire themselves and the people who work for them. They translate that compelling vision into strategies and tactics. They assign those strategies and tactics to the right people. They hold those people accountable for results measured by metrics agreed upon beforehand. An article in the Pittsburgh Tribune describes how hospital leaders in North Carolina, Illinois and California are busy building new hosp...

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Water interests in hospitals: Spraying infections?

Running a hospital — Mon, 16 Jan 2012 13:12:00 +0100

By now, you may have heard about the outbreak of Legionnaires’ disease in Wisconsin that was linked to a decorative water wall in a hospital lobby. As noted in this Washington Post story: In 2010, eight people contracted the severe and potentially life-threatening form of pneumonia caused by the bacteria. None had been admitted to the Milwaukee-area hospital at the time of exposure. But they all had walked by the water wall in the main hospital lobby, researchers said. I wonder how many more people may have been unknowingly infected. The article continues: The study, published online in Infection Control and Hospital Epidemiology, is the second documented outbreak of Legionnaires’ disease in a health-care setting associated with a wall-type water fountain, a ...

Physician dispensing - the latest from Florida

Managed Care Matters — Mon, 16 Jan 2012 05:00:00 +0100

Physician dispensing in Florida is back in the news, as we await with bated breath the outcome of this session's legislative battle. On one side is the Florida Medical Association and Automated Healthcare Solutions, the Miramar company that provides software,... (Source: Managed Care Matters)

Canadian court to address end of life support

Running a hospital — Sun, 15 Jan 2012 20:12:00 +0100

The Supreme Court of Canada will soon be taking up the issue of whether doctors need consent before taking a patient off life support. As reported here in The Globe and Mail:The country’s top court has granted leave to appeal to the doctors of . . . a man who has been in a coma at Toronto’s Sunnybrook Health Sciences Centre since October, 2010. His doctors diagnosed him as being in a “permanently vegetative state” and recommended he be taken off life support, but his wife and substitute decision-maker . . . strongly opposed. Now the doctors have turned to the Supreme Court in hopes of disconnecting Mr. Rasouli from the medical machines that are keeping him alive.The outcome of the case could set a national precedent on protocol for end-of-life care when physicians and families don�...

Aging Physicians – A Valuable Asset

MSSPNexus Blog — Sun, 15 Jan 2012 19:54:40 +0100

Aging physicians on your medical staff are a cause for concern. Not just concerns regarding their ability to continue to safely care for patients, but concerns for them as valued friends and colleagues, for their dignity and self-esteem. Medical staff leaders struggle with what, if anything, to do when faced with this dilemma. Should the clinical privileges of older staff members be limited? Should they be forced to retire? Many leaders choose to look the other way, especially when the practitioner is well-loved in the community and no patients have come forward to complain. That philosophy, however, comes at a price; a high one if a patient ends up being harmed and an older, well-respected, physician’s mistake is the cause. Although there are no “one-size-fit...

NPSF listserv

Running a hospital — Sat, 14 Jan 2012 23:04:00 +0100

Many thanks to Dr. David Lawrance, at University of Illinois at Urbana-Champaign, for a lead to a good listserv run by the National Patient Safety Foundation. He notes:I find a lot of value following the National Patient Safety Foundation's listserv, which has a very ardent group of patient safety professionals. However, there is not enough participation by senior hospital administrators, current, former, or future. The consequence is a frustrating disconnect. I thought you might be interested.He's right. I joined and took a look around at the conversations. They are thoughtful and professional. You can find more information and join in the conversations here. (Source: Running a hospital)

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Making the constitutional argument

Running a hospital — Sat, 14 Jan 2012 13:30:00 +0100

MA Attorney General Martha Coakley has submitted an amicus brief in the pending Supreme Court case about the national health reform legislation. The brief focused on the "individual mandate" portion of the law. I think it is really well done and I copy the argument summary here:Having enacted six years ago a prototype of the comprehensive healthcare reform package that Congress would later adopt in 2010, Massachusetts is in a unique position to assess the rationality of the assumptions that underlay both enactments. Specifically, the Court has held that the Commerce Clause empowers Congress to regulate activities that substantially affect interstate commerce. Congress properly exercised that power in adopting a provision in the ACA that requires all non-exempt persons to purcha...

End of life care: advice for physicians dealing with families

Health Business Blog — Fri, 13 Jan 2012 22:02:57 +0100

Writing in Today’s Hospitalist, Dr. Stella Fitzgibbons offers specific and useful advice to physicians who have to deal with the wishes of a family when a patient can longer speak for him or herself. I’m confident that her approach will yield constructive results in most situations, but I’m uncomfortable with the shortage of empathy and reflectiveness that the article ultimately conveys. The scenario she introduces is as follows: [W]hat about a patient who can no longer speak for himself—and family members who either seem unrealistic about the effectiveness of medical treatment or actually refuse to honor his wishes? What about a doctor’s duty to relieve suffering and not provide treatment the patient wouldn’t want ow that does him no good? To summarize, her...

2011 in review

Life in the NHS — Fri, 13 Jan 2012 21:38:26 +0100

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog. Here’s an excerpt: The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 23,000 times in 2011. If it were a concert at Sydney Opera House, it would take about 9 sold-out performances for that many people to see it. Click here to see the complete report. (Source: Life in the NHS)

We’re going to connect the dots and simplify the process

Fox ePractice — Fri, 13 Jan 2012 21:11:47 +0100

This is the time, this is place — The Healthcare industry is finally realizing the potential advantages of a digital presence in the broader sense of their marketing or other strategic initiatives — but, actionable, best practice guidance is needed! We’re going to lead the charge. We’re going to connect the dots and simplify the process.I am (@hjluks) a practicing Orthopedic Surgeon in NY and current Board Member at the Mayo Clinic Center for Social Media. I have had a deep digital presence for nearly 4 years and now nearly 20% of my practice’s new patients come through a google search or social media related referral. I have worked with Fortune 500 companies on their online endeavors as well as solo practitioners. My personal experience and deep un...

The hardening work comp market

Managed Care Matters — Fri, 13 Jan 2012 05:00:00 +0100

Today's' WorkCompCentral arrives with a solid piece[sub req] from Greg Jones detailing the current work comp insurance market environment, which III's Bob Hartwig characterizes as "firming"; rates are up but not (yet) into the double digit territory which is Hartwig's... (Source: Managed Care Matters)

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Oxycontin and heroin addiction. Business opportunities in the push to address the problem

Health Business Blog — Fri, 13 Jan 2012 04:01:16 +0100

Growing up in the suburbs in the 1970s and 80s I knew of teens experimenting with alcohol and marijuana. Cocaine, LSD, PCP and barbiturates were around, too, but pretty rare. I only knew of one teen who misused prescription drugs (in his case codeine). And if anyone in my area used heroin I would have been shocked. Things have changed. In particular, strong opioids such as oxycontin are now widely prescribed. Teens may find some extras lying around in their parents’ medicine cabinets or even receive some themselves after an injury or medical procedure. Oxycontin has the veneer of respectability and the illusion of safety. After all it’s a commercially manufactured, legal product prescribed by a physician. But it’s pretty easy to get addicted and that’s when the real...

Earle of the islands

Running a hospital — Thu, 12 Jan 2012 20:50:00 +0100

Earle Nelthropp and daughter SonyaHere are some stories from one of my ancestral homes, St. Thomas. You may recall a previous one about how the island came to be covered with flamboyant trees.Today's stories are about an interesting personage from the Virgin Islands, Earle Nelthropp. You met his daughter, Sonya, in an earlier post, in which she presented several sayings from the islands, updated here.Earle served as Administrator of St. John from 1966-69, appointed by his old friend, Governor Ralph Paiewonsky. In 1970, he took over as manager of the Magens Bay beach authority. But it is his earlier history that offers a sense of the color of the times.Earle was born in St. Thomas in 1906. In an interview with Sonya in his later years (1988), he reminisced about the ...

Semester in Israel for undergraduates

Running a hospital — Thu, 12 Jan 2012 13:46:00 +0100

Here is a great opportunity described by Dr. Osnat Levtzion-Korach, Deputy Director, Assaf Harofeh Medical Center. It is for undergraduates with an interest in medicine, pre-med and other health/science students, to take a semester at a highly regarded Israeli institution: We would like to introduce to you our accredited academic elective program: The Voyage to Medicine in Israel. The Voyage to Medicine is a five-month program (either fall or spring semester) open to English-speaking undergraduate students who express an interest in the field of medicine. The program is a joint venture between Tel Aviv University and Assaf Harofeh Medical Center. The course offers participants the unique opportunity to gain experience in one of Tel Aviv...

What's up for 2012 - predictions for work comp in the Next Year - Part Two

Managed Care Matters — Thu, 12 Jan 2012 05:00:00 +0100

Okay, here's the last of my predictions for the work comp business 2012... 7. The physician dispensing cost control bill currently pending in Florida will pass. After several years of political intrigue, huge campaign contributions from companies making enormous profits... (Source: Managed Care Matters)

End-of-life conversations, as seen by the intensivist

Running a hospital — Thu, 12 Jan 2012 00:52:00 +0100

My recent post on end-of-life care issues, "What if they had had to pay?," generated a lot of comments in the blogosphere and beyond. One intensive care doctor sent me a particularly poignant note. It gives a good sense of what it is like on this person's side of the bed. The note re-emphasizes the need for better end-of-life planning, for the sake of patients, families, and providers.Here's my day so far. This is my first day of a 7-day stretch in a tertiary ICU. The average census in this ICU is 10, but today we have had to surge to 15.Let me stop right there. This is doctor (and nurse) shorthand for, "I expect to be very busy, very tired, and very stressed out. I am going to have to make some highly critical clinical judgments, sometimes with very lit...

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Is this the best way to cut the deficit?

Life in the NHS — Wed, 11 Jan 2012 21:30:59 +0100

No one doubts the need for deficit reduction. If I think about the difficult decisions I had to make 5 years ago or so, when I realised that my personal debts meant that my monthly payments to creditors practically outstripped my income. Something had to give, and that something was my credit cards and loans. The experience was painful, and sacrifices were needed. But today I have just a small amount of remaining debt (other than the mortgage and every month I have money to spend. Christmas, which used to be a time to dread has come and gone and I owe no more today than I did last month. The nation’s debt is thankfully much greater than anything I could conceive personally, but the principles are the same. The causes of this are well written about, but in my opinion not worthy of men...

Why does some “pure” vanilla contain corn syrup or sugar?

Health Business Blog — Wed, 11 Jan 2012 19:36:13 +0100

Last month I noticed that the store brand “pure” vanilla extract I had just purchased contained corn syrup, whereas the brand name version in my pantry didn’t. From the pharmaceutical industry I’m used to generic products being essentially identical to branded items, and I guess I just assumed the same was true with foods. Turns out that’s not the case, at least with vanilla. I sent the following email to SuperValu, whose name was on the Shaw’s brand product, on December 18: “In the past I have purchased McCormick Pure Vanilla Extract. This time I purchased Shaw’s Pure Vanilla Extract. When I compared the labels I was disappointed to see that while both products contain vanilla bean extractives in water and alcohol, the Shaw’s product a...

Removing barriers on WIHI

Running a hospital — Wed, 11 Jan 2012 18:46:00 +0100

Removing Barriers to Better Health and Better Care with Medical-Legal Partnerships January 12, 2012, 2:00 PM – 3:00 PM Eastern Time Guests:Barry Zuckerman, MD, Chair, Department of Pediatrics, Boston University School of Medicine; Founder, National Center for Medical-Legal PartnershipRobert Kahn, MD, MPH, Associate Professor of Pediatrics and Director, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical CenterCarol Beasley, MPPM, Director of Strategic Projects, Institute for Healthcare ImprovementLet’s face it. If someone mentions the words “medical” and “legal” in the same sentence, the next thing we imagine we’ll hear about is a lawsuit. Picture this instead: empowered, proactive social workers, collaborating with health care provider...

How concerned are workers comp execs about opioids?

Managed Care Matters — Wed, 11 Jan 2012 05:00:00 +0100

I'm finishing up compiling results from the most recent survey of pharmacy management in workers comp, and had to take a break and get this out. I just totaled up the responses to the question "How much of an issue... (Source: Managed Care Matters)

Work Comp Outpatient facility costs - the summary

Managed Care Matters — Wed, 11 Jan 2012 05:00:00 +0100

With the release of WCRI's latest report - this on on outpatient facility surgery costs - I'll have to leave the next and last wave of crystal ball gazing to tomorrow. That'll ensure it has a full charge before I... (Source: Managed Care Matters)

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Medicaid expansion: Will we get our money’s worth?

Health Business Blog — Wed, 11 Jan 2012 03:29:50 +0100

Should we just hand uninsured adult diabetics $1000 per year rather than enrolling them in Medicaid? That’s the question I’m left with after reading Medicaid Expansion Under Health Reform May Increase Service Use and Improve Access for Low-Income Adults With Diabetes in this month’s diabetes focused issue of Health Affairs. If the Patient Protection and Affordable Care survives the Supreme Court and the Republican Party, millions of uninsured, non-elderly, low-income adults will be newly eligible for Medicaid in 2014. The authors of the article compared diabetics on Medicaid to those who lacked insurance and found: Much higher health care spending for those on Medicaid: $14,229 v. $3,498 Much higher out-of-pocket expenses for the uninsured: $1,446 v. $415 Better access t...

Good diagnosis, Zeke. Why no cure?

Running a hospital — Tue, 10 Jan 2012 13:14:00 +0100

I really like it when I agree with Zeke Emanuel and never more so than with his recent column in the New York Times about proton beam machines. You will recall that I addressed this topic several months ago.He notes:If you want to know what is wrong with American health care today, exhibit A might be the two new proton beam treatment facilities the Mayo Clinic has begun building, one in Minnesota, the other in Arizona, at a cost of more than $180 million dollars each. They are part of a medical arms race for proton beam machines, which could cost taxpayers billions of dollars for a treatment that, in many cases, appears to be no better than cheaper alternatives.To generate sufficient revenue, proton beam facilities need to treat patients with other types of cancer. Consequently, they...

BioInnovations Conference at MIT

Running a hospital — Tue, 10 Jan 2012 12:34:00 +0100

A note from Lamees Hamada, a graduate student at the Sloan School:The MIT Sloan Healthcare Club is holding its annual BioInnovations Conference, Driving Innovation & Entrepreneurship in a New Era, on February 24th. The conference will feature keynote speakers, Chris Viehbacher (CEO of Sanofi), Phillip Sharp (Nobel Laureate and Co-founder of Biogen and Alnylam Pharmaceuticals Inc.), and George Scangos (CEO of Biogen Idec). Panels will focus on paradigm-shifting trends: personalized medicine that creates more value, new business models that sustain innovation, healthcare financing that nurtures entrepreneurship, and emerging market healthcare that tackles global challenges. The conference will conclude with a networking reception, the BioInnovations Poster Session, which will feature stu...

The harp delivers and soothes

Running a hospital — Tue, 10 Jan 2012 11:08:00 +0100

One of the most satisfying decisions I made during my tenure as CEO of our hospital was to introduce harp playing. This happened in an unplanned way. I was walking near the building and ran into a family friend, Nancy Kleinman, and asked what she was doing. She mentioned that she was spending a lot of time playing the harp, and I invited her to play in our public spaces. She was willing to volunteer, but I insisted on her being paid because I felt that this would be an important service, one that should be offered on a professional basis. Of course, no insurance company would cover this kind of service, so I paid for her personally for several months. Later a generous donor stepped forward to fund the program on a ongoing basis, and an additional musicia...

What's up for 2012 - predictions for work comp in the Next Year - Part Two

Managed Care Matters — Tue, 10 Jan 2012 05:00:00 +0100

My crystal ball blanked out yesterday after revealing the top three predictions for 2012; it recharged overnight and looks ready to continue this morning. I'll see what it shows and hopefully, before the light dims, we'll have a clear picture... (Source: Managed Care Matters)

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Kindle or actual book?

Life in the NHS — Mon, 09 Jan 2012 21:13:11 +0100

For Christmas I received a Kindle from hubby, along with a lovely leather cover with light for reading from my son. when these electronic book devices started appearing a couple of years ago I insisted that I would never convert. I love the feel of a real book, I love turning the pages, holding it and also love trawling bookshops for something new. When I go on holiday though, I have been known to take half a dozen books with me. There have been occasions that I have forgone articles of clothing or shoes for books. I have packed them into my hand luggage and bought more at the airport. This has to be madness if there is an alternative. When I went on a coach trip to Germany recently I looked over the kindle of my friend Sue and decided that this was a good idea for ease when travelling and...

Are cadavers dying? Medical schools turn to simulation

Health Business Blog — Mon, 09 Jan 2012 21:05:46 +0100

New York University medical students are moving beyond the traditional cadaver of anatomy class to dissect a virtual model made by BioDigital Systems, reports the New York Times. It’s pretty cool, but hardly surprising that advanced 3-D graphics and simulation technology are making their way into health care. Memory, processing speed and rendering techniques have gotten to the point where the building blocks are accessible and even commonplace in other parts of the economy, such as entertainment. The creators have big ambitions: BioDigital plans to develop the virtual cadaver further on its new medical education Web site, biodigitalhuman.com, with the aim of providing a searchable, customizable map of the human body… In the coming months, the company plans to offer its code to...

What's going to happen in workers comp this year?

Managed Care Matters — Mon, 09 Jan 2012 05:00:00 +0100

There's a lot happening in the work comp industry: a hardening market; frequency ticking up; consolidation/mergers/acquisitions and buyouts; legislative and regulatory changes; and management moves. And all this against the backdrop of a very big election year. So here's what... (Source: Managed Care Matters)

Tracking adverse events

Running a hospital — Sun, 08 Jan 2012 21:18:00 +0100

This study, which used the AHRQ Patient Safety Indicators (PSIs) to analyze safety events in 69 million hospitalizations over a 10-year period, also finds no clear evidence of improved safety. Of the 20 PSIs analyzed, 7 increased in incidence over the time period studied, 7 decreased, and 6 did not change. While PSIs are best used for screening purposes and not for direct comparisons between hospitals, they have been used to track system-level rates of safety problems over time. The results of this study and other recent literature provide continued urgency for the safety movement to strive to improve the safety of the entire health care system.What's going on? Answer: We hear of great work done in quality and safety improvement by hospitals on the leading edge. And that work i...

Front page ads hiding as news stories at the New York Times

Running a hospital — Sun, 08 Jan 2012 16:51:00 +0100

This article was adapted from “The Obamas,” by Jodi Kantor, which will be published Tuesday by Little, Brown & Company. Indeed, the whole article is just a teaser for the book, for it can scarcely be considered front page news. Since when does a reporter get to publish a self-referential story based on his or her book? Since when does a newspaper permit this kind of commercial use of a front page story, whether for its own profitability or that of its reporters? (Source: Running a hospital)

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Physicians study leadership at HSPH

Running a hospital — Sun, 08 Jan 2012 03:22:00 +0100

Each year, I am delighted when Jim Conway invites me to be a guest lecturer in a class on Physician Leadership at the Harvard School of Public Health. The attendees are senior doctors from institutions around the world who come to Boston several times over two years for four-day weekends of classes. Jim, as many of you know, served from 1995-2005 as Executive Vice President and Chief Operating Officer of the Dana-Farber Cancer Institute. After leaving that position, he was senior vice president and senior fellow at the Institute for Healthcare Improvement. During my tenure as CEO of BIDMC, he was a true mentor to me in learning about the process of quality and safety improvement. He also played a key role in helping our hospitals' boards learn how to exercise ...

Commit to patient experience in 2012

hospital impact — Sun, 08 Jan 2012 01:23:23 +0100

by Jason A. Wolf With another year of rapid change in policy and practice now behind us, healthcare organizations are looking to 2012 with great anticipation. A significant shift is that the concept of patient experience was forever changed in 2011. The year started as "conceptual," meaning organizations were being measured on patient experience performance based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and results were reported compared to their peers. This comparison generated interest in some leaders and drew on the competitive nature of others. It provided a general feeling of pride and accomplishment to know your organization scored well and created a need for urgent action when it did not. In this light, it made patient experience an is...

Overcome healthcare fears with courageous leadership

hospital impact — Sun, 08 Jan 2012 01:23:23 +0100

by Thomas Dahlborg These are challenging times in healthcare--an obvious observation. Perhaps not so obvious is the fear that exists in the healthcare system. People are scared. Patients are scared. Your staff is scared. Maybe as leaders you are scared. The fear throughout the system is palpable. It is tangible. It is harmful. It is injurious to each of us and it is adversely affecting our ability to honor our commitments to our patients, our staff, our communities and one another. Today I want to focus on the fears of us healthcare leaders and those of our staff, and provide an opportunity for both sharing and learning. Healthcare leaders are scared--scared of making a mistake that costs lives, impacts the bottom line, effects their status or reputation, could cost them their own j...

How to help hospital employees find their 'flow'

hospital impact — Sun, 08 Jan 2012 01:23:23 +0100

by Anthony Cirillo In his book, "Drive: The Surprising Truth About What Motivates Us," Daniel Pink talks about the concept of flow. I'll describe it my own way. When I work on music in the recording studio at home, I am oblivious to everything--time, thirst, hunger, etc. I can go in the studio at 7:00 p.m. and not even realize that it is 4:00 a.m. when I get done. That's because in flow, Pink says, "people lived so deeply in the moment, and felt so utterly in control, that their sense of time, place, and even self melted away." He makes the case that when this happens to employees it is magical. And he realizes that not every work experience provides surges of flow. He goes on to say that "the shrewdest organizations afford employees the freedom to sculpt their jobs in ways that bring a...

Health insurance coverage for legal immigrants in Massachusetts: Doing the right thing and the smart thing

Health Business Blog — Fri, 06 Jan 2012 18:06:57 +0100

Legal immigrants will enjoy the same rights to subsidized health insurance coverage as citizens of Massachusetts, thanks to a ruling by the Supreme Judicial Court. Although it will be painful for the state to fund the approximately $150 million hit to the budget, it’s the right thing to do and also a smart thing. Massachusetts has achieved near-universal coverage thanks to its health reform law. Although health insurance costs are among the highest in the nation, Massachusetts can afford to have everyone in coverage. That’s because Massachusetts has a modern, knowledge based economy with high wages, thanks largely to the state’s investment in education and infrastructure, and its open minded populace. Still, high and rising costs are a burden and universal coverage places a s...

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Why such a short reply?

Running a hospital — Fri, 06 Jan 2012 13:17:00 +0100

A physician friend with whom I have been corresponding wrote, after I sent a short reply to an email:You have perfected the CEO art of short, succinct emails. All CEO's I know can do this. I can't. Do they teach that art in CEO school?My reply: It is a post-graduate course.So, here's my philosophy on email, from the work environment, which tends to run over into personal stuff. I never wanted to be the bottleneck in something that was going on. I always figured that a quickly delivered short, responsive note was better than a delayed expansive one.Also, when you get 500+ notes a day, it is important to answer each one as you read it. If you hold it to think about, and then read it again, and then respond, you have doubled your intake folder and used...

Steve Spear's MIT webinar on January 9

Running a hospital — Fri, 06 Jan 2012 10:04:00 +0100

Here's another great webinar being offered next week by the MIT System Design Management crew:Creative Experimentation: Developing a Skill Critical for Managing Complex Operating SystemsMIT SDM Systems Thinking Webinar SeriesSteven J. SpearSenior Lecturer, MIT Sloan School of Management; Senior Lecturer, MIT Engineering Systems Division; Senior Fellow, Institute for Healthcare Improvement; and author, The High Velocity EdgeDate: January 9, 2012Time: Noon - 1 p.m.Open to all RegisterA broad-based capacity for experimentation is critical for organizations to succeed because the systems in which people are embedded are increasingly complex and fast. For instance, medical treatment used to be accomplished by "going to the doctor," a sole practitioner supported by a handful of other p...

Health Wonk Review - upcoming hosts

Health Wonk Review — Fri, 06 Jan 2012 09:14:26 +0100

Submit entries to Blog Carnival 1/19/12 - Julie Ferguson at Workers' Comp Insider Submission deadline: 9 am on Wednesday, 1/18/12 2/2/12 - Louise Norris at Colorado Long Term Care Insider Submission deadline: 9 am on Wednesday, 2/1/12 2/16/12 - Jason Shafrin at Healthcare Economist Submission deadline: 9 am on Wednesday, 2/15/12 3/1/12 - To be announced (Source: Health Wonk Review)

New Health Wonk Review at Center for Objective Health Policy

Health Wonk Review — Fri, 06 Jan 2012 09:05:04 +0100

Jared Rhoads has posted Health Wonk Review: 4th time hosting series at The Center for Objective Health Policy (Source: Health Wonk Review)

For work comp, the soft market is over

Managed Care Matters — Fri, 06 Jan 2012 05:00:00 +0100

It's increasingly evident that the way-too-long soft market in workers comp is coming to an end - if it isn't already over. The latest news comes from MarketScout (reported by Mark Ruquet in PropertyCasualty360.com), which indicated WC rates were up... (Source: Managed Care Matters)

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HWR is up

Managed Care Matters — Fri, 06 Jan 2012 05:00:00 +0100

The first edition of Health Wonk Review for the year is up at the OHP blog - a well-organized and quick review of what happened while you were otherwise engaged.... (Source: Managed Care Matters)

Academic medical center advertising: Pump up the volume

Health Business Blog — Thu, 05 Jan 2012 19:17:21 +0100

More academic medical centers are turning to national advertising, with many seeking to boost admissions of well-insured (or simply wealthy) patients from outside their local catchment areas. It’s hard to say whether such initiatives will generate an attractive return on investment for the institutions, but it does tell you something about the state of the market that these initiatives are being pushed now, when hospitals are worried about squeezes from Medicare and from private payers pursuing capitation. NPR covers the topic under the misleading headline In Tight Times, Medical Schools Market Themselves, describing initiatives by Mayo Clinic, Mount Sinai, New York Presbyterian and Vanderbilt. Many of the advertisers are a bit cagey or even misleading about why they’re investi...

Rapid response teams and end-of-life care

Running a hospital — Thu, 05 Jan 2012 16:11:00 +0100

How well are end-of-life issues dealt with in emergency situations in hospitals, i.e., when rapid response teams are called in? Researchers in Australia, Canada, and Sweden asked that question and studied the treatment of several hundred patients over the course of a month. Nearly one-third of patients seen by a rapid response team ultimately had limitations placed on their care (such as do-not-resuscitate orders). This is suboptimal compared to making those plans earlier, during less stressful times. Here is the formal conclusion published in Critical Care Medicine:Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participatin...

Changes to Managed Care Matters

Managed Care Matters — Thu, 05 Jan 2012 05:00:00 +0100

Nothing drastic, so no, we're not going away or selling the site to the New York Times, and despite rumors to the contrary, MCM has not been acquired by a very large TPA. No, we've added a feature that should... (Source: Managed Care Matters)