The Connected Patient
From scheduling appointments to viewing lab results, more healthcare consumers are demanding information access 24 hours a day. Some innovative providers are using interactive online services to open their data caches to...
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What is RSS?
Insiders’ Insights
Alternative Route
Alternative Route
Preparing for a Pandemic
Five ways you can help your hospital and your community get ready now.
Five ways you can help your hospital and your community get ready now.
Safety in Numbers
Minnesota hospitals band together amid expanding public scrutiny of nonprofits.
Minnesota hospitals band together amid expanding public scrutiny of nonprofits.
Worth A Look
A Delaware company’s philosophy of collecting dirty linens is simple: out of sight, out of mind.
A Delaware company’s philosophy of collecting dirty linens is simple: out of sight, out of mind.
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The Power of Consolidation
After leading St. Agnes’ transition from multiple systems to a single IT platform, William Greskovich has his eyes on a new prize: CPOE.
After leading St. Agnes’ transition from multiple systems to a single IT platform, William Greskovich has his eyes on a new prize: CPOE.
DEAL!
An inside look at an IT contract.
An inside look at an IT contract.
Space Hogs
Massive digital records present a familiar problem from the paper chart era: Where do you store it all?
Massive digital records present a familiar problem from the paper chart era: Where do you store it all?
Worldwide Integration
Robert Foster spearheads the Military Health System’s mammoth electronic health record project.
Robert Foster spearheads the Military Health System’s mammoth electronic health record project.
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Gather ’Round
Group medical appointments improve efficiency for docs while giving patients more face time.
Group medical appointments improve efficiency for docs while giving patients more face time.
Grading Your Nurses
Report cards help hospital leaders develop nurse-staffing plans that work.
Report cards help hospital leaders develop nurse-staffing plans that work.
Recruit While You Teach
Harvard Children’s internship program gives the hospital an employee recruitment base and students some valuable healthcare management experience.
Harvard Children’s internship program gives the hospital an employee recruitment base and students some valuable healthcare management experience.
Rethinking Patient Safety
Hospitals are getting results from initiatives focused on teamwork, quick reactions and bringing patients into the loop.
Hospitals are getting results from initiatives focused on teamwork, quick reactions and bringing patients into the loop.
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Consumerism Litmus Test
Omaha’s Alegent Health prepares for consumer-directed care by doing market research on itself.
Omaha’s Alegent Health prepares for consumer-directed care by doing market research on itself.
Friendly Takeover
Moving medical records into the finance department pays off for California system.
Moving medical records into the finance department pays off for California system.
Not On Call
‘Surgicalist’ concept gains acceptance among physicians and helps keep the patients flowing.
‘Surgicalist’ concept gains acceptance among physicians and helps keep the patients flowing.
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Don’t Knock Limited Benefits
I take exception to the comment in your article (“Limited Expansion,” May 2006) from Holyoke (Mass.) Medical Center CEO Hank J. Porten, who states, “Charging up front becomes a little bit ridiculous when people are really sick and need care. I’d like to have insurance companies collect the copay. If an insurance company feels that increasing copays is strategically necessary and the way they have to go, let them figure out how to collect them.” I think limited-benefit plans are better than nothing and a step in the right direction for employers who can’t afford full major medical coverage for their employees. Also, it provides some protection for employees who are just barely making enough for their daily expenses, let alone spending hundreds of dollars each month for major medical insurance. For nearly 20 years in the insurance industry, I have wanted to say to physicians and hospital administrators, “Don’t blame the insurance companies for the problems with healthcare.” We are only part of the vicious spiraling costs cycle. Let’s step back 50 years to a time when most Americans had to pay out of their savings for hospital services. At that time, they only went to the hospital to die or if they were severely ill or injured. If today’s hospitals had to charge their patients for services rendered, most of them would go out of business.
I take exception to the comment in your article (“Limited Expansion,” May 2006) from Holyoke (Mass.) Medical Center CEO Hank J. Porten, who states, “Charging up front becomes a little bit ridiculous when people are really sick and need care. I’d like to have insurance companies collect the copay. If an insurance company feels that increasing copays is strategically necessary and the way they have to go, let them figure out how to collect them.” I think limited-benefit plans are better than nothing and a step in the right direction for employers who can’t afford full major medical coverage for their employees. Also, it provides some protection for employees who are just barely making enough for their daily expenses, let alone spending hundreds of dollars each month for major medical insurance. For nearly 20 years in the insurance industry, I have wanted to say to physicians and hospital administrators, “Don’t blame the insurance companies for the problems with healthcare.” We are only part of the vicious spiraling costs cycle. Let’s step back 50 years to a time when most Americans had to pay out of their savings for hospital services. At that time, they only went to the hospital to die or if they were severely ill or injured. If today’s hospitals had to charge their patients for services rendered, most of them would go out of business.
Measuring Up
I read with great interest Philip Betbeze’s article “Early Warning Signs” featured in the June 2006 issue of HealthLeaders, and I wish to pass along my applause. In today’s healthcare environment, something that cannot be measured should not be done! Mr. Betbeze addresses a difficult subject and shines a light on a key area of hospital performance: agility. With the right information and leadership, hospitals can quickly adapt their strategy to accommodate difficult-to-read changes in the marketplace. In today’s “evolve or perish” healthcare environment, innovation drives success, and measurement defines innovation.
I read with great interest Philip Betbeze’s article “Early Warning Signs” featured in the June 2006 issue of HealthLeaders, and I wish to pass along my applause. In today’s healthcare environment, something that cannot be measured should not be done! Mr. Betbeze addresses a difficult subject and shines a light on a key area of hospital performance: agility. With the right information and leadership, hospitals can quickly adapt their strategy to accommodate difficult-to-read changes in the marketplace. In today’s “evolve or perish” healthcare environment, innovation drives success, and measurement defines innovation.
Nursing Business
In catching up on some of my past HealthLeaders magazines, I read with great interest your article from April 2006, “Scalpels and Briefcases,” and would like to add my two cents. As an operating room director for more than 12 years, I came to understand the need for having increased business acumen to efficiently run my ORs. Receiving my MBA has certainly helped me be a better business manager, but the clinical piece is still very important. I was a bit offended at the column title “Desperately seeking M.D.-MBAs” and your comment that the business of the OR is too overwhelming a job for a nurse. In my operating room I had responsibility for a budget of more than $10 million for salaries, supplies and capital equipment. I can’t remember when I became overwhelmed. There are more and more registered nurses who are receiving their MBAs for the very reason you mention in your article. Nurses control pretty much all of the costs in a hospital, not just the OR. And don’t underestimate the influence the R.N. has with the M.D. on product selection. Granted, the OR is the biggest cash guler, so having a savvy business-oriented yet clinically experienced person is paramount. We have had the ability for years to evaluate a surgeon’s time, their expenses per case and how their personal preferences drive the costs in the OR. I encourage my nurses to be cost-conscious, not just in the procedure areas but on the units, as well. Who better to bring value to the bedside, where the care takes place, than the R.N. who spends 24/7 with the patient?
In catching up on some of my past HealthLeaders magazines, I read with great interest your article from April 2006, “Scalpels and Briefcases,” and would like to add my two cents. As an operating room director for more than 12 years, I came to understand the need for having increased business acumen to efficiently run my ORs. Receiving my MBA has certainly helped me be a better business manager, but the clinical piece is still very important. I was a bit offended at the column title “Desperately seeking M.D.-MBAs” and your comment that the business of the OR is too overwhelming a job for a nurse. In my operating room I had responsibility for a budget of more than $10 million for salaries, supplies and capital equipment. I can’t remember when I became overwhelmed. There are more and more registered nurses who are receiving their MBAs for the very reason you mention in your article. Nurses control pretty much all of the costs in a hospital, not just the OR. And don’t underestimate the influence the R.N. has with the M.D. on product selection. Granted, the OR is the biggest cash guler, so having a savvy business-oriented yet clinically experienced person is paramount. We have had the ability for years to evaluate a surgeon’s time, their expenses per case and how their personal preferences drive the costs in the OR. I encourage my nurses to be cost-conscious, not just in the procedure areas but on the units, as well. Who better to bring value to the bedside, where the care takes place, than the R.N. who spends 24/7 with the patient?
“Pay for Measurement”
In response to your July cover story (“5 Intersections”), I am not surprised that the pay-for-performance movement is being touted as a mechanism of our health system’s salvation. It is, more accurately, a pay-for-measurement movement. With DRGs in the 1980s, we learned to document the care of a patient so that we could qualify for the highest reimbursement available for the treatment we had given. Now we are learning to document and retrieve evidence that we are doing what the system demands that we do. You can bet that the indicators will all trend toward 100 percent—which will be good only to the extent that the designers of the system are wise. Our country bows down to the god of the free market. We believe that any problem can be solved as long as we can devise the perfect free-market solution. We continue to seek that magic incentive in healthcare. We will most likely continue that journey until the system implodes, at which time, if we have courageous leadership, we may be able to devise a system that works for everyone.
In response to your July cover story (“5 Intersections”), I am not surprised that the pay-for-performance movement is being touted as a mechanism of our health system’s salvation. It is, more accurately, a pay-for-measurement movement. With DRGs in the 1980s, we learned to document the care of a patient so that we could qualify for the highest reimbursement available for the treatment we had given. Now we are learning to document and retrieve evidence that we are doing what the system demands that we do. You can bet that the indicators will all trend toward 100 percent—which will be good only to the extent that the designers of the system are wise. Our country bows down to the god of the free market. We believe that any problem can be solved as long as we can devise the perfect free-market solution. We continue to seek that magic incentive in healthcare. We will most likely continue that journey until the system implodes, at which time, if we have courageous leadership, we may be able to devise a system that works for everyone.
Another Perspective on “5 Intersections”
I can see you’ve talked to top-down pundits and leaders about the terrible, deplorable and correctable state of U.S. healthcare (“5 Intersections,” July 2006). Permit me to give you a bottom-up perspective from the clinical trenches. First, clinicians bristle at the notion that quality is going to hell in a hand basket. This attitude stems from the notion that doctors who don’t adhere to best practice protocols, don’t follow medical evidence, don’t meet all of the 469 quality indicators, and don’t install EHRs are either technological troglodytes or care only about the bottom line. Those in executive suites, policy think tanks and Medicare offices who embrace this terrible quality message have likely never been in a physician’s office. Second, I remain skeptical about the power of P4P to segregate the “good” guys from the “bad” guys. I am equally skeptical that it will reduce costs. Everybody is pushing P4P because it is politically and managerially correct, it can be measured, and it is the last rational resort to bring doctors to heel. It also may just be a reshuffling of the reimbursement deck. I agree P4P is an irresistible and inevitable force, but to what end? I do not think rewarding doctors in the 5 percent to 10 percent range will sway them to embrace P4P and to install EHRs. It will take 5 percent to 10 percent of their income to install and follow quality guidelines. On the other hand, making it crystal clear they won’t be paid until they document everything electronically will motivate them. The author makes a good point about the power of multi-specialty groups to enforce quality standards and the fact that only 9 percent of doctors belong to these groups. I have been hearing for 25 years that 10 of these “mega-groups” would dictate, direct and revolutionize healthcare, but I have yet to see evidence—with the exception of Kaiser Permanente—that doctors are flocking to join them. EHRs are beginning to take root with surprising speed, but for marketing and reimbursement reasons, not for upgrading “quality.” As for RHIOs, I await evidence that rhetoric from on high, which says employers, hospitals and doctors working together will insure quality and transparency and value, will turn into reality on the ground. I agree that “mess-information” will begin to sort itself out. I think you see this most vividly with the health plan Web sites that have an “Rx calculator” that compares brand to generic prices. Consumers in these plans are switching in record numbers to cheaper generics. The movement is much slower for consumer-shoppers seeking to compare hospital and doctor pricing. It may be that high-deductible plans will take the edge off the issue of the uninsured. After all, 23 percent to 40 percent of the employees offer these plans, and a like percentage of people signing up either did not previously offer coverage or were previously not covered. If these plans capture 15 percent to 25 percent of the market by 2010, as predicted, we might see a change in attitude.
I can see you’ve talked to top-down pundits and leaders about the terrible, deplorable and correctable state of U.S. healthcare (“5 Intersections,” July 2006). Permit me to give you a bottom-up perspective from the clinical trenches. First, clinicians bristle at the notion that quality is going to hell in a hand basket. This attitude stems from the notion that doctors who don’t adhere to best practice protocols, don’t follow medical evidence, don’t meet all of the 469 quality indicators, and don’t install EHRs are either technological troglodytes or care only about the bottom line. Those in executive suites, policy think tanks and Medicare offices who embrace this terrible quality message have likely never been in a physician’s office. Second, I remain skeptical about the power of P4P to segregate the “good” guys from the “bad” guys. I am equally skeptical that it will reduce costs. Everybody is pushing P4P because it is politically and managerially correct, it can be measured, and it is the last rational resort to bring doctors to heel. It also may just be a reshuffling of the reimbursement deck. I agree P4P is an irresistible and inevitable force, but to what end? I do not think rewarding doctors in the 5 percent to 10 percent range will sway them to embrace P4P and to install EHRs. It will take 5 percent to 10 percent of their income to install and follow quality guidelines. On the other hand, making it crystal clear they won’t be paid until they document everything electronically will motivate them. The author makes a good point about the power of multi-specialty groups to enforce quality standards and the fact that only 9 percent of doctors belong to these groups. I have been hearing for 25 years that 10 of these “mega-groups” would dictate, direct and revolutionize healthcare, but I have yet to see evidence—with the exception of Kaiser Permanente—that doctors are flocking to join them. EHRs are beginning to take root with surprising speed, but for marketing and reimbursement reasons, not for upgrading “quality.” As for RHIOs, I await evidence that rhetoric from on high, which says employers, hospitals and doctors working together will insure quality and transparency and value, will turn into reality on the ground. I agree that “mess-information” will begin to sort itself out. I think you see this most vividly with the health plan Web sites that have an “Rx calculator” that compares brand to generic prices. Consumers in these plans are switching in record numbers to cheaper generics. The movement is much slower for consumer-shoppers seeking to compare hospital and doctor pricing. It may be that high-deductible plans will take the edge off the issue of the uninsured. After all, 23 percent to 40 percent of the employees offer these plans, and a like percentage of people signing up either did not previously offer coverage or were previously not covered. If these plans capture 15 percent to 25 percent of the market by 2010, as predicted, we might see a change in attitude.
Overdue Links
There is a point at which American consumers' view of a new technology or innovation shifts from "something that I like" to "something that I expect." Air conditioning in cars went from a luxury to a necessity in the 1970s. Cell phones transformed from a toy to a tool in the 1990s.
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