Barack Hussein Obama was sworn in as the 44th president of the United States on Tuesday and promised to "begin again the work of remaking America." At his inaugural speech, Obama acknowledged that the nation was enduring a "winter of our hardship," and he reiterated his plans for massive federal spending to jumpstart the economy, particularly in areas like alternative energy, infrastructure repair, and healthcare.
Some older physicians have been known to be, shall we say, change-resistant. Chances are some of the operational practices they learned fresh out of medical school are what they're still using today. Who needs electronic medical records when you've got 5x7 note cards, a unique flair for penmanship, and a sturdy manila folder?
The problem is that the way medical care is delivered has to change quickly to adapt both to a shortage of physicians and an aging and chronically sicker demographic. This is particularly true in rural America.
A big catalyst for changing healthcare delivery in the future will be in the hands of the residents being trained today. Understanding the difficulty of teaching old docs new tricks, the University of Kansas School of Medicine has opened a new medical home program at its Smoky Hills Family Medicine Residency Program in Salina, 90 miles north of Wichita. The hope is that three years of residency under a medical home model will ingrain lessons that include the proactive coordinated care for chronic illnesses, with patients taking a role in their treatment plan; managing staff, building teams, and delegating responsibilities within the doctor's office; and cultivating technophilia, especially for electronic medical records and other areas of health information technology and linkage.
"The adoption of the medical home model at the residency level is particularly important because the office practices physicians learn in residency—good or bad—tend to translate into their 'real life' practice upon graduation," says Rick Kellerman, MD, professor and chair of the Department of Family and Community Medicine at the KU School of Medicine-Wichita.
"We're integrating all of the different components of the medical home. There are a lot of different practices that do certain elements, but to put them all together has never been done," he says.
The Smoky Hill medical home will steer 12 family practice residents—four residents per annual class—away from the traditional mindset of providing acute care and toward proactive management of chronic illnesses. "One of the big pushes in the medical home concept is not just waiting until the patient shows up in the office, but to identify those who are at risk or out of control and reaching out to them," says Terry McGeeney, MD, president and CEO of TransforMED, a subsidiary of the American Academy of Family Physicians, which is coordinating Smoky Hill's move toward the medical home model. "That is a very different model from what most of us have trained in, where we wait for the patients to show up with a problem and you take care of them and then wait until they show up the next time."
Smoky Hill residency teaches the young doctors to avoid micromanaging and encourages delegating responsibility to staff, which is crucial to the success of the medical home. McGeeney says a competent physician assistant can increase per-physician capacity by at least 20 patients a day, but only under a team concept. If the physician is checking temperatures and blood pressure and doing the paperwork instead of delegating to a physician assistant or an office administrator, that reduces the number of patients who can be seen, reduces patients' face time with their physician, and defeats the purpose of the medical home.
"When I trained in the '70s it was more 'captain of the ship' mentality," McGeeney says. "Now we need physicians to be more comfortable working with nurse practitioners and physician assistants and allowing them to do what they go to school for. We're urging physicians to practice in an environment where the patients participate in the decisions, so you work with patients and not just talk at them."
McGeeney and Kellerman carry a missionary's zeal for medical homes, particularly in the age of medical subspecialties, where the product of medical schools isn't meeting the needs of the greater society. "It's probably healthcare in America's only hope at this point," McGeeney says. "I do strongly believe the healthcare system in this country needs a strong primary care base. We know specialty care by itself is costly and fragmented and we absolutely need it but one of the big concepts of medical home is somebody coordinating the care."
Kellerman says he believes the medical home is here to stay because it's the only model that addresses the pressures facing healthcare delivery now and in the foreseeable future, particularly access. "In 20 years we are going to look at the way we've been treating patients now and we are going to disbelieve that we did it this way," he says. "No EMR, no registries, no emphasis on taking care of chronic illness and preventive care, with group visits and working as a team. I don't think it's going to be a flash in the pan."
John Commins is the human resources and community and rural hospitals editor withHealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.
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Let's face it, there's a time and a place for the "before and after" bariatric surgery campaign. That time isn't now—at least not for the team at St. Joseph Health System. St. Joseph, located in Lexington, KY, saw the before and after approach and thought, "been there, done that." Setting out to find a more effective approach, they discovered just how touching, truthful, and successful the emotional side of bariatric surgery could be.
The lesson came straight from St. Joseph's patients. "With candidates for weight loss surgery, it's not just something they decide to do overnight," says Steve Castle, vice president of St. Joseph's agency, D S Tombras in Nashville, TN. "What we found through the interview process is that people really just wanted their lives back. This campaign focused on the wants that they couldn't fulfill anymore because of their weight."
The multi-media campaign, coined the "I want campaign," is based on testimonials about the wants and needs of a bariatric patient. The messages, particularly in the TV spots, are simple and relatable.
"We had an amazing turnout at our casting call and were able to learn from the actors we featured as well," says Bill Seymour, senior vice president at D S Tombras. "Sometimes we just let the talent speak on their own about how they felt about their current situations. It's rare that you end up taking creative direction from the people that you're casting which is an indication of how enthusiastic people were about the message."
The day after the launch of the campaign, St. Joseph had 20 walk-ins—up from the one or two they had been seeing each month.
To support the campaign, St. Joseph set up informational seminars—all of which were filled and some of which required increased capacity based on the positive jump in response.
The campaign was also used for facilities across six different markets, including Los Angeles, Houston, Orlando, Tampa, Phoenix, and Nevada. In each market, the campaign tracked 3–5 times more responses that the facilities had previously seen.
"This campaign got great results," says Castle. "It was almost like people felt like they were supporting a cause. They had voice."
Kandace McLaughlin Doyle is an editor withHealthLeadersmagazine. Send her Campaign Spotlight ideas atkdoyle@healthleadersmedia.com. If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
I've been doing a lot of research about the newly revised IRS form 990H lately, trying to gauge how prepared healthcare organizations and marketers are for the latest government push to take transparency to yet another new level.
I've found there are many different ways that hospitals are getting ready. And a few reasons why they haven't yet developed a strategy.
There seem to be four main excuses:
1. "I'm a marketer, so I don't have to worry about 990H—it's a finance thing (and I was told there wouldn't be any math)."
Most experts and professional organizations—including the American Hospital Association, say that healthcare marketers should be working together with finance and other departments to gather the information that's required on the form, which includes a new open-ended essay question.
As I wrote in the January issue of HealthLeaders magazine (see A Story to Tell) finance might be the best department to compile and report numbers. But marketing is the department best equipped to tell your organization's story. You'll need both skill sets to fill out the newly revised IRS Form 990H.
2. "The IRS is never going to revoke a hospital's tax-exempt status based on this form—not anytime soon, anyway."
The IRS has said flat out that this is true—for now. But they are going to be compiling the data on the forms and creating a benchmark based on what all tax-exempt hospitals are doing. The results will likely be distributed along a bell curve—and you don't want to be on either of the low ends.
3. "We don't have to file the form until 2010—we have plenty of time to get ready."
Again, experts and associations say hospitals should start getting ready now in order to be prepared when it counts. "Actually, yesterday would be preferable," Patsy Matheny, a Sugar Grove, OH-based community benefit consultant, told me for the magazine article. "Since community benefit activities happen throughout the organization, it takes quite a bit of time to ferret out all the activities."
4. "We're not a tax-exempt organization—so there's no reason for us to gather this information."
First, it's true that only tax-exempt hospitals must fill out form 990H. But all hospitals must communicate the good they are doing in they're community. Are you really going to let your tax-exempt competition crow about all they do for the community without responding in kind?
Second, in the current economy, cities and towns and states across the nation have started to take a good look at tax-exempt healthcare organizations, asking: "What have you done for us lately?" It's only a matter of time before the reporters and advocacy groups in your community start asking you the same question.
There are many hospitals that are ready for form 990H. They've been promoting their community benefit activities for years and they have a plan in place for this new government mandate. But there are too many that are not ready, that don't have a clear plan, that haven't even decided what role marketing will play in the process.
Remember in elementary school when your teacher told you not to leave that big project till the last minute? Don't be the kid who was up to his or her elbows in wet paper and glue the night before the papier-mâché volcano was due.
The Mayo Clinic wasn't sure what to expect from social media when it gave it a test run four years ago, but it has come a long way in just a few years since adding a Facebook page with more than 3,000 friends, a YouTube channel with videos of doctors talking about illness, treatments and research, a health blog for consumers and another for media to improve the process of medical reporting. It's also creating "secret groups" on Facebook to connect patients to others with similar illnesses, an area it hopes to expand in the future. But that's just the tip of the iceberg in the brave new world of Health 2.0. as more providers use social software and its ability to promote collaboration between patients and the rest of the medical industry.
Brookwood Medical Center, St. Vincent's Health System, and Select Specialty Hospitals are opposing Birmingham-based Trinity Medical Center's plan to move. January 20 was the last day for healthcare providers to oppose Trinity's application to spend $280 million to finish and move to a former HealthSouth hospital on the U.S. 280 corridor in Alabama. The opposition means it will be many months before the State Certificate of Need Review Board will vote on Trinity's application to move from its current facility. The case now goes first to an administrative law judge, who will hold a trial and hear evidence from all sides.