One healthcare trend that I hear repeatedly is that we need to do more with less—less money, less physicians, and less access to care. I doubt this trend will abate any time soon. First of all, there's not going to be a sudden influx of specialists choosing to practice in rural America. But an even greater concern may be primary care. If you live in a small town and your family physician has announced plans to retire, good luck finding a replacement. The number of U.S. medical graduates going into family medicine fell by more than 50% from 1997 to 2005. The fact that family docs earn on average about $170,000 annually while specialists earn on average about $322,000 annually isn't helping matters. Certified registered nurse anesthetists are earning more (on average about $185,000) than family practitioners, as well, according to a recent report by Merritt, Hawkins, and Associates. So unless family docs start getting paid more, I doubt we'll see more med students signing up for primary care—and who can blame them?
There are programs to entice primary care docs and specialists into rural practice like loan repayment, providing med students more experience in rural healthcare, and recruiting people from rural areas into the healthcare field. While these efforts may help increase the supply of physicians to rural areas, odds are there will still be major gaps in the rural healthcare delivery system.
One way to bridge these gaps is through telemedicine programs, which scored a big win yesterday when Congress voted to override President Bush's veto of HR 6331. The legislation, which stopped a Medicare physician pay reduction, also provides nearly $2 billion to rural healthcare including a provision that makes skilled nursing facilities, hospital-based dialysis centers, and community mental health centers eligible to participate in Medicare's telemedicine program. This is great news for people living in remote regions with little or no access to specialty care like mental health services.
While this legislation helps address some of the gaps in the rural healthcare delivery system, the full potential of telemedicine to help rural practitioners provide the high quality care that their communities not only expect but demand has yet to be realized. Hospitals and physicians have been using telemedicine to offset work force shortages, provide additional services, or improve access to specialty care for people in their communities—mostly through real-time videoconferencing consultations. But scheduling these consultations can be difficult given the high demand placed on some specialties in rural areas. In many nonemergent situations, store-and-forward telemedicine would be a more efficient model. Under this scenario, providers would capture the patient data and send it to the consulting physician, who can then review it at a time that is convenient. The problem? Currently, Medicare only reimburses for store-and-forward telemedicine in Alaska and Hawaii. (I'm not referring to teleradiology-type services for which Medicare does reimburse providers. Rather, I'm referring to consultations with specialists like dermatologists or ophthalmologists, which are not covered.)
Recently, I spoke with Stewart Ferguson, PhD, the director of telehealth for the Alaska Native Tribal Health Consortium, who is no stranger to the store-and-forward telehealth model. He heads the Alaska Federal Health Care Access Network, which is now in its ninth year and provides healthcare to federal beneficiaries in remote areas via telemedicine. Ferguson says that AFHCAN has found significant value in store-and-forward telemedicine and believes that the private sector could benefit from this model, as well. "Most of our healthcare delivery is not something that has to be dealt with immediately, but can be dealt within a 24-hour window. [Store-and-forward telehealth] is a really efficient use of our healthcare resources, which has got to be the focus of any solution at this point," he says.
Is telemedicine helping you improve access to care in your community, or are you struggling to afford or implement the technology? I would like to hear about your successes and headaches, please drop me a line at cvaughan@healthleadersmedia.com.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
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The future for hospitals is not dependent on getting more dollars in the door to offset revenue restrictions but to focus on stopping dollars from going out the door. The Centers for Medicare & Medicaid Services' pain-for-gain revenue policies drive hospital leadership to pursue new revenue streams to relieve the pain, rather than reduce operational inefficiencies and preventable medical errors—each of which CMS continues to reward through cost reports and increasing DRGs, respectively.
On October 2008, CMS will tweak its traditional pain-for-gain policies in the inpatient prospective payment system and not reward reimbursement for select preventable medical errors. This contradicts prior CMS statements. On May 18, 2006, a CMS press release stated, "Reducing or eliminating payments for ‘never events' means more resources can be directed toward preventing these events rather than paying more when they occur." This is true for commercial insurers, not for Medicare, which usually pays less for healing than the cost of prevention. Even though CMS promotes Medicare benefits that cover a broad range of services to prevent diseases, it lacks a policy to do so for preventable medical errors. Hospitals should not be surprised that IPPS will not include the promised prevention funds that could be financed with a portion of projected savings unless CMS has an epiphany or a crisis of conscious.
Whether you chose to respond with new services or not, focusing on operational efficiencies, which are the rails quality travels on to achieve excellence in patient and financial outcomes, will keep dollars in the bank. It is what CMS wants you to pursue, but is clueless in how to manage the transition with less pain, so it remains committed to utilizing revenue pain-for-gain policies. You have to be committed to achieve excellence, pain or no pain. You can do this with little financial investment, but a major personal investment in using your leadership skills to inspire staff to execute the basics flawlessly.
My suggestion to leadership is simple to state but mentally hard to pursue. Start listening to your physicians, nurses, patients, and support staff —especially those you are actively avoiding. Rather than rounding with a "hi and good-day" approach, start engaging the staff throughout the hospital on a daily basis and become known as the barrier slayer. You are not there to go to meetings; you are there to facilitate the meetings of minds, ideas, and outcomes throughout the hospital. Implement a survey where all hospital services—from volunteers and housekeeping to the executive suites —are rated by other services in meeting their needs and identifying what barriers prevent them from achieving their goals. Be relentless in identifying all barriers every service feels or knows inhibit them from being efficient and quality driven. Learn to let the facts take shape and put feelings on hold before decisions are made. Create an environment where individual anxiety is to elevate excellence, not to compromise it. Inject comfort zones with large dosages of accountability. Inspire all leadership levels to be the force behind an efficiency evolution by adopting these tactics.
Remember that the No. 1 operational disease in hospitals is the communication breakdown that usually exists in the black hole of an information chasm under the oversight of complacent leadership. These characteristics do not inspire reflection, inquiry, and collaboration, which are critical to an efficiency evolution. Leadership, information, and communication are the three piers necessary to build the foundation for a culture of excellence in the shifting sands of the healthcare delivery system. If these piers are structurally weak, you limit the number of "pillars" your hospital can support, if any.
How will I know that you are in the midst of an efficiency evolution? When I enter your hospital and approach a housekeeper who has the emergency room looking exemplary and compliment him or her and then ask, "Do you know the CEO?" and I see a face light up with an affirmative response. I then look to the waiting area in the ER where patients look anxious but not angry, and I think, "This place is busy!" But my senses tell me this is not organized chaos because every staff member is moving with purpose, uninhibited by the sense of disorder that operationally inefficient ERs cultivate. And this affirmative response towards you and a sense of purpose by employees is repeated throughout my tour. Then I know this is a hospital in the continuous pursuit of excellence, because the people know that leadership believes in them and that they are the only means to make a hospital quality-driven, profitable, and great--no matter what pain CMS inflicts.
R. Daniel King is a retired healthcare consultant in Tyler, TX, with a background in operational, financial, and crisis-management for hospitals, medical practices, and skilled-nursing facilities.
Many marketers treat the 78 million baby boomers as if they were cut from the same cloth, but there are many sub-demographics of Americans born between 1946 and 1964. In order to market to them effectively, you've got to know the specifics.
Want to take your performance to that ideal level of highly effective and efficient marketing? It takes better access to detailed data and ROI discipline, but it also comes along with greater growth and better levels of budgets, according to the recently released Lenskold Group/Kneebone 2008 Marketing ROI and Measurements Study.
Business author and speaker Harvey Mackay outlines 12 secrets to sales success. Mackay says knowing something about your customer is just as important as knowing everything about your product, and that your reputation is your greatest asset. He also suggests positioning yourself as a consultant, a principle that more and more healthcare marketers are starting to embrace.
I hear it all the time from healthcare marketers and experts alike: hospitals and health systems should look to other industries for marketing and advertising ideas. After all, this tactic has worked in other areas of healthcare. Patient safety and quality have both been improved thanks to best practices borrowed from outside the healthcare field, for example. But will that innovation ever find its way into the marketing department? Or are healthcare marketers too entrenched in the "this-is-the-way-we've-always-done-it mentality"?
Here's the problem. The way it's always been done is not very well.
Really, how long will hospitals run ads with pictures of a team of doctors in white coats with their arms crossed or a nurse at a patient's bedside offering a comforting touch and a friendly smile or pictures of medical devices and buildings?
OK, so it's no secret that healthcare is a little behind the curve when it comes to marketing. And that's why some savvy healthcare marketers are looking beyond their own departments and hallways for inspiration, advice, and a new way to do things.
And there are lots of things that healthcare marketers can learn from other industries, especially in areas in which healthcare marketing is—let's face it—weak. From product development to how best to use new media to creating a brand that engages consumers to measuring return on investment (the latter being the weakest of all weak spots, for sure), why not turn to others for a little help?
So, who should you turn to?
In this month's issue of HealthLeaders magazine, I wrote about some of the lessons healthcare marketers can find in the business models of companies in other industries, such as pharmaceutical, finance, travel, and hospitality.
The people I interviewed for this article said you have to go beyond the obvious. Yes, hotels have valet parking and yummy room service choices. But there's more to it than that.
"Our patients don't understand why they can stay at the Marriott and have an accurate bill under their door the morning they leave the hotel, yet the hospital sends an inaccurate bill months after they are discharged," Lynne Cunningham, principal of Cunningham Associates, a healthcare consulting firm in Sacramento, CA, told me. "Patients don't understand why we have asked for the same information upon registration—every time—even if they are being seen on a regular basis."
So, what else can you do to learn from other industries? A few suggestions:
Get on mailing lists. Every time you order from a catalogue or drop your business card in a fishbowl at a conference, you'll increase the number of direct mail pieces that land on your desktop. More clutter, yes. But also more inspiration from a variety of industries upon which to draw. Don't forget that even industries that have nothing to do with healthcare are, in a way, your competitor—those direct mail pieces are competing for the time and attention of your audience.
Sign up for e-newsletters. Want to figure out what kind of online ads work? Well then, you have to look at a bunch of online ads. Sign up for marketing and advertising e-newsletters, of course. But if you have other hobbies—such as cooking, photography, personal finance, or the latest best-sellers—believe me, there is an e-newsletter (or five) for you. Even if you're not interested in the content, you can always open the e-mail and take a peek at what ads are inside.
Build your collection. Invite your colleagues from across the hospital to join your new recycling program—by dropping all the direct mail they get into your mailbox. Your physicians are getting direct mail from pharma, medical device companies, sporting goods companies, travel companies, credit card companies and a host of others. Nurses and staffers, too. If you want to know how to reach your internal audience, study marketing that targets them.
Step outside for a minute. Check out that crafts fair under way down the street from your hospital or pop by that art gallery opening after work. Breathe in the atmosphere, spy on the organizers to see how they're greeting and interacting with attendees, see what kind of food they're serving, and look for the posters and postcards they used to promote the current event as well as upcoming ones. You might get some ideas to liven up your next health screening or make your next employee appreciation event a little more fun.
You have to break out of the marketplace clutter. You must differentiate your organization from the rest. The best way to look different than everybody else might just be to look in a different direction from everybody else.
Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at gshaw@healthleadersmedia.com.
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