A robot in a lab at the University of Tennessee Health Science Center is making spinal medicine more precise. The robot combines off-the-shelf hardware used in structural engineering that has been modified by University professors or grad students. Proprietary software drives the system. Since its development, the robot has been used frequently to study the performance potential of artificial spinal discs.
At a recent appointment with my ophthalmologist, the topic turned to electronic medical records. Turns out my physician was familiar with my journalistic efforts—maybe he recognized me by my picture (which suggests my glasses need updating). He practices in a large faculty group that is affiliated with an academic medical center. The physician group began its EMR journey several years ago and has been deploying new software on a specialty-by-specialty basis.
Although brief, our conversation quickly focused on one of the key obstacles facing physicians as they convert to EMRs. Medicine is so highly specialized that having a one-size-fits-all documentation template is all but impossible. As my doctor explained, ophthalmologists like to document conditions using schematic diagrams of the eye. They also track a variety of measures on eye performance that would be all but alien to other physicians. Thus, his department had not rushed to deploy the EMR, as the department was waiting for its modules to be updated.
My physician is no stranger to technology. He has helped pioneer the use of lasers in corrective eye surgery, and the practice has built up a following for the high-end procedure. Maybe that explains why he volunteered to be the physician guinea pig for the department’s roll-out of the EMR. In the exam room, he showed me a flat-screen monitor, enthusiastically describing how having patient data available during the visit would beat having to rely on a dog-eared paper record.
When it comes to clinical documentation, physicians are not as averse to modern technology as they are sometimes reputed to be. They do, however, have legitimate concerns about how digital recordkeeping will mesh with their specialty. I have talked to many a multispecialty group practice that has made documentation flexibility the cornerstone of their EMR vendor search. They want to see some templates in action—or at least know that their software is pliable enough to fulfill their needs.
That can be a tall order. Just think about the respective worlds of, say, a pediatrician, an orthopedic surgeon, and a gastroenterologist. When they need new glasses, they all go to the eye doctor. But when they need an EMR, it’s another story.
P.S. Thanks to all the many readers who responded to my recent columns. I will print a few of the best letters next week.
Today's highly competitive healthcare marketplace demands much more than quality, profitability, and excellent customer service from its participants. Healthcare companies are increasingly expected to demonstrate strong commitments to good governance, financial transparency, community development, and environmental stewardship.
Our progress as an industry in meeting these new expectations has been gradual but uneven, with some institutions waiting to see if the new “corporate citizenship” trend would be a passing one.
Here's a news flash: This is not a trend. It's a business imperative, and it is here to stay. And with a little effort, the healthcare services sector can become a model for the broader business community. Through our practices, we will show that businesses can do well by doing good.
As you may know, VHA is a cooperative owned by nonprofit healthcare providers. So our earliest examples of corporate citizenship came from our owners, who have always understood the power of community involvement, the creativity that accompanies diversity, and the accountability that flows from greater transparency. Inspired by the examples set forth by our members, VHA's corporate citizenship efforts initially focused on our principles and our people. Now, we are explicitly adopting a third focus: our planet. We need to embrace the concept of sustainability and integrate it explicitly into our work and our concept of corporate citizenship; and our industry must do so as well.
Some folks have asked me why VHA cares about corporate citizenship, and how it makes a difference to our company and our members. Let me share one small example from our experience that illustrates the power of doing the right thing.
In 2002, we made the decision to invest money previously budgeted for an annual company holiday party to create an annual event that directly engages our employees with their communities. We call this annual event Community Day, and each year on that day, VHA employees across the country volunteer for local charities. It has become a much-anticipated and much-beloved tradition, which contributes more than 10,000 volunteer hours and nearly $100,000 to 80 local charities each year.
The success of Community Day goes beyond the donations of time and money. It has fostered strong and invaluable relationships with local community-based organizations across the country. It has also showed our employees that we share their commitment to community involvement. But most importantly, it has helped reinforce the way our employees think about the impact of their work on their communities and our world. It shows that our employees are a stewardship-minded workforce and find meaning in their work. And that's exactly what a company needs to be dynamic, creative, and successful.
For that reason, we are continuing to expand our corporate citizenship work. Just this week, for example, VHA will release its first annual Corporate Citizenship & Sustainability Scorecard, a report that highlights and rates our efforts on dedication to the workplace, operational transparency, community engagement and sustainability. Complete with performance indicators, it is another step forward in our own promise to well-rounded action toward the prosperity of our business, our associates and our communities.
We are especially focused on making progress in environmental stewardship and sustainability. As you will see, we are working hard to reduce our carbon footprint and to make a smaller impact on our planet. Our own experience proves that it doesn't take an enormous corporate undertaking to make a difference we can see. For example, we replaced all disposable cups, plates and bowls used in our corporate headquarters with post-consumer recycled paper products and exchanged other break room supplies including coffee filters, stirrers and plastic cutlery with biodegradable products. We've established an aggressive recycling program and are encouraging our employees to think eco-consciously both at work and home through national educational programs keying off Earth Day and Change-a-Light Day.
There is no perfect recipe for success or a perfect pathway to good corporate citizenship, and certainly we at VHA have much to learn and achieve. But small steps, steadily taken, will lead to bigger steps—and eventually to an entirely new way of working, for us and for our industry. Our individual and collective commitments to good governance, community involvement, and environmental stewardship will pay off, for our members and customers, our people and our planet.
Curt Nonomaque is president and CEO of VHA Inc. He may be reached at cnonomaq@vha.com.
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Big business spends a lot of time and money on research and development in the hopes that some of the investments will help create an economic moat for the company. They then own a proprietary product or service built around what they do well. They can charge comparatively more for such items or services, and they spend still more copious amounts of time and money protecting those products or services from competitors' encroachments.
"Of course they do," you say. "That's how business works."
Well, here's how it also works. The smarter big companies that want long-term success don't want to be overly dependent on just a few products that can be easily copied, thus throwing their business into a tailspin. Anyone seen Crocs' stock performance lately?
To help fight this complacency, smart leaders spend considerable effort on creative destruction—that is, working to figure out how to make obsolete a product, service, or business model that they've spent so much time developing and protecting. Seems counterintuitive, but it works. If you can destroy your own product, the thinking goes, you can keep from having your company destroyed out from under you—you can innovate before innovation is done to you, making the entire business stronger.
Hospitals haven't had to innovate for many years now. I'm not talking about innovations in patient care or in the kinds of technologies hospitals employ to help diagnose and treat more efficiently so patients live longer and recover better. Those aren't your products. Your hospital doesn't receive the incremental financial boost from using them—in fact, many new diagnostic and treatment technologies do nothing but drag on your bottom line as reimbursements don't match up with the cost of these products. Drug-coated stents come to mind as the best example of this. In this case, the innovations don't result from, nor are they attributable to, the hospital.
No, the hospital's product is patient care, and the stagnation of the hospital's business model has been one reason (before you start writing, I said one reason) hospitals are losing business to outpatient centers, wellness centers, and other outside influences. Let's leave out, for a moment, the issue of physician self-referral. Hospitals' business model hasn't kept up with their customers' desire for more convenience and better customer service, among other innovations these facilities often boast. That's because until recently, they haven't had to innovate in this area. They haven't had to put a high priority on destroying themselves because reimbursements depended on procedures, not outcomes. Slowly but surely, that's changing.
One hospital CFO I know kind of stumbled upon creative destruction, but he's happy it's shaking things up because it's making his local system more competitive. It stemmed from an internal discussion his organization's leaders were having about price transparency. His system faced pressure from a powerful payer to disclose its prices through the payer's Web site. Concerned that the payer was going to disclose prices to its customers only where it served the payer's interest, such as getting price concessions on diagnostic imaging, the hospital's leaders opted for full transparency, putting all its prices on its own Web site where anyone could browse them. These are not only prices for certain goods or services. In some cases, it's for an entire procedure, including follow-up care.
By playing that card, the hospital system has created certain tensions because it's actually shifting business away from its own higher-cost, hospital-based outpatient environment to freestanding ambulatory centers. But there's no reason the hospital can't shift its priorities to capitalize on what its customers want. And this hospital has figured it out well before it would have been forced to otherwise. "It's intentional disruption," he says.
That's the tension they have created in their own market, to their own hospital. It sounds counterintuitive, but the market is going to do it anyhow, so they're trying to lead instead of follow.
Under a healthcare program is called Medi-Share, Biblical Healthcare Solutions, a pastor's nod and a monthly fee provides nonsmoking, church-going Christians with paid medical bills. With 50,000 clients nationwide, the Melbourne-based organization is the biggest of at least three such groups that have grown in the wake of skyrocketing health insurance costs. But so far, these groups have operated with little oversight, and now the Florida Legislature is expected to consider whether Christian Care Ministry and other such religious groups should be exempt from oversight by Florida's Office of Insurance Regulation.
A new poll shows that most Californians are increasingly concerned about the state's healthcare system, and nearly three-quarters of them would have approved a healthcare reform plan led by Gov. Arnold Schwarzenegger that failed in the Legislature. Voters' key concerns included not being able to pay for all costs from a serious illness or injury, having to pay more out-of-pocket expenses for their health insurance coverage, and not having or potentially losing health insurance, the poll found.
Eight months ago, Tenet Healthcare Corp. traded for $3.67 a share and a well-known New York healthcare analyst issued a report downgrading the company stock to "under perform." The analyst predicted shares would drop to $2 and that the system would go bankrupt within three years. The same analyst has now changed his opinion of the company to "outperform" and increased his price forecast to $8 per share. Tenet's stock jumped 13 percent as a result of the assessment.
Atlanta-based Grady Memorial Hospital is engaged in a six-figure fight with a New York doctor who said the hospital hired him as a top administrator, moved him to the city and then killed the deal the day before he was to start work. William Bithoney, MD, said hospital officials misled him and then stranded him, personally and professionally, in Atlanta. Bithoney says Grady owes him $612,500 in severance pay, and a lawsuit seeking damages could drive that amount to more than $1 million.
Gregory Simone, MD, is a cardiologist but also a businessman with an MBA and chief executive officer of the Georgia-based WellStar Health System and its many satellite facilities. WellStar has 280 doctors in its physicians group, and a total of 1,100 who have medical staff privileges. The system has 1,311 beds and more than 11,000 employees—making it one of the largest healthcare providers in Georgia. Simone took over as the big boss of the system in 2007, six months after the death of his best friend, Robert Lipson, MD.
The Williamson Medical Center board of trustees has decided to appeal the Tennessee Health Services Development Agency's approval of an application by HCA/TriStar to build a 56-bed hospital in Spring Hill. Williamson representatives say HCA/TriStar's proposal would unnecessarily duplicate services and that there is not enough demand for another hospital.
