HealthLeaders Media Managing Editor Elyas Bakhtiari caught up with former Speaker of the House Newt Gingrich to discuss Gingrich's thoughts on the state of U.S. healthcare.
A patient walks into a doctor's office for the first time and immediately is handed a clipboard holding a form asking for all sorts of information on that person's health status and medical history. NoMoreClipboard.com, a Fort Wayne medical technology startup, hopes to tap into consumers' frustration with all that medical paperwork to become a player in the fragmented and competitive market of personal health records.
Former Speaker of the House Newt Gingrich and former Senator Bill Bradley kicked off the AMGA annual conference in Orlando with 30,000-foot discussion of the healthcare system that was characterized for the most part by compromise and bipartisanship--traits politicians tend to develop when they are no longer running for office.
The two agreed about the importance of insuring every American--though they disagreed about how to reach that goal--and emphasized personal responsibility as well as government oversight in revamping the healthcare system. One surprising twist: The Democrat on stage, Bradley, was unwilling to take a firm position on individual mandates, but Republican Gingrich surprised moderator Cici Connolly and some audience members by saying his views had evolved during the past 10 years and he now supports mandates for wealthy individuals who forgo health insurance to purchase luxury items. I caught up with Gingrich after the session to talk about the details of this mandate program.
Other topics discussed included:
EMRs. There isn't a single physician in the country who couldn't afford an EMR system if they had to purchase the equipment, and the government should step up its role in encouraging physicians to move in that direction, Bradley said. Gingrich said part of the problem was that government views spending on information technology as a cost rather than an investment that will pay off and improve the health system.
Medical errors. The key to reducing medical errors is providing incentives for providers to report errors when they occur so that healthcare leaders and government officials can identify patterns, Bradley said. He called for greater transparency, and said sometimes malpractice fears prevented physicians from being open about mistakes. Gingrich added that the industry could learn from the handful of innovators who have identified best practices and significantly reduced errors in their facilities.
Personal responsibility. Both Gingrich and Bradley said healthcare reform would depend on patients taking greater personal responsibility for their health and suggested the government could play a role in changing the culture by mandating physical education in schools or rewarding food stamp recipients who use the government funds to purchase healthy foods, for example.
Neither really addressed how the remaining presidential candidates would address the problems, or implement the solutions, they talked about. Though the session was billed as "how your vote will influence the future of American healthcare," the focus was on Bradley's and Gingrich's views, rather than McCain's, Clinton's, or Obama's.
But the two closed out the session by discussing the current race and by making predictions about the outcome. We may hear a lot more about some of the topics discussed today, particularly Gingrich's ideas, if one of Bradley's predictions turns out true: He thinks Republican nominee John McCain will pick the former Speaker as a running mate.
The national commission that accredits hospitals is investigating how administrators at Sacramento's Mercy General handled a power failure that may have left some surgery patients and their doctors in the dark during a massive storm in January. The Joint Commission made an unannounced visit to the hospital in early February to conduct an "on-site survey" related to the hospital's actions during the storm, which left an estimated 370,000 customers in the Sacramento region without power. The commission can remove accreditation if it finds a hospital violated established standards of care.
Tampa Bay's newest emergency room has opened miles from any hospital campus. The $9 million Morton Plant Mease Bardmoor Emergency Center in Largo is the first free-standing hospital emergency room in the seven-county Tampa Bay region, and just the fourth in Florida. The 15-bed facility will serve some of the estimated 84,000 central Pinellas County residents who visit hospital emergency rooms each year.
Less than two years after UNC Health Care pledged to ease billing practices some found threatening, the system is again ramping up efforts to collect money from its patients. All hospital and physician clinics affiliated with the state-supported health system have begun asking patients to pay their share of the bill upfront. That includes $15 and $20 co-payments to see a doctor, as well as big-ticket services such as MRI scans, which under many insurance plans can run into the hundreds of dollars. UNC Health Care leaders say asking for such payments doesn't conflict with their commitment to be more friendly to patients.
Continuing a race among Portland hospitals to add services for people with cancer, the Oregon Health & Science University Cancer Institute has hired a "Patient Navigator" to help patients do everything from finding support groups to paying bills. The American Cancer Society is covering part of the salaries for the new staff member who will try to help patients connect with services they need to ease their treatment.
Highmark Inc.'s recent decision to charge Medicare customers $25 co-payments on certain injected drugs--chemotherapy agents, immunosuppressants, anemia drugs--is becoming a financial burden to a number of customers who require such injections several times a week. A spokesman for Highmark said the new charges were needed to defray the rising cost of the injected drugs, which can run from $100 to $30,000 per dose, depending on the drug.
The good people in the Office of the Actuary at the Centers for Medicare and Medicaid Services take great pains every year to summarize and explain their health spending forecast without spin or exaggeration. The editors of Health Affairs are perennially grateful to them for taking an approach that helps the journal fulfill its mission of providing clear and objective analysis to inform debates on health policy. Thus, it is perennially disappointing to see how casually the careful CMS analysis is inevitably overlooked to fit the doomsday scenarios anticipated by pundits and politicos, and how quickly the policy discourse prompted by the forecast deteriorates into the rote repetition of preconceived interpretations.
Hospital leaders and their boards generally recognize that the board's role is shifting. Boards no longer swoop in quarterly to check financial status and go on their merry way. They are involved in patient-safety rounds. They review quality scores. And they are hospital spokespeople in the community.
For leaders, this means putting another hat on your already crowded head. Your job as board relationship manager extends far beyond the occasional dinner out.
Hospital boards must intimately understand the workings of your hospital and the emerging trends in healthcare. To this end, your role has expanded to include board education and coordination. And although they are more involved, board members aren't clinicians. They rely on you to tell them what they should pay attention to and what they can safely leave to others.
Some organizations have created the Chief Governance Officer position solely to handle their boards. Although this board-centric position sounds good in theory, not all CEOs agree with it.
"The CEO is hired by the board to be the board's agent. In return, one of the fundamental roles that the CEO should be playing is the Chief Governance Officer. When I look at allocation of my time, the care, feeding, nurturing, and maintaining of the board is a significant amount of what I do, and I think that should be it," says Robert Kiely, CEO and President of Middlesex Hospital in Middletown, CT.
So, how do you effectively do all that care and feeding?
Orientate. It's not enough to give new board members a bunch of reading material and send them to conferences. Board education requires hands-on teaching--both about industry trends and your organization itself. Some hospitals hold half-day orientation sessions, taught by their senior management teams, during the first month of new board members' appointment. Whatever your orientation process, make sure you have one.
Educate. Board education shouldn't end with orientation. Increasingly, board members must be able to speak to your organization's quality and patient safety performance--topics that won't come naturally to most board members. They don't need a clinical degree but they have to understand quality measures and hospital performance on an ongoing basis.
While teaching infection rates to bankers may not come naturally, it's essential to board effectiveness. That's why some organizations make quality and patient safety education a part of every board meeting. Sinai Hospital of Baltimore produces a monthly executive report card to show the board where they stand on quality indicators and how that has changed over time.
Evaluate. You've oriented new board members and educated the old, but how do you know if your board's really working? A 2007 Top Leadership Teams winner, Cary Medical in northern Maine, uses an annual Board Effectiveness Survey to evaluate individual board members and the board as a whole on each of the hospital's strategic categories. This four-page survey goes well beyond the typical board self-evaluation done at many organizations, and Cary's CEO uses the survey results over time to predict training needs for new and future board members.
As organizations like the IHI and The Joint Commission put more emphasis on the importance of governance, board members will continue to take a bigger role in your organization. And, as Kiely told me, "The fish stinks from its head"--if an organization's board and senior leaders are out of sync, so too is the organization. Your job as leader is to make sure your board truly is on board.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
