Despite experiencing a lawsuit and accusations of inefficient pressure on central Iowa's medical infrastructure, Story County Medical Center is finally breaking ground for a new facility. Bids were opened for the facility in 2007, but the project was put on hold after a lawsuit was filed by Wellmark Blue Cross Blue Shield. The medical center had been allowed to move ahead with the project without a certificate of need from the Iowa Health Facilities Council, and Wellmark's lawsuit was a declaratory ruling to force the medical center through a full council review. The new medical center mostly serves residents of eastern Story County, and provides for more than 40,000 patient visits each year.
Both Orlando Regional Healthcare and Florida Hospital are filing applications with the state of Florida to start a heart-transplant program in Orlando. Both already are heavily marketing their cardiac services, using billboards and full-page ads to promote themselves. East Central Florida is the only region in the state without a heart-transplant program, but no other metropolitan area has more than one such program. Neither hospital system would say whether it planned to oppose the other's state-required application.
Kansas is one of eight states selected by the Commonwealth Fund and AcademyHealth to participate in the State Quality Improvement Institute--an effort to improve healthcare quality. The program is designed to help states create and implement plans to improve performance in areas such as health outcomes, access and efficiency. The participating states were identified as those with the commitment, leadership and resources to build on previous improvements. The states inolved will convene teams consisting of state officials, major employers, healthcare providers and representatives from the healthcare advocacy community to develop policy and program strategies.
New York-based law firm Meltzer, Lippe, Goldstein & Breitstone is considering banning cell-phone and BlackBerry use during major meetings to discuss issues, such as key law changes, that might affect clients or significant internal developments. The "no-device policy" came about as the steady buzzes and vibrations signaling a new call or e-mail were increasingly interfering with meeting-goers' focus, according to those in the firm.
What Can We Expect as the U.S. Population Ages?
The oldest of the 80+ million “baby boomers” (more than 25 percent of the entire U.S. population) turn 65 years old and become Medicare eligible in 2011. Medicare enrollment will reach nearly 80 million, or about 22 percent of the U.S. population, by 2030. That’s nearly double the enrollment in 2006.
What actions will be required to sustain the Medicare program? Raise taxes, reduce benefits, prolong eligibility, increase contributions, change behavior, reduce the cost of care, or all of the above?
What Will the Aging of the Population Mean to Providers?
Industry leaders are increasingly uneasy about potential responses to this challenge. Many expect the ratcheting down of payment levels as a likely element of any plan for paying for the care of the increasing Medicare population. Boomers are heavy users of hospital and healthcare services. What would happen in your local market if your Medicare population were to double in 2020 or 2030? How would you respond?
How will you prepare your organization for the likely increased demand particularly in light of the recent under-investment in plant and equipment and expected shortages of beds, physicians and nursing and support staff? Will you have enough beds, physicians, staff and ambulatory facilities? Will you respond to all demands for service or offer only a select portfolio of clinical services? Will you have created plans and relationships that permit you to respond in an orderly fashion while ensuring that the healthcare need of the communities you serve are met?
How Can Providers Prepare?
A current “working” understanding of the implication of the aging of the boomer generation is critical to setting strategic direction particularly given the time and expense required to adjust clinical portfolios, design, build or remodel facilities and recruit and train clinicians and other workers.
Many hospital organizations focus their attention primarily on 3-year time horizons avoiding the time and expense associated with longer term planning. These plans resemble 3-year capital budgets with limited attention to how these investments will help prepare for the longer term.
How do you provide a framework that puts short-term planning and investments decision-making in the context of potential market changing events? The same question pertains to other potential longer-term market-changing events other than the aging of the boomers. The implementation of a universal healthcare program, a major breakthrough in biotechnology or the coming of age of the generation following the boomers comes to mind.
Here is a straightforward approach that might help:
1. Create a High-Level Understanding of the Potential Demand for Services for 2020 and 2030. Get beyond the “policy” discussions. Don’t get trapped by debates over methodology. Do not seek a level of precision that is not available.
Review age- and gender-adjusted demographic data. Look for an “order of magnitude” understanding.
Review use-rate trend data. Look for likely changes that could have a significant impact.
Define the assumptions you are using and the “unknowns” that will need clarification over time.
Create 2-3 plausible demand scenarios including a simple forecast of current use rates moving forward, a high demand and a low demand alternative.
Identify the impact of future demand on your organization, your physicians, your competitors including potential new entrants and your community.
2. Create a High-Level Vision for 2020 and 2030 for Your Service Area and Your Organization. A doubling of the Medicare population in your service area will likely produce additional demand for beds, emergency departments, ambulatory facilities, and physicians. How much of this demand would you plan to meet? Would your plan change your current facility plans? Will your plan require a shift in physician recruitment and alignment strategies? How will you recruit sufficient nursing and other staff? What investments must you make now to meet your longer-term requirements? What are your lead times for these initiatives?
Cleary define the assumptions that are driving your vision.
Define the clinical portfolio you’d like to offer to match the needs and demands of your community and your organization’s vision and capabilities.
Identify the performance requirements, level, and kinds of facilities, technology, physician, staff resources and organizational relationships that will be required to implement your vision.
Complete a high-level financial plan to test your ideas particularly about investment and financial performance requirements.
Make adjustments as necessary.
Be as clear and specific as possible. Consider this kind of vision statement to be a blueprint for the future not a paragraph to put in the annual report.
3. Build a high level “Roadmap” to 2020 and 2030. Pharma and Biotech companies make big bets on offerings likely to come to market in 20 or 30 years. While hospitals and health systems do not operate under the same business model, we must create the roadmaps and bridges that more effectively link the longer-term vision or model with a shorter-term investment strategy. Being able to respond flexibly for demand that will take years to mature requires careful ongoing monitoring and investment management. Healthcare related investments in facilities and clinical programs also require years to complete.
Determine how you will change your clinical portfolio over time to achieve your intended results.
Determine how you would change your current facility plans, and physician recruitment and alignment strategies.
Consider how you will recruit sufficient nursing and other staff, a special problem given the aging nursing workforce.
Determine how you will work with or compete against other providers in your market.
Create links between your long and short-term investments strategies.
Consider lead times for these initiatives and what investments you must make now to meet you longer-term requirements. Build in monitoring mechanisms to make certain that adequate attention is paid to the longer-term vision.
4. Review 3-Year Strategic Plans and Prepare 1-Year Action Plans Annually. Kick off your 3-year planning cycle with a review of the vision for 2020 and 2030. Complete this work at the beginning of your traditional planning cycle. Be disciplined so that this effort informs your shorter-term planning. Make adjustments as necessary as more information becomes available or you change your view of the market and vision. Draw implications for the short term clearly and factor them into the 3-year and 1-year plans.
Critically review progress against strategies and actions contemplated in the prior year’s plan. Acknowledge what worked and what did not.
Complete the necessary updates with careful attention to the longer-term vision.
Define a limited number of actions and investments required for success.
Monitor execution carefully.
Be prepared to make adjustments to prepare for the longer term.
Make the development of this longer-term working vision an opportunity to explore possibilities with important stakeholders including community leaders, physicians and staff. Be prepared to iterate or create alternative scenarios. Review your thinking on a quarterly basis while you review your annual and 3-year plans. Regular reviews, updates and accountability assessments will help focus your organization.
Edward M. Hindin, a frequent contributor to HealthLeaders Media, is president of Hindin Healthcare Advisors, LLC. He can be reached at ehindin@hhadvisors.com.
Are you a good leader? Asking that question is a lot like asking whether you’re a good parent. I mean, everybody thinks they are. How many fathers would say, “I’m a terrible dad.” Leaders are much the same. But how do you really know? For parents, the answer often comes 20-30 years in, when your children become functioning, responsible, happy adults. But CEOs don’t have that kind of time.
Whenever I attend a leadership conference, I’m amazed by how many leaders leave early during the presentation on good leadership. By session’s end, it’s usually just me, a few other journalists, and three or four fresh-faced business grads being groomed for future leadership. Apparently long-time leaders don’t need new tips to lead, nor do they need a refresher course.
But here’s the thing: Like parents, leaders change, evolve, and grow over time--as do the people they’re leading. Parents will tell you they’re still learning and adjusting their parenting style 10, 20, 30 years in. Parents don’t parent a 30-year-old the same way they parent a 3-year-old. How do you lead over time? How do you ensure that you’re still giving your staff the leadership they need?
A few weeks ago I wrote about George Masi, executive vice president and COO of Harris County Hospital District in Houston, whom I met at last month’s ACHE conference. During his presentation, Masi outlined the attributes of a good leader. A few of his rules are worth reading even if you think you’re an able leader.
Good leaders write it out. So many leaders will pass workers in the hall and shout out a bunch of to-do items for a project, then wonder why the process ends up broken. Don’t send your staff running around trying to decipher your instructions. Set clear directions and take the time to write them out.
Good leaders research and make decisions. Some executives are great at the research but not so good at the decision-making. These leaders do a lot of ready, aim, ready, aim, but never pull the trigger. You need analysis and research but at some point you need to fire. All that research you’ve been doing on retail clinics? As my grandfather says, “it’s time to act (not exactly his word) or get off the pot.”
Good leaders don’t promise what they can’t deliver. Nobody wants to be the bearer of bad news, but as leaders, occasionally, you have to be. Don’t tell people you’re going to fight to add staff or get bigger raises if you know that won’t happen. Sometimes being a leader means being able to tell the hard truth.
Good leaders run a good meeting. By Masi’s definition, a “good meeting” is under an hour. I’m not sure all meetings will fit in that category but it’s a good goal. More importantly, make sure yours are organized and action-oriented.
Good leaders promptly return phone calls and e-mails. Oh, such a simple thing but in the Land of a Thousand E-mails, it’s not so easy. Easy or not, it’s an essential leadership principle. Leaders who sit on e-mails hold up processes.
Obviously there’s a lot more to leadership than timely e-mails and well-run meetings, but these few rules are among the most often broken by leaders. I’ve written before about the importance of evaluating your leaders, but you also must evaluate yourself (and do so honestly). Do you regularly assess your leadership style? Do you talk to your staff about how you can improve? Like parenting, leadership may seem like a natural inclination but it’s not. The best leaders read books, consult experts, and seek to constantly improve.
Masi’s best indicator of good leadership came at the end of his presentation--ironically when many of the leaders in the room had walked out.
“You have arrived as a leader when your staff does their jobs because they don’t want to disappoint you--not because they are scared of you or other reasons--but because they don’t want to disappoint your expectations.”
Hmm, sounds a lot like good parenting.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
Mobile, AL-based Infirmary Health System and Bishop State Community College have announced a new partnership that will provide up to 100 nursing scholarships per year as part of an effort to draw more students into the nursing field. Those in the program will become registered nurses with two-year degrees and will receive most of their clinical training at Infirmary Health System facilities. Upon graduation, they must go to work full-time at one of the facilities, for a specified minimum amount of time.
Budget-cutting by Louisiana House leaders could lead to reduced access to healthcare services by the poor, elderly and disabled, according to the state Department of Health and Hospitals. Cutting the Medicaid rates paid to doctors, hospitals and other healthcare providers will reduce access and potentially lead to higher long-term costs as more people seek care through expensive emergency-room visits, according to a letter from the Department to lawmakers.
Minnesota health plans spent more on medical and administrative costs than they received in premiums in 2007. As a result, premiums may rise faster in the future. A spate of hospital construction, higher labor costs for hospitals and higher prices for new and existing medical technologies were among factors pushing up prices for medical services, said the chief financial officer for Blue Cross and Blue Shield of Minnesota.
Physicians and Republican legislators say that bills to create massive changes in Minnesota's healthcare system could drive small hospitals and clinics out of business and harm patient care. One proposal drawing criticism would require providers to set a single price to treat patients with some chronic conditions—at least for public employees and those on Medicaid and other state health programs.
