Inspectors gave Massachusetts General Hospital high marks during a surprise inspection earlier this year, a difference from a review three years ago that turned up numerous problems at the facility. The Joint Commission re-accredited MGH following the inspection.
The hospital received two "direct impact" recommendations for improvement, MGH President Peter Slavin, MD, said, which involve "areas of sufficient concern that the commission believes noncompliance could pose an immediate risk to patient safety or quality of care."
Online health sites have been booming in the past five years, experts say, driven by the popularity of social networking and patients' desire to become more empowered in the medical field. Officials of the Health 2.0 Conference, which tracks the industry, estimate that the number of such sites climbed to nearly 500 from about 35 four years ago. The sites generally have evolved from the encyclopedic-styled WebMD, becoming more interactive and case-study- oriented, such as Inspire, PatientsLikeMe, and CureTogether. Many of the sites have also recently experienced heavy traffic from users seeking information on the H1N1 virus.
Obama administration officials are pushing back against opponents of the healthcare reform bill, seeking to maintain momentum for the measure as criticism continued from both Republicans and Democrats. Administration officials fired back at insurance companies and their Republican allies over what they described as their efforts to undermine the legislation in recent days. The officials reiterated comments by President Obama hinting at the possibility of limiting or revoking health insurers' antitrust exemption if they were to continue to fight the legislation.
A judge on Friday halted enforcement of a New York State directive requiring that all healthcare workers be vaccinated for the seasonal flu and swine flu. The temporary restraining order by the judge, Thomas J. McNamara, an acting justice of the State Supreme Court in Albany, is likely to add to the growing debate about the flu vaccine. Justice McNamara scheduled a hearing on the case for Oct. 30.
The University of Pittsburgh Medical Center announced today that its money-losing UPMC Braddock community hospital will close on Jan. 31 because of declining inpatient volumes. Clinical operations at UPMC Braddock will begin shifting to other UPMC facilities next month.
"UPMC's mission of providing access to superb clinical care must be carefully balanced with a prudent stewardship of our economic resources and their effective utilization across the entire UPMC system," says Elizabeth B. Concordia, executive vice president, UPMC, and president, Hospital and Community Services Division. "This decision was made in the face of continued declining community utilization of UPMC Braddock, which impaired the long-term viability of services we're able to offer."
Inpatient utilization at the 123-bed, 277,000-square-foot hospital in Braddock, which is 9 miles east of Pittsburgh, declined significantly in the past several years, UPMC said. Admissions fell by more than 21% between 2004 and 2009 and were projected to decline further in 2010. The average daily census of 51 is well below operational levels necessary to ensure sustainability. Braddock-area residents are increasingly going to facilities other than UPMC Braddock for their inpatient care. In fact, the hospital only has a 20.8% market share, meaning nearly four out of five area residents are choosing to go elsewhere for their hospital care, UPMC said.
Braddock Hospital, which has been on the same site since 1906 though it has gone through numerous renovations, is located within 10 miles of five other UPMC hospitals.
It's not immediately clear if layoffs are planned for any of the 652 full- and part-time employees at Braddock. UPMC said the medical staff at Braddock will be incorporated into the staffs at other UPMC facilities, and that "most current employees will be offered positions elsewhere within the system."
Since UPMC acquired the then-failing Braddock Medical Center in 1996, it has invested more than $60 million in UPMC Braddock, including $30 million in capital projects. The health system also launched a number of outreach and marketing initiatives, and allocated funds in support of community-based physician practices and other "in-kind" health and social services, according to UPMC.
UPMC said it has absorbed nearly $27 million in operating losses over the past six years, and projects another $50 million in operating losses in the next five to six years.
UPMC added it will continue to operate outpatient programs in Braddock. It will also work with local physicians to expand access to primary care and with the community on the disposition or redevelopment of the building and land.
Wayne Sensor, president and CEO of nonprofit Alegent Health, the largest integrated healthcare system in the Nebraska and Iowa region, has resigned, effective immediately.
In a four-paragraph announcement this morning, Alegent Health said its board has asked Richard A. Hachten II to return as interim President and CEO. Hachten served as Alegent's president from its creation in 1996 until his retirement in April.
He "will provide immediate leadership to move the organization forward as well as assist the board in finding a permanent replacement," according to Alegent's statement, which was signed by Alegent board chairperson, Leslie Andersen.
The statement did not explain why Sensor has resigned. However, it credited his leadership for the organization receiving the top rank in quality and patient satisfaction by the Network for Regional Healthcare Improvement.
"Our board, along with physicians and employees, wish to thank Wayne for his innovation and commitment and dedication to Alegent Health and to our community. His legacy of innovation and commitment to high quality, low-cost care, patient-centered care will carry through our employees, our physicians and our mission."
According to Alegent Health's Web site, the faith-based system encompasses nine acute care hospitals, 1,832 licensed beds and more than 1,300 physicians on its medical staff.
Headquartered in Omaha, Alegent provides services at more than 100 sites and has 9,000 employees.
It was created by the consolidation of Bergan Mercy Health System and Immanuel Medical Center in 1996. Its sponsors are Catholic Health Initiatives and Immanuel Health Systems, which is affiliated with the Nebraska Synod of the Evangelical Lutheran Church of America.
Sensor is one of the most well-known health leaders and has been honored by publications for his work in healthcare.
It has been a challenging year for hospital leaders when it comes to managing talent. The economy has forced many to freeze hiring or lay off segments of the workforce, and the general pressures of a changing industry and strained budgets have tested the morale of many staffs.
Yet building the successful hospital of the future requires attracting the best physicians, nurses, and support staff, and creating a patient care environment that keeps them around. Hospital leaders face the divergent challenges of managing the workforce in today's economy while building the workforce to succeed in tomorrow's healthcare system.
1. Define your values. Healthcare leaders play a key role in defining the values that make their organization unique, but organizational values only take hold if they are internalized throughout the workforce. "Values are the foundation of everything else," said Joe Tye, CEO of Values Coach, which provides training and coaching on values-based leadership and cultural transformation for hospitals.
Even if an organization has a clear mission and list of priorities, defining values requires translating words into culture and action. That starts with hiring, panelists said. Debra A. Canales, executive vice president and chief human resource officer at Trinity Health, recently invited a potential CFO recruit to a three-hour dinner during the hiring process, in part to pick up clues about whether the candidate would be able to live the organization's values. "I expect [interviewees] to have technical expertise, but more importantly, I want to know how they will live our mission," she said.
2. Weld training to mission. Defining values doesn't end after the hiring process. Many people assume that certain personal values or qualities are inherent, but "values are skills, and attitudes are habits," said Tye. Like anything, they can be learned.
3. Bind recruiting and retention. Hospitals don't have to surrender to the mobility of today's workforce, panelists said. It is still possible to "recruit for life," but it takes some flexibility. Trinity Health encourages employees to be mobile within the organization, Canales said. If employees aren't entirely happy in their current position, they're encouraged to speak with leaders about different career paths and take new jobs, while staying within the health system.
4. Find true leaders. Chris Van Gorder, FACHE, president and CEO of Scripps Health, meets with top departmental managers at least once a month to talk about some of the decisions that take place behind the scenes in the system. He begins by talking about the patient experience before every management meeting, and said it has dramatically changed the culture of the organization and reminded managers about the importance of their jobs and developing skills they might need as future leaders.
5. Walk the talk. It's easy to lead during easy times; the true test comes when the going gets tough, the panelists agreed. Trust is a key part of the follow-through. Burns and McDonnell, an engineering firm that represented an outside-the-industry voice on the panel, doesn't use internal operating budgets, said Melissa Wood, vice president of human resources for the firm. Employees are owners of the company, and managers trust them to make the right financial decisions, even in a bad economy.
Last week, I told you about the past nine years of Jim Anderson's 13-year tenure as CEO of Cincinnati Children's Hospital, which is coming to an end as the calendar rolls into 2010. During that time, he's made his fair share of mistakes, but perhaps his greatest success was initially seen as a mistake by many in the hospital. If not an outright mistake, most of the caregivers initially decided his initiative to do better on infection control and quality care was well-intentioned, but would cut his own financial throat.
That's because of the perverse incentives in healthcare that have received a lot of attention lately—chief among them that if complications ensue when a patient gets to the hospital, leading to a longer stay, the hospital does better financially. Before you besiege me with notes about how those perverse incentives don't exist anymore, both you and I know that much work still needs to be done on this front. Hopefully healthcare reform will take care of some of them, but last time I checked, most of healthcare, in terms of dollars, was still fee-for service. That doesn't mean that hospitals actively seek to injure or otherwise extend patient stays in order to do better financially, just that they don't have a lot of incentive to improve.
Set that debate aside for a moment, because as many of you have doubtless seen for yourself, here's where the sales job got difficult for Anderson.
"In early 2000, we were exposed to the idea of family-centered care," he says. "We got the notion that healthcare is dysfunctional and the opportunity to focus on processes to provide better value was a critical underdeveloped area filled with enormous opportunity."
Silly fool. What did this big-time lawyer and industrial company president (who was appointed from the hospital's board) know about how healthcare worked?
"I was unburdened by that knowledge and it was clear there was a dramatic difference in attitude and approach to quality. That was perplexing and intriguing to me, but I didn't know what to do with it."
He started, rightly, with the caregivers, selling them the idea that relying on evidence-based protocols and family-centered care was the right thing to do, regardless of the business implications. Problem was, many of them didn't trust his motives at first. Neither did his CFO. But he had an influential physician champion on his side and that helped get the ball rolling.
"Jim and the physician came in to show me how a significant portion of treatment we delivered was outside the evidence-based guidelines," says CFO Scott Hamlin. "I asked them if they realized I bill for such things. I thought we would be out of business."
Early on, Anderson and Hamlin joked about the initiative being a "faith-based investment," because some of the things in which Cincinnati Children's invested reduced revenue—but only temporarily.
"We found that those (now-empty) beds filled up with more complex cases and enabled us to build tertiary and quaternary care, allowed us to develop specialists, and expanded the geographic pull of the institution so now we're clearly a global enterprise," Anderson says.
Yes, it's a children's hospital, a vastly different business than running an adult hospital. But Anderson's initiatives at Children's have their origins in businesses outside healthcare, which is really different. Most importantly, these activities are implemented for better outcomes, he says.
"If you lose track of that, and get tempted into selling the cost reduction aspect, you lose the traction that is essential with front-line caregivers."
It's like dancing on the razor's edge, but I can't paraphrase what Anderson told me next about balancing the clinical case with the financial case any better than he said it himself.
"We thought that in conventional business terms that this would take cost out of the system. We made the argument that there was a great cost reduction opportunity. To all the business guys, that was music to their ears, but what none of us recognized is that the people you have to have doing it would understand the logic, but wouldn't necessarily change their behavior. Once we realized we weren't getting action, we decided not to talk about dollars anymore. Better outcomes and family experience was what resonated with docs and nurses. They thought we were just winking at that. We told them that actually, evidence-based protocols would reduce revenue and admissions, so we became credible on that issue. We were really in this for the outcomes."
So, what lessons can adult hospitals take from Cincinnati Children's journey? Again, Anderson says it better than I can:
"If I were leading an adult hospital, this has to start with the board and the CEO and they have to demand it and invest in it. Be willing to devote a disproportionate share of your time to making it happen. Without that, it's unlikely to occur downstream. The next piece is engaging on strategic planning to develop mission and action plans that embrace improved outcomes and value. Develop common ground with the broad organization. And lastly, you begin to invest in actions to make those things happen. Part of it is data collection and tracking. That's never been easier than it is today. No reason to reinvent the wheel there. Plagiarize them broadly and incorporate. Connect with organizations that are proven catalysts in transformational change. There are none better than IHI, which has lots of affordable mechanisms to begin to unleash this energy to improved outcomes, and then you follow the direction that's established by that preparation. Like Nike says, just do it."
Hamlin, the business guy in the room, anticipated my next question:
"How does that work when you're not in the tertiary business that can make up for more discipline by drawing patients from the outside to your tertiary programs? There are two choices. Let's say you are a community hospital that implements these and you take care of your community's population and it's not a growing population or it's shrinking. The principles are better utilization of the assets you already own, whether people or bricks and mortar. So now you've created extra capacity and you have two choices. Getting smaller and more profitable is a super win, but doesn't work in healthcare, obviously. So that excess capacity can be put to use for gaps in the community service that others won't provide. For us, we went into mental health. It's most underserved, it's not profitable, and it's not well received. Economics are such that no one wants to provide the service. We use what we've gleaned from our program to offer those services."
So no, it won't ultimately improve your finances. But it will improve your value to the community, and after all, if you're a nonprofit hospital, you're there to maximize the benefit to your community, right? Right?
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Congressional Budget Office analysts have given House leaders cost estimates for two competing versions of their plan to overhaul the healthcare system, concluding that one comes within striking distance of the $900 billion limit set by President Obama and the other falls below it. The report from the CBO puts the cost of one plan at $859 billion over the next decade and the other at $905 billion. The cheaper version would rely heavily on a more dramatic expansion of Medicaid, reports the Washington Post.
Deep fissures among Senate Democrats became evident on two issues as lawmakers moved closer to a floor debate on legislation to remake the healthcare system: whether the government should sell health insurance in competition with private insurers, and whether Congress should offset any of the cost of legislation to increase Medicare payments to doctors. The Senate majority leader, Harry Reid, Democrat of Nevada, said that he would try next week to pass a free-standing bill that would pour $240 billion into Medicare to shield doctors from cuts in their Medicare payments that would otherwise occur, under existing law, in the next 10 years.
