PR's Rule One—check facts when editing copy—is becoming a forgotten art in the Internet environment. Failure to follow such basic communications principles can have embarrassing and widely publicized results as the Minnesota Democratic Party recently discovered, and was validated in an AP report that was picked up by CBS News and other media outlets.
An independent national poll released this morning reveals broad public concern and skepticism about the ability of Congress and President Barack Obama to pass meaningful healthcare reform without deficit spending.
The Quinnipiac University poll of 2,409 registered voters nationwide, taken from July 24-Aug. 3, also shows that Obama's handling of healthcare reform has seen significant public opinion slippage in the last month.
"President Barack Obama and Democratic leaders in Congress appear to be losing the public relations war over their plan to revamp the nation's healthcare system," says Peter A. Brown, assistant director of the Quinnipiac University Polling Institute. "Americans are more willing to scrap a healthcare overhaul than they are to increase the deficit in order to produce such legislation. That's a bad omen for the White House and Congressional leadership as they try to sell their plan to the country this month before the vote counting gets serious on Capitol Hill in September."
By a canyon-wide 55% to 35% margin, voters told Quinnipiac researchers that they are more worried that Congress will spend too much money and add to the deficit than it will not act to overhaul the healthcare system. By a 57% to 37% margin, voters say healthcare reform should be dropped if it adds "significantly" to the deficit.
By a whopping 72% to 21% margin, voters do not believe that President Obama will keep his promise to overhaul the healthcare system without adding to the deficit. American voters also disapprove (52% to 39%) of the way Obama is handling healthcare, down from 46%-42% approval July 1, with 60%-34% disapproval from independent voters. Voters say 59%-36% that Congress should not pass healthcare reform if only Democratic members support it.
The poll has a margin of error of +/- 2 percentage points.
Voters were split 39%-41% on whether the president's healthcare plan will improve or hurt the quality of healthcare in the nation, with 14% saying it won't make a difference.
Only 21% of voters say the plan will improve the quality of care they receive, while 36% say it will hurt their quality of care and 39% say it will make no difference.
Positives for Democrats
There is some good news for Democrats in the poll, which found continued strong support for critical elements of the Obama/Democratic plan:
62%-32% in favor of giving people the option of a government insurance plan
61%-36% for higher taxes on high-income earners to pay for healthcare reform
60%-32% in favor of insurance subsidies for individuals making up to $43,000 and families of four making up to $88,000
54%-38% for requiring businesses to provide insurance or pay the government
Meanwhile, voters oppose 68%-26% requiring people to have health insurance or pay a fine and oppose 68%-27% taxing employees for healthcare benefits from employers.
Independent voters are concerned
Independent voters are more worried about the deficit rising than Congressional inaction, 54%-37%. These voters say 59%-36% that overhaul should not occur if it would "significantly" increase the deficit. Independents oppose 63%-33% passing a bill with only Democratic votes. Independent voters also don't think Obama can keep his promise to avoid increasing the deficit and pass healthcare by an overwhelming 77%-17%.
"The key to this political battle over healthcare out in the country is independent voters. And that bloc is the key to most elections," Brown says. "These are the voters who broke strongly for the president last November and who were in his corner during the first months of his administration. But on these key healthcare questions they are siding with critics who question whether health care reform is worth the projected cost."
Obama support is down
Support for Obama's handling of healthcare is down among key groups:
Women disapprove 49%-41%, which is down from a 48%-39% approval July 1
Voters 18 to 34 years old disapprove 48%-44%, which is down from a 54%-35% approval
Low-income voters disapprove 47%-43%, down from a 49%-37% approval.
Since Quinnipiac University's July 1 survey, support for a government-run option has fallen from 69%-26% to 62%-32% and the number who would rather buy insurance from a private rather than public insurer has jumped from 53%-28% to 61%-25%. Brown says this is "another indication that opponents of the president's approach have been making points with the voters."
Consumers spent $33.9 billion out-of-pocket on yoga, chelation therapy, herbal supplements, meditation, naturopathy, manipulation techniques, massage, hypnosis, and many other alternative therapies for the purpose of improving health during 2007, according to a new federal report.
The study, based on a national household survey, is the first such report in 10 years and the first done with interviews conducted on the topic within sampled households as opposed to by telephone.
The new survey found that consumers spend about as much on such products and services as they do in their out-of-pocket costs for conventional physician services and prescription drugs.
The report defined alternative complementary and alternative medicine as therapies not usually taught in U.S medical schools and which are not generally available in U.S. hospitals. "CAM therapies include a broad range of practices and beliefs...not presently considered to be part of conventional medicine."
One significant difference between the most recent survey and the one from the 1990s is in an apparent drop by about 50% in spending for providers, which the 1997 survey said accounted for the majority of consumers' alternative remedy spending. This report found that instead, two-thirds of consumers' alternative spending went to products.
In 2007, about two-thirds of this spending went to self-care purchases of products, classes, and materials, while the remaining one-third paid for practitioner visits. About 38.1 million adults made an estimated 354.2 million visits to practitioners of CAM.
"With so many Americans using and spending money on CAM therapies, it is extremely important to know whether the products and practices they use are safe and effective," said Josephine P. Briggs, M.D., director of National Center for Complementary and Alternative Medicine. "This underscores the importance of conducting rigorous research and providing evidence-based information on CAM so that health care providers and the public can make well-informed decisions."
The agency estimates that CAM products and services account for 1.5% of total healthcare expenditures of $2.2 trillion, and 11.2% of total out-of-pocket expenditures.
Approximately 38% of adults use some form of CAM for health and wellness or to treat a variety of diseases and conditions.
On average, adults spent $121.92 per person for visits to CAM providers and paid $29.37 out of pocket per visit.
"Some of the highest per person, out-of-pocket costs are associated with visits to practitioners of naturopathy and chelation therapy, while one of the lowest per-person, out-of-pocket costs is associated with visits to practitioners of chiropractic or osteopathic manipulation therapy," the report said.
The report breaks down spending in categories of acupuncture; ayurveda; homeopathic treatment; naturopathy; and traditional healers, such as a Curandero, Espiritista, Felenkreis, Shaman, Botanica or Native American Healer/Medicine Man.
Other categories include biologically based therapies, such as chelation, nonvitamin, nonmineral; natural products and diet based therapies, such as Pritikin, Ornish or South Beach diets; manipulative therapies, such as chiropractic or osteopathic manipulation, massage or movement therapies; biofeedback; relaxation techniques; hypnosis; and energy healing therapies.
One should never start a story with a series of numbers. But the amazing turn of 112-bed French Hospital Medical Center in San Luis Obispo away from the brink of bankruptcy justifies an exception.
Here the dollars—pre-tax net income—do tell a lot about the struggles and successes of this hospital near the Central California coast.
2000: $-2,682,415.
2001: $3,371,702.
2002: -$6,229,620.
2003: -$2,612,078.
2004: -$1,397,690.
2005: $1,977,660.
2006: $16,868,195.
2007: $1,800,282.
2008: $6,827,234.*
In 2004, those leaks from its bottom line were matched by 200 leaks in its roof, beneath which buckets dotted the hallways and rooms to catch periodic torrents of rain.
Its once prized cardiac program's equipment had deteriorated so badly, physicians repaired it with equipment from older devices no longer fit for use. Disgusted doctors started admitting their patients to Sierra Vista Regional Medical Center, French's primary competitor.
French's pain management and psychiatric programs were closed in 1999. Its pediatric program closed in 2001. Sierra Vista started its own heart program a few miles away.
"They had taken it from what was a very successful and prosperous hospital to one that was sorely, almost criminally in neglect," says Alan Iftiniuk, who took over as CEO in 2004 under the hospital's new operator, Catholic Healthcare West. "There were serious discussions about padlocking the building and developing the grounds for condominiums, although the community rallied to stop that from happening," he says.
David Garth, president and CEO of the San Luis Obispo Chamber of Commerce, says he knows a man who was undergoing a cardiac catheterization procedure at French during its period of poor management. "He was getting his heart cathed when the machine broke, and they had to take him by ambulance over to Sierra Vista," Garth says.
He added that during these tempestuous times, "the employees had a tremendous spirit that was kind of a tradition. They were doing everything they possibly could under very difficult circumstances to try to keep the hospital afloat."
That neglect stemmed from events beginning in 1996, when French's owner, OrNda Health was purchased by Tenet Healthcare Corp.
Tenet also owned Sierra Vista and another French competitor, Twin Cities Community Hospital in Templeton.
A year later, the Federal Trade Commission acted on anti-trust laws to order Tenet to sell French and another hospital. Many in the community suggested that from the way the hospital languished, the buyer, Vista Hospital Systems, did not appear motivated to operate a thriving healthcare facility.
"I believe the previous management did not negotiate properly for costs that it could charge for services, or that's what I was told," says San Luis Obispo Mayor Dave Romero. "Now, French has a much better, superior management."
Iftiniuk echoed his view. "It seemed that Tenet looked to find the least experienced buyer, some would say a corrupt new owner to take it over," Iftiniuk says.
The turnaround came after Vista filed for Chapter 11 in 2004 and prepared to sell both French and Arroyo Grande to a for-profit company in Pennsylvania. A group of about 50 physicians stopped the deal. They organized the San Luis Obispo Physicians Alliance, which purchased the property and persuaded Catholic Healthcare West to lease the building and run the hospital.
Long a for-profit facility, the 1972-built French Hospital would now become a non-profit facility for the very first time.
In came Iftiniuk as CEO, and after talking with the doctors and the community and his bosses at CHW, he immediately launched a plan of attack. Here he describes 10 key steps to making the successful turnaround.
Convinced key former hospital executives to come back and terminated others who couldn't meet performance expectations, which boosted employee and physician staff morale.
CHW made a capital investment to improve the physical plant and shored up medical equipment.
Conducted community-wide survey with town-halls to find out what people wanted in their hospital.
Hired a vice president of medical affairs to help rebuild bridge to physicians in the community, and gave him a seat at the management table.
Infused the cardiac program with expertise and equipment with $4 million from Catholic Healthcare West and $5 million from philanthropic donations. Cardiac program is now in the process of becoming a county-designated STEMI receiving center.
Conducted employee satisfaction surveys twice a year, and allowed employees to help support the hospital's mission through a donation program.
Crafted a philosophy that if the hospital improves quality, safety and service, the rest of success will follow.
Conducted and incorporated patient satisfaction surveys. "The hospital culture became very metric driven," Iftiniuk says.
Established a Community Board Development with key business and community leaders and charged them with oversight responsibility. "Past boards had been ineffective, and not taken seriously," Iftiniuk says.
Created a hospital foundation with a separate board to connect with donors. The foundation has thus far raised $7 million for services in the community.
Focused on marketing and promotion through chamber mixers, direct mail newsletters and ads to get out a message that the hospital has changed.
The leaks are fixed. Many of the physicians have reactivated their staff privileges and last year, the reinvigorated and modernized cardiac program was recently named one of the 30 best community hospitals in Thomson Reuters' Top 100 cardiac hospitals, and the only one named in California.
There's a new 64-slice CT scanner, a cardiac MRI, two mobile C arms for imaging during vascular surgery and two state-of-the-art cardiac catheterization labs to better treat emergent patients. The "Brain Lab" offers cutting edge surgical navigation tools for orthopedic and ear, nose and throat specialists.
In 2008, it received a grant from the Hearst Foundation to open the Hearst Cancer Resource Center to bring cancer support and education groups together under one roof, free of charge for participants and visitors.
Average daily census for fiscal year 2008 is up 33% from fiscal year 2005.
Open heart procedures have increased 13%.
Emergency visits increased by 20%, because patients have more trust in the facility, and patient satisfaction with E.R. services was in the top tier of all CHW hospitals.
By most reports, the physicians, the staff, CHW and Iftiniuk have made sure the hospital won't ever become condominiums.
"He really has turned it around 180 degrees," says the Chamber's Garth. "The fact is that it went from being a substandard hospital to being a profitable, well-managed one."
*Based on Office of Statewide Health Planning and Development Calendar Year Pre-Tax Net Income.
The print ad for Covenant HealthCare's features a photo of a smiling woman—but her entire left side is blurred, making her features indistinguishable. Her right side is crystal clear. "Wouldn't you want your surgeon to see in HD? Precision matters," the copy reads.
The Saginaw, MI-based health system launched the campaign in May to promote its da Vinci High Definition Robotic Assisted Surgery—the region's first. The health system worked with Detroit-based agency Brogan & Partners to create the integrated campaign, which consists of TV, radio, print, and outdoor elements.
"Brogan & Partners developed a different approach for the da Vinci promotion, focusing on the new high definition feature that is unique in this market," Covenant's Director of Marketing Larry Daly said in a release. "The resulting ad campaign, Precision Matters, has really hit home with our patients and target audiences, as reflected in the high number of da Vinci surgeries."
The ad targets women ages 35-64 and highlights the importance of high definition—the da Vinci technology alone isn't new to area hospitals, after all. So far the campaign has proven successful, with 50 new surgeries scheduled in the first two months since the campaign launched.
"Our strategy was to set Covenant apart from the competition in the minds of consumers with a clear focus on the superior competitive differentiator," said Brogan & Partners Healthcare Division Partner and Director Julia Shea in the release. "We thought the HD benefit of Covenant's new robotic assisted surgery would resonate well with the public, partly due to the increasing awareness and popularity of HDTV."
Americans are so afraid of the big, bad Canadian healthcare system that the threat of "Canadian-style healthcare" makes for a compelling anti-health reform message.
Even if it's not exactly true.
"I survived a brain tumor, but if I relied on my government for healthcare, I'd be dead." So says Canadian Shona Holmes in an anti-healthcare reform ad sponsored by the Washington, DC-based Patients for Prosperity Foundation.
Holmes chose to fly to the U.S., where she was treated at the Mayo Clinic for a tumor that, according to Mayo, could have caused her to go blind. But did the tumor threaten her life? That's not so clear.
(Mayo, which published a story about Holmes on its Web site, notes that their purpose in writing about her treatment was "to capture the essence of the care that she received while at Mayo in the hope that it might be helpful to others who are facing similar medical challenges." The article goes on to say that the story "is not related to the current national discussion on healthcare reform, or Mayo's role in that issue.")
In a man-on-the-street style interview by the non-profit Real News Network, Canadian citizens in Toronto reacted to the anti-reform ads that feature sad, sad stories of Canadians forced to wait for appointments with specialists and denied life-saving drugs because the government just doesn't care about them.
"I think it's totally shocking," one man says in the piece. "It doesn't reflect reality."
Most said the stories featured in the ads are not typical, though they admit that some people do fall through the cracks. "Those stories are probably true. But not everything is perfect with the healthcare [system]," another interviewee says.
Most Canadians, both said, are very happy with the socialized medical system.
"For a person living with cancer, the idea that someone's care could be unreasonably delayed is truly scary. It also doesn't reflect the experience I've had or the experiences that have been shared with me by so many other patients," writes columnist Julie Mason. She also provides evidence that wait times are much shorter than anti-reform ads suggest.
"As the debate on healthcare reform heats up the United States, it seems certain that Canada's public healthcare system will be used, or more accurately misused, in the battle for hearts and minds," she concludes.
Does the Massachusetts model of mandatory health insurance work? The voiceover asks. "Take this doofus-looking guy," the narrator continues, as a picture of a young fellow in baggy khakis and a frumpy wrinkled plaid shirt pops up on the screen. Justin is healthy, likes to bike to work, and has a $5,000 deductible health insurance plan. "If he lived in Massachusetts, he would be a criminal," the narrator claims, since the maximum deductible in Massachusetts is $2,000.
The ad shows poor Justin behind cartoon jail cell bars. "Justin shouldn't be a criminal for buying affordable healthcare," our friendly but wildly misleading narrator concludes.
It's an inaccurate scare tactic—not having health insurance or not having a qualifying policy is not a crime in Massachusetts (or, safe to say, anywhere else).
But, hey, it's funny! And—scariest of all—it's probably effective.
Next week I'll write about some pro-health reform ads, just in case you're getting ready to e-mail me and tell me how misleading this column is. So instead, write to tell me what you think of the current crop of healthcare reform ads. Are they mostly accurate or wildly off-base? And, in either case, are they effective?
Note: You can sign up to receive HealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
Lance Lang, MD, consulting medical director at Health Dialog, speaks about why shared decision-making should be a key component of healthcare reform. [Sponsored by Emdeon]
With a public insurance option hanging over their heads and a sputtering employer-based market, health insurers are rightfully concerned about their future. But there is another issue slated for 2013 that could prove as difficult for health insurers.
Health insurers are understandably edgy just thinking about the breadth of this change. This transformation will potentially touch nearly all operational systems and procedures, according to Deloitte Consulting LLP, which recently joined forces with America's Health Insurance Plans to serve as its ICD-10 and 5010 training partner.
Deloitte said ICD-10 implementation requires a "massive wave of system reviews, new medical coding or extensive updates to existing software, and changes to many system interfaces.
"Because of the complex structure of ICD-10 codes, implementing and testing the changes in EMRs, billing systems, reporting packages, decision and analytical systems will require more effort than simply testing data–it will involve installing new code sets, training coders, re-mapping interfaces and recreating reports/extracts used by all constituents who access diagnosis codes," said Deloitte in its ICD-10: Turning Regulatory Compliance into Strategic Advantage.
Just how large is the ICD-10 change over? It should easily surpass the Y2K system upgrades of 1999-2000. David Biel, principal of the ICD-10 service offering for Deloitte in Chicago, says this is because health plans will have to deal with business processes and staffing. In other words, ICD-10 is more than technological improvements. "These codes are embedded in all of their financial transaction systems as well as their clinical systems. In order to order a drug in a hospital, you need to have a diagnosis. All of those things are going to change. This means huge people changes and huge training issues that they will have to deal with," he adds.
But with the ICD-10 changeover also comes an opportunity. Deloitte said ICD-10 could be a "potential platform for future strategic innovation." Though most health insurers will simply comply with the ICD-10 standards, Deloitte estimated that 10 to 15% of health insurers will become "innovators." Deloitte predicts that these innovators will "approach ICD-10 compliance as a strategic initiative and, as a result, could increase patient satisfaction and quality of care, while moving their business and clinical model into new markets."
To become an innovator, however, health insurers will need significant capital and personnel investments, which many insurers might not be able to achieve. What's important is to think of the ICD-10 change not as merely a bottom line concern, says Biel. "We're out in the market talking to a lot of insurers about ICD-10, and they're a number of them asking, 'what can I get out of this' rather than just thinking of costs," he says.
One potential benefit for health plans is having more accurate and a wider breadth of health data. This could help insurers learn more about member health issues and could allow insurers to break down the data into smaller groups for more targeted interventions. This could especially help disease management and care management programs find at-risk members and link them to programs that could improve their health outcomes.
Whether a health plan wants to merely comply or become an innovator, the company needs to prepare now. The North Carolina Healthcare Information and Communications Alliance, Inc., and The Workgroup for Electronic Data Interchange recently released a timeline for ICD-10 preparation. The groups estimate that it could take four years for providers to implement ICD-10.
Biel concurs with the assessment. "Even though we're four years away technically, the magnitude of the change is large enough that if you don't start looking at the impact now, then you won't have created a budget for 2010 to start the process," he says.
So, what can health insurers do now? Biel offers these four steps:
Review your technology to understand the impacted areas and how they are embedded in your systems.
Conduct an operational assessment to see the business processes that are touched by this change.
Conduct a people assessment to see the people who will need training in ICD-10.
Conduct a strategic assessment and figure out how your company wants to handle ICD-10 (i.e. comply, collaborate, or innovate) and review what would go into each option.
But don't wait to start this process. If your company has not already started the process to implement ICD-10, you are already behind your competitors. Get to work now.
"I believe all health plans before the 2010 budgeting cycle should have an idea of what the impact is, what their road map is to compliance, and how much they need to budget over the next three years—especially the next year," says Biel.
Try this trick to see if your hospital staff's values are consistent. Have them write down their values from the usual list of values "keywords" that hospitals use. Then ask them how they would describe their hospital to a friend applying for a job. You'd be surprised at the different results, says Joe Tye, author of "The Florence Prescription: From Accountability to Ownership," and a featured "Talent" panelist at the HealthLeaders 09: Hospital of the Future Now conference.
"The answer is always totally different," Tye says, "and the answer always tells you more about what your values are than what they put down on paper."
Hospitals may want to hire for skills first, but what binds the staff together as a whole are the values they share. The first step in creating a set of common values is to select the values that apply to your healthcare organization. "The first thing is getting clear what your values are. A number of hospitals take some phony acronym like ‘WECARE' and force fit words into it, or they write down what they think everybody expects," Tye says.
"Very few hospitals have authentic value statements," he adds. "One insurance company I know says one of their values is hard work, and another is loyalty. I don't know of a hospital anywhere that has come out and said their values are hard work and loyalty."
Tye cautions against trying to select values from a list of common ones all hospitals would have. "First of all values define who you are, what you stand for and what makes you special."
Another misconception is that one set of values is replicated through the culture of the hospital, he says. A leader must recognize the cultural differences between the night shift and day shift, and the ED nurses and the OR nurses.
"Be very clear what are the elements of culture, because a hospital does not have a single culture: it is the ultimate multi-cultural enterprise. Like Southwest Airlines, the pillar of their culture is fun, and they have a different culture in Phoenix or Poughkeepsie or wherever they fly to. But everywhere their expectation is they are going to be lighthearted and have fun."
Above all, the values must match accountability. If your values are "compassion," but nurses are judged almost exclusively on "productivity," those nurses would feel the values are disconnected, if not downright hypocritical, Tye says.
The HealthLeaders 09: Hospital of the Future Now conference (Oct. 15-16, Palmer House, Chicago) gathers a carefully selected faculty of 30 healthcare pioneers to share strategies for creating your next-generation hospital in five key leadership areas: Talent, Outcomes, Patient Experience, Design and Culture.
Interactive format built for peer exchange.
Small group discussions.
Pre- and post-event online idea exchange community.
Learning focus on action points to take back to your healthcare organization.
Groups of all stripes are blitzing lawmakers to shape a trillion-dollar healthcare overhaul that would reach into every business and every home in the country. In the lobbying frenzy, many longtime allies are divided, with fault lines emerging where the bills' provisions would cost them money. With the legislation now held up until after Congress's August recess, interest groups are treating the next few weeks as a critical time for rank-and-file members to try to snare one-on-one meetings with lawmakers back in their home districts, says the Wall Street Journal.
