All the way from Thailand, Chatree Duangnet, MD, joined us in Chicago last week to accept a Top Leadership Teams in Healthcare award on behalf of Bangkok Hospital Medical Center. This was the first year of HealthLeaders Media's global hospital category.
During the awards ceremony, Dr. Chatree, CEO of the system that includes four hospitals and more than 650 physicians, shared with the audience of senior leaders of hospitals and health systems from across the U.S. some of the challenges his leadership team faces.
He says his private health system has much to contribute to Thailand, a developing country of about 65 million. Dr. Chatree acknowledged that some find it hard to understand how a country struggling to provide public healthcare can be home to private hospitals that provide world-class care to medical travelers. He says private hospitals, like Bangkok Hospital, not only improve health coverage for Thais, they also bring international standards of care to the country. "The public hospitals are interested in coming and looking to us and seeing how we" provide care according to JCI standards, he says. In addition, he says private healthcare in Thailand advances medical research and brings additional revenue to the country.
As a private corporation, Bangkok has aggressive ambitions to grow by 15% annually, says Dr. Chatree, so executives, physicians, and employees depend on a culture of teamwork. "If we cannot work well together then we cannot serve 3,000 outpatients a day," he says.
But like many CEOs, Dr. Chatree says physician alignment can be one of the most difficult leadership challenges. Sounding much like a CEO here in the States, he says Thai physicians are uninterested in administration, but are passionate about patient care. Whenever possible, Dr. Chatree and his management team try to relate administrative decisions to JCI requirements. "We don't focus on administration, we focus on patient-focus care, so we use JCI for everything," he says.
Currently, Bangkok Hospital's growth is supported by medical travelers from the Middle East and Asia's growing middle class. Dr. Chatree says elective surgeries and cancer care will continue to be strong service lines for Bangkok Hospital and he also sees growth potential in stem cell injections for terminal heart failure patients; he says Bangkok Heart Hospital is advancing research in this area with the University of Pittsburgh.
I was sitting with some U.S.-based hospital executives when Dr. Chatree received his award. They were impressed by his candor and found it humorous that many of the challenges he faces seem so familiar to them.
These are tough times for medical groups, and the MGMA annual conference in San Diego kicked off with an acknowledgment of that harsh reality.
"People are postponing care. Many practices are already reporting that patient volume is down. Rising unemployment means more people without health insurance. Tightening credit requirements mean that practices are postponing capital investments, including such urgent needs as e-prescribing and electronic records," William Jessee, MD, CEO of MGMA said during his opening session remarks.
But as we reported in this month's magazine cover story, although the model may be changing, success is still possible for right-minded medical groups.
In fact, Jessee held up the October issue of HealthLeaders magazine during his open remarks as evidence that medical groups can still thrive. "I noticed that the October issue of HealthLeaders has a cover story on 'surviving and thriving in difficult times.' That story features MGMA data on highly profitable medical groups, and a number of examples of groups that we've identified as better performers. So despite the economic hard times, doing well by doing good is still possible," he said.
The breakout sessions here are all about figuring out the specifics of how to do that. There is a lot of focus on leadership and financial management—two areas that take on added importance in the current environment.
A nurse at West Jefferson Medical Center in Marrero, LA, was responsible for bringing attention to allegedly fraudulent Medicaid claims that have resulted in a $3.3 million settlement with the state and federal government. Leslie Klemm was identified in the settlement agreement as the private citizen who sued the hospital district over allegations it overcharged Medicaid by about $1.49 million, stemming from charges made by her unit. Klemm alleged that the hospital's Pediatric Intensive Care Unit led Medicaid to believe it could perform certain services that it did not have the capability to provide, officials said.
Amber Joy Milbrodt checked into Dallas-based Parkland Memorial Hospital's emergency department on a Wednesday night, complaining of a fractured bone in her right leg. She spent all night and the next day waiting to see a doctor before giving up and leaving. Two weeks after her visit, she received a bill from Parkland for $162. Now Parkland officials, already on the defensive about wait times after a man died in the ER following a 19-hour wait in September, say the charge was appropriate because a nurse spent time assessing Milbrodt for triage.
Working Americans once could rely on employer-based benefits. But more people are being forced into the individual market, where coverage is costly, bare-bones and precarious. The health insurance system has become increasingly expensive and inaccessible, and at the heart of the problem is the clash between the cost of medical care and insurers' need to turn a profit.
More than 40 supporters of a proposed community hospital in Holly Springs flocked to a public hearing to lobby for southern Wake County, NC. The proposal was one of a handful competing for 41 new hospital beds and four operating rooms that state regulators say fast-growing Wake County needs. WakeMed wants to build the county's first women's hospital in North Raleigh and add operating rooms at WakeMed Cary Hospital. Rex Healthcare wants to add obstetrics and surgical beds on its main Raleigh campus. Rex is also competing with the Southern Surgical Center to build an orthopedic ambulatory surgery center with four operating rooms.
The University of Minnesota Medical School is considering a very strict new conflict-of-interest policy. The far-reaching policy comes as congressional investigators and the U.S. Justice Department are probing ties between doctors and drug companies and medical device manufacturers—probes that have raised some difficult questions for the university. The Medical School's proposed policy digs deep and reaches far into the entrenched relationship between the drug and medical device industries and the university's doctors, researchers, and students, as well as the institution itself.
In-store health clinics continue to expand in the Pittsburgh market, but research is raising concerns about their long-term viability. The Pittsburgh area is expected to have 24 retail clinics by the end of 2008, almost evenly divided between Take Care centers at Walgreens and MinuteClinics at CVS. But a HealthPartners study and another led by a UPMC internist acknowledged that several key issues were ripe for further research, including assessing the quality of care given the absence of a physician and whether the cost savings merely shift the burden onto primary care physicians who see fewer and sicker patients.
Iowa's Executive Council voted to make Wellmark the only health insurance option for state employees and ended its coverage with UnitedHealthcare. Officials say the change will save the state as much as $9.5 million next year, but opponents say thousands will be left with fewer options.
Spurred on by smaller instruments and wider acceptance by doctors, minimally invasive surgery is now common in children from birth onward. Pediatric surgeons in Orlando, for example, routinely fix complex internal birth defects, drain chest infections, and ease chronic acid reflux with slender instruments and camera views provided through small slits in the skin. And some procedures in children and adolescents, such as appendectomies and gallbladder removal, are almost exclusively done with less-invasive techniques.
