The University of Pittsburgh Medical Center intends to consolidate UPMC South Side with UPMC Mercy, as well as spend $75-$90 million on an expansion of Mercy's campus. The South Side campus will begin moving to Mercy in summer 2009 and close over a period of five years. The Mercy renovations include the creation of a rehabilitation "center of excellence," as well an expansion of UPMC Mercy's emergency department, additional operating rooms, intensive care unit, and ambulatory capacity and enhancements in ear, nose and throat services.
Despite a looming nursing shortage in North Carolina, a state-funded group that develops strategies to find nurses may shut down for lack of money from the General Assembly. The NC Center for Nursing was founded in 1991 to avoid nursing shortages that have periodically crippled hospitals, nursing homes, mental institutions and home healthcare services in the state. The Center, however, was not included in the state House budget that recently passed. Advocates for the Center are now trying to persuade Senate leaders to include funding in their budget.
Florida Hospital has contracted to buy the same piece of land near the Lake Nona "medical city" that was once slated for the Nemours Children's Hospital. The Florida Hospital system plans will likely build a regional or teaching facility on the site. Nemours backed out of their deal in February, and moved its planned site 1 1/2 miles west.
Former U.S. House Speaker Newt Gingrich has outlined his strategy to combat rising healthcare costs, a plan that includes insurance mandates for people who earn more than $75,000 a year. Gingrich called it "fundamentally immoral" for a person who can afford insurance to save money by going without, then show up at an emergency room and demand free care. Under Gingrich's strategy, those who can afford insurance and choose not to buy it would be required to post bonds to pay for care they may someday need.
When it's your job to monitor the quality of a healthcare organization, there's a long list of items that you think about on a daily—if not hourly—basis. You're always looking for new ways to prevent the spread of infection, or how to keep patients who are susceptible to falls from getting out of bed without assistance. You're up to date on your organization's readmission and mortality rates, and you're on top of your hospital's latest HCAHPS scores.
But in the minds of our consumers, a quality healthcare experience is something completely different. A cardiac patient may be given an aspirin immediately after being admitted to your hospital. He may be shielded from a hospital acquired infection by your new infection control protocol, but if he must wait for hours in a crowded waiting room to receive care, he'll remember that experience as anything but "quality."
I know this because last week I was one of those patients. After taking ill at work, my doctor recommended that I get myself to the closest emergency department for evaluation. Five hours later, when I finally got to see a physician, they couldn't find anything wrong with me.
"I don't know what may have caused you to pass out, Ms. Larkin," the doctor said after monitoring my vitals for a couple of hours. "Granted, that was almost eight hours ago now, so there could have been something going on that we can't see now."
Gee, thanks.
I had a great nurse tending to me in the ED. He made sure that I was fed, hydrated, and comfortable. He came in often to check on me and kept me informed about when the doctor would be in to chat with me about my test results, and finally, when I'd be able to go home. But when anyone asks me about my ED experience, the first thing I tell them is how long I had to wait-and how my waiting didn't even produce a diagnosis.
I'm not telling you this because I need a place to vent about my ED experience. Nor do I want you to think that I expected to receive care immediately after walking in the door. I understand that a person with nausea and lightheadedness isn't going to be seen before the woman who comes in bleeding with a large cut on her forehead, or the man experiencing chest pains. But as more people in America seek care at emergency departments, we must figure out a way to provide better experiences for patients in our EDs. Delivering a "quality" experience in our EDs may be rare, but it's possible.
Earlier this year, my colleague Molly Rowe wrote about the challenges that EDs pose to hospitals in HealthLeaders magazine. She profiled several hospitals that recognize the importance of the ED to the rest of the hospital's operations. They've changed their processes and staffing levels to allow smooth patient throughput regardless of how many patients are waiting to be seen. They recognize that patients coming through the doors of the ED—60% of hospital admissions come from the ED—are important to the hospital's success. A "quality" experience in the ED can bring you a patient for life.
When it comes to providing high quality care, there's a lot that leaders must think about—infections, falls, and the timeliness of procedures—but we also need to keep in mind what quality means to patients. There may come a day when we've eliminated MRSA and we no longer worry about pressure ulcers, but if we can't give timely treatment to a patient in our emergency department, will we really be able to say that we offer a quality healthcare experience?
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media QualityLeaders, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.
Collectively, physicians can sometimes be their own worst enemies. Just when primary care physicians caught a break and the Medicare Payment Advisory Committee advised Congress to find a way to increase their payments, their surgeon colleagues fired off a letter in an attempt to prevent a possible payment change.
A consortium of 14 associations representing surgical specialists wrote to MedPac and members of Congress expressing "strong opposition" to the recommendation. The problem, from the surgeons' perspective, is that the advisory group suggested a "budget neutral" payment adjustment, which would require cuts from other specialties to fund the increase for primary care.
This budget neutrality requirement is at the heart of the subspecialty payment disparities that I touched on last week. The physician payment system is often likened to a pie—there are only so many ways it can be divided, so to offer one specialty a bigger piece, CMS must give other specialties a smaller one. Years of competing with each other for a bigger piece of pie has created some pretty significant rifts between primary care and specialists.
William C. Thornbury, Jr., MD, medical director of Medical Associates of Southern Kentucky made the case for primary care in an e-mail I received this week, and he didn't mince words in placing the blame on specialty physicians. "The irony of it all is that though they are paid the least, primary care physicians and general surgeons are the most gifted and most intelligent physicians in the system. However, specialists, which have markedly easier, finely defined roles, are banded together to support their own efforts at the expense of the system that cares for us all."
He directed his criticism in part at specialist overrepresentation on Medicare committees, like the Relative Value Scale Update Committee—an argument that has some merit and has been made before.
On the flip side, a physician blogger using the moniker "Buckeye Surgeon" defended surgical specialists against criticism over the letter, arguing that higher malpractice premiums and additional training warrant higher reimbursement rates. "Surgeons aren't opposed to primary care docs getting more money," he wrote. "We're all for that. But don't obtain that funding from the already dwindling surgeon's piece of the pie."
It's understandable that physicians would identify with their specialty first and defend their turf against reimbursement encroachments, but these divisions can be counterproductive to efforts to enact widespread payment reform. Physicians are competing against very large industries (pharmaceutical, managed care) for the federal government's attention, and lately the physician community has been too disjointed to develop a clear message about what a reformed system would look like. If physicians are sending Congress mixed messages about how physician reimbursement needs to change, they'll probably continue to get more of the same.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
After winning the Nobel Prize for medicine, University of Utah geneticist Mario Capecchi learned he has a younger sister. Capecchi and half-sister Marlene Bonelli met last month in northern Italy. They were too young to remember when they were separated in the early days of World War II, and Bonelli had long believed that Capecchi and their mother had died in the war.
Colorado Governor Bill Ritter has signed a bill that would require insurers in the state to issue patient identification cards with both written information about the patient and insurer as well as machine-readable information on a magnetic strip. The legislation helps reduce the potential for human errors and the data entry burden posed by nonstandardized cards, and is an important step in reducing administrative complexity and its impact on healthcare costs, according to a release from the Medical Group Management Association.
The South Carolina Medical Association has formed a new company to offer malpractice insurance to physicians in the state. The South Carolina Physicians Assurance Company is designed as a safety net should commercial carriers leave the market during an earnings downturn. Currently, most physicians have their malpractice insurance through South Carolina Joint Underwriters Association.
Did you ever wonder why two similar clinicians can have such similar practices with wildly different financial situations? I see this all the time—similar services, payor mix, age, location, and patient demographics, yet astonishingly different revenues. One is struggling and the other is breaking records every week.
Why? I have researched this field extensively to find a satisfying answer. I studied the business management gurus, including T. Harv Eker, Robert Kiyosaki, Tony Robbins, Dan Kennedy, Jay Abraham, Brian Tracy, Michael Gerber, Suze Orman, Sir John Templeton and many others. The difference lies primarily in the mindset of the two physicians. They prioritize their activities differently and perceive things according to differing values and beliefs.
Successful physicians do the following:
1. Focus on the future. Successful people in all areas of endeavor tend to focus on an idealized version of the future. They think about what things would be like if they were perfect and then they focus their energies on bridging the gap from where they are now to where they want to be. Successful people don't get caught up focusing on the problems, challenges, worries, and frustrations of today.
Successful physicians and physician leaders constantly ask themselves, "How would my practice (or organization) look, feel, interact, and function if it were perfect in five years?" Five years is an important part of the phraseology of the question. According to Peter Drucker, we vastly overestimate what we can accomplish in one year and vastly underestimate what we can accomplish in five years. Choosing a long-term time horizon keeps successful doctors focused on strategically sound initiatives.
2. Keep score. Many professionals, including doctors, are renowned for impulsively putting high ticket items on their credit cards, presumably as a way to distract from the stresses of their career. Expenditures—both business and personal—must be considered carefully. Will the expenditure bring in more revenue? If so, how much and when?
If you're going to buy a whiz bang piece of diagnostic equipment, can you rent it first to make sure it performs prior to committing to the purchase? Can the rep bring it into your office for at least a complete billing cycle so you can be sure the reimbursement is there or to get the patients' perception of the new doo-dad?
Business expert Michael Gerber says that every decision you make has financial consequences. The traditional way to keep score is to sit down with your accountant at regular monthly intervals and evaluate trends in income and expenses. Perhaps an equally important way is to track your net worth (assets less liabilities).
3. Plan better, including for contingencies. Rich doctors tend to have their day's work planned the night before, organized into lists for better follow through.
Better planning doesn't just involve attention to detail, though. It also includes a keen recognition of what does not need to be done on your list. According to T. Harv Eker, "cleanups, completes, and deletes" are important to you psychologically. Anything that you committed to but didn't follow through on or are procrastinating about carries a heavy mental weight in your psyche. Eker encourages you to every week either delegate a task, resolve to complete it once and for all, or acknowledge that it is no longer important to you and allow yourself to let it go.
4. Work to the clock. Marketer extraordinaire Dan Kennedy writes ad campaigns for $100,000 per project and up. He acknowledges that the best thing in the world for him is a deadline.
Working to task and to the clock, keeps him crisp, focused, and efficient. The structure of deadlines and commitments improves performance in the same way a speed skaters performance improves when her coach is measuring her performance with a stop watch.
5. Build championship teams. You can't become extremely successful at anything alone. You not only need the help of others, but you need the help of the very best people you can find.
This means that you have to have all the team members talking together and you have to sell them on your plan, your vision. I often hear from clients that their staff just doesn't want to work, doesn't want to be told what to do, and basically hasn't bought in to the vision of the practice.
I'm really a "nice guy" at heart so this is a little hard for me to say. Sometimes there is nothing better for the success of a practice than a few well-earned pink slips. Usually the rest of your staff knows when someone needs to be fired long before you do. The good ones are always relieved when the troublesome employees are fired. It is a reminder to everyone of the reason they are there in the first place. Building a championship team means you sell your vision to the team members so they can carry you forward to your ultimate destination.
6. Have high self esteem. Every one of us functions at peak levels when we align our values with our actions. In our consulting group, we insist that every client goes through a values clarification exercise at least quarterly. When your actions contradict your innermost values and beliefs, you experience stress, worry, frustration, and even anger and resentment. It has been said that every human problem can be solved by a return to values. Yet so few organizations approach workplace problems this way.
Your past achievements provide insights into your values. What have you done in the past that made you feel intense personal pride? What are the activities that you were involved in that made you feel the happiest? What activities have you participated in that you would do even if you didn't get paid for your involvement? Somehow, those activities allowed you to experience a value that you hold dearly.
Self esteem happens when we act on our values. High self esteem is absolutely necessary for success. According to Steven Covey, "While you're scrambling up the ladder of success, make sure it's not leaning against the wrong building."
7. Take action. Rather than getting stuck in the paralysis of analysis, successful doctors live in the field of action. They tend to bulldoze through multiple projects simultaneously. They tend to make decisions before all the facts are in. In a study or Fortune 500 CEOs, the typical CEO makes a decision when 30%-70% of the relevant information is in. They shoot from the hip.
At the same time, successful doctors tend to look closely for feedback on what is working and what isn't in their endeavors. They use this feedback to make an adjustment in their method and quickly move back into a new action. They continue to alter their methods until they finally get what they want. They are decidedly biased in favor of action.
8. Model what works for others. You won't find a highly successful doctor doing his/her own taxes. However he may call 20 of the most successful people in his/her circle of influence to get the name of a great accountant.
Rather than reinvent the wheel, these success-minded people tend to keenly observe what works around them and try to implement it into their lives by "modeling successful behaviors."
9. Respect and learn from more successful people. Rich people tend to not get immobilized feeling envious of others. They tend to seek them out and learn from them. Business guru Jay Abraham advocates taking a millionaire out to lunch once a month. Successful people are often surprisingly generous when it comes to sharing their wisdom and contacts with someone who has a genuine desire to improve their situation. Better yet is to form a mastermind group that meets monthly to allow the flow and interchange of best practices and ideas from a number of highly successful people. The clients in our mastermind groups learn the fastest because they process the new material at such a high level.
10. Invest in education. If you think education is expensive, try ignorance. Financially successful doctors are constantly learning, growing, and challenging themselves to be better people—not just at making money, but at everything. High education and intelligence correlate with high self esteem. Why not take advantage of that fact and commit to education in all facets where it is important to you.
Can a physician really feel great about him or herself if they are out of date with their clinical acumen? Or for that matter if they are out of shape physically? Or if they can't pay their bills because their practice isn't profitable.
The best reason to educate yourself is the growing confidence you will gain that you have what it takes to manage anything life throws at you. I think that is what it means to be rich—confidence and certainty that you will be okay no matter what.
David Zahaluk, MD, is a practicing physician, author of The Ultimate Practice Building Book, and the founder of "MIP Consulting Group," a coaching and consulting group for physicians only offering innovative solutions to practice marketing and staff development. For more information, visit www.UltimatePracticeBuilder.com.
