Very nice well dressed people gathering for a break fast feast ran out of movies and veered to rationing within 5 minutes of sitting down to dinner. Because it was a social event and not a scream fest at some town hall, everyone smiled and worried about how they won't get all their CT scans if reform goes through. They talked about the hippie public health types being interviewed who brought up all the moral justification.
Okay, for the record, moral justification in this country only works for little children. Adults are generally supposed to fend for themselves and even most juvenile offenders are treated as adults these days. SO forget the moral argument.
And forget the rationing. Change the incentives for physicians and hospitals to practice sound scientificly based medical care and there will be no need for rationing. You won't need to worry about all the radiation from your sixth CT scan because someone might actually have looked at the last three. Read the attached link...
In Delivering Care, More Isn't Always Better, Experts Say
» Links to this article
By Ceci Connolly Washington Post Staff Writer Tuesday, September 29, 2009
What will we talk about next time, "less is more".. Rationing is sexy face it!
Tuesday, September 29, 2009
Tuesday, September 22, 2009
Rookie docs talk reform....
Okay its from the Huffington Post so its on the liberal side. But it is interesting to hear from Residents and Medical Students - Check out the link. http://www.huffingtonpost.com/youth-radio-youth-media-international/rookie-docs-talk-health-r_b_292086.html
If you have ever been told that everyone can get emergency care, just read this link. As you well know, ER without drug coverage, primary care or followup specialty care doesn't get you very far and is a very expensive plug.
If you have ever been told that everyone can get emergency care, just read this link. As you well know, ER without drug coverage, primary care or followup specialty care doesn't get you very far and is a very expensive plug.
Monday, September 21, 2009
Are we having fun yet?
Monday, September 21, 2009
With the downturn in the economy, all my colleagues are facing cutbacks and projects slowed down. They are working harder with less. The cutting edge folks are facing budget cuts to their R and D budgets.
So how will innovation occur that will actually save all that money?
It will not occur in a vacuum or at the pace of normal healthcare innovation. Look around, there are loads of new ideas.
Let's have some fun. A treasure hunt. Let's start with a question?
Do you know where to find Docs? No not in a hospital...how about on google? No not medical docs, free floating documents on google docs.
What info have you been dying to get your hands on from your senior staff this week but don't want a meeting....try something new.
Go to Google. Sign in (takes one minute or less to sign up - free too!) Go to Docs. Press New. Press Form. When it opens - title it something important - Like Mandatory Data Request!!! Then give wonderful instructions like "I need by 5pm. Fill in all required fields."
Then go to town. Asked for anything. (Where the sample question box is) - Be creative: "What is the leading safety concern of staff today in our ICUs". As soon as you type it in it gives you another box! Yippee! Now you can go crazy on the next one. You can even give them a selection....check boxes or multiple choices, etc. They can even rank something! What are you wasting meeting time on this week that you senior staff can just get you the data today?
Keep it short for your first venture.. Don't get so carried away that they take you away by afternoon!
Now if you are not having fun with this, its because your creative juices are just starting - so go to Theme and pick one. You could go serious so that your team knows you mean it or you could go fun to get their attention. Just pick one. Then pick see responses so that you can see that all your responses will either be graphed or put in a spreadsheet for you so you can just look at it at 6pm on your way out the door!
Now you have to "share" Just load in the folks you want to give you info. You can always email it to them, but sharing is nice too.
Now in case you are feeling guilty wasting your time on the internet think what you just learned:
1. Creating data is extremely simple in this day and age and you should be getting it realtime.
2. You now have a google account so you are in this millenium.
3. Your managers could be getting data from their frontline people on any problem area at any time.
4. You can focus attention rapidly without a meeting. The new kids on the block are not going to tolerate our long agendas.
5. You have created transparency among your team by sharing...not for competition but for "signing on to each others success" -
I hope you had fun. More soon.
PS. You can get estimated revenue variances this way too! Daily!
With the downturn in the economy, all my colleagues are facing cutbacks and projects slowed down. They are working harder with less. The cutting edge folks are facing budget cuts to their R and D budgets.
So how will innovation occur that will actually save all that money?
It will not occur in a vacuum or at the pace of normal healthcare innovation. Look around, there are loads of new ideas.
Let's have some fun. A treasure hunt. Let's start with a question?
Do you know where to find Docs? No not in a hospital...how about on google? No not medical docs, free floating documents on google docs.
What info have you been dying to get your hands on from your senior staff this week but don't want a meeting....try something new.
Go to Google. Sign in (takes one minute or less to sign up - free too!) Go to Docs. Press New. Press Form. When it opens - title it something important - Like Mandatory Data Request!!! Then give wonderful instructions like "I need by 5pm. Fill in all required fields."
Then go to town. Asked for anything. (Where the sample question box is) - Be creative: "What is the leading safety concern of staff today in our ICUs". As soon as you type it in it gives you another box! Yippee! Now you can go crazy on the next one. You can even give them a selection....check boxes or multiple choices, etc. They can even rank something! What are you wasting meeting time on this week that you senior staff can just get you the data today?
Keep it short for your first venture.. Don't get so carried away that they take you away by afternoon!
Now if you are not having fun with this, its because your creative juices are just starting - so go to Theme and pick one. You could go serious so that your team knows you mean it or you could go fun to get their attention. Just pick one. Then pick see responses so that you can see that all your responses will either be graphed or put in a spreadsheet for you so you can just look at it at 6pm on your way out the door!
Now you have to "share" Just load in the folks you want to give you info. You can always email it to them, but sharing is nice too.
Now in case you are feeling guilty wasting your time on the internet think what you just learned:
1. Creating data is extremely simple in this day and age and you should be getting it realtime.
2. You now have a google account so you are in this millenium.
3. Your managers could be getting data from their frontline people on any problem area at any time.
4. You can focus attention rapidly without a meeting. The new kids on the block are not going to tolerate our long agendas.
5. You have created transparency among your team by sharing...not for competition but for "signing on to each others success" -
I hope you had fun. More soon.
PS. You can get estimated revenue variances this way too! Daily!
Wednesday, September 9, 2009
Reform debate....do your staff have the facts?
Two nurses had a heated hallway debate recently on whether socialized medicine (if it were only so) was going to become a reality under this administration. One nurse loudly proclaimed the evils and the panels that would be overseeing and restricting care, pointing toward the rooms where elderly cardiac patients, many of whom had just had a procedure rested hooked to monitors. The other nurse equally loudly proclaimed how broken the current system was and how she trusted Obama to fix it.
Wow, was there alot in that discussion - besides how inappropriate it was in the hall with patients in earshot who were overwhelmed with their own current issues. It would be helpful if we could get facts out to our employees on this very important issue. We are not going to get the hallway debates to end, but we might be able to take a small step for mankind in moving the debate forward.
Let's break it down shall we:
1. Panels - Death or otherwise. Many people without insurance or those with inadequate insurance (that may be more than we know) might say that they already experience rejection from needed and life saving procedures. They definitely will tell you that quality of life issues are already on the economic table. Will a government affilliated panel be that much worse?. I personally believe that they will act more like our current hospital P and T committees (remember formularies) or the way Medicare does now.
2. Payment for end of life considerations and education. This is only the tip of the iceberg of the discussions, and time, that primary care doctors should be educated about and participating in. For anyone who has gotten on an airplane thinking a sick relative is recovering, only to get a call a couple hours later asking you to decide not to intubate, the idea of a face to face discussion in advance sounds like a good thing. Let alone the poor patient suffering through unnecessary intubation and extubation only to die a few days later in a coma.
3. Can the government be trusted to run anything without gaming it? I think we can agree that gaming the system is not only the purview of government! Having said that, the idea of a having a group of commissioners oversee seems not only sensible but critical. Let's get the criteria right for the commissioners instead of debating the need for government to take responsibility for a segment of the population.
4. From the sound of the debate, it seems that there is a loud minority who do not believe that the current system needs fixing. Have they been sick? Have they never had a safety issue, have they never had a wrong test or missed diagnosis or 12 page long bill or stack of bills from so many doctors, many whom you never met? Have they never met an uninsured patient or someone who could not afford to pay hundreds of dollars per month for chronic disease medications?
5. One size doesn't exist for everyone now with private insurance. Care for the poor is different state by state; payment is often not received by the doctors in Illinois for months on end. When those doctors choose to no longer take poor patients or better yet, to no longer take any form of insurance - will that be the status quo that we are protecting by rejecting reform.
6. The trillion dollar budget deficit contributed to by the new plans sounds like a real issue. Do we think that this is new cost. Do we think that folks aren't accessing care now but in the most convoluted and expensive ways with long term consequences. Do we think Medicare will be reformed to stay solvent without someone overseeing the system and redirecting the wasteful way that we consume healthcare dollars.
7. And when the plan says that care for undocumented residents may be available but will not be subsidized, that means that the government is not providing care for illegal aliens. If care was not available to those who come to our country from abroad, just think of yourself on a trip oversees and needing care.
Some facts of what works and what doesn't might help healthcare employees navigate the debate and help others see the system for what it can do and could do. If you don't agree with my facts, share some real ones.
And by the way, whether the number is 50 million at some point in a year that are uninsured or 8 million as my father believes, it is too many. One close relative is too many. An entire community is too many and millions are too many.
Wow, was there alot in that discussion - besides how inappropriate it was in the hall with patients in earshot who were overwhelmed with their own current issues. It would be helpful if we could get facts out to our employees on this very important issue. We are not going to get the hallway debates to end, but we might be able to take a small step for mankind in moving the debate forward.
Let's break it down shall we:
1. Panels - Death or otherwise. Many people without insurance or those with inadequate insurance (that may be more than we know) might say that they already experience rejection from needed and life saving procedures. They definitely will tell you that quality of life issues are already on the economic table. Will a government affilliated panel be that much worse?. I personally believe that they will act more like our current hospital P and T committees (remember formularies) or the way Medicare does now.
2. Payment for end of life considerations and education. This is only the tip of the iceberg of the discussions, and time, that primary care doctors should be educated about and participating in. For anyone who has gotten on an airplane thinking a sick relative is recovering, only to get a call a couple hours later asking you to decide not to intubate, the idea of a face to face discussion in advance sounds like a good thing. Let alone the poor patient suffering through unnecessary intubation and extubation only to die a few days later in a coma.
3. Can the government be trusted to run anything without gaming it? I think we can agree that gaming the system is not only the purview of government! Having said that, the idea of a having a group of commissioners oversee seems not only sensible but critical. Let's get the criteria right for the commissioners instead of debating the need for government to take responsibility for a segment of the population.
4. From the sound of the debate, it seems that there is a loud minority who do not believe that the current system needs fixing. Have they been sick? Have they never had a safety issue, have they never had a wrong test or missed diagnosis or 12 page long bill or stack of bills from so many doctors, many whom you never met? Have they never met an uninsured patient or someone who could not afford to pay hundreds of dollars per month for chronic disease medications?
5. One size doesn't exist for everyone now with private insurance. Care for the poor is different state by state; payment is often not received by the doctors in Illinois for months on end. When those doctors choose to no longer take poor patients or better yet, to no longer take any form of insurance - will that be the status quo that we are protecting by rejecting reform.
6. The trillion dollar budget deficit contributed to by the new plans sounds like a real issue. Do we think that this is new cost. Do we think that folks aren't accessing care now but in the most convoluted and expensive ways with long term consequences. Do we think Medicare will be reformed to stay solvent without someone overseeing the system and redirecting the wasteful way that we consume healthcare dollars.
7. And when the plan says that care for undocumented residents may be available but will not be subsidized, that means that the government is not providing care for illegal aliens. If care was not available to those who come to our country from abroad, just think of yourself on a trip oversees and needing care.
Some facts of what works and what doesn't might help healthcare employees navigate the debate and help others see the system for what it can do and could do. If you don't agree with my facts, share some real ones.
And by the way, whether the number is 50 million at some point in a year that are uninsured or 8 million as my father believes, it is too many. One close relative is too many. An entire community is too many and millions are too many.
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