My daughter (16) is in Rwanda with WE ACTx* helping with a camp for HIV-infected teens. They visited an incredible project designed to overcome the poverty and famine of the region. We in the US need to start thinking some of these insoluble problems are opportunities for audacious thinking and lose our fear of the unknown. Look what creative people focused on the right goal can do. http://www.millenniumvillages.org/aboutmv/mv_mayange.htm
What lens are you looking through toward the future?
*WE-ACTx is an international community-based initiative that was launched in fall 2003 by frontline AIDS physicians, activists and researchers with extensive ...
www.we-actx.org/
Thursday, July 22, 2010
Real caring
Health Affairs published a truly thoughtful article (blog) about the reality of caring and the culture for caring. It is well worth the read. Dr. Han's comparisons of our reaction to the tragedy in Haiti and our response to our own health crisis in this country is thoughtful and long overdue. Anyone who works on the provider side of healthcare knows how much his experience rings true. It may be an eye-opener for the non-provider and brings a face to the incredible disconnects in the system.http://healthaffairs.org/blog/2010/07/21/calculating-caring/
Tuesday, July 20, 2010
Paradigm shift for CEOs
Inpatient is the revenue driver. More admissions are better. Shorter LOS is the solution. Employee physicians to control them. Every bed and hospital is needed. Emergency rooms will be perpetually overcrowded without more high tech ERs or beds. Nursing is an inpatient profession. Medical Records are the hospitals property. If everyone were insured, there would be financial stability in the hospital sector.
Are you bored yet with the list? So what's the point, you ask?
I suggest that you take a fresh look at the list. And when you have tipped these notions upside down, you might be starting to work toward Reform solutions. I also suggest that you relook at who is in charge and where the power in the organization needs to go. The hospital CEO just may become just that and nothing else....which may not be the top of the heap. The hospital will be a cost center operation...not necessarily a revenue center.
How do your clinics look? How competitive are they? How loyal are your doctors and how tied in are they? Whose software is going in their offices? Who is going to take care of all your newly insured but difficult patients?
The safety net that the hospital's bought with a pass from the Indepent Payment Advisory Commission may cause this to roll through in ways that complicate your efforts to reform. Hospital's need to get behind money for rehab, primary physicians, specialty chronic disease clinics that help them bridge the new world.
As costs go up nationally, the hammer will come down. Will you be ready?
Are you bored yet with the list? So what's the point, you ask?
I suggest that you take a fresh look at the list. And when you have tipped these notions upside down, you might be starting to work toward Reform solutions. I also suggest that you relook at who is in charge and where the power in the organization needs to go. The hospital CEO just may become just that and nothing else....which may not be the top of the heap. The hospital will be a cost center operation...not necessarily a revenue center.
How do your clinics look? How competitive are they? How loyal are your doctors and how tied in are they? Whose software is going in their offices? Who is going to take care of all your newly insured but difficult patients?
The safety net that the hospital's bought with a pass from the Indepent Payment Advisory Commission may cause this to roll through in ways that complicate your efforts to reform. Hospital's need to get behind money for rehab, primary physicians, specialty chronic disease clinics that help them bridge the new world.
As costs go up nationally, the hammer will come down. Will you be ready?
Monday, July 19, 2010
Prevention may be your main product line
While patients should be focused on Inpatient QI indicators and Patient Safety indicators, Hospital leaders are hopefully transitioning their resources into AHRQ's Prevention Indicators. Prevention has gotten lots of lip service in the past, but your performance may become the bread and butter driver of financial performance, differentiating you from others in the market.
Do you know how many admissions were for short and long term diabetic complications? Do you know how it compares to your competitors? Do you know your rates of Pediatric asthma admissions? Perforated Appendices? What are your rates of admission for COPD and CHF? What about UTIs?
The future relationship with your medical staff (or accountable care organization) is going to be about admissions avoided, healthier populations, consistent ambulatory standards and fewer admissions.
Growth in admissions in the past 10 years while assumed to be skewed toward the aging population is really reflective of a major increase in 45-64 year olds, procedures and chronic conditions. Over 70% of admissions was the result of a chronic condition or the chronic condition was a co-morbidity.
The cost curve bending will be in the form of per admission revenue if health systems are not bending the curve through more appropriate ambulatory delivery models? (Don't let the Medicare cut protection lull you into thinking you have time...Medicaid will be a greater issue for many hospitals.)
Do any of these indicators show up on your key indicators of performance? Does your Board know that this is their business model into the future?
Do you know how many admissions were for short and long term diabetic complications? Do you know how it compares to your competitors? Do you know your rates of Pediatric asthma admissions? Perforated Appendices? What are your rates of admission for COPD and CHF? What about UTIs?
The future relationship with your medical staff (or accountable care organization) is going to be about admissions avoided, healthier populations, consistent ambulatory standards and fewer admissions.
Growth in admissions in the past 10 years while assumed to be skewed toward the aging population is really reflective of a major increase in 45-64 year olds, procedures and chronic conditions. Over 70% of admissions was the result of a chronic condition or the chronic condition was a co-morbidity.
The cost curve bending will be in the form of per admission revenue if health systems are not bending the curve through more appropriate ambulatory delivery models? (Don't let the Medicare cut protection lull you into thinking you have time...Medicaid will be a greater issue for many hospitals.)
Do any of these indicators show up on your key indicators of performance? Does your Board know that this is their business model into the future?
Wednesday, July 7, 2010
Don Berwick
Congrats to President Obama for moving ahead with this appointment. The cost curve doesn't bend without data applied rationally. Dr. Berwick is respected by the hospitals that he has guided toward making quantitative leaps in quality and safety. Only with thoughtful leadership is there going to be change that is sustainable and not strictly political.
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