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Entries from February 2011 ↓

Healthcare Innovation … Where Does It Exist?

Posted by ClearDirections on February 26th, 2011 in Accountable Care Organization, Communication, Innovation, Legislation, Patient Protection and Affordable Care Act | 1 Comment

“For innovation to be meaningful, it must always take the customers’ point-of-view. … Innovation simplifies your business to its critical essentials. … It should make things easier for your people in the operation of your business, otherwise it’s not innovation but complication.”

-Michael E. Gerber,The E-Myth Revisited

Innovation in an industry that is being rocked by the most wide-sweeping change since the advent of Medicare on July 30, 1965, is not only important – it is imperative. With the new and continual change on the horizon under the Patient Protection and Affordable Care Act (PPACA) signed into law by President Obama nearly one year ago, all product and service providers to the care of the human body need to examine all the leverage points for their businesses/organizations. These industries that help us keep our human chassis in top shape or attempt to repair them when they are “run down and broken” stand to offer value under the proposed delivery chain of the Accountable Care Organization (ACO).

According to Elliot Fisher, MD, MPH who is credited as the father of the term, ACO, defined an ACO as such in a 2010 article on he co-authored:

ACOs consist of providers who are jointly held accountable for achieving measured quality improvements [note that “measured quality improvements” is synonymous with report cards] and reductions in the rate of spending growth. Our definition emphasizes that these cost and quality improvements must achieve overall, per capita improvements in quality and cost, and that ACOs should have at least limited accountability for achieving these improvements while caring for a defined population of patients.

So, if PPACA and ACOs stand the test of Congressional time, gone are the days of finger-pointing on why a patient’s health status doesn’t improve, and finally patients and their family members might have a prayer of a chance of better “hand-offs” (as I like to call them) through stronger accountability and communication between care providers. In fact, just this morning I helped a group of MBA students at Kellogg Graduate School of Management review their business plan for a cool new communication tool that would help hold patients and their post-acute discharge caregivers more accountable for compliance with their prescribed regimen. It’s these types of business innovations that will create the proverbial win-wins for American healthcare. So, we know healthcare innovations are emerging from America’s top business schools. Where else does innovation exist?

Few likely know that Don Berwick, MD, head of the Centers for Medicare and Medicaid Services, is overseeing the new Center for Medicare and Medicaid Innovation. The Innovation Center claims it will “consult a diverse group of stakeholders including hospitals, doctors, consumers, payers, states, employers, advocates, relevant federal agencies and others to obtain direct input and build partnerships for its upcoming work. This dialogue will center on three areas of emphasis consistent with the Innovation Center’s goals.

* Better Care for Individuals: Improving care for patients in formal care settings like hospitals, nursing homes, and doctors’ offices, and developing innovations that make care safer, more patient-centered, more efficient, more effective, more timely, and more equitable. The Innovation Center will also promote the use of “bundled payments,” a more efficient approach to paying for care where providers collaborate to manage multiple procedures as part of a single episode with a single payment, rather than the current fee-for-service method of submitting separate bills for each procedure, which leads to higher costs.
* Coordinating Care to Improve Health Outcomes for Patients: Developing new models that make it easier for doctors and clinicians in different care settings to work together to care for a patient. Examples include identifying and widely deploying the best advanced primary care and health home models, and supporting innovations in accountable care organizations.
* Community Care Models: Exploring steps to improve public health and make communities healthier and stronger. The Innovation Center will work to identify and address major public health crises and the appropriate interventions for areas of great concern, such as obesity, smoking, and heart disease.”

Sounds wonderful, right? Well, if the “freshness” of the site for The Innovation Center is any indication of how innovative this new entity will be, I’m a bit concerned. The events page doesn’t even display a February calendar and it’s nearly March. And, the latest blog post is dated Nov 16, 2010. If those like us who deeply care about the healthcare system we leave to future generations abdicate the charge for innovation to the government, this sweeping change will not happen. And, the business thought leader Michael Gerber’s definition of innovation just becomes another jargon-ridden alphabet soup served by Congress. As Gerber said, it will not be “innovation, but complication.” Innovative business leaders in this country absolutely need to step forward to help create the new American healthcare system. Maybe Michael Gerber will join the conversation with us?

Hospital CEO: One of the Toughest Management Jobs in the World

Posted by ClearDirections on February 12th, 2011 in Financial, Hospital Management | 21 Comments

In reading the results of the recent American College of Healthcare Executive’s (ACHE) hospital CEO member survey (click here for details), I am reminded of those executive team meetings where we deliberated for hours about solutions to seemingly impossible management challenges. For those physicians, nurses, techs, volunteers and general public who have never experienced reading the financial statements of a not-for-profit hospital, you absolutely need to know that those organizations do not run a positive balance (net revenue) on hospital operations. The ACHE (isn’t that acronym ironic?) survey results are no surprise.

Seventy-seven percent of CEOs ranked financial challenges as the number one issue by a landslide for at least the last three years. So, yes, even before the global financial crisis, hospitals were in trouble — in deep trouble. The financial architecture of hospitals is doomed to fail under the current basic financial equation:financial crisis for healthcare

  • highly trained, high cost employees (physicians, nurses, executives) +
  • upkeep of aging facilities (average age of plant 10+ years) +
  • burdensome compliance reporting requirements +
  • new, nebulous “unfunded” mandates (ACOs) +
  • soaring device and equipment costs +
  • decreasing reimbursement

= Bloody Bottom Line

Peter Drucker said, “The four hardest jobs in America (not necessarily in order) are: President of the United States, a university president, a hospital CEO, and a pastor.” Without a change to one of the factors in the equation above, the bleeding will only worsen.

A Stick in the Arm is the Easy Part

Posted by ClearDirections on February 4th, 2011 in Communication, Inconvenience, Lack of Coordination, Outpatient Lab Testing, Time Waste | 6 Comments

You would think obtaining a standard, fasting blood draw for a 9-year-old before school would be simple, right? Wrong. After spending the morning today hearing complaints about not wanting to go to the lab to endure the prick of the needle, I successfully ushered our son out the door for a blood level check required after taking a new medication for a month. Driving through the slippery, bitter cold streets of southwestern Chicago just two days after being buried in a blizzard, we found our way to a community hospital-owned outpatient lab on the way to our son’s school.

When we arrived, we were thrilled to find just one solitary person waiting in the room to be called for his test so we could be certain to avoid being late for school. However, when we presented our lab order to the registrar, she wrinkled her nose at the order from our specialist at Children’s Memorial Hopsital. Because the order had been generated by Children’s EMR and did not have a physical signature on it, the registrar’s policy said she could not accept it. I explained that the order is just as it was when I received it from our physician, however that was not sufficient for her policy. So, we left without the test as I groaned about the wasted angst for our son. The other half of this equation is that my husband had to delay his arrival at work to take our daughter to school (who would never be ready to leave earlier than necessary for school!). What a waste of his time, as well.

After this disappointment, I called our specialist’s office and the staff member there said “we don’t have this problem with any other labs.” I apologized and asked her to track down our physician to get her to physically sign the paper and fax it to our testing facility that is geographically convenient for a fasting test tackled before school during the week. She also recommended we could have the test performed in the western suburbs at a Children’s facility 35 minutes away without question. By this time, I calculated that one testing facility’s outdated policy had cost three people (the registrar, our son and myself) 20 minutes of wasted time at the facility this morning plus my husband’s lost 30 minutes at work this morning. Couple that with the Children’s staff member who took the call I wrote about and a few others in between (add 10 minutes X 2) plus the time to bother the specialist for a signature (3 minutes) and we have at least 113 minutes of life due to lack of electronic seamless discussion in healthcare.

We need to prevent this waste within the system and create a better outpatient registration experience through a higher level of coordination and communication. I invite you to share your ideas and suggestions for improving these types of situations as I know I am not the only person who experiences these. Clear Directions for Healthcare is dedicated to destroying this inefficiency in the U.S. heatlhcare system.

If you have ideas for improving America’s healthcare, I invite you to continue the dialogue here or send us a 2-minute video response that we’ll review for our video podcast. Let’s “crowdsource” our way to better healthcare for all of America. Join us!