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Interview with Kathleen Benner Part III: Doctors Need to Listen More Than 18 Seconds

Posted by ClearDirections on April 12th, 2011 in Communication, Financial, Hospital Management, Innovation, Lack of Coordination | No Comments

After reading about Kathleen Benner, the vibrant and energetic president of Hospital Companions and Empowering Pages, both of which are based in Hinsdale, IL, in a Crain’s Chicago Business article last year, I connected with her to find ways to help her healthcare startup. She also is an attorney and mother of three with her entrepreneur husband, all who keep her balanced. To view more about her healthcare businesses, visit http://hospitalcompanions.com/ and http://empoweringpages.com/. Her companies’ mission is to bring peace of mind to both the patients and families they serve. Read on to hear more about her ideas to help you become a “Best Competitor.”

Stillman: Any other overall suggestions for improving America’s healthcare system, not just looking at the patient experience?

Benner: Of course. I can’t say it loudly enough: medical malpractice reform. It’s coming from a legal background and reading some of the cases. Yes, there are some horrendous things that happen, of course. But, we have to reform that system. It is dragging on costs. It is putting insurance companies in a much more difficult position and the doctor in a much more difficult position. That would be my first recommendation.

I have never written to a senator or President before, but when they were doing the healthcare reform talk, I wrote to the President, to my senators and my representatives and said, “How are you not talking about medical malpractice reform as an integral part of this?” To be able to improve, you have to remove the shackles of malpractice.

The other issue is insurance portability. My husband and I are both self-employed, so our healthcare insurance is our single largest payment every month. I don’t know why I can’t shop in North Dakota for insurance. You know what I mean? Why can’t we compete across state lines? More competition seems to be better. These companies already exist. They’re already providing this type of a service.

You know, my parents went through the same thing when were moving from Illinois to Florida when they had to obtain new insurance from Florida. I think that the portability of your insurance and to be able to compete over state lines would help the healthcare system, because again, you’re going to be approaching costs at that point. More competition would lead to better insurance programs being developed.

Stillman: I have to admit, I never had to think about that in terms of switching from state to state. I wasn’t aware that when you move that you would have to switch insurance.

Benner: The other thing that’s crazy is the volume of patients physicians see in a day. Some physicians I know are seeing 45 to 65 patients a day. How do you provide personalized, effective healthcare to 45 to 65 people a day?

Stillman: That’s pretty much the norm, and some think nothing of it. I agree. How could you possibly connect with 45 to 65 people in one day, and affect their health status in a meaningful way? At some point, it would seem impossible for them to see their patients as anything more than widgets. I have to imagine at the end of a long week, some think, “How many more are we just going to touch and get through the assembly line so I can get out of here?”

Benner: Yes. I read a study that a doctor lets a patient talk for 18 seconds before he or she typically interrupts them. That’s the average. So, some doctors are treating people literally how they present in that moment, but they’re not looking any further back or forward in the lives of their patients. And, that’s not really healthcare. That may be medical care. That’s not healthcare.

Stillman: Wow, 18 seconds. That’s an interesting statistic. Certainly if you want to have a competitive edge as a physician, let your patients talk, and listen. That’s easy.

Benner: They don’t have time. And, you know when people talk, and I know this as an attorney, too, you’ll get a lot of superfluous information. And, you’re trying to dig through it just for what’s important. You want the bullet point. But, that’s not an effective way to get the information a physician needs to effectively treat a patient, right?

In our next post, you’ll hear more of our interview with Kathleen Benner of Hospital Companions and Empowering Pages. Subscribe to the Best Competitor Blog to read stimulating ideas for improving the American healthcare system and ways hospitals, systems, large medical groups and healthcare product manufacturers can better compete in today’s marketplace. We welcome your suggestions for future interview subjects or topics. Simply leave a comment below. We’d love to hear from you!

Do you have what it takes to be part of an ACO?

Posted by ClearDirections on April 9th, 2011 in Accountable Care Organization, Financial, Hospital Management, Patient Protection and Affordable Care Act | No Comments

Reading the 460+ pages of proposed ACO regulations (42 CFR Part 425 to be exact) has been a daunting task, but a necessary one for those of us who will lead the world of healthcare through this unprecedented sea change to our system. To help you wrap your organization’s strategy around this new concept, we will break down the salient parts of the regs for our readers, bit by bit.

One of the most important features of the new regs is the “three-legged stool” of the Shared Savings Program:
– to provide better care for individuals;
– to encourage better health for the whole population; and
– to lower the growth of healthcare expenditures.

The Shared Savings Program promotes accountability for a patient population’s health, coordinates patient care and encourages providers to invest in infrastructure and redesigned care processes for high quality and efficient service delivery. This Shared Savings Program will be in place by January 1, 2012, according to the proposed regs. Now, the key is how to qualify to participate in the Shared Savings Program.

The new regs outline several requirements to be eligible to be part of an ACO. Providers must be willing to:

1. Become accountable for the quality, cost and overall care of the Medicare FFS beneficiaries assigned to them;

2. Enter into an agreement to participate in the ACO for at least three years;

3. Have a formal legal structure that allows the organization to receive and distribute payments for share savings to the participating providers;

4. Include enough primary care ACO professionals sufficient for the number of beneficiaries assigned to the ACO, and each ACO will have a minimum of at least 5,000 beneficiaries assigned to it;

5. Provide CMS with any information the government deems necessary to support three things: the assignment of Medicare beneficiaries to the ACO, the implementation of quality and other reporting requirements, and the determination of payments for shared savings;

6. Have in place a leadership and management structure that includes clinical and administrative systems;

7. Define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care (i.e., telehealth and remote patient monitoring); and

8. Demonstrate that they meet patient-centeredness criteria specified by CMS (think HCAHPS), such as the use of patient and caregiver assessments or the use of individualized plans.

Just a few things … right? Well, take a day to digest this portion of the regs and we’ll explain later how CMS has proposed very detailed specific formulas to determine how the Shared Savings Program works. Hint … providers won’t receive a portion of ALL of the savings they deliver to Medicare. CMS has proposed a Minimum Savings Rate or MSR that ranges from 2.0% to 3.9% before an ACO can begin sharing in the savings. More to come on this in future posts.

If you enjoyed this material, please share it with other healthcare executives you know, so we can help them get their heads around ACOs quickly and painlessly to position them to compete better in the brave new world of ACOs.

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.