2. No visitation hours…

Yes, we’ll allow visitors. But it’s the hours we’re getting rid of. If a patient wants visitors for a game of cribbage at 8:00 p.m., good. If a patient wants visitors at 7:30 a.m. for breakfast and 4:00 p.m. for Oprah, better. If a patient wants visitors 24 hours/ 7 days a week, best.

Unrestricted visitation hours. It’s not a new concept, but it’s definitely something we will incorporate into our own system.

Aside from the relevant research claiming improved patient outcomes that come along with unrestricted visitation, it’s (again!) the right thing to do. Tara Parker-Pope writing (way back in 2004) in the Wall Street Journal says:

While visits from family and friends may not seem like a pressing health-care concern, doctors and nurses say there’s growing awareness that family members are a key part of a patient’s recovery, whether it’s to provide information, to alert health-care providers to changes and symptoms or simply to offer emotional support to the patient.

In a (increasingly) competitive market, unrestricted visitation hours can be a distinguishing factor for patients. Parker-Pope continues “Health-care experts say that while the quality of medical care is obviously the biggest priority, visiting policies and other patient-centered services also make a difference in a patient’s recovery, and should be priorities when choosing a hospital.”

Principle #2: unrestricted visitation hours for families. Always! And Forever! No debate! Exceptionless.

WSJ Article reprint status courtesy of the Institute for Healthcare Improvement

Influence: Planetree

Virgin Health Care?

If any you have ever flown Virgin Air across the pond, you know how great flying can be.

Well, (arguably?) the coolest business innovator of our time is up to his old tricks. Richard Branson has introduced Virgin Healthcare to the United Kingdom. The business will basically manage NHS primary care services and provide complimentary services alongside.

Could we see an incarnation in the U.S.?

Hat tip, WSJ Health Blog

Make an informed decision…

All of these early primaries/caucuses have made the winter blahs a bit easier for me to deal with. And whether you consider yourself a political wonk or a newbie it would be in your best interest to make an informed decision in any voting situation you may find yourself in the near future.

My focus here is going to be on links to information regarding the candidates’ plans for health care. Republicans and democrats differ (a lot!) in the plans they offer. Variation within their respective parties is less. As we continue on this process throughout 2008 I am going to assume plans may become more detailed.

Generally, comparisons amongst all candidates can be found here (Kaiser presents the information well) and here (HealthCentral’s spicier comparison).

Democratic plans (candidates who have a realistic chance): Clinton, Edwards, Obama

Republican plans (again, candidates who have a realistic chance): Giuliani, Huckabee, McCain, Romney

Analysis (courtesy of Health Care Policy and Marketplace Review): Clinton, Edwards, Giuliani, Huckabee, McCain, Obama, Romney

Banter: banter, banter, more banter, banter, banter, banter

Places You Should Go, Sites You Should Know

There is a plethora of information on anything health care on the web. Below I’ve listed several foundations that produce quality research on an array of topics in health care. Their research is worth the read.

RAND Corporation: “a nonprofit institution that helps improve policy and decisionmaking through research and analysis.”

The Kaiser Family Foundation: “a non-profit, private operating foundation focusing on the major health care issues facing the U.S., with a growing role in global health.”

The Commonwealth Fund: “a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.”

Robert Wood Johnson Foundation: “the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans.”

Why hasn’t anyone seriously tried a preventive care delivery model?

As you all know the United States spent $2 trillion+ on health care in 2006. Not that we needed to surpass such a milestone to toke the flames of the how-to-cut-costs debate, but it seems like a good reason to start that conversation here. We’ve been talking about preventive care for a while now and as far as I can tell there hasn’t been much action.   Plus, most of the presidential candidates (save for a couple of republicans) claim (on their websites) cost savings would be generated if we only utilized preventive care.

A quick Google search didn’t turn up any specific citations of how much preventive medicine could save. In fact, the National Center for Policy Analysis (they tout themselves as a “nonprofit, nonpartisan public policy research organization” cites several studies that show no improvement in health and claims:

But study after study has shown that preventive medicine adds to overall health care costs. The reason is fairly straightforward: Testing everyone costs a great deal of money, and the diseases being screened for are fairly rare. At best, the tests benefit only a few. And the savings generated by early detection of these few instances of disease are far outweighed by the costs of testing large numbers of people.

But Health Beat (I’ve been citing them a lot lately–there is just so much good stuff there) gives this anecdote from my home state of Minnesota:

This is also true (of preventive care benefits) in the U.S., in states like Minnesota, where there are many more primary care docs and many fewer specialists than in Southern California. After adjusting for differences in race, sex, age and overall health of the population, it turns out that care in Minnesota costs half as much–and outcomes, patient satisfaction and health are better. So it could happen here, without single-payer. We just need to limit the supply of specialists and make more primary care available and affordable.

So there is some decent debate to be had here.

But to my question: why hasn’t anyone seriously tried a preventive care model? This would be a lot of work (but a great experiment): a small to medium sized health care system (that utilizes a physician-as-employee model) would negotiate contracts with insurance companies to insure reimbursements do not dip below a pre-specified level during the duration of the experiment. But over (say) a two-year period the physicians and the hospital system would implement a preventive care strategy for all patients (while still providing traditional medical care). Obviously a great deal of planning and pre-implementation strategy making would have to occur.

My explanation is simple, but that’s the basic idea. Who would lose here? Insurance companies potentially (if preventive care adds a great deal of costs) but I would still argue it would be a very worth while experiment for them. The other problem I foresee is the fact that much preventive medicine doesn’t show its benefits immediately, it’s a long-run investment (which I am assuming is a large part of why there has been so little investment, businesses don’t see the payoff if an employee would only stay for five years).

There is some pretty important conversation to be had in regard to preventive care. I think we need to start thinking long-term, short-term fixes are exactly that. Could this experiment potentially work?

PS: This looks like an interesting for-profit foray into preventive medicine.

Bad News: Health’s Carrot and Stick Approach May Be Coming to an End

The Wall Street Journal wrote yesterday (the article was available without a subscription, so check it out) that new guidelines issued by the United States Department of Labor could bring an end to firms charging workers who make unhealthy choices higher insurance rates than their more healthful cohort.

Regulatory guidelines recently issued by the department are likely to curtail the ability of employers to motivate workers to kick unhealthy habits. In effect, the guidelines close a legal loophole that could have allowed employers to make health insurance more expensive for unhealthy workers than for their colleagues.

Not an indicative sign for the cost of health insurance premiums going down any time soon.

Top 10 Health Policy Stories of 2007

This was published a while ago, but nonetheless worth a read. The Commonwealth Fund is full of resources related to improving our health system (that’s their mission…). Every one of the stories is going to affect us as health care practitioners in the very near future, if they are not already.

Anyway, if you read much on the web concerning health care, you will see The Commonwealth Fund research oft cited. A good site to know about.

Hospitals and Community Benefit

We were discussing community benefit in class the other day. If you don’t know what community benefit is the Catholic Health Association’s website is a good place to start. This website goes more in depth. Basically (says Senator Grassley’s website) (it is my understanding that he started the look into community benefit in 2005) “providing community benefit is required for hospitals seeking and retaining tax-exempt status as charities.”

The CHA says community benefit includes the following:
-Charity care
-Government-sponsored indigent health care—unpaid costs of public programs (Medicaid, SCHIP, medically indigent programs)
-Community Benefit Services (I guess this is the extensive “other” category–dw)

And does not include the following:
-Bad debt
-Contractual allowances or quick-pay discounts
-Any portion of charity care costs already included in the subsidized health care services category
-Medicare shortfall (this can be included in other financial reports but not in a community benefit report)

But as far as I understand community benefit is not limited to just these broad categories…one of the issues is that exactly how to define community benefit is a matter of contention.

In 2005 there was a big uproar concerning the tax-exempt status of not-for-profit hospitals and whether or not they provide enough benefits to the communities they serve. Hospital associations around the country with the help of the aforementioned CHA quickly put together a reporting system to outline provided benefits. Some associations seem to be reporting an extensive amount of community benefit (I’m using CB from here on out).

The American Hospital Association deems the tax-exempt status of not-for-profit hospitals an “issue” but you have to be a member in order to access any releases (sorry, I’m on a student income and unable to afford such a luxury at this time so I can’t even summarize).

Since then, it has been rather quiet on the CB front. However, in July the IRS released an interim report (pdf) that apparently outlined a not-so-good effort by not-for-profit hospitals to provide CB. And most recently the IRS updated its Form 990 that not-for-profits use to claim their CB (side note: kind of ironic that a non-taxed entity submits forms to the government agency responsible for taxation. I guess someone has to watch over us…).

I’m sure this story hasn’t ended quite yet. CB is a very important function hospitals provide to the communities they serve. Hopefully the amount of CB provided won’t have to be mandated by the federal government…stay tuned.

Do you think hospitals currently provide sufficient community benefit (any examples)? What do you think is an appropriate policy for providing community benefit at our own system?

A Helpful Website

Are you interested in pursuing a Master in Health Administration (MHA) or MHSA, or a MBA with a health care focus (as you can see there are a few different names for a degree to become an administrator in a health services organization)?

A great place to start is this website. It is a very extensive listing of health administration programs. Start exploring. And if you have any related questions email me, I’ll give you my thoughts.

Us! Us! Us!

While doing some research today for a project on the use of persuasive advertising messages by hospitals in patient success stories (that’s a working description, I’ll work to make it a bit more succinct) mixed in with my daily blog reading I came across this post by the always thought provoking Tom Peters (a business idol of mine, as well as an inspiration/influence on my writing style). My enemy is me. Our organization’s enemy is our organization. As Mr. Peters quotes Mr. Walt Kelly “We have met the enemy and he is us.” Combine these two serendipitous moments with my earlier post about the patient-is-first focus in today’s hospitals and is/will continue to be the rallying/battle cry for our health services organizations…and I came up with a little far-from-scientific experiment/information-gathering-session.

You can very subjectively do this (I did it, so you don’t have to): Visit US News and World Report’s Best Hospitals 2007 Honor Roll. Then visit every hospital’s website on that list to see what the first clickable link is. (I didn’t explore the mission/vision/values/raison d’etre, but let’s assume (reasonable assumption) that these 18 hospitals rank patient care pretty high on the list of importance.)

Here’s what I found to be the first clickable link on the websites:

About Us: 9 hospitals
Medical Specialties: 4 hospitals
Appointments: 2 hospitals
Find a Physician: 2 hospitals
Patient-Centered Advertisement: 1 hospital

An argument could reasonably be made that only five of eighteen hospitals directly target patients with their first link on their website. What does that mean? The majority of honor roll hospital websites are more concerned with telling the world about themselves (US! US! US!) then a potential patient’s first interaction with the health system. Most of the hospitals (they are all huge) on this list are academic medical centers (meaning complicated campuses) and many of us can imagine our grandparents’ struggles with navigating the many buildings–one of only many foreseeable issues with a first visit (there are so many more opportunities for website improvement, use the comments section to add your thoughts).

My point: if you are reading this blog, the importance of websites as a marketing tool needn’t be expressed. Let’s fully commit to making patient experience with our health systems the most important aspect of our organization’s existence, starting with a hospital website fully dedicated to the patient.