Walmart reduces obesity

A synchronistic finding as Walmart continues efforts to shed its image of old: the presence of a big box retailer seems to translate into community member weight loss.

From Portfolio’s Odd Numbers:

The researchers think this happens because cheaper goods from Wal-Mart allow shoppers to spend more of their budget on relatively expensive healthier foods. Providing some support to their assertion, when Courtemanche and Carden broke down their results by income, they found that the lowest-earning people saw the most weight loss.

Interesting.  Whatever your thoughts on the company (or the rebranding), they do sell stuff for cheap.  Cheap is good right now, especially when it means healthier Americans.

Up, Up, Up

Here’s a shocker: health care spending increased in 2007.

What matters, at this point, is what effect the deepening recession will have on spending in 2009 (and had in 2008).  Delivery system job cuts and reduced drug spending (down big) are likely indicative of a tough 2009 (duh.).

The good news from the “U.S. health system” level (and it’s hardly good news) is that outlays increased slightly slower in 2007 than in 2006 (6.1 percent vs 6.7 percent respectively), much of the slow down is attributable to reduced prescription drug demand.  The other side: health care costs grew faster than wages and and GDP. Health care now consumes 16.2 percent (up from 16 percent in 2006) of our nation’s entire gross domestic product.  The dollar figure is a cool $2.2 trillion or $7,421 per person.  Government spending on health care also increased.

Here’s how some media outlets covered the news (updated throughout the day):

Spending on prescription drugs slows USA Today

Health-Care Outlays Climb at Slowest Rate in Years Wall Street Journal

Spending Rise for Health Care and Prescription Drugs Slows The New York Times

Nation’s health spending rises, but not so much Associated Press

Healthcare spending in U.S. slows Los Angeles Times

Health Spending Continues To Explode Forbes

Carol shifts strategy

You may recall a Minnesota company that debuted an online marketplace for health care services a few months back.

Well, it’s not working out.  Carol has announced a shift in strategy.  From the Minneapolis Star Tribune:, a Twin Cities start-up that drew national attention for its efforts to create an online medical marketplace, has cut 25 jobs, or a quarter of its workforce, a sign that consumers may not be ready for the trend known as consumer-driven health care.

Bloomington-based Carol has struggled to attract users to its year-old website, which it bills as a Travelocity for health care.

Medical providers never got comfortable with the idea of posting their services online for comparison shopping and consumers “didn’t know what to do with us,” said Carol’s chief marketing officer, Marcia Miller. The economic downturn and the pressure to produce results finally forced a shift in direction.

What are they going to do now?  Focus on providers.  Again, from the Star Tribune:

Carol’s two consumer websites — in the Twin Cities and Seattle — will remain up. But the company will now focus on consulting and software services aimed at hospitals, clinics and physicians.

It will help providers repackage services in ways patients can understand, rather than in the current system organized around insurance payments. It may also rent the Carol software platform for hospital and clinic groups to include on their own websites — backing off from the original goal of allowing users to compare directly among providers.

Interesting.  Wonder if they always had a back-up plan?

The Bottom Ten

You may be familiar with the Jack Welch management principle where the lowest performing ten percent of managers were ousted from the company.  The ethics of such thinking can be/have been debated, the reality is that his method was successful at General Electric.

It has also happened in health care (believe it or not):

Colorado Permanente Medical group chose to deal with negativity by letting go of 10-20 negative doctors each year, increasing morale and profits in the process. Turns out the negative doctors were creating a poor work environment and scaring away patients.

Quite interesting.  Inspiring even.  The above comes from The Positive Business Manifesto by Jon Gordon on ChangeThis.  Gordon’s manifesto addresses the lack of positivity in business and gives advice on how to stamp out the negativity.  Here’s the starter:

You would have to live on another planet not to notice the plethora of business books and articles discussing the importance of developing a positive organizational culture at work. The research is clear. Positive leaders, positive work environments, and positive engaged employees produce positive results.

However, if building a positive business is so important and beneficial, then we are left to wonder, “Why aren’t more companies, more positive?”

Different equations?

From FierceHealthcare on Aug 22:

Despite the subprime mortgage-fueled financial markets meltdown, ongoing problems in the U.S. economy and ongoing pressure on margins, things weren’t too bad for not-for-profit hospitals in 2007 according to financial industry ratings firm Moody’s Investors Service. After reviewing audited fiscal 2007 financial statements for 410 non-profits, the firm concluded that operating performance and liquidity remained stable for non-profits last year.

From Kaiser Network on Aug 26:

Downgrades in the credit ratings of U.S. not-for-profit health care systems and hospitals exceeded upgrades by a 2-to-1 ratio this year for the first time since 2003, according to a report released on Monday by Standard & Poor’s Ratings Services, the Arkansas Democrat-Gazette reports.  The report examined trends at the 138 not-for-profit health care systems and 470 stand-alone hospitals that S&P rates.

Excerpts they are, but it seems like two different conclusions, no?

Watch out, Tom Peters is on the health care trail

It’s no secret that Tom Peters is on the health care quality trail.  Instead of a nice hike through the grasslands of a state park, his approach is more of a rampage with a machete through the rainforest of the Amazon.

Some are glad he has arrived, others should be fearful.  Regardless, expect more of this:

Could it be that the odds of a screwed-up colonoscopy are higher than the odds of detecting a problem relatively early enough to justify the risk? I don’t know the answer in this instance, but I do know that in any number of situations “Stay the f#^* away from the hospital” is the statistically correct choice.

They’re talking about you

Who is in charge of your hospital’s online reputation?  Oh, no one?

It’s increasingly important and becoming difficult to ignore.  BlogsTwitterEtc.

It need not be a full time position (yet).  Preferably it be someone who has used the technology before.

And you really should start strategizing for sites like this, this, this.  P.S. There are more and use will only increase.

People may be talking about your hospital online.  That’s good.  Especially when you can participate in (or even lead) the conversation.  They may not be talking about your hospital online.  That could be good, too.  Regardless, you have the ability to know what they’re talking about—and take appropriate action.

UPDATE: Read this story.  Decide upon appropriate action after finding your hospital here.

Management is a “cancerous growth?”

Biting words about administrators from a National Health System physician in the U.K.:

He calls the administrators the Stasi – nicknamed after the former East Germany police – and the management system a “cancerous growth” which would only be improved by sacking nine out of 10 managers.

He said: ‘Unfortunately I honestly believe that the service I am allowed by the Stasi to provide to my patients is not as good as it was nearly 30 years ago when I came to this hospital.

Dr. John Riddington Young has written a book on his experience.  He continues:

He dismissed suggestions that the rising number of managers have made a positive difference, such as cutting waiting times.


‘You could ask almost any working doctor and he would be of the same opinion, that administration is incompetent, top-heavy and unnecessary’, he said.

Anecdotes from foreign countries with universal health care are often used in our health care debate, both pro and con.  Regardless of your position, it’s worth listening to the dissenters.  Our (more so) market driven system probably produces the same feelings in some physicians in this country as well.  Eliminating administration isn’t the answer, but an argument can be made that we’re over-managed.

Second Opinions Online

USA Today has an article about online second opinion services. One would think it to be a booming market, however the largest three providers of said services only offer about 3,000 opinions annually.  Here’s the service explanation:

Online second-opinion services offer patients consultations from specialists based on the medical records that they fax, mail or send via the Internet. The average cost, payable upfront via credit card, is $500 to $1,500, depending on the number of radiology or pathology interpretations required. Patients then receive online access to a second opinion in about two weeks.

The problem: “A limiting factor is that most insurance companies do not cover remote second opinions.”

However, the Cleveland Clinic and Cigna recently inked a deal to provide (the former) and cover (the latter) online second opinions for insured individuals.  As more insurance companies begin to reimburse for the service, utilization is likely to rise.

Surgeon Shortage Confusion

The Columbus Dispatch carries an AP story on a report about West Virginia University hospitals, “A severe shortage of heart surgeons forces West Virginia’s largest medical center to divert some 500 patients a year to Pittsburgh and Columbus, Ohio.”

A quick visit to their website reveals an interesting front page highlight—“The WVU Heart Institute — Excellence in Cardiovascular Care.”

That highlight links to this page with some intriguing verbiage:

The WVU Heart Institute has the doctors, technology, and facilities to make a rapid diagnosis and take, quick effective action 24 hours a day, 7 days a week, 365 days a year. We’ve refined our coordination and teamwork to a science.

To be fair, the AP story does have this bit from interim vice president Fred Butcher:

But Butcher says the report has errors. He also complains it’s based on interviews with 14 of nearly 360 faculty. He says another review is likely.

Interesting. Something (or lack of) is going on at WVU.

UPDATE: An article today in the Pittsburgh Post-Gazette clears things up…a bit.  The hospital was not happy with the reporting effort of health adviser R&V Associates—so they fired the group.  But read the article, things are a bit tumultuous at West Virginia University’s Health Sciences Center.