Thursday, October 01, 2009

32nd Infantry Brigade - Wisconsin

Dear Readers: Today, I received a letter from a friend that really made me pause and reflect on the bigger picture. The video clip below is from the 32nd Infantry Brigade (produced by one of their own) and shows excerpts from their work in Iraq. The friend who serves, I have not seen for several years, since, as you may expect he has been deployed in Afganistan and now Iraq. He has missed many of the greatest parts of his children's growing up years because of his (and his family's) selfless dedication to serving his country with honor. The last time I saw him was at a Christian family camp at Fort McCoy in Wisconsin. Please take a moment to thank those whom you know are serving in our military. These men and women deserve our respect.

Sunday, August 23, 2009

Brad Shiverick joins Grindstone Consulting.

We are pleased to announce that Bradley N. Shiverick, CPHQ has joined the Grindstone Healthcare Consulting team. Mr. Shiverick comes to us with over 20 years of experience in senior care service. He was most recently the Chief Quality Officer for My InnerView, of Wausau, WI. My InnerView is the premier provider of quality management consulting to the long-term care industry. While with My InnerView, Brad worked closely with senior care service provider organizations on strategic development, customer service initiatives and quality management oversight. He also oversaw the research agenda and new product development and authored several articles and reports on workforce development, customer satisfaction and loyalty as well as employee commitment.
Prior to My InnerView, Brad was the Vice President of Quality for Harborside Healthcare, a Boston based long-term care organization which oversaw the operation of 76 long-term care facilities. As VP of Quality, Brad was responsible for the quality of care and service provided to over 8,000 residents. During his tenure, Harborside received numerous awards for quality and published a first-in-the-industry, comprehensive quality report that set a public accountability standard for quality performance.
As a member of the Grindstone team, Brad looks forward to continuing to work with senior care organizations –helping them to define strategy and identifying the pathway to accomplishing that strategy. He brings with him a strong quantitative and policy background, extensive experience in customer focused quality management systems and a passion for making a difference in the lives of the nation’s seniors.

Tuesday, August 18, 2009


A Message From Dr. Eric Radin to my colleagues for the benefit of our patients:

Few attempts by the government to reform health care delivery have been successful. Massachusetts-Health is proving everyone can’t be insured without lowering the cost of treatment. The debate over President Obama’s attempt to cover the uninsured has discovered the same thing. It is too expensive. This suggests it will require a cultural change of our heath care providers to accomplish reform.

In our current medical culture it’s almost impossible to control runaway health care costs. Attempts at spending caps were successfully blocked, appeals to professional pride didn’t work, and mandatory continuing medical education failed to make health care delivery more affordable.

To lower the cost, and hopefully to increase our national quality of care, we need to make health care more effective and efficient. But accepted practice protocols, although generally useful, should not be expected to include patients toward the ends of the bell-shaped curve that all biology is described by. What will it take to improve our clinical results and lower the cost?

First, since healthcare is acting like a business, treat it as a business. This idea, proposed in 2006 by Porter and Teisberg in their book Redefining Health Care, and recently updated in the lead article in the July 9th edition of New England Journal of Medicine (NEJM.361(2) ;109-112), are a business school critique of our health care system. It suggests a business-type solution, pay for value. Value in the marketplace has always been judged by consumer satisfaction, related to what was bought and what it cost. Porter and Teisberg recommend paying doctors bonuses for value received, defining value as clinical outcome divided by cost. To avoid paying for quick fixes and preventable relapses, pay some of the fee initially; pay the bonus for value when the outcome and total cost become apparent. This should encourage innovation and limit high-tech, high-cost treatments to those who require them.

Second, encourage real competition between providers as well as health care centers. Publicize success, by diagnosis, to the public on the Internet. Rank every practitioner and medical group practice. Public pressure and patients preferentially flocking to high value providers, plus substantial bonuses for increasing value should bring about the beneficial cultural changes needed. It is a concept that makes the medical profession shudder but would be a boon to the sick and injured.

How can outcome be fairly judged? It would seem best by using functional criteria: Has the patient returned to his/her expected full activity? What activities of daily living can the patient accomplish that he/she could not accomplish before the medical intervention? How have the appropriate clinical measurements responded to the treatment? How does the patient rank his/her recovery? It is important, as well, to publish the methods used by the innovators to increase value, so other practitioners and their patients and the system can benefit from the same measures.

So, instead of detailed protocols, those who deliver heath care would be able to rely on well-rewarded innovation and well-publicized competition instead of payment schedules, forced discounts by insurance companies and cookbook-like protocols. Research in evidence based medicine, best practices, comparative treatments, and team effort should all be energized by the value payment incentives. Rather than using these findings to hamstring medical practice, value payment incentives should free practitioners to use their judgment to practice value-driven care. Medical judgment could be maintained.

Widely advertising the value of their treatments by diagnosis, should make American health care more efficient, effective, and affordable without destroying the profession. Good medical practice will be allowed to remain something of an art, built on the scientific data of what works when.

The country wants affordable health care. Currently we physicians are the deciders of what treatment our patients receive and thus directly and indirectly control the costs. Wouldn’t it be better for the medical profession to decide how to lower the costs of care rather than have the government and other third parties do it? My colleagues need to admit that that time is running out for the status quo. Our present health care delivery system is no longer sustainable. By now, it should be obvious that health care delivery will be more closely regulated. If my colleagues and I don’t change our ways, someone else is going to do it for us.

Eric L. Radin, M.D.
Marion, MA

The author is orthopedic surgeon and an Adjunct Professor at Tufts University School of Medicine.

Tuesday, August 11, 2009

Federal Reserve Board and Off Balance Sheet Financing

A colleague recently sent along a video from Congressman A. Grayson (Florida). Upon further review, we find a number of interesting and enlightening interviews from the congressman.

Many who work in the field of health services leadership, hold a public trust, much like those who serve us at the federal reserve, as members of community based 501,c, 3 tax exempt organizations. As such, we are held to a level of accountability for which the trust is placed.

Apt reminder that we serve not ourselves, but the communities to which we have been entrusted to serve by our mission(s).

Friday, July 10, 2009

Update Prairie River - Trout

Last year, about this same time, after having no luck finding trout in the usual haunts, I met a grandfatherly fellow who kindly pointed out that by this time of year, all the trout have travelled north...'won't find none here, son!'.

So, this year, i resolved to travel north until I found the wily fish.

At last, after fending of ticks, mosquitoes, over-grown brush, mushy and putrid smelling swamps and the like, I found that indeed the old fellow was correct. Decent sized browns and brookies do migrate north as the summer comes on. I resolve to migrate with them.

Just goes to show you, sometimes folks really do know what they're talkin' about!

Happy Hunting!