Is there Health Care Reform in Your Future?

To Be or Not To Be, That is the Question;
Whether ‘tis nobler in the mission to suffer
The regulations and congressional acts of outrageous politics,
Or to take the balance sheet against the sea of credit troubles
And by opposing end them. To rest – to sleep,
No more; and by a sleep to mean we end
The heart-ache of a thousand budget cuts and layoffs
That administration is heir to: ‘tis a consummation
Devoutly to be wish’d. To end the senseless war;
To sleep, perchance to dream of a former time –
Ay, there’s the rub:

The above, though poorly transposed from Bill S. however, describes the results of a recent survey from a small panel of notables in the field of healthcare asking if they believe meaningful federal healthcare reform will actually happen this year. The majority indicated a firm belief that reform will crash on the rocks before we hit the summer (July) recess. Neither fiery debate nor the ramrod of reconciliation can result in reform according to the survey responses. Interestingly enough, of all the respondents a few (less than 30 % indicated reform will happen. Yet of these optimists most felt that reform will come via the parliamentary maneuverings of budget reconciliation…not much confidence that meaningful debate would actually yield thoughtful reform.

So, what do we make of this? Charge ahead and take to the sea with your healthcare venture as the domestic issues are far from clear. Even if reform does happen, promulgating regulations and the inevitable ‘adjustment’ period means that we are several years out from reform (again!).

Survivor

When the host comes out at the end of the show, after all the contestants finish their game for this round and have thoroughly thumped one another, it's time to find out who get's voted off the island.

These days, healthcare reform, competition and policy is more similar to Survivor than to a thoughtful and well crafted incrementalistic approach we all expected. Sometimes it just doesn't work out that way.

For about the last 18 months or so, we've been wondering with more than passing speculation who will survive. Due to a confluence of completely unexpected events (credit debacles, major recession) and some expected results (sea change in Washington) change does appear imminent.

So, we asked a panel of experts who survives and who gets voted off the island.

First, the survivors. Our experts predict that Large Integrated Health Systems and the Federal Government will be the two surviving entities. These two organizations (if that is the correct term) were the #1 and #2 vote getters in our poll. A distant third place was single specialty group practices. What is even more interesting is that the younger experts (20's, 30's and 40's) tended to favor a government run system whereas the older (AARP eligible) experts anticipated the continued rise and dominance of integrated health care delivery systems.

No one thought that niche hospitals or large national managed care companies would carry the day. If you find yourself in one of 'these'...perhaps it's time to get your lifevest and consider paddling to the next island.

Going Back to What Works: Quality and Productivity

Going Back to What Works: Productivity & Quality
By Michael O’Rourke


With the major changes in our country’s economy and that of the world in the last 12 months, and the corresponding drop in your 401K, you may wonder “What really happened?” We may never understand nor do we have the time to do so. The world economy and the Unites States economy are so intertwined that there were no doubt a multitude of factors that led us to where we are today – inflated home prices, greedy investors, poor lending policy, oil prices & supply, the sinking value of the dollar and on and on.

Some have said this is the worst economic time since the great depression. If that is even partially true, then what can we learn from history to get us out of this economic mess once again? As a nation, as a community and as an individual, the answer is the same:
Get back to the basics of Productivity and Quality. After the Great Depression and during World War II our country was called on to increase productivity and the military contracts required increased quality. Inspection standards were put in place for goods being produced. Bullets made in California had to be the same as bullets made in Minnesota and so on with every item purchased by the military so all parts and pieces worked together no matter where they were made. American workers responded and put in the effort and focus required to produce the goods and the arms to ‘save the world” from the Nazis.

After WWII , while the U.S. went back to business as usual, Japan welcomed W. Edwards Deming’s advice on not just inspecting the quality of the final output of their factories but on improving all organizational processes through the people involved. He introduced Quality as a culture. ‘Made in Japan’ went from being a statement on cheap trinkets to a stamp of quality on the world’s best electronics and automobiles. Japan became an economic powerhouse. The U.S. finally paid attention starting in the 1970’s and saw increased quality of goods, increased productivity and many years of economic prosperity.

Today we need to again focus ourselves and our companies on both productivity – getting more accomplished in the same amount of time, and quality – getting it done right the first time with less cost and more value. Employees who are not being truly productive and doing quality work have been cut or will be cut if the economy gets worse. The best employees are retained and will be expected to work smarter to provide goods and services so the business can stay in business.

As a member of the American Society for Quality I am able to learn and stay sharp on areas of quality in Healthcare, Government, Education, Service and Manufacturing. Their website www.ASQ.org is a great free resource for non-members and members alike. One can learn about Leadership, Change Management, Teams, and Employee Empowerment and Involvement.

Now is a great time to create a safety net around ourselves and our families by protecting our own position in the workforce. We must be the best at what we do. A solid commitment to being more productive with an eye on the quality of our own work is where we must start. After seeing our own improvements we can share these concepts of productivity and quality with our colleagues and those whom we manage.

Michael O’Rourke is an independent Healthcare IT Analyst with his company Secure Business Group Inc. Mr. O’Rourke is also a member of the Association of Productivity Specialists and the American Society for Quality.
He can be reached via email at: Michael-ORourke@comcast.net.

Health Care Resources - Useful Websites 4

The Wall Street Journal has truly captured the core of great health industry reporting. We recently came across the WSJ Health Blog and found it to be an exceptional coverage of the health industry from review of publically held securities, to health care policy to breaking news. What we really enjoy about the WSJ blog are the quick links embedded within the stories. No more need to hop to other websites to research a related topic, just click and go (functionals somewhat like Wikipedia).


We'd suggest you subscribe to the blog feed and have the updates dropped to your email. Read or delete as the entries come in.

Health Care Resources - Useful Websites 3

The Medicare Payment Advisory Commission (MedPAC) was formed as part of the BBA of 1997 and functions to advise Congress on issues effecting Medicare - primarily payment issues, yet also reviews and advises on the broad topics of access, quality and other factors effecting Medicare.

The Commissioners, 17 in number and serving 4-year terms, bring a range of expertise and interests from policy to financing to health services delivery.

MedPAC issues two major reports each year, holds public meetings and seeks input from a very broad sector of government, academia and interested individuals. Occassionally, I've been asked for input on these policy papers and find that the commissioners are truly seeking solutions that work yet are mindful of the realities in which Medicare policy is formed and executed.

MedPAC reports tend to be 'leading' indicators of future potential policies effecting Medicare. Such as the future of IDTF imaging reimbursement, SGR changes and the like. The lag time can be 6 months to never for implementation of MedPAC findings. For those who are attempting to predict or influence the future of Medicare financing policy, pay attention to MedPAC.

There is a special section on the website to sign up for electronic mailings. Strongly recommended.

Health Care Resources - Useful Websites 2

The National Academy for State Health Policy provides a nice cross sectional view of health policy concerns and solutions at the level of state policy (often given short shrift with the overly abundant emphasis on national health policy). So often, leading indicators of significant policy shifts are developed and executed at the state level, that any health industry person would be well advised to become familiar with the key issues and possible solutions occurring at the state level. Lest we forget, it was only 2 years ago that Massachusetts broke the mold and created a universal health plan (at the state level at least) and not that long ago that state funded rationing experiments were implemented in Oregon.

The website hosts a number of policy papers, notices of conferences and exploratory topics.

Health Care Resources - Useful Websites I - Dartmouth Atlas

The Dartmouth Atlas website [link: http://www.dartmouthatlas.org ] provides a wonderful capstone to years of research in small area analysis. Not only does the website review the famous atlas of health care, but it also interactive programs for comparative analysis, research articles, lectures and presentations, many tools for data review and analysis as well as detailed instructions on how to use key functions.

How can you use this information? Estimating community health use is possible for regional areas particularly if the analysis isn't overly sensitive to very discrete areas. The above graph, for example, can help provide a quick estimate of physician visits for end of life care compared across regions.

Take a tour of the site -- quite helpful to get a good understanding of health services variation along a number of dimensions.

Health Care Resources - Useful Websites I

Over the years, we've come across a wealth of useful websites for those working in Healthcare. Covering Health Policy, Performance Improvement, Marketing, Operations Management, Law and Human Resources. This series is intended to provide a review of websites and will be amended from time to time. We hope you enjoy!

Free Healthcare via Identity Theft

The below article is submitted to the blog by Michael O'Rourke...a good friend who specializes in the field of identify theft prevention and protection. Apparently the field of identity theft has more angles to it then we knew about when we first wrote about it a few months ago. Also, it would seem that a few state hospital associations are interested in the issue as well...interested enough to seek proposals to offer prevention and risk management options to their member hospitals.

Letter follows from Michael...

A retired California schoolteacher found out the hard way about the newest form of identity theft -- using someone else's information to obtain medical care.
Hospital bill collectors demanded Ms. Weaver, 57, pay for the amputation of her right foot after an identity thief obtained care under her name and had the bill sent to her insurer, the Los Angeles Times reports.
Experts say rising medical costs have made it profitable for thieves to obtain care under stolen identities. Unlike theft cases involving credit cards, unraveling medical identity theft is much more difficult due to the Health Insurance Portability and Accountability Act of 1996.
The HIPAA law makes it difficult for patients to view their own medical records since doctors and hospitals face stiff penalties for improper disclosure of information. Medical records become even harder to obtain if a person reports possible medical identity theft because now their information is mixed with that of another person.
Fraud victims also face possible injury or death if doctors make treatment decisions based on wrong information.
How much is a stolen medical ID worth to a thief? A feature article in the November 2006 Reader’s Digest by Max Alexander states:

“For some unfortunate victims, medical identity theft is the last straw; after crooks steal their wallet and max out the credit cards, they turn to the health insurance card for even more freebies. "An insurance card is like a Visa card with a $1 million spending limit," says Byron Hollis, national anti-fraud director of the Blue Cross and Blue Shield Association. “
The middle man who is selling the manufactured or stolen medical insurance cards may be charging $50.00 - $100 for the card, a small price compared to the cost of healthcare. And the theft may go undetected, especially if an address change is also done on the first visit. The person obtaining the raw information; name, address, social, birth date and insurance subscriber number could receive $10 or $15 for each set of patient information.
Legislation in the form of FACTA, HIPAA, and GLB dictate that all businesses take certain steps to protect this non-public information and protect the organization from the legal consequences of lost data. Along with additional training specifically directed toward the prevention of ID theft, offering your employees continuous credit monitoring and ID Theft restoration as an employee benefit is another step toward compliance. By doing so, less private information may be unknowingly or intentionally leaked to potential thieves by your employees because of heightened awareness and security of information.
Action steps: To protect the patient, greater attention to verification of a patient’s true identity before medical services are performed is recommended. To protect the healthcare organization, block display of all numbers in the social except the last 4 digits. Ask a patient for a photo ID and insurance card if they have it. Determine which departments really need to see address, age, birth date, social security number and insurance subscriber numbers on their computer screen or on paper documents. By focusing on ID Theft awareness training for all employees and making additional changes to your information security policy, you may reduce the liability to your healthcare organization. By offering continuous monitoring for the employees you reduce the liability to your employees and their families.