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  • Hospital Impact - More unintended consequences of healthcare reform
    and seamless communication systems that many stand alones do not have the capital to support 4 Reimbursement reform Pay for value has created a self limited regulatory industry in which once organizations attain the targets e g core or surgical care improvement project measures HCAHPS etc the targets are no longer useful Thus pay for value is a moving target in which metrics and targets will continually evolve based upon the next important stretch goal Hence in 2014 CMS will reduce the percentage weight of core measures from 70 percent to 45 percent and will replace the difference with â œhealthcare outcomesâ that have not been fully defined Most healthcare practitioners will tell you pay for value measures make up a small part of what they would define as quality and yet 11 million to 14 million beneficiaries employers third party payers and managed care organizations access this data monthly through online sources and base their healthcare and network referral decisions upon them Healthcare organizations must standardize their processes with the medical staff s blessing to achieve 100 percent compliance with regulatory quality 100 percent of the time This cannot be done through optimizing individual performance as has been demonstrated in the military nuclear regulatory airline and other high risk industries A culture of process improvement will not only follow the moving target of regulatory compliance and pay for value but also will achieve lower costs through continual redesign and innovation For instance many organizations are replacing physicians and nurses with clinically trained coders to perform documentation and data entry which enhances productivity satisfaction and return on net accounts receivable Customer satisfaction and loyalty is similarly addressed through standardizing communication e g scripts and care processes so patients and customers receive the same high level of service and care every hour of every day Again this can be accomplished through the judicious use of non physicians and nurses who have the time to dedicate to enhanced patient communication and customization Again full physician integration and alignment is necessary to accomplish these goals Conclusion The Affordable Care Act was created to enhance quality and access lower cost secure coverage for the un or under insured extend the life of Medicare and prohibit denial of coverage based upon pre existing conditions The law of unintended consequences has proven once again that intent does not equal impact and that healthcare leaders will need to continue to innovate their healthcare systems on the ground to ensure they can respond to economic and quality exigencies in a responsive and adaptive way while the private and public sectors seek better tools to guide the necessary changes that must occur to create the healthcare system that we deserve Jonathan H Burroughs MD MBA FACHE FACPE is a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives He also is president and CEO of The Burroughs Healthcare Consulting Network Leave a comment Please enable JavaScript to view

    Original URL path: http://www.hospitalimpact.org/index.php/2013/12/03/title_115 (2016-02-10)
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  • Hospital Impact - Healthcare leaders face unintended consequences of reform
    agreement with a dominant healthcare system The Memorial Hermann Physician Integrated Group was so successful at improving quality and reducing costs that Aetna one of the three major insurers in the Houston market offered the organization higher reimbursement with an incentive to drive more than 10 percent market share into the integrated network to enable higher quality and lower cost services for beneficiaries and increased margins for Aetna When Blue Cross and Blue Shield failed to offer the same deal Memorial Hermann declined to cover BCBS beneficiaries and the company caved and capitulated Thus healthcare consolidation is paradoxically breaking up a healthcare insurance monopoly that has kept insurance margins unreasonably high 2 Increasing un or underinsured populations Insurance carriers and large employers e g Wal Mart are creating narrow networks of preferred organizations and providers based upon quality and cost metrics that both restricts cost effective access for patients and reduces coverage for organizations and providers Some beneficiaries employees who had their insurance coverage cancelled because it did not meet the PPACA criteria are unwilling or unable to afford the higher cost policies and so are choosing to go bare and risk the tax that will probably not be collected Most high performing organizations understand entry into the narrow networks is essential and can only be done by standardizing regulatory quality and reducing cost structure by redesigning the healthcare delivery system This requires the full cooperation and integration of physicians who are aligned with management to accomplish these goals What s shaking out is a vast divide between the haves the minority of organizations of all sizes that can achieve top performance and the have nots the majority of median performing organizations that will increasingly be treated as a commodity and receive lower reimbursement every year Patients respond through medical tourism the fastest growing sector of healthcare that is a 125 billion industry projected to double every two years Last year almost 1 million Americans went overseas to seek high quality low cost care and many countries are developing deep expertise and branding in various specialties For instance Germany excels at oncologic services and Mexico at orthopedic services Large employers respond by diverting their employees to centers of excellence like Wal Mart with significant incentives such as forgiveness of the deductible co payment and co insurance and coverage of a significant other to accompany the patient Third party payers respond by diverting beneficiaries to high quality low cost centers through similar incentives for elective surgery ancillaries and case management Excellence is no longer a choice it is a necessity if organizations are to thrive Look for part 2 of the post in the Dec 5 newsletter Jonathan H Burroughs MD MBA FACHE FACPE is a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives He also is president and CEO of The Burroughs Healthcare Consulting Network Leave a comment Please enable JavaScript to view the comments powered by Disqus

    Original URL path: http://www.hospitalimpact.org/index.php/2013/11/25/healthcare_leaders_face_the_unintended_c (2016-02-10)
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  • Hospital Impact - The origins of healthcare-aviation comparisons
    the correct one This was despite other professionals who did not agree That horrific accident and followed by another a year later when a United Airlines flight ran out of fuel over Portland Ore changed the airline industry forever It adopted the ideals of crew resource management CRM which United Airlines was the first to do in 1981 These ideals include Flattened hierarchy where everyone assumes responsibility for an optimum outcome while serving on interdisciplinary teams The captain is still in charge of the flight but must take team membersâ input into consideration when making decisions and respect other membersâ specialized expertise Communication protocols that include pre briefing de briefing and scripted communication when subordinates wish to express a concern Situational awareness that includes a broader perception of the entire environment and not merely the task at hand This requires delegation to and trust in others who can focus on specialized issues at different points in time Flexibility and adaptability after recognizing bad things happen when foundational perceptions turn out to be incorrect Captain Van Zanten assumed the control tower and his two officers were incorrect and this locked him into fatal actions Good leadership requires self awareness and the willingness to question oneâ s beliefs particularly when others perceive them differently Teamwork to ensure the final outcome is greater than the sum of the parts Highly functional and interdependent teams are far more effective than even the finest experts in performing complex interdisciplinary tasks Many in the airline industry resisted these changes and even as late as 1988 most felt a few commercial aviation crashes a year was merely the cost of doing business However in 1989 the concept of zero accidents gained ground and up until the Asiana Airlines crash in San Francisco this year there had not been another commercial aircraft fatality in U S airspace for the previous 11 years Flash forward to the early 1990s at Beth Israel Hospital in Boston where a second year obstetrical resident thought she saw significant decelerations on a fetal monitoring strip and called her attending who was sleep deprived disagreed with her interpretation and refused to come in Instead of going up her chain of command she acceded to her attending s judgment After the stillborn was delivered management brought in the Federal Aviation Administration to train physicians and management in CRM to prevent similar errors in the future Healthcare is still undergoing the painful transition from individuals to teams from independence to interdependence from non value added variation to only value added variation This transition does not obviate the responsibility or accountability of physicians nurses management and staff from doing the right thing for their patients nor does it marginalize individual responsibility and accountability What it does underscore is the need to standardize to excellence work in interdisciplinary teams respect those with expertise communicate openly and clearly develop situational awareness and sublimate ego to mission Pilots are permitted to circumvent check lists and not follow protocols when appropriate

    Original URL path: http://www.hospitalimpact.org/index.php/2013/10/22/the_origins_of_healthcare_aviation_compa (2016-02-10)
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  • Hospital Impact - 6 strategies hospitals should steal from the airline industry
    The vast majority of delays in these expensive settings involve the discharge planning process as patients in these areas often have no place available to go thus backing up operations throughout delaying treatment for others waiting to come in reducing patient staff satisfaction and increasing costs Ironically most discharges are predictable to within one hundredth of a day based upon risk and severity adjusted length of stay data bases e g Premier for each diagnosis related group Therefore most discharges should be scheduled at least 24 hours to 48 hours in advance ideally when the patient arrives with arrangements made for nursing home or ventilator beds physician appointments home health on the day of admission in anticipation for discharge Many healthcare organizations are purchasing or contracting with nursing homes home health services psychiatric facilities and physician practices to gain greater control and ease of scheduling by extending the chain of its operations into the outpatient setting 4 All arrivals are scheduled in advance One healthcare myth is that emergent arrivals are unexpected As it turns out if emergent ED surgical or ICU admissions are tracked over time the vast majority are predictable For instance most emergency department admissions arrive between 3 p m and 11 p m with the fewest arrivals between 4 a m and 9 a m There will be rare disasters which require special resources through a disaster planning process however these can be managed and illustrate the difference between random uncontrollable and non random controllable variation in flow Truly random variation can and should be managed by policy whereas non random variation should be eliminated by standardizing flow to accommodate predictable admissions in a predictable way through optimum staffing resource allocation including beds and standardized admission processes 5 Flight schedules are smoothed throughout the day and week An airport only can handle its capacity of arrivals and departures at any point in time and so it manages the schedule to ensure a consistent schedule of flights throughout the week and time of day Emergency departments surgical facilities and intensive care units can be similarly managed so that non emergent patients who arrive at the ED can be transferred to lower acuity areas during peak hours elective surgical schedules can be scheduled evenly throughout the week to avoid demand surges and ICU admissions can be coordinated based upon regional transfer agreements in compliance with EMTALA to ensure appropriate stabilization and safety The system needs to be viewed holistically so all of the units and outpatient facilities coordinate flow in a synchronized and synergistic way to accommodate flow throughout the system and not within a unit alone 6 Delayed flights are taken off of main runways and taxiways When air traffic control delays a flight the delayed flight does not block other flights but is directed to another area to await further instruction and movement Delayed discharges transfers and admissions should not sit in beds blocking patient flow but should be immediately moved to a comfortable and appropriately

    Original URL path: http://www.hospitalimpact.org/index.php/2013/09/17/6_strategies_hospitals_should_steal_from (2016-02-10)
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  • Hospital Impact
    this order is often reversed which is why so many engagement and alignment efforts fail If you attempt to work on quality efforts with an independent practitioner who has no interest in working with your organization and who has no vested economic interest in the outcome most of your efforts will be in vain Read more Leave a comment Physician engagement What not to do June 24th 2013 by Jonathan H Burroughs Alignment of organization and physician interests depends upon successful physician engagement Unfortunately the traditional approaches of purchasing a physician practice or employing physicians have little if anything to do with alignment Thus it seems instructive to share a few insights as to how NOT to engage physicians The following summarizes some key ways in which an organization can fail to engage physicians and lead to an unaligned environment with unnecessary conflict division strife and cost Read more Leave a comment Just what is healthcare reform anyway May 20th 2013 by Jonathan H Burroughs That was a question a physician asked me at dinner last week and I answered simply World class quality safety and service at half the price Healthcare reform transformation is a problem in the guise of a political conflict What the two political parties argue over is who has the legal right to control and regulate the healthcare market the federal government state governments or private industry This is a war that has been waged since we began as a nation and it shows no sign of slowing Unfortunately while corporate lobbyists spend hundreds of millions of dollars to defend their entrenched positions our country is losing the increasingly global competition to provide high quality low cost healthcare services Read more Leave a comment How to handle medical professional conduct violations March 27th 2013 by Jonathan H Burroughs Medical staffs throughout the country are working to raise the bar for professional conduct Physicians have always been respected for the technical and clinical expertise Unfortunately there have always been a few within the profession who feel their elevated professional status gives them the right to act in a disrespectful and disparaging way towards others particularly at times of disagreement or stress Often their frustration is justified due to some form of systems failure However the act of treating another professional with intimidation or disregard worsens the situation by undermining effective communication trust and the ability to work in a team which is the basis for good care The challenge for many is how to maintain a high level of professional conduct to assure good quality outcomes foster a respectful working environment and provide high levels of service to patients and staff Read more Leave a comment Previous Page Next Page Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jonathan%20Burroughs&page=1&disp=posts&paged=6 (2016-02-10)
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  • Hospital Impact - Tough to focus on patient care and productivity at the same time
    guru John Holland would say As such we re comprised of many interconnected pieces have the ability to change based on past experience and to make adjustments based on emerging needs and new realities I m not a clinician but I do believe that positioning people for true healing requires a complete understanding of the many dimensions that affect each patient e g physical mental emotional spiritual financial environmental and the reactions thereof It requires having time to develop a true relationship understanding and trust between patient and physician And yet our health care system continues to rely on brief encounters between physicians and patients as the focus remains on revenue generation Funding mechanisms are based on productivity and thus result in limited time between physician and patient The result is often physician dissatisfaction and burnout Thomas H Dahlborg M S M has 21 years of experience creating competitive advantages analyzing customer expectations and developing and implementing focused and aligned strategic deployment plans He s executive director of True North where he focuses on improving growth while ensuring access for the uninsured and the elderly Formerly he served as the chief business strategy officer at Network Health a comprehensive Medicaid health plan based in Cambridge Mass and was COO for the U S Family Health Plan at Martin s Point Health Care in Portland Maine 83 comments Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates

    Original URL path: http://www.hospitalimpact.org/index.php/2010/03/11/can_physicians_really_focus_on_patient_c (2016-02-10)
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  • Hospital Impact - Relationship-centered care can fix a broken system
    this caring Why do I feel worse after my visit She went home straightaway and told her husband that they were both going to leave this physician practice and find their former doctor the one that knew them both and whom they trusted albeit the one whose office is a good distance away Rotating physicians who have little relationship and minimal time with patients and thus who don t truly know their patients are not how best to help people she shared with me She did eventually get in to see HER doctor the one that knew her and her husband and with ample time and an opportunity to share fears and concerns did receive confirmation from HER doctor that indeed her EKG was fine and there was nothing to worry about Healthcare the way it should be she concluded The way it should be yes but clearly not normative in our broken healthcare system As A Country Doctor MD shared in a recent blog Continuity of care starts with caring Yes caring And yet in speaking recently with a local healthcare leader with great influence in the community I found that even though this leader logically understood and acknowledged the importance of these aspects of healing and could share his own stories translating the importance of time relationship caring continuity trust and empathy into the healthcare model in his eyes is not yet practical and may not provide longitudinal financial success to healthcare organizations Now I truly understand that there is a wide variety of solutions to our broken healthcare model And I also believe that one size does not necessarily fit all But again the foundation of healthcare is CARE Time relationship continuity trust and empathy are all key components of caring and stated as such in the Hippocratic Oath So again it still amazes me how important these aspects are to healing AND how consistently the healthcare system considers them impractical or worse sets them aside to ensure longitudinal financial success To continue to sacrifice the health of our friends families and communities for longitudinal financial success is appalling and highlights another side of a sick system It is time to heal the sick system Thomas H Dahlborg M S M is executive director of the physician practice True North Health Center where he focuses on improving growth while ensuring access for the uninsured and the elderly He has 21 years of experience creating competitive advantages analyzing customer expectations and developing and implementing focused and aligned strategic deployment plans Formerly he served as the chief business strategy officer at Network Health a comprehensive Medicaid health plan based in Cambridge Mass and was COO of the U S Family Health Plan at Martin s Point Health Care in Portland Maine 10 comments Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at

    Original URL path: http://www.hospitalimpact.org/index.php/2011/06/02/relationship_centered_care_can_fix_a_bro (2016-02-10)
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  • Hospital Impact - How a lack of empathy affects our healthcare
    empirical data supporting benefits of this healing encounter She blames our medical education system for some of the decrease in empathy between a physician and patient and claims that much of this is due to the medical education system s emphasis on emotional detachment clinical neutrality and an over reliance on technology limiting human interactions So the Hippocratic Oath our medical schools at least 30 years ago and empirical data all agree that to quote the Hippocratic Oath again warmth sympathy and understanding may outweigh the surgeon s knife or the chemist s drug Yet with all this wisdom we still have a healthcare system that is not leveraging this information to improve the healing encounter and to improve the health of individuals and communities The system continues to rely on short episodic office visits The funding model still rewards based on production primarily Our innovation of a Patient Centered Medical Home PCMH creating a care team consisting of a physician and extenders is still predominantly reimbursed based on production and still does not position physicians to develop empathy human connection and authentic relationship with their patients and in many cases exacerbates the issue by trying to leverage rotating practitioners as a means to improve access optimize reimbursement and lower overhead The pay for performance P4P component of the PCMH reimbursement model is flawed as well as it is based on flawed clinical outcomes data but that is a whole other discussion Even the current medical education system is designed to train physicians to not honor the importance of empathy and relationship in the healing encounter I initially thought the reason s for the lack of empathy human connection and authentic relationship between a physician and a patient was because the stakeholders in the broken healthcare system did not know any better Could it possibly be that the importance of empathy human connection and authentic relationship between a physician and a patient is known has been known since the days when Hippocrates drafted the oath and is intentionally being ignored due to other factors My heart says no way but then I see the reality of our broken system and must wonder Do we dismiss the importance of empathy human connection and authentic relationship between a physician and a patient because creating a healing model that leverages these principles would decrease productivity and cut into revenues because each visit would be too time consuming Do we avoid empathy human connection and authentic relationship and dismiss the concept as woo woo in general because relationships are hard and we are afraid to go there A yes to any of the above items is distressing and as healthcare leaders we must reevaluate our motives and stop being afraid Our patients and our communities need us to best position them to be well If we need to tackle the hard stuff and change our reimbursement model so be it Thomas H Dahlborg M S M is executive director of the physician practice True

    Original URL path: http://www.hospitalimpact.org/index.php/2011/02/08/what_a_lack_of_empathy_does_to_our_healt (2016-02-10)
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