Sharon Begley wrote for Newsweek Magazine an article entitled Where Are the Cures? Scientists call the gulf between a biomedical discovery and new treatment ‘the valley of death.’ This has been a topic about which I have written several times. As a relative newcomer to the world of scientific research, my journey has been somewhat perplexing and always disconcerting. Every day articles, web stories, and scientific papers cross my desk touting the amazing discoveries that are being made at the basic science level. When I query my insiders, they point out that these discoveries very rarely ever get to the public for their care and treatment.

Some of the reasons behind this gap in medical science lead back to a broken system with inappropriate incentives locked firmly into place. How do we get the basic discoveries to be translated and moved into actual treatments?

Why are so few of the discoveries making their way to both treatments and cures? It is because our system of NIH-sponsored science is set up to discover things; plain and simple. Once the discovery is made, articles can be written, and that is the sought after reward in academia because these publications lead to more grants from the NIH, and the circle goes round and round.

The obstacles to translational research where the studies actually move from the scientist’s bench to the patient’s bedside are so intense that they are referred to in some areas of the scientific community as the valley of death. According to the article, “The valley of death is why many promising discoveries-genes linked to cancer and Parkinson’s disease; biochemical pathways that ravage neurons in Lou Gehrig’s disease-never move forward.”

The author challenges the incoming Obama administration and Congress to take a look at this daunting dilemma and to begin to revamp our biomedical research system by creating what Richard Boxer, a urologist at the University of Miami, and Lou Weisbach, a Chicago entrepreneur, call a ‘center for cures” at the NIH. Interestingly enough, the model that they endorse is exactly what was created here in Windber where multidisciplinary teams of biologists, proteomic and genomic scientists, technicians, and biomedical informatics specialists work together with Walter Reed Army Medical Center to move a discovery to an actual cure.

Of course, with the cuts made to the NIH funds, creating anything new that is unfunded could take away from basic research, and limit hopes for these cure discoveries. The article explains that while the NIH budget was doubling, new-drug approvals fell from 53 in 1996 to 18 in 2006. What’s wrong with this picture? Twice the money, less than half the discoveries.

The sad case, however, is that even those organizations that try to establish these new world order cure centers are not funded by the NIH because of this fundamental design to enhance only basic research. The article ends with this “I’d be willing to put up with potholes in exchange for a new administration spending serious money to take the discoveries taxpayers have paid for and turn them into cures.”

There was a television show on at about 3:00 AM the other morning that, once again, predicted the end of the world. This time, it was the manifestation of predictions from two ends of the earth: both the ancient Chinese and the Mayan Indians concluded 5,000 years ago that the world would end on December 21, 2012. (I think that Merlin the Magician was involved too, but he would have been just a kid 5,000 years ago!) Both predictions were written at nearly the same time, and both predicted the same date, but I believe that I have discovered what may contribute to this major catastrophe:

It is my prediction that the collapse of the planet as we know it will come from HIPAA.

According to Wikipedia,

“The Health Insurance Portability and Accountability Act was enacted by the U.S. Congress in 1996. The Centers for Medicare and Medicaid Services explain that Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.”

Sounds pretty reasonable, doesn’t it? Just hire a full time security person for your electronic medical records, oh and don’t forget to spend millions to create the medical records in the first place. After that, life will be just fine? Right? Wrong.

If you have had little training in what the term oxymoron means, this would be a classic example; “The Administrative Simplification provision.” This provision was intended to deal with the privacy and security of health data. That is also a very noble idea. If two patients are in the same room, and someone is discussing the status of either patient, there should be a sound proof curtain between them. Soundproof curtains would also qualify as an oxymoron. For those of us who have lived this nightmare called HIPAA, Senator Kennedy has often been quoted regarding the fact that his intentions when designing this act have become grossly bureaucratic in their implementation.

Here’s the totally mystifying, Merlin-type description; the standards are meant to improve the effectiveness of our health care system by encouraging the extensive use of electronic data interchange in the U.S. health care system. Seriously, all of this sounds good. The problem comes when hundreds or thousands of government bureaucratic health care wonks and healthcare attorneys are introduced into the equation.

Well, a few weeks ago, according to Managed Healthcare Executive Magazine, the department of Health and Human Services, Office of Civil Rights (OCR) and the Centers for Medicare and Medicaid (CMS) and Providence Health Services, Providence Health System, and Providence Hospice and Home Care entered into the first case where a monetary settlement was paid to resolve a potential violation of the HIPAA privacy and security standards.

Providence agreed, without admission of liability, to pay $100,000 to the government over a data breach. This case did not involve a single egregious violation. So, it appears that, HHS may believe that enforcement time has come as they become more aggressive in their investigations and enforcement of these laws. Hence, the end of the world may be approaching. If all of the hospitals are fined into closure, and then the avian flu hits, the most often heard phrase will be “Hasta la vista, Baby.”

I don’t mean to make light of such an important topic as patient confidentiality or the potential portability of health insurance, but, if any of us mere mortals could objectively step back and witness the chaos, expense, and outright insanity created by the current implementation of these statutes, the only objective phrase that could eventually emit from that experience would be, “Holy, $%#@&!”

This week we are off to Charleston, South Carolina to present a keynote speech for the Carolina’s Healthcare Public Relations and Marketing Society Fall Conference. The primary theme of the presentation will be directed toward creating a market niche through instituting an Optimal Healing or Planetree Environment and then promoting that niche through Web 2.0 techniques. Truthfully, the art (not the science) of marketing and public relations has been a dominant driver in my career, and this presentation will be coming directly from the heart, as I combine my two greatest work passions for a single presentation.

After the Carolina blitz, we are off to the Clinical Breast Care Project off-site with Walter Reed Army Medical Center in Hershey. This year we will celebrate over a decade of amazing progress, advancements, and scientific growth.

COL Craig D Shriver, MD

We will also celebrate our Principal Investigator’s mile-stone birthday, a significant birthday that brings him closer to the age of “Yoda” wisdom. When we began this journey together Dr. Craig Shriver was a young Lieutenant Colonel and I was, well, I was the age that he just embraced at this birthday. Time flies as we work diligently to find breakthroughs and eventual cures for breast cancer. Dr. Shriver has been an amazing partner and friend, and I can only hope that we will have opportunities to continue our work together in some significant ways in the future.

So, what else has been happening? With SunStone Consulting we have been working with Corathers Consulting and numerous regional hospitals to begin serious fiber networking and telemedicine technology for telepsychiatry. How did this come about? A funny thing happened on the way to an economic bailout. Inserted in the $700+ B bailout was parity for mental health coverage and included in that parity is the ability to compensate psychiatrists for their work in telemedicine. Let the networking begin.

Intelli-Surge is doing a tremendous amount of work in the region to assist several local hospitals in their efforts to construct new buildings. The uniqueness of their approach is that hospitals will be able to build thier facilities without necessarily having to come up with the enormous amounts of cash typically required for this work.

Finally, Pittsburgh Gateways is helping several of us to come together for economic development gains for the Greater Pittsburgh region. With their guidance and connectivity we are hopeful that the future will be filled with opportunities for economic stability for many of the start-up companies in our area.

So, off for another round of busy . . . as we do our thing in the air and on the ground.

My Facebook friend, Anne Zieger, editor of Fierce Health Finance, wrote a compelling piece the other day regarding the potential demise of hundreds of hospitals. Her prediction is based upon some very valid financial realities, and we are witnessing them locally as well as nationally. Not unlike the little banks in our area that seemed to have been insulated from Wall Street’s collapse, some of these national problems seem to be washing over some of the smaller hospitals with relatively minimal damage. Yes, many of us have seen as much as a 10% decrease in elective, outpatient procedures.

In fact, while visiting a really upscale mall for a photo session with my two year old granddaughter, Lucy, an employee engaged me in a conversation about the rotten economy. About five minutes into the conversation, she indicated that there are currently 150 stores in the chain for which she works, and that only five percent of them made budget last month. Portrait pictures must fall into the category of a luxury as their business is severely impacted by this economy. More directly, however, she indicated that she needed stitches removed the other day, and that, “she did it herself” rather than spend the $20 co-pay.

So, are we seeing decreases in important tests? Are we seeing patients avoiding emergency room visits? Are we seeing patients cutting their prescriptions in half? Yes, to all of these questions. Anne, however, seemed to be talking about the “big boys,” where their millions or billions in investments have recently tanked. If you are so big that your income from running the hospital is not a major source of protection, and your income from your investments is propping you up, then the problems begin to manifest themselves exponentially.

“Some hospitals are responding by digging into their investment income more deeply than usual, using it to finance capital projects, or even meet operational needs. Others are issuing bonds with the scary codicil that they’ll buy them back if finicky investors want to dump them,” states Zieger in her column.

She further goes on to explain that “both of these situations put a huge squeeze on hospitals’ long-term viability. One robs from their long-term assets to solve medium-term problems, while the other puts the hospitals at risk of being bled dry by investors who get spooked.”

Well, wouldn’t ya know? Yes, we are seeing a few challenges due to decreased electives, but not because we were living off of our investments. The other good news is that, because we froze our fixed pensions several years ago, we are seeing very little impact upon them from the huge drop in those investments as well. Unlike many of our larger peers, neither of these issues is similar. Between the drops in the market, the loss of pension funds, the decrease in electives, and the down-grading of their viability by the bond markets, their challenges look galactic in size compared to ours.

Sometimes smaller is just safer.

A Note from Nick

On October 23, it was my honor and privilege to speak at the PATIENT-CENTERED CARE CEO CONFERENCE in Chicago with some very impressive CEO’s and Leaders. My topic was “Linking a Patient-Centered Approach to Quality Improvement and HCAHPS,” but my deeper theme was “Leadership with a Heart - Developing Love and Respect in the Workplace by Nurturing Staff, Physicians, and Patients.” For those of you who were able to attend, thank you for your kind words of encouragement and support.

As was explained during my introduction, I have made the very difficult decision to leave Windber Medical Center, but I leave with a commitment to spread the word both nationally and internationally about the journey to Patient Centered Care and how to achieve it.

Obviously, it is a risky time to attempt to begin this endeavor, but, because no time is ever completely safe, it was my decision to reach out to my peers and friends to offer my commitment to work with you with that same passion to help you achieve your goals regarding this effort.

Because Sunstone Consulting is an organization that has specialized in finding additional financial support for hospitals, we can bring you not only the formula for Patient Centered Care, but also the needed additional financial support to achieve your goals in this area.

Although I will not officially complete my assignment at WMC until December 31st of this year, my current schedule permits me two days per week to begin to develop new relationships with my friends and peers. Should you have interest in contacting us for a visit to Windber, or if you would just like to make inquiry regarding engaging us for work at your facility, please feel free to either respond to this letter by E-mail or to call me at the following contact address below.

Once again, thank you for the privilege of working with you on such a significant topic.

Warmest Regards,

Nick

F. Nicholas Jacobs, FACHE
International Director
SunStone Consulting, LLC
1411 Grandview Avenue Apt. 803
Pittsburgh, PA 15211
nickjacobs@sunstoneconsulting.com
jacobsfn@aol.com
Mobile: 412-992-6197
Fax: 866-381-0219

Yesterday afternoon the realities of humanism, mortality, and fear attempted to take me out for about the one millionth time in my life. A phone call came from a loved one casually explaining that the doctor had potentially discovered a problem that needed further examination. When the office called for an appointment to have the scan done, they were told that it would be approximately a week before there was an opening in the schedule.

As an insider, I knew that a certain number of slots were held each day for emergency or unscheduled procedures. Not unlike the hotel that holds back a room or two from the 1-800 reservation list, just in case a preferred guest or luminary comes through the doors, flexibility is something that hospitals have to embrace at some level.

Once again, as an insider, a call to the department resulted in an immediate invitation to come in for the test the very next day.

My route to health care management was a particularly unique and circuitous route, and it left me asking the question, “why does it have to be this way?” I’ve personally done everything that I can to make it humane, patient centered, and sensitive.

If you or your loved one wants to know the inside story on how hospitals work, take a look at my new book, “Taking the Hell out of Healthcare.” It really can help. It is a simple “how to” book aimed at the everyday person who is having to deal with this complex and sometimes difficult world of health care.

My passion and personal commitment has always been to patient advocacy, transparency, and human kindness. Find out how to make the system work for you.

Over the years people who’ve liked me have referred to me as a real visionary, but, in all fairness, the people who thought that I was an incompetent also called me a visionary. One group called me that as a compliment. The other group used the description as a put down. Considering that my physician discontinued my prescription of Atromid S medication back in the late 70’s because he said the it caused early cataracts, I’m not all that sure about my actual vision.

As a kid it was fair to say that my approach to any problem that came my way was, well, it was just different. In fact, I’d spend hours trying to come up with unique solutions to problems that otherwise might have only taken a few minutes to solve the normal way. It was my thing.

In fact, my problem solving skills could only be described as journeys down the “Road Less Traveled.” Kind of the McGyver approach. What can I do to meet this challenge by using a Zippo, some thread, a chewing gum wrapper, and piano wire? Of course there were sometimes periodic episodes of near tragedy from this approach, you know, like the time I watched the front right wheel on my wagon roll past me as my journey took me down the 80% grade that my parents called the backyard. Thank God the axle dug in just enough to stop me before the approaching cliff. (The bobby pin didn’t hold.) Between Evelyn Wood’s Speed Reading course and Cliff Notes, I read Moby Dick in about 13 minutes.

By the time college rolled around, it was clear that my addiction had spread from alternative methodologies of problem solving to a pure and simple love affair with anything that was new, cutting edge, leading (or even bleeding) edge or avant garde. “Contemporary” was the catch word all those years ago. From art films to modern music, there was no end to my attraction to new and novel things.

Well, Inside Healthcare ran an article by Clay Sherman that was entitled Think Global and Act Local that contained some great tips for survival in healthcare. Mr. Sherman talked about the Joint Commission the way that most hosptial CEO’s would like to, but do not have the guts to do so. He described the Joint’s role as one of minimalism, and that was where his description stopped. His suggestion was to drop the Joint and to engage some larger, more aggressive organizations like NCOA or Leapfrog. His words of wisdom here were, “Either embrace a rigorous standards process, or watch your successor do it.”

Mr. Sherman went on to suggest the need for us to embrace best practices methodologies, new standardization techniques, online communities for patients with similar diseases, and he closed by saying “Stay centered focused in building human assets — its their brains that are going to get you there.” Hmmm? Sounds a little like last week’s blog.

There is a very popular book, DVD, and pop culture hit entitled “The Secret.”  Only two days ago I made a 12 hour round trip to Syracuse, New York to speak to a group of Human Resource professionals from New York State.  (It was faster than flying from Pittsburgh to Philadelphia to Syracuse.)  It struck me that my presentation could have been called The Secret.  It could be, but truthfully it really is no secret at all.  Most probably it would have been better to have named it “Common Sense.”  

The speech was all about treating  employees as well as the patients.  Employee empowerment,  physical wellness, communications, emotional health, the use of integrative health techniques, employee personal growth, dedication to fun, and, most importantly, the elimination of bullies from the workplace are just a few of the major topics that we discussed with our audience.

Interestingly enough, the outcomes generated from these actions are not only remarkable, they are, in fact, predictable.  Exceptional stability in the workplace with barely a 10% turnover rate; impressive HCHAPS scores,  high employee satisfaction ratings, low infection rates, extremely low settlement rates from lawsuits of any kind, and high profitability created from a word of mouth chain of endorsements that results in enormous increases in the patient count. 

So, it is all about common sense. If you treat your employees with respect, and love, they will do the same for the patients.  If you nurture them, care about them, assist them, pay attention to them, and are open and honest with them, they will do the same for you and for the patients. 

Wanna know more about this revolutionary new way of caring for employees, just give us a call.

Not long after the attacks of 9/11, the pundits began to attempt to discern their impact on our every day lives. No one fully understood the domino effect of these actions both nationally and internationally. Who could have predicted the over negative blows on all forms of air travel; the economic spin down, the billions in investments needed or reportedly needed to protect us; and finally, the breakdown of our personal freedoms?

Similarly, as we watched the large investment and mortgage related financial institutions begin their minute by minute trip into no- man’s land, we could only shudder with concern over things like pensions, business investment opportunities, ownership of our homes, and the future of our overall economy. As our government began to move from deregulation to government control and ownership, the hollow words of the past certainly rang out like a clapper-less bell.

Allow business and industry to be free, deregulated, uncontrolled, and we will all be better off, or will we? As we see the results of the cheaters, the liars, and the snake oil salesmen, it becomes abundantly apparent that left unregulated our current business culture is filled with those who don’t play correctly, ethically, or reasonably. As the great grandson of prominent and trustworthy Quaker merchants, it pains me to observe the obvious corruption, corner cutting and lack of ethical conviction present in today’s business world. It is reminiscent of Henry F. Potter from “It’s a Wonderful Life.”

How will this impact your health? The slide has already begun. As reported in the Wall Street Journal by Vanessa Fuhrmans, “As the credit crunch threatens to throw the economy into a deep slump, Americans are already cutting back on healthcare spending, a sector once thought to be invulnerable to recession.” Visits to physicians, purchases of prescription drugs, and preventive tests are all measurably decreasing. Some people are cancelling their own health insurance to cover the costs of gasoline and consumer goods. Others are just avoiding what they know to be appropriate medications and screenings.

Quest Diagnostics reported in this article that the number of tests ordered for the uninsured fell 8% in the second quarter compared with their normal 1% quarterly growth. OB/GYN visits, according to the same article, dropped 6% in the first quarter alone this year.

It’s not just the uninsureds who are cutting back. “A recent analysis of claims from 250,000 people in several dozen mid-Atlantic employer health plans suggests even people with coverage are cutting back on care.” They reported nearly a 19% cut back in elective knee surgeries, a 6% decrease in pap smears, and a drop in prescriptions for anti-depression of 29%. Actually, that one was the most mystifying for me. It would seem that there would be exponential growth in this area.

This particular snapshot of the future also presented this query: “What’s next: Doctors and health-policy experts worry that by delaying care in the short term, patients will end up paying more in the long term if their health deteriorates.” Deregulated health care which will lead to deregulated health?