Archive for August, 2010

A Speech to the Risk Managers at RM&PSI

August 27th, 2010

The RM&PSI is a national leader in clinical risk management practices and patient safety programs for health care institutions and providers.

RM&PSI, the Risk Management and Patient Safety Institute provided a forum for me to not only give a speech today on patient advocacy, but also to passionately press for its members to take up the cause of transparency, patient and patient family support, and healthcare quality.  Yes, the speech touched on Social Media tools as a means of reinforcing the message, but it was really all about patient adovcacy.  The RM&PSI is a national leader in clinical risk management practices and patient safety programs for health care institutions and providers.  It primarily focuses its efforts on clinical risk reduction strategies, quality patient outcomes and health care provider education.

Their conference was held in Traverse City, Michigan which functions as the major commercial area for a seven county area and is one of Northern Lower Michigan’s two anchor cities.  Tourism is a key industry and the area features freshwater beaches, vineyards, a National Lakeshore, downhill skiing areas, and numerous forests. But when you’re there to make a speech, it simply features nice people, a hotel room, and a conference room.  (So much for the sun, sand, golf and gambling.)

Nick Jacobs, FACHE - F. Nicholas Jacobs - Healing Hospitals - Sunstone Consulting

Nick Jacobs, FACHE

This opportunity was unusual for me because my typical speech-making effort includes a trip in, a speech, and a trip back out.  This time, however, they graciously invited me to attend both days of the two day event, and my eyes were opened even wider to the quality of the dedicated people who perform these “risk management” and quality assurance  jobs for our healthcare systems.  The people were absolutely delightful; warm, welcoming, open and honest, and it was a particular pleasure being the wrap-up speaker for the conference because I had been given the opportunity to listen to two days of presenters, to take notes, and literally to recraft my presentation to embrace the tenor and tone of their overall seminar.

The one thing that came out loud and clear for me is that our C’s (CEO’s, CFO’s, CMO’S, CNO’s, etc.) must carry the flag for our risk managers and quality assurance professionals. By being transparent; open, honest, caring and kind, we can make a real difference.  It is about taking care of our caregivers and taking care of managing the expectations of our patients and their families while supporting quality at all costs.

Thanks, RM&PSI for your invitation, your warm welcome and  your kind response to my work.  It is what I live my life to do.  It is what we need to be about.\

Free Resources from RM&PSI:

And one more thing . . .

August 12th, 2010

These blog posts are supposed to be directed toward creating healing hospitals. That objective seems to be compromised from time to time as I post genuine opportunities for hospital CFO’s and CEO’s to trim monies from their budgets, to find money that their hospitals should have received, or to initiate new ventures that will create additional, positive economic yields for their facilities.  I’m sorry, but I just can’t help myself.

One of my “gifts” as a CEO was to always find ways to pay for the challenges that we faced so that new ideas, new modalities and  new healing techniques could be introduced to our healthcare environmentI even wrote a book about it. Interestingly, the biggest push back that I experience when presenting to my former peers is that bottom line, no nonsense question: “How the heck are we supposed to pay for this stuff?”

The Benefits of Healing Hospitals

View more presentations from Nick Jacobs.

Over the years I’ve prepared charts, graphs, and narratives demonstrating the dramatic growth patterns, the huge economic surpluses, the wonderful bottom lines that were generated by embracing a “healing” philosophy, but those of you who have been lured by “snake oil salesmen” in your past lives are very leary that my passionate dialogue is simply that, dialogue. You have  no  reason to believe me when I say that improving your employee morale will improve your patient satisfaction scores. Of course it’s common sense, but if you’re too nice to your employees, they’ll think you’re a push over and they’ll take advantage of you, right?  Well, after 22 years of niceness, the one thing I can tell you is that niceness can be confused with weakness, and that needs clarification early on in your journey.

You see, my recent devotion to the economics of healthcare was prompted by the knowledge that you will be treating much larger quantities of patients for less reimbursement. Consequently, new streams of funding will be imperative. For example, the annual amount of discretionary healthcare dollars spent on integrative and holistic medicine is well into the double-digit billions of dollars.  Logic would tell you that at least a percentage of these dollars could be spent at your facilities.  The downside is that your patients have not been used to paying cash for anything except co-pays, but the reality is that “they will pay,” if the service is meaningful, helpful, and healing; money simply becomes a way to get them there.

Wellness Wheel - Image credit: Marquette UniversityIf you, however, don’t believe that massage is good for you, don’t believe that some people respond well to acupuncture or Reiki, don’t care that aroma therapy, floral essences, or pet, music and humor therapy have a place in “legitimate medicine,” that’s a problem, a personal problem.  Go on vacation to some place like Canyon Ranch, and let go for a few days.  Allow yourself to be open to new modalities.  The body and mind can work extremely well together . . . if you’ll just give them a chance.  More importantly, you can generate additional funds for your facilities that will result in additional growth in market share, in patient loyalty, and in patient and employee  satisfaction.

So, this week’s tip . . . financial transaction services: Over 1/4 of your facilities daily financial transactions are completed electronically.  We are currently providing the interface for your financial transactions that will reduce your costs of doing electronic business exponentially.  It is seamless, requires no interruption of your current banking relationships, and invisible to the patients and your staff, but why, for example, would you pay 4.5% if you could complete the same transaction for 2.5%?  It’s savings that can contribute to your bottom line to allow you to supplement your staff with those individuals who can add additional depth, healing activities, and peace of mind to your patients’ experiences.

It’s all good.

Could We Do It Better?

August 8th, 2010

Several months ago, I met a white-haired gentleman of average stature at a meeting.  When I asked him what he did, he replied, “I’m a patient advocate.”  “So am I,” I said. “I even wrote a book, Taking the Hell out of Healthcare’ about it.  “Yes,” he continues, “but I found a way to make a living from doing this.”  His name is Harry and he is an actuary.  In those yin and yang posters, that would put us at opposite ends of the proverbial left brain/right brain spheres.  He had analyzed health care records for about thirty years and could prove what we all know, that between 5 and 7% of our employees use up about 80% of our healthcare dollars. That, my friends, is not rocket science.   All you need to do is hang around some sick people for a while, and you’ll realize that “our system” is set up to keep doing things to them over and over again.  Usually, it’s not to help them eliminate the problem, but to maintain their life in a chronically challenged situation.

Ryan Is An Actuary.  Look It Up. Flickr photo credit: evaxebra - © all rights reserved

Flickr photo credit: evaxebra © all rights reserved

So, I asked Harry what he does, and he indicated that he hires nurses, pays doctors and employs “MANAGED CARE’S GREATEST HITS.”   Now every health insurance company in the world will claim the same thing, but everyone who has ever been turned down for anything by any health insurance company knows that: 1.) the bottom line reason was usually their bottom line, or: 2.) it’s a nurse against your doc, and your doc has not employed all of the verbal and intellectual tricks to convince him or her to allow you to have the test or take the drug that he thinks you need.

Harry went on to explain that these “5  percenters”  usually have anywhere from nine to fifteen docs with whom they interact on a yearly basis, and, not coincidentally, these physicians usually don’t do a great deal of interacting with each other, hence the need for patient advocates.  This is where Harry’s nurses come into the picture.  He assigns a nurse to each high-risk patient, allows the patient to pick their “favorite quarterback doc,” and then pays that physician to help hold down the duplication of unnecessary tests.  Makes sense, huh?  I can just hear my Internal Medicine physician saying, “Nick, you don’t need those 13 other chest x-rays this month, the first one will do fine for all of us.”

Interestingly enough, this system WORKS, and it works pretty darn well because it’s not about saving money for the insurance company;  it’s not about depriving the patient of needed tests;  it’s not about controlling the patient, or preventing him or her from having what they need, but it is about eliminating wholly unnecessary tests, meds, and procedures.  Harry had letter after letter from grateful patients, families, and employers thanking his people for helping them navigate their way through the maze of this very complex, sometimes-disconnected, procedure-oriented system.

The other interesting thing is that Harry likes to go to a town and start first with the hospitals, because their employees are the most comfortable with using everything, and have the easiest access to the most doctors.  It’s a great way to prove  the system works.  From that point on, he then works to bring all of the major employers into the fold, and ties them into the primary hospitals.  It’s something that only an actuary could have accomplished, because, as Harry readily states, “It’s taken me about 30 years to perfect this system.”  The patient is protected from being over-tested in an indiscriminate manner; the hospitals or businesses save a considerable amount of money, thus limiting reases in their annual healthcare costs, and the savings are cumulative over the years.  So, why not try something that will improve the employee morale, patient satisfaction, and quality?

If you are interested in learning more about this program, give me a call.

Modern Healthcare’s “Don’t Ask, Don’t tell”

August 1st, 2010

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The July 19th edition of Modern Healthcare had a very revealing article by Melanie Evans entitled “Don’t ask, don’t tell.” The cut line under that title was “A third of physicians in a  study don’t feel obligated to report impaired [fellow] docs.”  Ms. Evans went on to describe the fact that the word impaired refers to drugs, alcohol or mental illness.  The study was from the Journal of the American Medical Association and it queried nearly 1,900 physicians.  Having been involved with the management of hospitals for over two decades, the results of this study shocked me.  Not because I didn’t believe it was possible; not because I didn’t believe there could be a problem but because it was clearly not my experience.  Yes, there were impaired physicians, administrators and staff members, but the programs available to them were comprehensive, thorough and unending.

If the question was posed, “Is there a problem with drugs, alcohol, and mental illness among physicians?,” my answer would have been  yes.  The same, however, is true of administrators, staff and employees.  None of those exposed to an environment that intersects with life and death issues on a daily basis and that requires the incredibly long hours necessary to keep the  proverbial “wheels on the bus” is without risk of these problems.  Add to that the relative ease of going  from one “friend” to another to get the prescription that is needed, and we have created a potential formula for disaster.

The seriousness of the outcomes derived from this series of questions is not something that any of us “in the business” is in any way ignoring.  It is real.  It definitely could result in injury andor death through medical errors.  So, the question becomes one of management, monitoring and self-policing.  The airline industry pays very close attention to the impairment of their pilots. Why?  Their crashes are typically not between one pilot and one passenger.  They are large, emotional events that impact literally thousands of lives.

When will the medical community begin to embrace the same standards as the airline industry?  It seems to me that we are currently “on  the move toward that objective now,” and as the public and government put more and more pressure on the healthcare industry to be transparent, it will become harder and harder to hide those shadow surgeries that went wrong  or those mis-diagnosed cases that could be traced back to impaired professionals.

Image credit: Edie Falco as Nurse Jackie - (c) Showtime Networks

The Modern Healthcare article ended with the statement that doctors “need more education on programs that evaluate and manage treatment and monitoring for impaired doctors.”  I agree . . . in this case, more is better, but how many “Nurse Jackies” (i.e., the hypothetical impaired employees) do we have flying low throughout our facilities as well?  The healthcare industry needs to pay attention to all of its impaired at all levels.