Archive for April, 2011

A Personal Post – Just for Fun

April 25th, 2011

One warm Sunday afternoon, in the early 1990s, Uncle Bert indicated to me that, after his death, he was going to leave the my brother and me the money that he had made from selling the little house that he had built for our grandmother. My brother decided to take his share to physically trace our roots back to the small Italian city where our grandfather and grandmother had been born and raised. That is where this story begins.

In order to get to Alvito, in the Province of Frosinone, in the region of Lazio near Rome, my brother and his wife took a train part way and then hired a driver for the last leg of the journey. The driver asked them where they would like to go, and my brother in recently learned Italian, directed Leonardo to take them to the cemetery where he would try to find and take pictures of the grave markers of our great uncle and his wife.

When the driver heard the names, he immediately said, “That’sa my name.  Do you wanta meeta you cousins?”  They got into the car and were driven a short distance to a house where Leonardo knocked on the door and introduced them to our cousin Rita and her husband Giuseppe. They later met her brother, Nino. We had discovered a part of our family that we had no idea even existed!

After their return home, an email quickly clarified that an older sister of the two in Italy, Valeria, her husband, their two sons and their families, as well as Nino’s two sons, all live in Columbus, Ohio! We were invited to share in their hospitality, friendship and love, this past week-end. As we pulled into their driveway, it was abundantly reconfirmed that in the Italian culture, blood is thicker than water. With that, the party began! Our host, Valeria’s husband Mariano, immediately took us to his wine cellar to show us the prosciutto and homemade wine that would be brought out for our visit and the lamb and rabbit that would be offered for the Easter Dinner.

Afterwards, Valeria invited us to try the four types of pizza that she had prepared as the opening salvo of a series of appetizers.  Then came orange slices marinated in olive oil and a little sea salt; tomatoes stuffed with feta cheese, basil and olive oil; stuffed zucchini with meat, bread, olive oil and parsley. The food was amazing and all homemade by cousin Valeria!
Your average American would have thanked them and headed off to bed, but the meal hadn’t started yet. The first course was an absolutely superb Italian wedding soup, then stuffed manicotti, homemade bread, the most delicious grilled filet mignon wrapped in prosciutto, more stuffed zucchini, fresh green beans in butter and garlic, rapini, and and a wonderful salad.  All of this was accented with potent, high quality homemade-wine.  If you weren’t Italian before you started this feast and drank the vino, you were by the time it was over!

At that point the desserts appeared: homemade cookies, an amazing tiramisu, watermelon, pineapple, grapes, and cantaloupe all topped off with homemade limoncello, sambuca  and espresso.
The next night saw the same course formula, but a completely different menu that included pesto/broccoli shells, handmade noodles with red sauce, meatballs. . .  . You get the idea.  Having been to Italy and eaten in restaurants, I would never have believed that it was possible to consume more than 55,000 calories in a two- day period, but I can attest that, when you are at my cousin’s house, it is most definitely possible.

I’ve been sitting on my couch eating carrots and drinking water now for four days, hoping that at least one pair of pants will fit me within the next week or two.  What a wonderful lifetime memory of friendship, love and FOOD.

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Accountable Care Organizations

April 2nd, 2011

Avery Johnson of the Wall Street Journal wrote an excellent explanatory article this week about accountable care organizations – ACO’s. They’re a potential spin out from the Health Care Reform Act which are about to begin taking shape within the U.S. healthcare system.  The four hundred plus page proposal that was released this week is now being made available for comment, but those administrators and physicians who generally get the concept already are quietly pouring through the pages of this document to determine how it can become a part of their practices.

Donald Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services stated that ACOs were brought into effect with three major aims which are better care for individuals, better health for populations, and slower growth in costs through improvements in care.

Proposed Measures for ACO Quality-Performance Standards.

Scheduled to begin in January 2012, the primary goal of the ACO concept, not unlike other previous historical steps, such as PPO’s and HMO’s, is intended to extract about a billion dollars in costs from the existing Medicare system.  Theoretically, this model is not without merit.  Because most healthcare in the United States is still literally “a cottage industry,” simply having patient advocates help co-ordinate the care of those mega-users, the 18 Club of patients with nine physicians with whom they interact annually and nine different drugs that they take daily, should benefit tremendously.  If these patients can be directed to avoid those unneeded duplications, millions could be saved.

The government outlined rules for how doctors and hospitals can organize into new businesses to reduce Medicare costs and improve care are at the heart of the accountable-care organizations.  The new partnerships that could/should evolve from ACO’s would be aimed at controlling these costs.   They would be structured to coordinate care and their reward would be to share financially in savings with the government if they could come in lower than expected.  There is an alternative universe, however, where they would risk being penalized financially if they go over the anticipated costs.

There is no question that better synchronization of care could help to reduce both hospital readmissions and medical errors which in turn would produce Medicare savings.  In line with this, one of the primary reasons that ACOs might not work is that some of the largest health insurers in the country, including Humana, United Healthcare and Cigna, already have announced plans to form their own ACOs. Insurers say they can play an important role in ACOs because they track and collect data on patients, which is critical for coordinating care and reporting on the results.  As Jenny Gold quoted in her NPR report, “This could just be HMO in drag.” These partnerships of primary-care and specialists doctors with hospitals and clinics might help to produce a model that, although directed toward Medicare, could also have a positive impact on all of U.S. health-care.

Obviously, both hospitals and physicians are worried about ACO’s because they represent CHANGE, but it is common knowledge that if something is NOT DONE, our health care system will crash and burn.   Think of this, providers would get paid more for keeping their patients healthy and out of the hospital. What a concept.

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Posted in Healthcare, Hospital Administration, patient-centered care

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