Archive for the ‘Boomers’ category

NickJacobs.org???

April 2nd, 2009

Let me open this blog with a little housekeeping chore. Because I’ve retired from being a hospital president (Yes, they replaced me with two great people, count ‘em, two.) , I’d like to change the name of this thing. It’s not that I’ve established a P-Diddy-type Twitter following where 100,000 human beings are waiting with baited breath to see what my next move will be, it just doesn’t seem right to keep calling myself a hospital president. We know who reads this thing, and we are grateful to our loyal, talented, and brilliant followers. We also know that we can link the old blog names to get you here. So, regardless of what you typed, or what gets Googled, our genius social media maven & webmaster, Michael Russell, can help to bring you home to this site.

Okay, so as a transformational advisor, a broker of sorts, most people with whom we have consulted have described me as a person who can fix things that are broken before they actually break. Maybe we should call it the “Break it if it’s not already fixed” blog. I’d love it if it was a name that would generate millions of hits and companies would fight to advertise on it.

My first thought was to use nickjacobs in the title because there is a Nick Jacobs on Facebook who teaches Aboriginal people in Australia, and he seems popular. There is another Nick Jacobs who is a professional organist, and one who is an athlete. There’s a Nick Jacobs who is a consultant and another a paramedic in London, one who had a blog who is a yachtsman, there’s my son, the commercial real estate broker, and finally, there’s a Nick Jacobs who does pornographic movies who is not my son. Actually, that Nick Jacobs’ followers would probably be the most disappointed by this blog.

Since the .com version of nick jacobs was already taken by some guy in England, we captured nickjacobs.org, and that will work for right now.

If you have any ideas, however, that you think would really rock the blogspere, let us know and we’ll check with our domain registrar to see if it is available. In fact, if you are the winner of a Name Nick’s Blog Contest, I’d be happy to consult for free BY PHONE for at least one hour of brainstorming with you about the topic of your choice: music, healthcare, proteomics, teaching, PR/Marketing, the travel business, or even physician recruitment.

Remember, Hospital Impact is already taken, and, because my last three consulting jobs have been with a newspaper, a nonprofit arts oragnization, and a chain of hotels, we don’t want to think too restrictively. Gotta earn a little money, too.

When we ran the breast center, we found that the website got more hits than anyone could imagine. The problem was that the readers were mostly thirteen-year-old boys who probably weren’t too interested in running a hospital. After Miss America had visited us, the hits went up exponentially when those two searches were combined. Somehow, I don’t think that Nick Jacobs’ Breast Center for Miss America would probably get me the type of following I’m currently hoping to attract. On the other hand?

A very good friend recently asked me to write a brief bio about what my new life is like, and it struck me that it is very much like my old life but without any restrictions. This is what I wrote:

While teaching junior high school instrumental music in the early 1970’s, Nick Jacobs made an extraordinary discovery. He learned that, by empowering his students and surrounding them with positive influences, he no longer was providing a service or even an experience for them.

What this entirely unique teaching style resulted in was a method for helping to transform students. By providing with both passion and commitment the tools needed by them to undertake their journey, his involvement with the students became a means of dramatically helping them to make whatever positive life changes they were seeking.

It was during that early period in his career that he also discovered that this formula could work to positively change lives in almost any aspect of living as he ran an arts organization, a convention bureau, and finally a hospital and research institute.

Since that time he has dedicated his personal work to helping others make their lives better, and that is exactly what he is doing in his position as an international executive consultant with SunStone Consulting, LLC.

Maybe that will give you something to chew on? Okay, something on which to chew.

SunStone Consulting. With more than 20 years experience in executive hospital leadership, Nick has an acknowledged reputation for innovation and patient-centered care approaches to health and healing.

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The Not-So-Merry-Go-Round

March 7th, 2009

Dr. Wayne Jonas, President and CEO of the Samueli Institute, a friend and mentor, testified before the U.S. Senate on February 23, 2009 regarding his views for creating a path to health care reform. Dr. Jonas, a well respected member of the Washington D.C. health community formerly served as the Director of the Medical Research Fellowship at the Walter Reed Army Institute of Research (WRAIR), a Director of a World Health Organization Collaborating Center of Traditional Medicine and a member of the White House Commission on Complementary and Alternative Medicine Policy.

Wayne B. Jonas, M.D.

Wayne B. Jonas, M.D.

It is not my intent to copy this testimony, but only to accentuate some of the salient points contained within his work. Let’s begin by looking at some chilling facts. By 2082, healthcare expenditures will represent 49% of our Gross National Product. This is due to the fact that in 2011, the baby boomers will begin to turn 65 when, in the words of Dr. Jonas, “an avalanche of aging care needs…will bury the current Medicare system.”

Obviously, this is a case where more of the same is not necessarily better and, unless or until the system changes, and we fashion a new vision to create health, we will bankrupt our country. Dr. Jonas then went into the facts and figures that those of us in health care who believe in wellness, integrative medicine, and a holistic approach to healing have known for years. Seventy percent of chronic illness is due primarily to lifestyle and environmental issues, including proper substance use (smoking, alcohol, drugs, diet, and environmental chemicals), adequate exercise and sleep, stress and resilience management, social integration and support, and selective disease screening and immunization.

We are on a not-so-merry-go-round, which has an entire system of illness incentives that are improperly reimbursed, improperly addressed, and inappropriately segmented as if each part of our body was not a component of the whole. It is time to begin to throw the switch and to teach our patients what we already know so that wellness, wholeness, and health can be given a new definition.

Dr. Jonas specializes in Systems Wellness. Dr. Leroy Hood specializes in Systems Biology. We as a country need to demand that our medical schools embrace both concepts as, like indigenous man, we begin to realize that our brains do have something to do with our bodies, as we realize that our commodity driven society does not always promote the BEST food, the BEST exercise, the BEST of anything but, instead, because of the quarterly reports to the stock holders, promotes the most lucrative.

We know that drinking a soft drink with 10 teaspoons of sugar is not exactly healthful. We clearly understand that quadruple cheese anything might eventually catch up with us, or that Uncle Buck’s 72 oz. steak can’t really be good for your arteries. Fried and buttered everything, a total lack of exercise, and more stress than anyone can ever dream of will not extend our lives. There is a reason why most of our physicians die ten years before their patients. Between the battles to get their degrees, the incredibly long hours, the pressure of dealing in life and death issues, and the demands of dealing with a broken healthcare system, they need stress management as much as anyone.

How much further down must we go as a country before we begin to realize that millions of dollars, dozens of expensive toys, mansions, and rich food are not true measurements of success? During a visit to the Netherlands a few years ago, I told my host that I would be back in August. She looked at me, smiled, and said, “Don’t bother. The entire country will be on vacation,” and they were. Many European countries take 52 paid days off per year. Sure, their cars are smaller or they use bikes and generally they may own less clothing, but they are living longer, healthier lives.

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A view from both sides of the street

September 17th, 2008

What do you do when you don’t have enough money to do what you need to do for you or your family’s health? I know, it’s a redundant question? You go without, delay or borrow from your future in the form of debt. According to Reed Abelson and Milt Freudenheim of the New York Times in their recent article Even the Insured Feel the Strain of Health Costs, as employers struggle to keep up with mounting costs to cover their employees, the average cost of an annual health care premium for that employee has nearly doubled since 2001, from $1800 to nearly $3300 a year.

Example after example is delineated in the Times article regarding those individuals who just can’t afford the challenges presented by the rising food and gasoline prices. Those featured families and individuals skip meds, wait longer to take sick children to their pediatrician or are facing staggering bills from health care institutions. According to the accounting firm, Deloitte, the average American income that goes toward health care expenses is now approaching 1/5 of their total household spending annually.

As a hospital administrator, it is never easy to listen to the general public throw stones at the medical industrial establishment, but when it comes to fancy, esoteric diagnostic tools, unproven drugs that can cost $6000 a dose or the very best physicians known to man, bring ‘em on becomes the hue and cry as we, the health care consumer wants nothing but the best for ourselves and our families. This is America. We deserve it.

Of course, if you are looking for elective surgery and you happen to live in England, you will wait on average 1.5 years for that intervention, and if you are in Scotland, it will be very close to 2.5 years before that same surgery is available.

My Democratic friends embrace the hope of the future through proposed health plans that insure the masses. My Republican friends warn of the horrible train wreck those plans will cause in hospital emergency rooms as every George, Dick and Conde will make their way to our hospitals with no barrier in place to prevent them from over running our already strained bastions of care.

Regardless of your political bent, it does seem unconscionable that we have nearly 48,000,000 uninsured accounted for by the government. Most of these uninsured are young, single moms and kids who either can’t or choose not to vote. (No one has ever believed that to be a co-incidence.) This figure also does not include the underinsured and quite possibly may not include any of the 50,000,000 illegal aliens. We are the only industrialized nation in the free world that does not have a true health policy for our citizens.

So what is the answer? The iron triangle of the best, fastest and cheapest health care is something that cannot exist in a system that is still hanging on ever so completely to an acute care based model when the vast majority of our health care challenges are now chronic care cases. We 78,000,000 Baby Boomers are taking more pills to control our varied maladies than existed in total just 20 years ago. Ask your pharmacist how many drugs there are now compared to 1988.

One very real answer to this health problem sometimes seems too simple. Our nearly $2 trillion in yearly health care expenditures includes less than four percent of its total dollars for preventative care. Much of our problems are about wellness.

So, wash your hands, drop some weight, exercise, cut out the saturated fats, stop smoking and live a less stressful life by doing something other than stare at the television…or else just wait for that little blue pill that will help you be skinny, tan and sexy, and then sell the family car to pay for it.

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Quality of Care

July 31st, 2008
Back in the 70’s, competitive marching bands came into vogue in Western Pennsylvania. Let me explain the before and after of this phenomenon: Before there were competitions, bands were made up of nearly 10 times more students than they typically have today. My bands ranged in size from 120 to 185 students. Once competition came into play, the borderline students were not able to survive. Consequently, it is not unusual now to have 20 students or less in a band.

Steelcity_border

What’s happening in medicine and in health care overall? The Government is taking a three-pronged approach to improve quality in health care:

1. They are pushing quality through public reporting. (Check a website near you.)

2. Enforcing quality through the False Claims Act. (Check a prison near you.)

3. Incentivizing quality through payment reform. (Check a checkbook near you.)

Senator Chuck Grassley is quoted as saying, “Today, Medicare rewards poor quality care. That is just plain wrong, and we need to address this problem.”

HMO’s are currently embracing “pay for performance” plans for physicians and hospitals. Medicare is introducing value-based purchase plans. Medicare is proposing the linking of quality outcomes to physician payments.

As I have written before, hospitals will no longer be paid for hospital acquired conditions. That seems like a rather simple fix, but to appropriately determine if the condition was not acquired at the hospital, extensive testing must be added pre-admission at considerable costs to the hospitals.

James G. Sheehan, Medicaid Inspector General of New York said, “We are reviewing assorted sources of quality information on your facility to see what it says and if it is consistent. You should be doing the same.”

Except for the financial implications, not unlike my competitive band story, the goal was to work toward perfection. The public reporting of quality of care is intended to:

1. Correct inappropriate behavior

2. Identify overpayment’s

3. Deny payments

KirkOgrosky
The False Claims Act, on the other hand has different goals. When asked how he viewed the False Claims Act, Kirk Ogrosky, U.S. Deputy Chief for Health Care Fraud said, “You will see more and more physicians going to jail.” I guess the prisoners will be receiving better care.

Where’s it all going? Competitive band. Will it improve health care delivery? Probably, for the patients who can find the few docs and hospital that will be left? I recently had a conversation with a young computer specialist who took care of physician practices. He said, “Doctors and hospitals haven’t figured it out yet, but they are simply becoming data entry centers for ‘Big Brother’ as the facts and figures are accumulated to be used against them any way the payers decide to move forward.”

Looking back at the school year that included gym class twice a week for the entire year, rich courses in music and art, and remembering a time when priorities included those classes intended to make every student well rounded, we have to ask, “Is education today better?

Maybe this is all too complicated to get our arms around, but if there are 78 million Baby Boomers, and the Medicare Trust Fund is heading toward bankruptcy, then we probably will see every rule in the book being applied to keep from paying out money, because there is simply not enough money to go around.

Will health care improve? Once we understand that technology is not the end all and cure all that creates healing; once we endorse prevention, wellness, optimal healing environments, and systems approaches to health and wellness, health care will improve. I’ll bet you that it will have very little to do with the rules that are unfolding right now and much more to do with the creation and acceptance of a National Health Policy.

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A Time to Reflect On Life

June 15th, 2008

With the passing of Tim Russert, we are all made critically aware of the fragile nature of life and our need to embrace every moment as a gift.  Obviously, within a split second, every aspect of our lives can change, and, as in Mr. Russert’s case, can end.  This is not a blog about instant death, and it is not just about recognizing our mortality.  It is about preparing for our passing carefully.

Russert
Liz Szabo, a writer with USA Today described in a recent article the cancer patient experience by saying, “Patients with advanced cancer often don’t know how long they have to live or how chemotherapy will affect their lives.”  According to a study by the Journal of the American Medical Association, many physicians either don’t give patients that type of information or the patients only “hear what they choose to hear, or very often misunderstand what is said to them.”

This situation often leads to patients requesting incredibly disruptive and sometimes painful therapies that have no hope of succeeding.  According to the study, more than 20% of Medicare patients who have advanced cancer begin a new chemo regimen two weeks before they die.  Many times patients are admitted to hospice days or hours before they die.

What has been observed in cases like this was that the patient often misses the opportunity to repair relationships, get their spiritual house in order or even prepare the necessary documents such as advanced directives.

Where is this going?  Sarah Harrington, an assistant professor at Virginia Commonwealth University School of Medicine in Richmond, co-author of the quoted article, indicated that “in the last few weeks or months of life, a lot of good work can be done.”

One of the points brought up in the article was that only about 37% of physicians told patients how long they had to live. This fact was not surprising to us because we have seen dozens of patients who were admitted to hospice over the years return home and live several more months or years. This particular prediction is not always dependable. The other fact quoted in the article, however, was that many patients learned more about their cases from other patients than from their physicians.

The article concluded with the suggestion that “patients and their families may have to take the initiative in finding answers to important questions.”  Thomas Smith, co-author and Chairman of Hematology and Oncology at VCU’s Massey Cancer Center suggested that the following questions should be asked by any patient in this situation:   What are my options?  Can I be cured?  Will I live longer with Chemo?  Should I consider Hospice or Palliative Care?  Who could help me cope?  What do I want to pass on to my family to tell them about my life?

Eldercare_visit
Palliative care is not limited to cancer.  All end-of-of life diagnoses qualify patients for hospice and palliative care.  Tim didn’t need or have this opportunity, but for those who do, embrace it. The primary thing that can be delivered to the patient and their family is the comfort of having caregivers dedicated to helping you move through your transition.  It is what they do.  These amazing people, volunteers, employees and physicians are dedicated to “paying it forward.”

So, as we eventually face our own mortality, as we evaluate what it is that we want to share with our families, as we consider the legacy that we wish to leave, having a clear mind and looking to those professionals who can help us is not only necessary, it is imperative. This transition can come in the blink of an eye.

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$4.3 Trillion in U.S. Health Care Spending?

May 9th, 2008

“Money doesn’t make you happy.  I now have $50 million, but I was just as happy when I had $48 million.”
–Arnold Schwarzenegger

According to an article in Internal Medicine News by Mary Ellen Schneider, spending on health care in these United States is projected to reach 20% of the gross domestic product on the one hundredth anniversary of my father’s birth, 2017.  Of course that projection is only an estimate made by CMS, the Centers for Medicare and Medicaid Services.  That estimate is, of course, based upon a continued escalation of nearly 7% each year for the next nine years.  In lay terms, that escalation would mean that the total dollars spent on health care would hit $4.3 trillion…Whatever a trillion is? I still can’t fathom a billion of anything.)

Burdenicon2
We all should realize by now that this spending in the public sector, Medicare and Medicaid, will increase due to the first wave of Baby Boomers entering the Medicare system in 2011.  My 78 million peers, like the lemmings, are working their way toward the proverbial wall, and for those of you who will have to carry the load until we are wearing our wings, that is not a pretty financial picture.

The same economists from CMS are predicting a decrease in reimbursements to physicians over the next several years while Home Health will likely grow faster than most other sectors except perhaps prescription drugs.

What does it all mean?  We are spending more on health care in the United States than any industrialized country in the world and, truthfully, our overall age of death is significantly surpassed by many of those “spending less” countries.  How can that be?  Well, for one thing, we have 47 million uninsured citizens in this country and no one really knows how many illegal aliens. Why so many uninsured?  They don’t vote.  The vast majority are young, single mothers with small children, and this does not take into consideration the illegal aliens who are also not insured.

Back to the answer. . . prenatal care is inadequate and infant mortality in the United States is still an embarrassment. A few of the countries that do better than us in the world in infant deaths per thousand are:  Australia, Austria, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Ireland, Japan, South Korea, New Zealand, Norway, Portugal, Spain, Sweden Switzerland and the United Kingdom.  Hmmmmmm?  Could it be because we spend 30% of our annual health care dollars on the last thirty days of life, and less than 4% of our monies on preventative and wellness care?

Of course, Hospice would be a tremendous help.  We could reduce expenditures on end of life care, properly care for our babies with the excess funds, and ensure that our uninsured are properly covered as well, but what politician is willing to touch that electric third rail of the electorial subway tracks?

We could begin by putting in a network of sidewalks, bike trails, and walking trails.  We could actually walk once in a while and treat our bodies like a true temple, not the “Temple of Doom.”

HospiceOne of the least often heard issues revolving around these expenditures is the continuation of our archaic hospital system.  It is based on the acute care model, and the vast majority of our diseases are chronic.  We rush the victim to the hospital, patch them up, send them home and then rush them back again without any commitment to behavioral modification.  I have seen individuals reverse their heart disease from diet, exercise, and stress management.  Why can’t we embrace this concept, reward these activities, and change our society?  The millions of bicycles in Europe are no accident.

So, as I’ve quoted in some other blogs, “Change or Die,” or just spend ourselves into oblivion as we attempt to prop up a system that should have gone out with the Industrial Revolution.  Good luck kids, your ole man needs you to keep working to cover my health insurance.

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