Archive for the ‘Healthcare’ category

Look, Up In The Sky…

October 7th, 2011

I have to admit that the 12-credit, continuing education course I signed up for was not supposed to be fun. In fact, I fully expected it to be two full days of classroom work, in a room with no windows, followed by exactly zero recreation time. I knew it would include a working breakfast, working lunch and a couple of bathroom breaks. I’ve done this before in places like Hawaii, Fort Lauderdale, Cape Cod; you name it. And,  because of my work schedule, I usually fly in, take (or teach) the course, sleep in some no-nonsense business hotel, then head home the following day. What have I been thinking about for all of these years?

Vintage New Mexico Postcard - Nick Jacobs, FACHE - HealingHospitals.comWhen I arrived in Albuquerque, New Mexico on Sunday and went to the rental car agency desk for my trip to Santa Fe, I should have guessed that something big was going on that week. The service representative told me that she could not rent me the compact car that I had ordered, but, in fact, had to rent me one of those black Secret Service type RV’s that hold eight people, a few rocket launchers and a small quad, but she’d cut me a break on the price. When I asked her about gas mileage, she put her head down and said something like, “Drill, Baby, drill.”  The helpful young lady informed me that the Albuquerque International Balloon Festival was taking place throughout the week, and there were virtually no rooms and very few rental cars available anywhere in the area.

Because I had run a visitors bureau in the 80’s, I had seen pictures of hundreds of hot air balloons floating over New Mexico and knew there was such an event, but didn’t realize it was, you know, this week.

My course was being offered by an organization called the American College of Healthcare Executives; the recipient of many thousands of my dollars over the last 25 years.  You see, they provide you with a credential that some hospital CEO’s have, and even when you’ve stopped running hospitals, it is important to keep paying them and taking courses in order to maintain the credential until at least six months after your death.

Albuquerque Baloon Festival - Humpty DumptyOne of the unusual things about this credential is that it is spelled FACHE.  My former assistant once asked me why I signed my name as Nick Jacobs, FACHE, but she pronounced it “fake.”  It actually means Fellow in the American College of Healthcare Executives, but, really, her pronunciation was more fun…and a great conversation starter, too.

The rain started during my 5:00 AM trip to Santa Fe and continued for two days.  So, because the balloons always fly very early in the morning, I never saw even one of them, but on my way to the airport this morning in the shuttle, I overheard a man and his wife discussing “the cow.” He went on and on about how big “the cow” was. It never dawned on me that he was talking about a cow balloon.  Finally, when he said, “Those were the biggest set of udders I’d ever seen,” I had to interrupt and question this discussion.  At that point he explained to me that the basket was in front of the udders, but I still didn’t get it until he laughed and said, “Heck, man, it was a hot air balloon the size of the Astrodome.”  Hence, the title of this post.

I’m glad New Mexico, the Land of Enchantment, isn’t wine country. Could you imagine finishing that 22nd sample of some great vintage, walking outside and seeing that colossal, airborne cow coming at you?

The course was great, the hotels were clean, and the people were nice, but missing that cow has me really upset.  I mean, how many chances do you have in your lifetime to see 600 hot air balloons flying overhead?  How many days in a lifetime provide a person with that type of visual opportunity?

It’s time to stop and smell some roses. From now on, I’m only going to go to courses that end at noon.

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In Memoriam, Dr. Lee Lipsenthal

September 22nd, 2011

We have not even to risk the adventure alone; for the heroes of all time have gone before us. The labyrinth is thoroughly known. We have only to follow the thread of the hero path. And where we had thought to find an abomination, we shall find…God.
—Joseph Campbell

Such has been my experience with Dr. Lee Lipsenthal. Lee was the co-founder of Finding Balance in a Medical Life, a recognized leader, teacher and pioneer in the field of provider wellness. He was internationally known for his research work with my friend Dr. Dean Ornish in preventive cardiology. He was also well known in the field of Integrative Health, and past president of the American Board of Integrative Holistic Medicine.

Lee Lipsenthal, MD - Enjoy Every Sandwich - Nick Jacobs, FACHE - HealingHospitals.comAlthough Lee’s entrance into medicine was traditional, (a BS from George Washington University, his MD from Howard and an internship and residency at the Medical College of Pennsylvania), he started on his truth path of healing as a resident, where he developed the first multi-disciplinary cardiac rehabilitation program in Philadelphia, a plan that addressed stress reduction, exercise and nutrition teaching.

He then went on to become the Director of Cardiovascular Services for the Benjamin Franklin Clinic in Philadelphia, as well as a staff physician at The Pennsylvania Hospital. In this role, he developed treatment programs for patients with heart disease or risk of heart disease; he developed corporate wellness programs for national companies, and consulted on patients with cholesterol disorders at the hospital.

But who was the real Lee Lipsenthal? Lee was a hero who embraced the adventure and led the way for us all. In an incredibly selfless and positive way, like all heroes, Lee “lost himself and then gave himself to all of us.” He mastered the transformation of consciousness, and taught us all to look deeply inside ourselves. Lee’s life and teaching was always about the powers of life and their modulations through the action of man, and Lee’s actions led us all to a better place; a place of healing, love and understanding. He did this through his words, his music, his soul and his heart.

Lee Lipsenthal, MDLee captured the imaginations of many of us and gently drew us into his circle of positive influence where he provided a psychological center for our lives, he fed our individual and collective souls and he helped us to experience life at its fullest. He often took us to the edge of self-discovery, but he always took us to a place of peace and love. He could literally show us the “belly of the whale,” and then bring us back to a deeper understanding of our lives, our abilities and our spirits.

In many ways he helped us transcend our humanities so that we all could emerge into a deeper reality of serving our fellow man. He taught us that, as a person, if we don’t listen to the demands of our own spiritual and interior life, we will drift dangerously off-center.

Lee was our center. Lee was our friend, our mentor, our spiritual guide and our hero.

Lee passed this week, surrounded by his wonderful, loving family, and our hearts are breaking from the loss, but also reveling in the joy of having known him, having shared him and always loving him.

Learn more about Lee’s extraordinary journey, and his wonderful book, Enjoy Every Sandwich below.

You will be inspired and moved.

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On Cancer Research, Incentives and Cures

September 18th, 2011

From a blog entitled TTAG, The Truth About Genetics, comes a scathing indictment of the American Cancer Society. Truthfully, some of the contents are infuriating, but especially so, because as a co-founder of a research institute, I’ve lived them. First hand. When I saw that  the American Cancer Society’s two CEOs make a combined $1.6 million dollars in salary, I wasn’t shocked. Heck, the president of a 120 bed hospital who retired recently made almost that much. ACS is a big organization with lots of moving parts. It takes talented people to run big organizations, and they typically don’t work just for food.

From the TTAG  blog:

Today, ACS’s revenue is $1 billion, and the amount that goes to research is a measly 16%. Research is not the primary goal of ACS, and one of the great things they do is help patients undergoing chemotherapy by buying them plane tickets and paying for their costs. But, even when you consider other program costs like cancer treatment for patients, ACS has the lowest score for charities in terms of efficiency: 1-2 stars out of 4. (24.78%, according to CharityNavigator.org)

See also:

Once again, no surprise. The main issue that I had with the ACS was that their research funding, as meager as it is, goes to the “Good Ole Boys,” the group that is already part of the NIH/NCI club. Okay, you say, they have to have some standards. The Komen people don’t follow that same “Good Ole Boy” path, and thank goodness. They look for good science wherever they can find it.

So, what’s the real reason that I get upset? I sometimes think I’ve written too many posts about this already, but let me say it one more time: Unless and until we realign the system that currently is used to fund basic science in this country, we will never find true cures for cancer. There is very little to no incentive to cooperate, to work together, to encourage scientists to share and to reward them with grants for cooperating.  In fact, the entire system actively discourages it. It is a “Diva”-based system, that encourages silos of power around individuals.

Bottom line? We have a healthcare system that does not support wellness and prevention, but  instead financially rewards sickness and continuous testing and care for what may have been preventable ailments, and we have a research system that discourages cooperation and collaboration. We have a pharmaceutical industry that is interested in financial blockbusters…just like the movie industry.  We have a political system that caused our country’s credit rating to be downgraded and the price of money to escalate, and finally, we have an infastructure that is crumbling.

The good news, however, is that we still are the United States of America, and if we work together T-O-G-E-T-H-E-R  this can all be fixed.  It’s time for those of us who understand this to be heard.

Health 2.0 Leadership (1 of 2) from Nick Jacobs, FACHE on Vimeo.

Sandpaper sheets, green jello and patients who leave with infections they didn’t have when they were admitted. Hospitals DON’T have to be this way. Nick Jacobs FACHE reveals how, as CEO, he transformed a rural, critical care hospital from near bankruptcy to a consistently profitable, internationally-recognized model of patient-centered care and innovation. By creating a hospital environment that embodies healing in every aspect of its operations, Nick’s hospital also achieved one of the lowest acquired (nosocomial) infection rates in the U.S. for five years running.

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ACO’s or SSP’s: “Change or Die”

September 6th, 2011

Walk the Walk” author Alan Deutschman’s previous book kind of said it all in the title, “Change or Die.” In that book, Alan carefully lays out the statistical survivability matrix, and poses the question:

Alan Deutschman - Author of Change or Die and Walk the Walk - Nick Jacobs, HACHE - Healing Hospitals

Alan Deutschman

“What if you were given that choice? For real. What if it weren’t just the hyperbolic rhetoric that conflates corporate performance with life and death?…What if a well-informed, trusted authority figure said you had to make difficult and enduring changes in the way you think and act? If you didn’t, your time would end soon — a lot sooner than it had to. Could you change when change really mattered? When it mattered most? “

Then, he articulates the actual outcomes of studies. Talk about “tough love.”

“…The odds? You want the odds? Here are the odds that the experts are laying down, their scientifically studied odds: nine to one. That’s nine to one against you. How do you like those odds?”

So, as a nation, as healthcare leaders, as human beings in a country that is currently facing the realities of potential economic disintegration, we are faced with what can only be described as another enormous challenge: a financially unsustainable healthcare system. Regardless of your politics, regardless of your personal beliefs regarding the competency of the federal government and its ability or inability to fix anything, the law has been passed, the train is moving and it’s moving directly toward you and your hospital.

Over the past three years, we have repeatedly presented money-saving and money-making ideas to help begin to position your healthcare organization for the impending tsunami of change that has been launched. As a veteran of TQM, Six Sigma, Baldridge, and a half dozen other consultant-delivered “fixes,” I’m sure I can hear the words going round and round in your head, but, not unlike the clamor that arose from the HMO/PPO days of yesteryear, this ACO/SSP challenge has to be met and dealt with intelligently, and it has to be done in such a way as to not destroy your hospital or health system.

Let’s face it, we’re all pretty smart folks. We’ve all been in permanent white water for years, and the last thing that many of us want to take on is the ole captain of the ship without a rudder, during a hurricane while the lighthouses are being moved around on the shore.  But, once again, it’s here. It’s upon us, and we must deal with this challenge in an intelligent manner.

One possible alternative for smaller organizations is the SSP, a Shared Savings Program, the alternative put forth by CMS, the Center for Medicare and Medicaid Services, to a full-blown ACO, an Accountable Care Organization. Either way, however, SSP or ACO, the primary, overarching goal is to try to improve quality, decrease costs, and provide patient-centered care in a meaningful way. Not unlike the old HMO/PPO days, the effort requires infrastructure (and plenty of it…the average participant in the demonstrations spent about $1.7M on this one, single aspect of managing the healthcare new world order.)

What do you need? Well, you need 5,000 patients, to start. Then:

  1. Decide if you will use Medicare only or other patient groups.
  2. Determine the exact service area that you will target.  How many square miles?
  3. Decide which reimbursement model will work for your organization, i.e., an SSP that is more risk-based, or capitated.
  4. Figure out which provider groups will be involved.
  5. Examine IT reporting capabilities and process improvement methodologies.
  6. Identify patient-related strategies such as enhanced experience for the patients or faster throughput as well as reduction in errors.
  7. Then, dig deep into the organizational strategies for improvement.

Infographic: Medicare Margins - Nick Jacobs, FACHE - SunStone ConsultingLet’s face it. From 2001 until 2008, total Medicare inpatient margins for acute care hospitals have decreased every single year.  (Source: Journal of Healthcare Management)   Reimbursements have decreased while your bad debt has increased.  So, regardless of your tolerance for risk or change, cost control simply must become the culture of every healthcare organization in the United States. We have seen the variances in costs based on geography in this country and treble charges in one area as opposed to another will not go on into the future. Joel Allison, CEO of Baylor Health has stated that this movement is “All about…focusing on wellness, on prevention.” (Arnst, 2010)

We need our primary care docs, we need physician participation to a far greater degree than we currently have, and, at the same time, the physicians must be partners in the effort.  Employing physicians is also a critical element.

SunStone Management Resources can assist you in this effort on numerous levels, but the time to act is now!

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The Alpha and Omega of Healthcare in the United States

August 27th, 2011

While serving as a hospital administrator for over twenty years, I was aware of numerous people who had died in the emergency room because they had no insurance, had not yet qualified for Medicaid and were terrified that the cost of care would force them to live on the street.  Consequently, they waited too long to come in for treatment, and they died.

Rep. Paul Ryan (R-W) and Gov. Peter Shumlin (D-VT) - Nick Jacobs, FACHE - Healing HospitalsModern Healthcare’s August 22nd edition has listed the 100 Most Influential People in Healthcare in 2011. (Somehow they’ve missed me again.)  They’ve listed Republican  Congressman Paul Ryan of Wisconsin as the number one most influential person, and the Democratic Governor of Vermont, Peter Shumlin, as number two. Ryan is interested in a complete re-make of the Medicare and Medicaid programs, and Shumlin wants to move the citizens of the State of Vermont to a government-run, single-payer system.

Needless to say, these are very different views. It’s interesting that they both agree that employer-based insurance should be eliminated, so that neither portability nor employment is an issue. They differ in that Ryan believes that each individual citizen should receive a refundable tax credit for healthcare and that providers should compete based upon quality, price and outcomes. Shumlin, on the other hand, wants to do away with “fee for service healthcare,” but clearly understands the American’s public’s concern about government-run anything, and even says, “Government has gotten it wrong, every single time.”

According to Modern Healthcare, both want to fix the system that is bankrupting the nation. Ryan wants to “maintain a world class system built on innovation and excellence,” while Shumlin wants that single payer system to eliminate waste, administrative overhead and insurance company profits. It is Shumlin’s contention that enacting all of the Tea Party cuts and taxing the wealthy would still lead to the same federal budget challenges in the trillions of dollars that we face now.

Ryan wants to cut $750 billion in Medicare spending by making the allocation a block grant. People like Rose Ann DeMoro, executive director of the AFL-CIO- affiliated National Nurses United labor union say, “The market isn’t magic and it doesn’t trickle down…the Paul Ryans of the world don’t want a society.  They want individuals and corporations to make ungodly amounts of money.”

And so the debate continues. There is no magic elixir that will fix this without huge disagreements and turf battles.  As the Obama legislation began to unfold, the initial reaction from many within his own party was that his administration had “sold out” to Big Pharma and numerous other lobbies, and, as the Republican plan continued to be unveiled, the response was similar to DeMoro’s, because it was so heavily skewed toward big business and the free market, while providing only marginal assistance for the underserved of this nation.

UPMC vs. Highmark (Illustration by Ted Crow, Post-Gazette) - Nick Jacobs, FACHEIronically, as I look out my window and then drive a block from my apartment in Pittsburgh, I see another new “colony” of homeless people living under the bridge, and as I round the corner under Route 279N, there is a virtual apartment building under that road comprised of sheets and blankets hung to create separate partitions for the individual homeless people to live. At the next light leading to the North Side, a 30ish young mom begs on the corner for money for her kids, and two blocks past her is a homeless Veteran asking for money as well.

In the midst of all of this, the $9 billion UPMC battle with the nearly $4 billion Highmark juggernaut continues over an insurance company owning a hospital, and a hospital owning an insurance company.  Surely, in the richest country in the world, there are answers to these challenges that do not bankrupt the pharmaceutical or insurance companies, do not make our physicians second class citizens, and do not close two thousand small and medium sized hospitals while still providing care for everyone.

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E-Patient Dave: Let Patients Help!

August 7th, 2011

After a life-changing experience, Boston area businessman Dave deBronkart has re-named himself E-patient Dave.  My introduction to Dave took place on January 26th, 2010.  We were both invited to make presentations in Washington D.C. at the Health 2.0 STAT event. This was my first rapid-fire Ignite or Pecha Kucha-style presentation, and, frankly, I was at first a little overwhelmed by the brevity. Having been a teacher for the first decade of my career, the experience was similar to following the Assembly Day bell schedule in any school. We had strictly limited time to “tell our story,” and as the first hospital CEO in the country to have had my own blog (beginning in 2005), it was a story that I had told before in cities like Chicago, Las Vegas, Washington D.C., Charleston. What I hadn’t expected to hear that evening was my fellow presenter Dave’s powerful and inspiring story.

Interestingly enough, after retiring from my hospital CEO position in 2008, my passion had been redirected toward the one thing that touched me the most during my 22 years of hospital administration, patient advocacy. It was simple to me. The United States of my youth was changing, but healthcare, not unlike many other professions, has always been filled with terms, attitudes and activities that are mysterious, confusing, sometimes inhuman and usually concealed from the very patients who are receiving the services and benefits. Consequently, it was my desire to reach out to every person to let them in on the “inside track” to healthcare, to share with them the insights gained by my two-plus decades in the business, and to help them get the excellence they truly deserve regarding treatment, respect and care. The result was my first book, Taking the Hell out of Healthcare.

Dave, on the other hand, told the story of his own very personal journey through his near-death experiences as a patient at one of the Harvard Hospitals. His very moving and special story was one that not only touched everyone’s heart; it also demonstrated the very deep and real need for transparency, communication and access to our own health records.  Interestingly, the happy ending to Dave’s story was a twist on what had been a very moving and very different ending for one of my closest personal friends about two decades earlier. So, the good news for Dave was that they had refined, improved and eventually perfected that treatment that saved his life.

The most important aspect of his story, however, was that his physician encouraged him to seek input via the Internet from other people who had lived through similar experiences. It’s where Dave found the recommendation that later proved to be the secret to his survival.

Because of his compelling story, his amazing recovery and the beauty of having lived to participate in his daughter’s wedding, there was not a dry eye in the house. As a patient advocate, I freely admit that included my own eyes. Dave is exactly what this country needs right now. He is a man who is utilizing all of the tools available to all of us via Internet connectivity, and he is pushing hard for positive change that is sorely needed in our field.  So, you go, E-patient Dave… don’t stop now.  In fact, don’t ever stop.

e-Patient Dave de Bronkart, Nick Jacobs, FACHE, Health 2.0 DC STAT meetup #health2stat

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The Budget Impasse and Death

July 16th, 2011

David Brooks wrote a very interesting column last week in the New York Times entitled  Death and Budgets,” in which he explains the current Washington D.C. budget impasse and compares it to our collective inability to come to grips with our own mortality.

David Brooks - The New York Times - Nick Jacobs, F. Nicholas Jacobs, FACHE - healthcare - healing hospitals - SunStone Consulting

David Brooks | Josh Haner/New York Times

His treatise quotes S. Jay Olshansky, one of the leading experts on aging, who argues that life expectancy is now leveling off, and others who say that, we are marginally extending the lives of the very sick. Brooks goes on to articulate that, “A large share of our health care spending is devoted to ill patients in the last phases of life.”  Then enumerates upon the fact that, as a country, we will be spending $1 trillion dollars annually, double Medicare costs right now, on Alzheimer’s disease alone by 2050.

His closing thoughts revolve around the fact that “unless we confront death and our obligations to the living like his friend who was recently diagnosed with ALS, we will not be able to reduce health care inflation and balance our budgets. “ He then concludes that “we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.”

Since 2005 I have written  many times about this issue. In fact, one of my most quoted experts on this topic is a previous Pittsburgh resident, former Colorado Governor Richard Lamm, who spoke openly about the immorality of “inter-generational resource theft,” where the voting senior citizens have pulled the majority of the healthcare resources away from the children of our nation. According to Lamm, this generational robbery has contributed to produce one of the highest infant mortality rates in the civilized world  and has provided the resources allowing our seniors to squeak out another few months or days of life.

I also remember one of my Carnegie Mellon professors, Ian Rawson, PhD, describing the resource challenges presented in certain extremely conservative states where they have refused to fund organ transplants for children.  Obviously, those who voted most often and most passionately were the seniors themselves who could then use those resources for mechanical life support or surgeries on the frail elderly that neither extend nor improve the quality of their lives.

As a former hospital CEO, it seemed clear that the medical schools had taught the Northern European philosophy that “Death at any time is failure.”  It seemed that the very reality of our mortality was overlooked.  Having had responsibility for funding a palliative care unit in my last hospital, it struck me as sad that the vast majority of patients being admitted there arrived for the last week, day or few hours of life, and the “life extending measures that had be foisted upon the patient and their families” prior to that time neither reversed the disease nor improved the quality of their lives.  Unfortunately, some of this is about income for the provider, but most of it is about our inability to face the end of our time here on earth.

It was always disconcerting to see a priest or minister as a patient in critical care screaming out in fear of their own death.  It would seem that they, of all people, could find peace in the upcoming transition. So, what about the rest of us?

In closing, and this too is my “one note samba,” until or unless we begin to reimburse for wellness care, embrace death as part of life, and stop rewarding our scientists for “not sharing their ideas” with each other, we will continue to act pretty much like my daughter’s dog, Chipper. Tail-Chasing-R-Us, and Washington DC is currently engaged in chasing a tail that could easily wipe all of the china off the dining room table.

All we seem to see are blades of grass in our fields of dreams.

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Geographic Variances in Medicaid Spending – And the Winner Is?

July 7th, 2011

Health Affairs cover - Nick Jacobs, FACHE - Medicare - MedicaidWhen Health Affairs released a first-ever study of geographic variances in Medicaid spending on July 7th, it was a new twist on transparency that is just the beginning of what will become a detail-by-detail exposé of care and treatment of patients in the United States.  Just imagine a few years from now, when every record is electronic and every detail will be instantly available to the government.  Like this variance report, we will begin to see the good, the bad and the ugly of how medicine is practiced in this country.  So… how do you spell transparency?

A few weeks ago, the New York Times ran an article in which the “overuse of Medicare-funded CT scans” was explored. Featured in the digital version of this article was an interactive map showing virtually every hospital in the United States, and as the mouse was passed over each hospital, the percentage of inappropriate CT scans appeared above the facility’s name. If yours was one of the hospitals that was 80+ percent over using this device in multiple single-day scans, you were, as they say, “busted.”

Well, this release exposed at least one entire section of the country that is overusing Medicaid on numerous levels.  Although the study revealed a wide variance in per-beneficiary spending, one geographic region outshined them all.  The findings showed that after adjusting for the case-mix of patients, variations are driven mostly by volume of services provided and, to a lesser degree, by price.  Per-beneficiary spending in the ten highest states was $1,650 above the national average, mostly caused by the greater number of services provided.

Image credit: New York Times

One of the most significant findings revealed by this study was that the supply of primary care physicians in specific areas was associated with reduced rates of admissions for diabetes, lung disease, and adult asthma.  The authors suggest that this finding might point to the fact that increased access to primary care providers may result in improved management of common chronic diseases for people on Medicaid.

So, by now you’re asking, “Who won?  Who used more money per capita to treat Medicaid patients?”  It was The Mid-Atlantic States : New Jersey, New York and Pennsylvania used more Medicaid funds per capita than any of the regions in the United States. For example, the per beneficiary cost in New York was twice that of California; $21,195 for New York vs. $11,200 for California.

As a region, New England used the least amount of Medicaid resources and as a state, Washington provided the best example of “how things should be.”  How did they do it?  They increased access to primary care and reduced hospital care.

Todd P. Gilmer, Ph.D.

Todd P. Gilmer, Ph.D. - UCSD

Finally, places that had higher numbers of hospital beds and specialists were associated with higher numbers of hospital admissions while higher numbers of primary care physicians were associated with reduced rates of hospital admissions… Todd P. Gilmer, PhD, professor of health economics in the Department of Family and Preventive Medicine at the University of California – San Diego said, “By looking at service mix, access and price, states can find ways to make their programs work better.”

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People and Ponies

June 26th, 2011

I’ve been periodically volunteering my weekend time to help establish an equestrian healing center where the horses help to heal the people. Although I’m not particularly connected to horses, I appreciate them and like to watch them run freely through the fields. It’s the people in this particular volunteer leadership group, however, who “make me tick.”

Over the last twenty or more years, I’ve had several opportunities to meet healers. Now, don’t get all “New Age-y” here and run out of the room screaming. These people are “pure of spirit,” and have no ulterior motives, except to help other people navigate through this sometimes relentlessly unforgiving maze that we call life. There are two doctors, an RN, two equestrian specialists and a couple of administrative types like me who simply believe that mankind is somewhat intellectually challenged, and not always capable of grasping anything that is not black and white or concrete and factual.

Surely, with all of the things that we purport to believe in religiously, it seems incomprehensible to me that we, as a group, have problems giving it up to the fact that our brains, our spirits and our hearts don’t or can’t play a larger role than that assigned to us by our Primary Care Physicians or our big Pharma companies. For the most part, we believe in an after-life, we believe in miracles, we believe in goodness, but we have problems understanding how an Autistic kid on a loving, nurturing horse can be helped. It’s because there have not been enough control groups, double blind studies or scientific documentations to support the theory, and typically those scientific theories are only scientific law until they are proven wrong, and that has happened plenty of times.

The freedom of having been a nonmedical, nonclinical, nonscientific healthcare CEO was that “I really didn’t care what made people get better; just so they got better.” Consequently, if a golden retriever licking your hand or a clown bopping you with a sponge hammer, a violinist, a massage therapist, an acupuncturist, a flower essence or aroma therapy specialist, a reiki master or a visit from your grandchild helped you, it was all good to me. Pick your passion and start to heal.

The only real way to describe this philosophy was “Open” because that’s what it was and is. One of the amazing aspects of the collection of healers that have gathered to lay the groundwork to make this amazing dream operational is that they also believe that there is much more to healing than a pill or seven pills, and they are more than willing to be open to the spirit of healing.

Of course, one of the problems with this type of work is that you have to “let go” to allow things to happen, and if you are too into the discipline of concrete and only proven science, you will not let enough of your guard down to see what can happen. The problem is that we’ve all heard about the quacks who almost religiously rip off naïve people with magic elixirs or spiritual interventions like Whoopi Goldberg called forth in the beginning of the movie “Ghosts,” but our collection of healers is filled with people who are sincere, well-trained, highly-credentialed and, believe it or not, open to understanding what may otherwise be ignored by the scientists or the traditional establishment.

So, on we roll in search of others who believe that there may be ways to help people that have not been used for several decades or centuries where the brain leads itself into healing or where the switch that turned the gene on inappropriately can be coerced into reversing that physically destructive non-decision. Life is a journey, and when I look back at all of the people who were helped because of things that sometimes make no sense to anyone else, my only response is “Yeah, that’s right.” It can happen, and with the help of other believers it will happen.

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Coffee and Cancer

May 19th, 2011

Several years ago, at the Clinical Breast Care Project’s (CBCP) offsite retreat with the physicians from Walter Reed Army Medical Center, our biomedical informatics group had prepared a demonstration for the CBCP’s Scientific Advisory Board, a group of distinguished scientists, breast cancer consultants and physicians.

Colonel Craig D. Shriver, MC Director, Clinical Breast Care Project Program Director and Chief, General Surgery Walter Reed Army Medical Center

COL Craig D. Shriver, MC Director, Clinical Breast Care Project (CBCP), Program Director & Chief of General Surgery, Walter Reed Army Medical Center

As the 7:00 PM meeting time approached, it was obvious that there was not going to be a quorum present to start the formal meeting.  The two additional members had called in and we sat waiting patiently for the remainder of this august body to join us; fifteen minutes passed, then twenty and finally at about 7:25 PM, the group burst apologetically into the conference room to begin the call.

In case you’re wondering what would have caused such a delayed response from an otherwise very prompt group of individuals, it was the introduction provided by the biomedical informatics group of how this data repository’s capabilities could be explored.  The advisory group was so captivated by the power of this tool that they literally became lost in the excitement of the demonstration.

This form of science was fascinating to me, because having trillions of pieces of data available from thousands of women allowed the queries to be guided by the data itself.  When this power was coupled with the normal questioning generated by the intellectual curiosity of the individual scientists, the outcomes were beyond fascinating.

For example, you could ask the question, “How many of you drink coffee?” The thousands of participants whose biopsies – both malignant and benign – were being stored in the tissue repository at our research institute had agreed to answer over 500 demographic questions relating to their very personal and now anonymous lives. A graph appeared showing the proportion of women who were coffee drinkers. When I then asked, “How many cups a day do you drink?”a new graph appeared with that information as well. My final question was, “How many of you were diagnosed with breast cancer?” This resulted in an interesting fusion of information. The women who consumed the most coffee had the least amount of breast cancer. Of course, that general assumption needed to be researched, confirmed and proven in numerous ways, but there it was, way back in about 2005.

A report that touched on this topic was released during the second week of May, and it was fascinating. It was a Harvard study that followed almost 50,000 male health professionals for more than two decades.  Over 5,000 of the participants got prostate cancer – 642 of them the most lethal form. “For the men who drank the most coffee, their risk of getting this bad form of prostate cancer was about 60 percent lower compared to the men who drank almost no coffee at all,” says Lorelei Mucci, an epidemiologist at the Harvard School of Public Health and an author of the study. The same group reported about a 50 percent reduced risk of dying from prostate cancer among men who took two or three brisk walks a week. As a part of our funding, similar studies performed by the Preventative Medicine Research Institute under the direction of Dr. Dean Ornish also confirmed this exercise theory of risk reduction for prostate cancer.

The new study shows that a 60 percent reduction in risk of aggressive prostate cancer requires at least six cups a day. However, men who drank only three cups a day still had a 30 percent lower chance of getting a lethal prostate cancer, and that’s not bad. Earlier research also suggests coffee reduces the risk of diabetes, liver disease and Parkinson’s.

But here is best part of this story. Just last week, Swedish researchers reported that women who drink at least five cups of coffee a day have nearly a 60 percent lower risk of a particularly aggressive breast cancer that doesn’t respond to estrogen.

Epidemiologist Mucci says more research is needed before officially urging people to drink coffee for its health benefits. Meanwhile, she says, “there’s no reason not to start drinking coffee.

So, all of these years later, the National Cancer Institute is using about 200 of these CBCP biopsies from that same tissue repository to map the Human Breast Cancer Genome, and everyday new reports are emerging that confirm the value of this research. All of this from a little coal mining town in Western Pennsylvania – the location of the research institute and hospital where I served as President and CEO – just three seconds in air miles from where Flight 93 went down.

Now that’s a story.

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