This morning I had an experience that could only be described as Transformational. My presentation to the World Health Care Congress 2nd Leadership Summit was finished yesterday afternoon and it went as well as could be expected. We discussed HCAHPS, Employee Engagement, Patient/Family Partnerships, Evidence Based Design, and how to appropriately staff the various seats on the proverbial bus.

My flight was not scheduled until Friday, so attendance at the morning sessions seemed like a viable option. Listed on the speaker’s schedule was B. Joseph Pine ll, and his topic was “Work is Theatre and Every business a Stage and Authenticity: What Customers Really Want.”

As Mr. Pine went through his 55 minute presentation, my initial reaction was “Yep, knew that; heard that before; understand that,” but then, during the last five minutes of his prepared remarks, Joe hit us between the eyes with that thing that had always been there but had never become completely clear to me during the past two decades.

He asked us what people wanted when they joined a health club, went to business school, or a psychiatrist? The answer, of course, was that they were looking to be transformed. Each and every day for a dozen years, I have watched this process and never grasped the nature of this metamorphosis.

One of the participants made a point of asking why it was that a person could come to a hospital, have open heart surgery that changed or even saved their life yet would not donate even $200 back to the hospital during the annual fund drive? Yet that same person would leave their entire estate to a university that they had attended fifty years earlier? What was the difference? In both cases something dramatic had happened, but in the case of the open heart surgery, it was just seen and presented as a service or at best an experience.

The university however, provided a significant transformation of the life of that person. This simple description explains why so many open heart patients go back to doing exactly what they had done in the past, and end up back on the table two or three more times. It was seen by the patient as a service or at best an experience.

With this in mind, my observations of what happened to those patients who participated in the Dean Ornish Coronary Artery Disease Reversal Program was that, for the most part, they had joined that program looking for a transformation, and that indeed is what they found. Most of the participants who had come there seeking a total change and a new way of living a more healthful life were transformed by the program. They no longer perceived of themselves as being victims of their health.

How does this all play out in the field of healthcare? WalMart is going to produce a commodity, electronic health records, competing with WalMart on any level will prove to be a fruitless journey because they have mastered the world of commoditizing services. The Starbucks experience may get customers in the door time and time again, but what is it that we need to do that will produce grateful, loyal, generous customers or patients forever? Provide a transformation.

For those of us who are getting this, begin to look at your hospital, your practice, your business as more than just a service and much more than an experience. Think of what you do as providing the tools necessary to transform those with whom you are working, and present your product, your passion, your involvement with the client, the patient, the customer as a means of transforming them. Dedicate yourself to helping them reach their goal of changing their life in a positive way forever, and see where that leads you. TRANSFORMATIONAL CHANGE is what we all seek at some level. The product: To help us make our lives better.

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Hospitals and health professionals rate as some of the most highly scrutinized organizations and businesses in the United States. Hospitals and physician’s offices, durable medical equipment companies, and home health agencies are under the magnifying glass of federal, state, and local government inspectors.

Some would say that this is with good reason as we scrutinize the numbers behind the analysis. As annual health care costs continue to ascend toward a projected $2.4 trillion (16.6% of the GDP*) and with health coverage a major political issue this year, the potential of a $72 – $240 billion annual loss (3% – 10%** of the total health care outlay) to health care fraud and abuse and mistakes, remains a major issue for private citizens, corporations and government agencies.

In order to put this in perspective, the overall numbers at play relative to the $2.4 trillion healthcare budget are significant. The monies estimated to be consumed inappropriately reach a staggering $236 – $787 loss per capita, or enough money to insure up to 30.5 million Americans, or 65% of today’s total uninsured population of 47 million.

The pendulum swings both ways in this scenario, however, as these issues occur on both sides of the provider and healthcare user coin. The Centers for Medicare and Medicaid began RAC audits utilizing Medicare Recovery Audit Contractors (RACs) to recoup $980M from Providers in demonstration projects in California, Florida and New York. To say that this system is fair, equitable, and was well conceived would be an exaggeration because the auditors employed to do these audits are paid a percentage of their findings, and that inherent conflict alone stresses the validity of this arrangement on many levels.

A few specialty healthcare finance based organizations like my new employer, SunStone Consulting, concentrate in preparing hospitals for these inevitable visits by the RAC auditors. When these specialty companies do their work appropriately there is no reason for the RAC auditors to destructively move through the billing and medical records departments of each hospital.

The very essence of the problem is that, no matter what the intent, any time federal dollars are involved, these investigating authorities appear to have already made a determination that the problem or mistake was a purposefully fraudulent act whereas, in fact, it is quite possible that it was an oversight, an honest mistake, or an inappropriate key stroke.  To determine the validity of these situations in which fraud, abuse, and overpayment are suggested, research through organizations such as HealthCare Insight specialize in identifying, preventing, and investigating both provider and patient fraud health care claims.

Companies like this typically provide private and public sector health care claims payors (Health Plans, MCOs, Insurance carriers, TPAs, Medicaid, Medicare, etc.) with a comprehensive suite of clinically validated fraud and abuse surveillance solutions designed to maximize claims administration accuracy and minimize payment waste.

Interestingly, with the bailout bills from both the Bush and the Obama administrations being activated on an ongoing basis, one must stop and ask how much each one of those nearly trillion dollar initiatives will cost to audit, investigate, and qualify. It’s obvious that the hands off theories did not work, and now we will see the pendulum swing back as far as it will to attempt to  over correct the sins of the past.

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It’s 5:33 PM on New Year’s Eve.  For some reason New Year’s Eve has become a significant contributor to some landmark memories for me, memories that will always be with me.  Maybe it’s because the day represents such finality.  Starting tomorrow, for example, 2009 better be the number that you write on the forms, checks, and documents because 2008 will be gone, gone, gone. 

One vivid and unique New Year’s Eve memory occurred back in 1985.  After making payroll 24 times a year for 59 consecutive months, success or failure all boiled down to the last day of December.  Truthfully, for the first time in five years, there was not enough cash to compete the payroll.  As I was closing down the office and preparing to leave for the night, the main door of the building opened and footsteps could be heard coming through the gallery.  My mind went immediately to the dark side.  Is someone coming here to rob or kill me?  Let’s be candid, this was a rural arts center, for goodness sake on New Year’s Eve.  Who in their right mind would be coming into the gallery five minutes before closing? 

As it turned out, the footsteps were coming from a donor who was there to present me with a check.  That check came to exactly the amount of money needed to complete payroll.  My immediate response was that the universe had, once again, taken care of the problem, but later, the concept of almost not making payroll put me over the edge and sent me on a job search for something that was just a little more secure. 

For two years after my father died, pneumonia became my New Year’s Eve visitor.  My kids were two years old and five months old, and my chest cold had gotten worse and worse until finally, the doc said, “It’s pneumonia.”  So, 1975 and 1976 were my pneumonia years.  The most memorable part of those two years was that pneumonia boy got to stay at home with the kids while the rest of the world partied.

Finally, the New Year’s Eve of Y2K holds a prominent spot in my brain as well.  The team of IT specialists, finance personnel, maintenance, and administrative leaders all gathered in the conference room to ensure that the the world would not come to an end.  Some of you have read the story before, but just as the ball began to drop on Times Square, one of our computer jocks accidentally leaned up against the light switch and all of the lights went off simultaneously.  A wave of palpable fear swept through the room until one of the team members said, “Hey, the television isn’t off; we’re okay.”

Well, today was my last day of work as a hospital administrator and research institute executive, but the puropse of this New Year’s Eve blog is not to tell you about my pneumonia, about light switches going off, or even about making payroll.  It is to let you know that, in spite of the title and career change, we’re doing okay.  So, Happy New Year to all, and remember, the only bad New Year is no New Year.

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For those of you who might have any interest in this topic, read on . . . for the rest of you, have a great holiday. 

With seven working days remaining until the name of this blog should be officially changed to Ask a Former Hospital President.com, I’d like to just make a short list of the areas in which I have been and will be working as the International Director for SunStone Consulting.

1.  Patient Centered Care. . . It is clear that this area of expertise will be my first and foremost focus, my passion.  How can any hospital succeed in this arena?  How do you become not only patient but also employee centered in such a significant way that your HCAHPS scores improve, your infection rates will go down, your length of stay will decrease, and the bottom line will improve significantly?  That’s the story that is burning inside me.  So far my new job has included significant keynote speeches, visits to hospitals seeking this guidance, and plenty of blogs and articles.  With organizations like Planetree, the Samueli Institute, and American Healthcare Solutions seeking to spread this word, this topic should consume a great portion of my time.

2.  Patient Advocacy. . . When the day is done, and my time is over, it is my very deep desire to have helped to change healthcare significantly, and patient advocacy is a very clear key to the success of this goal.  My book “Taking the Hell Out of Healthcare” was the first step toward telling the advocacy story. 

3.  Being Green . . . No matter what the pundits say, the world will only become a better place if we all work toward a common goal, to reduce the carbon footprint.  The investments made in this arena will result in a multi-fold financial and philosophical payback to any organization seeking to explore a green philosophy.  We have agreed to do Beta work in this area, and believe that every hospital will benefit financially from this initiative.  Pittsburgh Gateways is leading this initiative, and it is my commitment to work with them to bring to my CEO peers not only the how to but also the financial benefits that will make this work possible.

4.  Being Digital. . . As my current position comes to a close, we can openly declare that we will be completely digital before the end of the fiscal year.  One of our tasks has been to bring groups of hospitals together through fiber connections for work on tele-mental health, tele-pharmacy, and disaster recovery.  These are only three of the myriad of initiatives that fiber connectivity will permit.  Corathers Consulting will be working with me to help introduce various aspects of this somewhat complex initiative to hospitals throughout the United States.

From these four areas of expertise, dozens of additional projects, services, and opportunities will also be made available like arrows in a quiver.  We will continue to promote our knowledge regarding the use of genomics in the hospital setting.  We are also working with groups to introduce other services through our peers and partners that will help hospital CEO’s in their journey to fortify and grow their organizations.  Areas such as strategic facilities plans, construction and finance alternatives, physician strategic plans, physician office work, legal partnerships, food purveyors, insurance services, benefits management, case management, fund raising, marketing, as well as literally dozens of other growth and infrastructure opportunities will be on this menu.

SunStone is also working with me on the most important aspect of these initiatives and that is to help hospitals, practices, and senior leaders find the money to initiate every aspect of the programs needed to thrive.  Be it DRG Transfers, Workmen’s Comp initiatives, RAC preparation, and a myriad of other financial initiatives that will result in finding or reclaiming money, SunStone has that expertise to bring to these initiatives as well.   

So, as Bob Hope said so many times, ”Thanks for the Memories,” and thanks to everyone who has helped me through this very emotional transition.  Please don’t forget to “Ask A Hospital President.com” after the new year begins because being busy is my goal and helping you is my passion.

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After nearly a dozen years, I attended my last board meeting as President/CEO of this hospital yesterday. I believe that I have missed only one meeting in all of those years. As I retire from the day to day operational aspects of health care and move into the next chapter of my life, it seems like a good time for reflection.

Looking back at the previous twenty plus years, my heart is filled with wonderful memories and the support of many friends, and it is also filled with the challenges and hurts that are almost always a part of senior leadership. A mentor once told me that, “The wind blows hard at the top of the pole.” I’ll never forget another suggestion that came to me from one of my former bosses when I informed him that I was thinking about becoming a hospital president. He said, “If you think you want to run a hospital, make sure you go somewhere where it is the only game in town, in the county, and preferably in the region.” Well, obviously, that was one more piece of advice that went by the wayside. We landed in a place where there were four hospitals all using the same media.

Having started as a musician and band and orchestra director, I have never moved very far from my education roots. It has always been about open communications, respect, dignity, encouragement, a spirit of co-operation, and positive mental attitude for me and those around me. In many ways, being a dad and a teacher was the best practice anyone could have had for running a hospital. Even though one of my favorite sayings was “I don’t want to be anyone’s parent here,” it seemed that there were numerous situations that were similar to the same types of issues that were regularly part of any family’s interactions.

Health care, however, is changing rather dramatically. As our economy and the Boomers both begin to shake, health care has to seek its own level. Will it be directed more toward wellness and prevention? Will it be rationed? (Rationing, of course, would indicated that everyone would get some of what is being offered. You know, similar to sugar rationing in World War II. They just wouldn’t get as much. The reality of our current system is that some get everything and others get NOTHING. Consequently, rationing may not be a great description of this process.)

My new charge is to help hospitals find their niche’, to help them find money and most importantly to find stability by becoming patient centered. We will be attempting to provide hospitals with the knowledge gained from over twenty years of experimentation into areas that had not been popular before we explored them. We will be helping hospitals to become patient-centered, digital, and green to name a few.

Some day, all of this will make sense to those of you who doubt. It was interesting when my career path went from teaching, to arts management, to tourism, to health care. The skeptics deeply questioned the transitions, but it all made sense. As I went from one discipline to the next, it all merged together in a meaningful way in health care management.

Now, we are launching into one more area of expertise, but this time, we have 40 years of experience, and deep knowledge regarding not only life, but marketing, communications, Web 2.0, patient centered care, construction, carbon credits, ambiance, Planetree, Optimal Healing Environments, employee centered care, recruitment, data mining, proteomic and genomic research, wellness centers, hospice, behaviorial modification, food services, fund raising, integrative medicine, and digital radiology equipment. So, if anyone needs a motivational speaker, some advice on OC48 lines, 3TMRI breast coils, micro turbines, public relations campaigns, or anything from the list above, remember me. My web address contact information will be nickjacobs@sunstoneconsulting.com.

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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.

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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.

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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?

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