Archive for the ‘Wellness’ category

Healthcare Reform? Blow it up, and Start from Scratch!

June 20th, 2009

Healthcare Reform? The premise and the incentives are wrong.  We treat sickness (which can be a good thing), however, we do it to the almost total exclusion of encouraging and incenting wellness. While in the Netherlands a few years ago, I asked a very comfortably-situated business person why she and her entire family all rode bikes. She smiled and explained that the millions of bikes in the Netherlands are a way of life because they keep people healthy.  Of course, we don’t have to ride bikes, but why not?  “It is much less costly.  It gets us where we want to go, and it is so much better for our bodies,” she said.

Photo credit: Amsterdamize
Photo credit: Amsterdamize

After going to doctor after doctor in my early thirties and then again in my early forties for a recurring and seriously painful back problem, someone suggested a Chicago-trained chiropractor.  After a very quick, one time manipulation, he said, “Follow me, please.”  When we descended the stars of his office, in front of me was literally an entire homemade work out facility.  This particular center seemed to emphasize strength training.   The Doc walked me over to a row of three machines and said, “If you use these three machine or their equivalent, just the way I show you, you will never have to come back here again.”  Then he said, “Oh, and if you drop fifteen pounds, you may be able to get off those blood pressure pills, stop taking that stomach medicine, and feel better about yourself in the process.”

The Dr. Dean Ornish Coronary Artery Disease Reversal Program is completely about health and prevention.  It is about wellness; treating yourself with the love and respect that you deserve, being kind to yourself, yet being disciplined enough to get you where you need to be in order to enjoy a healthy, pain free life.

We spend only 4% of our health care dollars on prevention.  That may sound like a lot to some of you, but do the math.  Take 4% and multiple it times $2.2 trillion …or possibly soon $3 or $4.0 trillion.  Every physician should endorse a workout facility and work to send you there, and every physician should receive bonuses for having you use it.  A primary care physician in Britain can make about $320K a year, which includes incentives directed toward encouraging healthy living for their patients.  Our primary care docs make, what, $130,000, $150,000, $180,00 in comparison?   Would you really care if your physician could make almost twice as much if you were living a wonderful, healthful, reduced stress life?

There is absolutely NO DOUBT in my mind that the reason I’m typing this here today and not deceased at age 58, like my father, is because of the work of people like Drs. Ornish, Benson, Jonas, and Weil.   It is not because of my old donut shop, the nachos and cheese, the automobiles, my Lazy Boy, or the grueling work habits that we Americans think of as normal.

And what about death?  I have to tell you that death happens to all of us.  (Sorry.)  When it happens may depend a great deal upon our recognition of that fact, but it is not avoidable.  So, why is it that we, as a society, reject death as evil, and ignore its possible existence?  How could we cut billions and billions of wasted healthcare dollars?  Hospice is the answer.  Don’t commission oncologists for drug use when there is absolutely no hope that the patient will live.  Don’t pay radiologists for radiation treatments that will not work in preventing death.  Don’t reward hospitals financially for readmission after readmission for people who should have been told to mark  their DNR’s months earlier.  Face death as part of life.

healthy_food

Finally, look at the food and restaurant industry.   For every restaurant or food company that pulls a killer food and replaces it with the reasonable alternatives, reward them through the $3 or $4 trillion health budget.  You can buy veggie hot dogs on the streets of Toronto.  (Try Morning Star Farms brand veggie hot dogs.  They rock.)

In closing; diet, exercise, stress management, balanced lives, less capitalistic rewarding of killer diets, higher reimbursements in healthcare for the “right stuff,” and acknowledgement that this will eventually end, can make it all work so much better, so much cheaper, so much easier.  Did you have your pneumonia shot yet?  Well, actually, you may not need one if you start taking care of yourself.  I’m going downstairs to workout now.

Next time?  Tort reform.

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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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Make Sure That You are on the Right Side of the Paradigm Shift

January 15th, 2009

The word paradigm provides a cerebral representation of a model that, throughout our lives has remained relatively constant. Transformational changes in the manner in which we travel, how we communicate, and even in the ways that we are educated have simultaneously produced significant shifts in those models as well. In the early 90’s, we were informed that the information being transferred to us would only be viable and, in fact, would be very nearly invalid within about 18 months or so after ingestion.

Those parameters of informational decay continue to diminish exponentially as we immerse ourselves in 24-hour instant access to changing data, innovative discoveries, and altering states of acceptance of ideologies that were once believed to be infinite in their substance. Science is only valid until the next discovery.

The archetypical model of high-tech health care that was believed to be our “Star Trek” salvation from the ills of our parents, and their parents is currently being exposed as an artificial promise that has failed to deliver healing. Each decade our technologists have produced new; more sophisticated, and higher priced equipment with promises of earlier detection. Unfortunately cures have not been part of the equation. The additional technology has simply produced additional questions.

As we delve into the diva world of science, we find many reasons why significant progress has not been made, mostly related to a lack of continuity in the incentive systems. But, because of these failures to heal, we also may now be able to discern another reality that will truly contribute to the new world order of medicine.

Dr. Lee Hood, M.D., Ph.D

Lee Hood, M.D., Ph.D

Dr. Lee Hood, infamous for his work in the creation of the equipment used by our present day scientists, launched a school of thought that has been generally accepted in the scientific community, Systems Biology. Dr. Wayne Jonas has pursued with passion his work in Systems Wellness. Both of these edge-running thinkers are also working to contribute to a medical degree at a leading university that will be entitled Systems Medicine.

The uniqueness of this type of thinking is not the newness of it. It is, in fact, a melding of the old and the new, the oldest and the newest approaches to healing. What Drs. Hood and Jonas separately yet collectively are advocating is an approach to illness that embraces the complexities of genomics and proteomics and allows that knowledge to be firmly wrapped in a swaddling of information that, in many cases, has been with us since indigenous man walked the earth, an Optimal Healing Environment.

Wayne B. Jonas, M.D.

Wayne B. Jonas, M.D.

We have all been inundated by the mythical promise of cures from fraudulent presenters, and the result of those untested, unproven, and unfounded promises has created a culture of distrust, cynicism, and fear that thwarts the reemergence of those healing practices that represented not only viable alternatives, but, in many cases, the only alternatives that were available to our societies less than eighty years ago. As we more clearly understand that the human body is a comprehensive system that interacts within itself on a myriad of levels, we also can begin to understand why individual responses to certain types of healing modalities also produce very different results, i.e., Systems Healing.

The philosophies, beliefs, and practices of the American Board of Integrative Holistic Medicine, a major group of practitioners who have come together to provide not only education, training, and additional resources to physicians in general, have also come together to ensure that those Systems Healing practices that were pushed aside for the promise of high tech and high chemistry are reintroduced to medicine and healing in an appropriate and informed manners. Their work is not new to mankind, to medicine, or to healing, but it is a reemergence of those long proven, highly embraced modalities that promote and support health and wellness, the new paradigm?

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In Their Own Words: Patients, staff and physicians on their experiences at Nick’s Planetree hospital

October 5th, 2008

View SlideShare presentation or Upload your own. (tags: hospital medical)
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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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