Posts Tagged ‘health’

Don’t Eat Sparkling Sandwiches

May 23rd, 2012

When I was 18 years old, I got a summer job for college in the local glass factory. As a pre-college student, I had assumed that my work would be in the corporate offices, but I was so wrong. That first night I was to report to a place called the forming department (I thought they filed forms there) but no, it was where the molten glass was molded into beer bottles, baby food containers, and fancy cut glass vases. This place glowed like the fires of hell. As I entered the building that very hot summer night, the unbelievable temperature from the furnaces hit me like the exhaust of a moon rocket, and my relationship with salt tablets, the treatment recommended for perspiring in those days, was also about to begin.

It was during my lunch break where I got my first real taste of the glass business, literally. My mom had packed a chicken breast sandwich with lettuce and mayo on white bread, an apple and a couple of chocolate chip cookies. All of the employees were permitted to use factory-made glasses for drinking their Mountain Dew, and there was even chipped ice to put in the glass to cool the hot sodas down.

I carefully positioned myself on a filthy bench without noticing the tracks where the batch cars passed overhead. As I carefully opened the waxed paper protecting my chicken sandwich and then opened my mouth to take that very first, long awaited bite, the wind blew. With that a magical cloud of fairy dust came blowing off the car above me. At first I was dazzled by the sparkles as they rained down on my body, but then I realized that the batch cars were carrying pulverized glass. They were filled with infinitely tiny recycled glass particles.

As I looked longingly at my sandwich, it struck me that the glistening topping twinkling across it was, in fact, glass, but my hunger prevailed. I took what turned out to be a little bit of a crunchy bite of the sandwich and began to chew that glass dust-coated chicken. It was after the first few bites that I seriously started to question my own sanity, but my hunger prevailed, and I ate the whole thing. To this day, my mind still wonders if any of my physical imperfections are directly related to glass consumption; GERD, nervous leg syndrome, painful itching…well, you get the idea.

Todd Robbins - Hyalophagia - glass eating - picaSo, the question remains. Did I eat that sandwich because I was starving, exhausted and overworked? Or did I eat it because the frontal lobes of my brain had not yet fully developed and, not unlike many other stupid things that eighteen year olds tend to do, it was the Gump saying, “Stupid is as stupid does.” Either way, it was probably an irresponsible, careless, foolish decision that minimally could have permanently damaged my – oh so exquisite – taste buds or at least caused irreparable tongue scars. The good news is that, to my knowledge, I have not eaten any more glass since then.

The moral of this story? Be aware of the fact that, if you are hired to work in a factory, you will probably end up actually working in a factory. If your black trousers turn white and your white shirt turns black from dirt and perspiration, don’t eat 15 salt tablets. Always, and I do mean always, duck when you see molten glass stringing wildly out of the ceiling like Toffee gone wild. Don’t ever steal uncured cut glass, because it will explode on your mom’s mantel a week or two later. Don’t sit under a batch car (whatever the heck a “batch car” is), and when your white bread makes a glass-like crunchy sound, for goodness sake, don’t swallow it!

As my grandmother would always say, “Keepa you chickie covered.”

Share

The Patient-Physician Connection

November 28th, 2011

With age, one sometimes begins to accumulate wisdom, and, although I am not one to focus on the woulda, shoulda, coulda opportunities that have passed me by, one regret that I surely have is that I had not met Dr. David Rakel  until about three years ago. Dr. Rakel is the Director of the University of Wisconsin Integrative Medicine program.  He attended medical school at Baylor in Houston, Texas, and completed a family practice residency in Greeley, Colorado.  He is a doctor, a father, an academician, but most importantly, he is a healer.  Of all of the physicians that I have ever known – and there have literally been hundreds of them, Dr. Rakel embraces all that is good in the medical profession.

David P. Rakel, MD - Healing Hospitals - Nick Jacobs, FACHE

David P. Rakel, MD

In his presentation, “Placebo or NoCebo,” David outlined the ingredients present in a healing environment:  1. A relationship with a helping person, 2. A healing setting, 3. An explanation that gives a sense of control of a symptom.  4. A ritual procedure or plan that involves active participation of both parties – patient and clinician – that results in belief towards action.  He spoke passionately about the importance of touch, the intrinsic value of healing, and the fact that something was done with the ritual.  One of my favorite, tongue- in- cheek quotes that David had was from Voltaire: “ It is the physician’s duty to amuse the patient while nature cures the disease.”

Dr. Rakel talked about the intelligence of being positive while giving the prognosis, showing empathy, empowering the patient, and demonstrating the importance of having a connection between the physician and patient.  I’m sure that I’m not capturing all of the salient points that David carefully made, but I am sure that I understood his commitment to connection with the patient and the significance of using as many positive words as possible to convey that connection.

Once again, a great quote from Dr. Rakel revolved around the fact that you get better faster if you have unconditional love from your pet than a bad connection with your doc.  He and his research on the common cold both suggested that, “It is better to stay home and be licked by your dog, than to spend time  at a clinic with a grumpy doc!”

His recommendations to his residents and to all of the physicians to whom he lectures is that the physician needs to display empathy, compassion, patience and the ability to listen.  His counsel to meditate revolved around the need for us to get out of our chaos and influence self-healing mechanisms.  He described this journey from awareness to awakening to authenticity and finally to awe where the closer that we get to authenticity, the more beautiful our lives become.

Dr. Rakel then launched into numerous studies that evolved around the placebo effect such as the study where arthroscopic knee surgeries were “faked,” but resulted in positive outcomes.  By referring to obesity as working toward optimal weight; chronic pain as myofascial health, depression (and this is my favorite) as potentially happy, the patients are not labeled with negative implications, and we accomplish a shift in our intentions.  Not unlike what Newton, Einstein and Stephen Hawkins have done in physics, perceptions have been shifted by changing the manner in which we observe things.  He said, “How about if we tell the patient that they are potentially happy rather than clinically depressed?” Our intention is reflective of our future.

Finally, Dr. Rakel suggested that physicians protect time in their schedules, create space, create positive patient expectations, be fully present and listen to the patient, that they offer support and collaboration and create a plan by using words that heal rather than words that harm.

Right on. Thanks, Dr. Rakel.

Share

Temporary Immortality

November 8th, 2011

ABIHM Header 1 - Integrative holistic medicine

I’m speaking at the American Board of Integrative Holistic Medicine’s Educational Conference today at 2:00 PM, but have been listening intently to the various presenters — my fellow board members, throughout the event. All of these folks are MD’s who embrace holistic (body, mind and spirit) and integrative (the world’s greatest) treatment modalities for appropriate care in medicine.

I’ve learned about Abraham Flexner who wrote a white paper in 1910 that became the de facto guideline for what would be taught in medical schools; essentially, a reductionist approach to practicing medicine which has led to the modern formula of medical practice, where the physician asks, “What’s your chief complaint.” Then he or she treats that — many times as if it were a stand-alone, unconnected condition, unrelated to any other causal factors.

This type of practice has virtually eliminated the holistic approach and pushed medicine into ICD9/10 codes, (currently going from about 14,000 codes to nearly 68,000…in fact, there’s even one, specific code for “injury caused by riding on the back of pig.)  It all becomes a matter of diagnosis of disorders leading to the prescription of drugs. The U.S. is spending $308 billion a year on pharmaceuticals, which is one half of the expenditures of the rest of the entire world in drug purchases. We’re spending about $14.6 billion on anti-psychotic drugs and $10 billion on antidepressants, alone.

The $2.5 trillion that we are spending on healthcare in the United States is NOT allowing us to live longer than other countries, and the really sad news is that most of these expenditures are for preventable diseases. About 90 percent of our expenditures are because of stress related issues, and when we take such amazing statistics into consideration as the fact that the United States consumes two times more fat than Asia, three times less fiber, and 90 percent more animal protein, it has to make us think a little bit about this course that we are currently pursuing.

If you study the statistics, you’ll see that China consumes less red wine than us…but their population lives longer. Japan consumes less fat than we do, and their population lives longer. Italians consume much more red wine than we do, and they live longer. Germans do everything wrong, i.e., eat high fat, drink lots of beer, eat sausages and fats and even they live longer than Americans. What must our conclusion be? Maybe living in the United States is the problem? (Just kidding . . . but maybe it is the fact that we are so intensely committed to a more-is-better philosophy.)

As a population we eat about 50 tons of food in our lifetime. In fact, it’s probably been closer to 51 tons for some of us, and, for the most part, we’re eating lots of chemicals, insecticides and antibiotics in our unnatural and subsidized corn fed animals, and farm raised fish.

Where am I going with all of this? Have you ever been around a really cocky kid who acts like he or she is invincible? That’s why our highest death rates in the teenage years are primarily related to automobile accidents with Caucasian teens and guns with many of the ethnic teens. They truly believe that they are invincible.

It’s always been interesting to me that those people who have been fortunate enough to have lived charmed lives with no sickness and no close relatives or friends who have died have a certain air of immortality that surrounds them. They are lulled into the belief that they will beat the odds and live forever. We are, in fact, on a finite journey that requires us to provide some self-nurturing, lots of personal lifestyle education and a willingness to try to do what is best for our long term quality of life issues the majority of the time.

The bottom line? as my blogger friend, Paul Levy says in his most recent blog post, we are dealing with “temporary immortality.” So, live every day as if it is your last and take better care of yourself.

Share

Steve, Dean and Nick: Be “Insanely Great.”

October 25th, 2011

Steve Jobs - HealingHospitals.com - Nick Jacobs, FACHE
During this time of economic uncertainty, the recent loss of creative, innovative leaders like Steve Jobs and Dr. Lee Lipsenthal adds to a collective national and personal concern over what seems like a serious lack of truly inventive and ethical leadership. Who will represent the next wave of 50-something leaders, and how will their personal characters influence upcoming generations?

One hope that I have for the future is Dr. Dean Ornish, a man who has been a personal friend, mentor and physician to both Mr. Jobs and Dr. Lipsenthal. To describe Dr. Ornish as a man of character, knowledge and creative medical vision would be akin to calling Winston Churchill a “good dinner speaker.”

Dr. Ornish and I have a long history of friendship, respect and support for each other’s work. Years ago, wanting to avoid being a heart surgery patient, I began to explore alternatives to legacy procedures and regimens. And, not unlike Steve Jobs, whose initial interest was also to avoid having his body violated by surgery, my research led me to the work of a young Dr. Dean Ornish. As soon as I learned more about his extraordinary program for coronary artery disease reversal, it was a simple decision to invest my own personal funds in one of his intensive workshops, held near his home in California.

Dean Ornish at PopTech (2009) - Camden, Maine - Nick Jacobs, FACHE - HealingHospitals.com

Dean Ornish at PopTech, Camden, Maine (2009)

 

As providence would have it, my own work resulted in what became a steady stream of research grants, and my subsequent personal decision to include Dr. Ornish in our appropriations for the next half-dozen years at the hospital and research institute where I previously served as President and CEO. Each year, I fought to have at least one million dollars invested in the Preventative Medicine Research Institute in California so that Drs. Ornish and Lipsenthal could continue to move forward in their research, as well.

Once, Dr. Ornish asked me, “Nick, what do you really want from our work together?” Without a moment’s hesitation, I replied, “Dean, I want to lose the question mark after the name of the town, ‘Windber.’  Whenever I tell people where we’re based,  they usually respond, ‘Windber?’…’You mean Windber, PA… the old coal mining town?'” Some history here: I had been hired by the board of rural 102-bed, acute care hospital in that historic, rural community to either radically turn it around, or shut it down. For me, the latter option was never a consideration.

Among the many transformational changes we made as part of the turnaround was to be among the first hospitals — and most probably the first rural hospital — in America to implement Dr. Ornish’s evidence-based program that arrests (and can even reverse) the effects of coronary artery disease. The results — with patients of broadly diverse ethnic backgrounds — were so successful, that we were asked to present to the World Congress on Cardiology in Belgrade, Serbia in 2007 on our outcomes and research discoveries, garnered from our experience implementing the Ornish program.

We were also instrumental in introducing the program at other sites for Highmark Blue Cross, as well as a host of other innovations and reforms at our own hospital; from live music playing, to fountains, delicious, nutritious food, cooked by classically-trained chefs, 24-hour family visitation and… wait for it… pajama bottoms for the comfort, dignity and modesty of our patients.

The goal: an environment entirely dedicated to the healing of body, mind and spirit.

The result: among other verified successes, one of the lowest hospital acquired (i.e., nosocomial) infection rates – less than 1%) in the U.S., where the national average is around 9%.

And, yes, we were profitable. Consistently profitable, quarter over quarter.

On one flight in a private plane with my board chairman and me from Cincinnati, Dr. Ornish and I had mutually planned to spend some “quality time” together – collaborating, planning and just trading stories about our experiences. Instead, he wound up honoring an emergent commitment as a personal health advisor and consultant to the leader of an Asian nation, and spent the majority of our flight in direct, one-on-one communication with this person. Awesome? That’s just the kind of guy he is.

My personal hope is that Dean Ornish will take up the mantle for both Jobs and Lipsenthal, as he takes his wellness programs to new levels through mobile apps and enterprise solutions using  iPhones and other mobile devices, and iPads and other tablets, making innovative use of social media technology. (Talk to my friend Mike Russell about that.) My further hope is that  Dr. Ornish’s success as an agent of influence and change will continue to be used in a powerful way, to not only help improve the health of the world, but to continue to positively influence public policy in the United States, as well.

Newsweek cover - Dr. Dean Ornish - Healing Hospitals - Nick Jacobs, FACHEDean Ornish has long been recognized as a leader, a man of character and a visionary, but with the loss of two of his closest friends, the pressure to perform grows exponentially greater. So, my best to you Dr. Ornish. Thanks for your confidence in my work. Keep the faith, and keep up the good fight to make a phenomenal difference in this world, thinking in insightful new ways and never resting on your laurels. As your friend  Steve Jobs famously said at his Stanford commencement address, “Stay hungry. Stay foolish”…but especially the phrase he immortalized early in his career: be “insanely great.”

Share

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.

Share

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.

Share

Barcelona, VAT and Ambiance

August 18th, 2011

Last weekend, I traveled to Barcelona. How does one afford to spend a weekend in Barcelona in this economy with the dollar at $1.40 to one Euro, one might ask?  Points, my friends, points. When you travel enough, it’s possible to build up quite a few of these delightfully-useful but quickly-diminishing-in-value “perks,” and that’s how I got there.

Because it’s “Vacation time in Europe,” numerous hotels, restaurants, and tourist attractions offer nice packages for a reasonable number of points, and because I’d never been to Barcelona or anywhere in Spain for that matter, it seemed like a good plan. Albeit brief, my 4 day journey into yet another culture was almost worth the pain of traveling. Of course, if you remember my Serbia, Nigeria, Bosnia, Netherlands and Italy blog posts, you know that I’m all about “experiences.”

Barcelona - juice seller - Flickr Photo

Barcelona: juice seller at the Mercat de la Bouqueria - Flickr photo credit: Halvorson Photo

The longer I live, the more interested I am in how other people live. Many years ago, probably 20 or so, we had an exchange student, Monica, from Barcelona who used to stand in my family room, look out the window into the rolling fields and proclaim, “Nick, Nick, I am sooo bored.”  Truthfully, I was, too.

So, why Barcelona, VAT and the “A” word? I fell in love with the city. I loved the ambiance, the food, the wines, the architecture, and the people. Maybe it was the fact that there are two million souls living there, and I never felt uneasy even once. Unlike my last trip to Chicago, where I couldn’t sleep all night because of the continuing chorus of sirens from emergency vehicles, Barcelona’s street in front of our hotel erupted in the wail of those distinctive, European sirens only
about four times, from Friday until the following Monday.

Interior of La Sagrada Familia basilicaSome of the little things that captured my attention included the walk/don’t walk sign on the streets that actually allowed you enough time to cross at your leisure without being hit by an oncoming car. The people and cab drivers were polite and, most importantly, there was a feeling of helpfulness and respect in the shops, restaurants and architectural wonders.

Of course, by Sunday evening, we had visited nearly every architectural work of Antoni Gaudí, and toured and listened to a great concert at the inspiring Palau Música Catalana. Barcelona is today one of the world’s leading tourist, economic and cultural and sports centres, and this all contributes to its status as one of the world’s leading cities.

But what about the rest of the title of this blog post? Every time we purchased something material there, the VAT tax was applied, and when I asked someone to explain it, the answer was simple, “It’s how we pay for healthcare.” Consequently, when we walked the streets over that entire weekend, we saw a total of five beggars, and three of them had a Starbucks Cup to catch the falling Euros.

The other things that we saw everywhere were dumpster-style recycling binsBarcelona: color-coded recyclying bins. And not just any bins, either. Very fancy, clean, able-to-be-picked-up-mechanically bins, that were specifically color coded for every imaginable kind of recyclables. Not rocket science, but a comment on community pride, sustainability or climate change, perhaps.

So, we’ve taken care of the creation of a pleasant ambiance on numerous levels with extraordinary architecture, beautiful tree-lined streets, recycling, healthcare, low crime and compassion for fellow human beings. We didn’t see many Mercedes, but we also didn’t see much evidence of poverty, either. The beaches in town were public, and not controlled by exclusive beachfront hotels. Barcelona’s public transportation was a pleasure — clean, comfortable and efficient, with a train to Paris that delivers you there in about three hours…and the Tapas, wine and customer service were all simply amazing.

Nationally, Spain’s unemployment rate hit 21.3%, and they are listed as one of the PIIGS:  Portugal, Ireland, Italy, Greece and Spain…i.e., economically-unsound EU countries. In spite of these huge challenges,  Barcelona was a great city, a great experience, and a great setting with world class arts. So, should we charter an Airbus 380, load up our U.S. Congress, and fly them to Barcelona?

Nah, it wouldn’t help.

Hmm. Maybe we should fly them to Somalia?

Share

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.”

Share

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.

Share

Treating People With Dignity

June 9th, 2011

As part of my continuing series of anti-bullying blog posts, this week’s post was inspired by a WDUQ/NPR interview of the authors of a book entitled: Unleashing the Power of Unconditional Respect: Transforming Law Enforcement and Police Training. It was written by Jack Colwell, a police veteran and trainer, and Chip Huth, who heads a SWAT team for the Kansas City, Missouri Police Department. The interview was inspired by the Pittsburgh police beating of CAPA (Creative and Performing Arts) student Jordan Miles, a who hadn’t done anything wrong. The interviewer stated that this beating, and the subsequent ruling regarding its legality, has seriously eroded the support of law-abiding citizens in the African American community and beyond toward the Pittsburgh Police.

CAPA student Jordan Miles and his mother, Terez

CAPA student Jordan Miles and his mother, Terez | Photo credit: Justin Merriman, Pittsburgh Tribune-Review

Why, in a healthcare blog, would I select this topic? It is my firm belief that treating people with respect and dignity, regardless of the situation, leads to a more harmonious environment. Chip Huth, one of the two authors interviewed by WDUQ,  commented that the he believes that the Kansas City police force’s policy of holding meetings that allow community members to express their points of view and to feel understood may open them up to understanding the police point of view. He went on to say that “after a SWAT raid…when the situation is secure, his teams sit down with the suspects and explain the terms of the search warrant, answer questions, advise of rights, etc.” Convicted felons heading off to jail have told him how much they respect the way his team treated their families.

So, read between the lines. It’s not any different from healthcare work when it comes to “Treating People With Respect and Dignity.” It is what it is, and that care and treatment must transcend all races, colors and creeds. More importantly, it crosses all professions. By analogy, think of us as the SWAT (caregiving) team. We break into your life and scare you. It’s a well known fact that those individuals who are most often sued in healthcare are those with the weakest interpersonal skills  and worst “bedside manner.” They are often mean, curt or simply uncaring in their attitude and responses. Or else they make sure that they just don’t communicate at all with the family or patient.

Not so many years ago, I was taken to task by a group of physicians who were upset because I had written an article about those docs “who make rounds before the families are present and the patient is awake.” The good docs were indignant — and in some cases rightfully so — because they were communicators, but the “bullies” that I targeted, who were not patient centered, came at me from all directions: letters, phone calls, and attempts to have me censured by my hospital’s board. It really reminded me of the often-paraphrased Shakespearean line, “methinks he doth  protest too much.” If they were truly “caregivers,” and not technical health scientists, they would want to communicate with the patients and their families, to answer their questions, to help them understand what is happening (or about to happen) to them, and they would be sensitive so as to ensure that the fears being expressed by those involved were ameliorated about as well as could be expected under the circumstances.

If the SWAT team can kick in your door, throw in flash grenades, tie your hands behind your back, and arrest you, but take the time to heat the baby’s milk and explain to everyone involved what exactly is going on and what to expect, there will be a marked difference in response from those who are being impacted by their work. A hospital does not attain 98 or 99% patient satisfaction scores by ignoring patients and their families, treating the employees and administrators like they are minions and ignoring the kindness and respect that should be part of their jobs.

Respect - Nick Jacobs, FACHE - healthcare - anti-bullying - Healing Hospitals

Okay, I’m done. Like Aretha Franklin sang, “R-E-S-P-E-C-T / Find out what it means to me.” Look up the Jordan Miles story online, or better still, buy the Unleashing the Power of Unconditional Respect book and see what can happen when you treat people with dignity.

Share