Posts Tagged ‘health’

Who Let Us Down?

June 12th, 2009

Recent news:

WASHINGTON, DC James von Brunn, the white supremacist who allegedly opened fire Wednesday at the U.S. Holocaust Memorial Museum in Washington, D.C., suggest that a lifetime of hatred had reached a critical mass. The 88-year-old is charged with murdering a security guard at the building.

LITTLE ROCK, Ark.  —  A Muslim convert charged with fatally shooting an American soldier at a military recruiting center said Tuesday that he doesn’t consider the killing a murder because U.S. military action in the Middle East made the killing justified.

NBC News is reporting that at Camp Liberty, the main U.S. military base in Iraq, which is located near the Baghdad International Airport, a yet unnamed serviceman walked into a “stress clinic” in the camp, opened first, killing at least five. Contrary to earlier reports, the soldier did not kill himself but is now in custody.

When things like this happen, we all stop and ask what went wrong?  In two of the three situations, we had relatives or friends nearby.  My daughter-in-law’s friend was working at the museum, and my son-in-law is stationed beside the stress clinic at Camp Liberty.

I’ll never forget when the Reagan administration began the movement to close down  mental hospitals.  A friend worked at the mental hospital nearby.  We had had a rash of threatening letters, some very upsetting encounters, and a several other incidents in the community when this friend said to me, “You know, we had 2,000 inpatients and 500 outpatients at the mental hospital.  Now we have 2,500 outpatients. Nobody’s left town, and when they don’t take their meds, there can be problems.”

Pfc. Joe Dwyer carried a young Iraqi boy who was injured during a heavy battle between the U.S. Army's 7th Cavalry Regiment and Iraqi forces near the village of Al Faysaliyah, Iraq, on March 25, 2003. Dwyer died of an apparent overdose at his home in North Carolina on June 29, 2008. Photo credit: Warren Zinn / Military Times file
Pfc. Joe Dwyer carried a young Iraqi boy injured during a heavy battle between the U.S. Army’s 7th Cavalry Regiment and Iraqi forces near the village of Al Faysaliyah, Iraq, on March 25, 2003. Dwyer died of an apparent overdose at his home in North Carolina on June 29, 2008. Photo credit: Warren Zinn / Military Times file

When you consider that there are about 6.5 billion people in the world, if only 5% of the total people living on this planet are suffering from some type of mental illness, we’re potentially talking about the equivalent of the entire population of the United States with some mental health issues. ( Sorry if  my math is slightly off.)  Point is, that’s a lot of people.  So, what are we doing for them?

The Rand Corp. released a study of returning service members and is estimating nearly 20 percent of the 1.6 million who have served since this war began will develop Post-Traumatic Stress Disorder (PTSD). That is nearly 320,000 PTSD sufferers – more than the population of Pittsburgh.

White supremacists are such old news.  We have had to hear about their beliefs over and over during the past sixty years or so.  Maybe when they are arrested,  as James von Brunn had been more than once, it would help them to serve their time doing community service as tour guides at Auschwitz?

Our soldiers, however, are an entirely different story.  We have spent the past several years meeting with experts in mental health who do know what to do for them.  That’s the good news.  The bad news is that this care is not being rendered.    The military has strict guidelines on the treatment of PTSD, but, if you ask our returning soldiers how faithfully these guidelines are implemented, the general answer is that “There’s not enough money to provide this care for our Guardsmen and women.”

We don’t pay our school bus drivers a living wage, and they are in charge of our most precious loved ones.  We couldn’t afford to send armour with our early troops deployed to Iraq and have had more amputees than in any war since the Civil War, and now we don’t have enough money to treat PTSD.

That type of rationalization makes me tired.  We have enough money, we just don’t have our priorities and incentives in line.

depression female young woman african american black mental health Nick Jacobs

Did anyone notice that James was boiling over with insanity?  How about Mohammed?  Our PTSD patient in Iraq knew that he was in troble, but we busted him, and then put him beside a driver with a gun on his hip.  That weapon became his killing tool.

This blog was not intended to be depressing.  It is intended to reemphasize that we in healthcare should be about caring. It is about teaching caring, love and respect.  It is about helping those who need help, and detaining those who won’t accept that help.   We have drugs, but, as the Virginia Tech shootings demonstrated, in certain phenotypes the receptors are not there to allow those drugs to be absorbed into the body.

Mental health help has a long way to go, and we all need to be part of that journey.  Telepsychiatry, PTSD clinics, screenings for radicals?  Surely someone cares.

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In My Opinion, It’s Tinker Bell Dust!

June 4th, 2009

Everyone has seen the media reports on the $1.7 trillion of cost cuts being projected by health care leaders over the next decade, but does anyone really believe it? According to this group, the premises embraced that will lead to these cuts are based upon improving care for chronic diseases, reducing unnecessary care, and streamlining administrative costs. Included in this wish/promise list are cutbacks, commitments to permit fewer Caesarean sections, better back pain management, less use of antibiotics and a reduction in diagnostic imaging tests.

U.S. President Obama meets with health care executives at the White House on May 11 (Pete Souza)
U.S. President Barack Obama meets with healthcare executives at the White House on May 11 (Photo credit: Pete Souza)

The groups involved have made commitments to try to reduce medical errors, begin the use of common insurance forms, to initiate a reduction in patient re-admissions, to improve the efficiency of drug development, and to promote the expansion of in-home care. (The majority of the preceding information comes from an article by Janet Adamy entitled “Health Groups Detail Plans to Reduce Costs,” in the June 2nd Wall Street Journal. )

If you are reading this, and you are a health care professional, it may be reminiscent of listening to your three hundred fifty pound, five foot tall neighbor describing how he is going to get back into his size 34 Levi’s. It also reminds me of a conversation that I had about 22 years ago when a hospital vice president said to me, “We are going to begin putting  computers into the hospital, and they will reduce costs, lower the need for staff, and contribute to much higher efficiencies.” What part of this equation didn’t happen? Even at the little hospital from which I just retired, we went from two, to three, to four… to about a dozen experts in every aspect of computer technology, and IT has been a dominant part of the capital budget for over a dozen years. So, what’s wrong with this scenario? As the equipment became more sophisticated, more well trained experts were needed. The higher the cost of the equipment, the greater the overhead required for maintenance, and the larger the demand became for everyone in the facility to be computerized.

It is not my intention to be a complete cynic, but isn’t it true that tens of thousands of people who have become used to a certain standard of living will be controlling these cuts? If we could have improved chronic disease care, why wouldn’t we have done that already? It’s all about the reimbursement system. We are still reimbursing for sickness rather than wellness. How do we line up the incentives so that statements like “we will permit fewer Caesarean sections or we will initiate better back pain management” will not ring hollow as words directed toward placating the new President? Nowhere in the equation is there any reference to initiating tort reform. As long as doctors, hospitals, and other clinicians have to practice defensive medicine, we will not be able to reduce tests. We will not be able to reduce unnecessary costs.

pixie-dustl1Yes, of course a reduction in medical errors would be great. So would common insurance forms, and fewer re-admissions. I’m sure we will see our peers work diligently toward those ends, but, unless or until incentives are aligned, the system will continue to roll along pretty much as is. I’m not sure why the President hasn’t called me yet. Maybe it’s because he knows how I feel about tort reform. Maybe it’s because he knows that I’ll say that the list articulated in the opening paragraph is filled with smoke, or maybe it’s because, like all government-touted initiatives, it’s not supposed to actually come completely into play until two and possibly six years after he leaves office. That philosophy certainly didn’t work for our former Presidents, and, unless someone gets really serious about changing the way healthcare is delivered in the United States, these pledges will be just what they appear to be, “Tinker Bell dust!”

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The Health Care Reality

May 15th, 2009

1979 was the year in Johnstown, Pennsylvania when I decided that it was time to leave teaching and transition into business.  For those of you who don’t remember that year, it was the beginning of some serious financial challenges for our country, but it was also two years after the Johnstown Flood of ’77, and there was an unemployment rate of 19.5% in Cambria County, PA.

1979 Rolling Stone cover Blues Brothers SNL Dan Ackroyd John BelushiIn 1980, when I accepted a job with a then bankrupt nonprofit organization in Somerset, PA, what had been a booming coal industry went into the skids. My house mortgage was about the same as the unemployment rate, 19%.  The job that I took was in the arts and Ronald Reagan was interested in cutting funding to the National Endowment for the Arts.

In 1985, my new job was with a tourism agency, and that was the year that then-PA Governor Casey cut funding to tourism.

In 1988, when I entered healthcare, it was clear that Johnstown could no longer support four hospitals, and the next decade and a half resulted in the closing of two (and almost three) of the four hospitals in that area.

Turn the clock forward to last October, when I announced my decision to become a healthcare consultant.  The stock market crashed, eight of every ten hospitals stopped, postponed, or scaled back needed capital projects, 58% of hospitals are now reporting  increases in uninsured patients using the emergency departments, 48% of hospitals have cut staff, and 80% have reported cutting expenses that include consultants.

As a consultant, the first thing I would tell anyone is that “No matter how bad things appear to be, you can do it.”

  • Our successes as a teacher continue to remain evident as former students ranging in age from 38 to 58 continue to remind me of great memories of our time together.
  • The arts organization became the largest and most successful rural arts organization east of the Mississippi.
  • The Convention Bureau went from almost closed to the fifth largest agency in the State, and most of you have tracked the successes that we experienced at Windber.

Not unlike the little engine that could, we focused on the positive, forgot about the negative, and never dealt with “Mr. In-between.”

roosevelt_action400

There are those who approach life cautiously, carefully, and very conservatively, and then there are those of us who drink from that same cup in big gulps and dream about how things could be rather than how they are.  There are those who are afraid of failure, and those of us who embrace failure because we know that it is getting us closer to more dramatic successes.

The only boundaries that we have are between our ears.

Because the future is a design function. Let me close this blog post with the ending from my commencement address to the graduate students of St. Francis University (with the help once again of Dr. Leland Kaiser):

  • Nothing has to be the way it is.
  • We can invent (or prevent) our future, because all limitations are self imposed.
  • We can empower ourselves to create a new world.
  • Reframe any limitations to become opportunities because…
  • Tremendous limitations breed success. They open doors.

So, as we design our future, remember that we should not work to create what people will like, but instead work to create what people will love!

…and we will know success beyond our wildest dreams.

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Focus on the Positive

April 29th, 2009

Okay, who wants to be the first one to have written about a pandemic?  Unfortunately, I know way too much about this stuff.  Guess it’s that old hospital CEO mindset.  Prepare for the worst, and expect it.  Well, let’s all pray that this thing settles down before more people die.  My friend, Dr. Matt Masiello wrote an E-mail today that could probably help a lot of people.  A public health message with a level of calm urgency.

Dr. Matt MasielloBased on the cumulative experience of the scientific and health promotion/disease prevention staff at WRI, we began a more active approach in  preparedness then what had been recommended by WHO/CDC and the local EMS. We feel that with WHO now raising the alert level to 5 our actions were appropriate. May I suggest the following.

1.    Prepare and distribute a letter to parents asking them to keep their children home if they have a cough, fever, headache. If someone in the family has the same signs and symptoms the children should also stay home until  the illness by the family member is confirmed not to be Swine flu.

2.    Place a small table with sanitizer bottles at the entrance ways of the school buildings.

3.    Encourage staff to carry on their person the small hand sanitizers.

4.     Instruct your teachers to review with the students advice on handwashing and use of the sanitizers. Teachers should remind students throughout the day of the importance of handwashing as well as keeping their hands away from their face and the importance of coughing into their sleeves. Wash/sanitize hands afterwards. I would encourage formal, scheduled trips to the BR to wash hands and when ever necessary.

5.    Place the attached sign in key locations and encourage staff and familes to take them and post at home as a reminder. Wash hands prior to and returning from work/school/play.

6.    Get plenty of rest, eat well and exercise.

7.    Open windows for better movement of air, when and if possible.

8.    Minimize social gatherings. The canceling of social events may come as  a formal recommendation via the CDC in the very near future.

Matt

So, that’s the official word from the United States’ representative to the World Health Organization.

Now, onto life.  Last night we completed a list of services that we are helping to provide to hospitals, schools, hotels, newspapers,  businesses and anyone else that might be interested.  Rather than list each business individually, let me list their services, products, and work, and, if you’re interested, give me a call.

  • Technology Solutions for Government
  • Sophisticated market research
  • Physician billing/Pre-certification and approval of payments for doc offices.
  • Telemedicine and medical device marketing analysis and launch
  • Food Services for hospitals and long term care centers
  • Education Programs and Leadership Solutions
  • Continuing Medical Education for physicans and nurses
  • State and Federal Lobbyists and Business Development Experts
  • Personal Healthcare and Corporate Wellness
  • Crisis Response Communications
  • Construction solutions (REIT)
  • HR and House Wide Quality System for Job Descriptions
  • Translation services (Contract pending)
  • Specialized Cancer Laboratory Services
  • Removal and disposal of hazardous waste, a green company
  • Economic Development and ECAP green initiative
  • The Doctors’ Doctor – Physician office mergers, acquisitions and general business operations consulting, and Hospital Physician strategic planning

Obviously, each line represents a company that we represent, and even more obviously, SunStone Consulting is your answer for all of the financial challenges that hospitals face.

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HIMSS

April 15th, 2009

HIMSS, Healthcare, IT, health, information technology

If you’re interested in finding about everything that happened at the HIMSS 2009 Conference and Expo, don’t read on, because I’m just going to focus on four or five companies that captured my imagination there. There were hundreds and hundreds of vendors attempting to do business in the massive McCormick Convention Center in Chicago, and most of the participants were clearly interested in attracting some bailout money. My host for the week-end was Apptis, and a special thanks must go out to them for allowing me to grace their exhibit as an observer.

Genova Technologies
The companies that grabbed my attention were rather unique; neither the largest, nor the most aggressive. Not the end all and be all of IT, but niche players that had their acts together. Dawn Ainger, the President and COO of Genova Technologies was the first to garner my complete attention. She and her people had come up with a software platform that is uniquely positioned to change the entire concept of Continuing Medical Education. Just log onto their product for somewhere around $100 a month, and voila, everytime you research a patient’s ailment online you get CME credits backed by a major university. Next, she plans to expand to nursing education as well. My oh my, will that change plenty of lives? Our typical employed physician used to get an automatic $4,000 a year stipend for CME in our little rural hospital and never got credit for the work they were already doing. Nice job, Dawn.

logo_aclaim
Not that all of the products that captured my attention were produced by companies run by women, but a-claim was, and their President and CEO Mary Dees Griffith had come up with a similarly low cost solution to a major, ongoing problem. Get your a-claim software, and prequalify your patients on line, have them sign the authorization prior to being seen, and then ask them for their check or credit card for the co-pay that you now know will be approved. Nice job, Mary. Every physician’s office in the world should spend $100 or so a month for that one, because it could virtually eliminate their accounts receivables.

logo_lifelinks
As I was walking by Lifelinks, I noticed a butterfly logo and was curious as to what they did. Once again, their basic, get-you-in-the-door fee was about $100 a month, and that will get you access to live human beings on your lap top who can perform sign language interactively with your patients, or, if need be, Lifelinks will get you live and online someone who speaks whatever language your patient needs. Okay, so that’s probably not a big problem in a small town in Western Pennsylvania, but I’m sure it’s perfect for those offices in highly diverse regions of our country. More importantly, their literature pointed out a case in New Jersey where a physician had been sued and the patient won $400,000 because the doc told her he couldn’t afford a translator. Good job, guys. Wesley Waite, the COO, actually hit the keyboard, and a woman came up on the screen to interact with me personally in sign language. Amazing.

Gemalto, health, security, Netherlands
Gemalto,
a Dutch based company really grabbed my attention in the world of cyber security on a small, simple scale. Well, okay, not so small I guess. They have over 100 million of their devices already in use in the EU, but not too many in the US yet. The Gemalto team took us happily through the safety and security they can build into their smart cards to keep you from being hit with a major civil and/or criminal penalty for compromised information.

voalte_iphoneThe wildest display tucked in the back corner of one of the exhibit halls was a lime green and pink booth with the word, voalté across the top of their exhibit. A really nice guy named Oscar in pink scrubs and a black voalté teeshirt was my tour guide through I-phone heaven for nurses, techs, and other hospital professionals. What they have created with this system can only be described as remarkable. It shimmies, it shakes, it crawls on its belly like a reptile. Seriously, paging, messaging, dosing, you name it can all be communicated to your staff via the Apple iphone. No more overhead pages, no more, “I didn’t get that message,” no more I’m busy because if you are, that page keeps being passed along until someone isn’t busy. This Sarasota company is fresh, fun, exciting, and competent.

So that’s my little trip down HIMSS lane. Oh yeah and I got to have lunch with the brilliant Tony Chen of both HospitalImpact.org and SavvyDaddy.com fame. I encouraged Tony to follow his dreams, and he told me today in an E-mail that he is going to do just that. You go, Tony. And Neil Versel, the very talented free lance writer, journalist, and U2 fan nearly knocked me over at the entrance. I met Neil a few years back at a Web 2.0 conference in Chicago, and there were at least two or three other people there I had worked with over my 22 years in Healthcare Management. The biggest outcome?

My feet are still killing me.

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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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The Not-So-Merry-Go-Round

March 7th, 2009

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

Wayne B. Jonas, M.D.

Wayne B. Jonas, M.D.

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

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

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

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

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

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

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A Proactive Approach to Ecology

February 22nd, 2009

The Greening of America is here.

Despite the fact that the Clinton and Bush administrations determined that we would not be legally bound by the Kyoto Agreement, President Obama has a more proactive view on the nation’s environmental policy.

The following is a short list of Obama administration initiatives that will be funded for greener solutions to clean, efficient, American energy: Smart grid, advanced battery technology, energy efficiency:

  • $30 billion for such initiatives as a new, smart power grid, advanced battery technology, and energy efficiency measures, which will create nearly 500,000 jobs.
  • Help state and local governments make investments in innovative best practices to achieve greater energy efficiency and reduce energy usage.

Tax incentives to spur energy savings and green jobs:

  • Provides $20 billion in tax incentives for renewable energy and energy efficiency over the next 10 years.
  • Provides a tax credit for families that purchase plug-in hybrid vehicles of up to $7,500 to spur the next generation of American cars.
  • Includes clean renewable energy bonds for state and local governments.
  • Establishes a new manufacturing investment tax credit for investment in advanced energy facilities, such as facilities that manufacture components for the production of renewable energy, advanced battery technology, and other innovative next-generation green technologies.

The Kyoto Protocol is an international agreement linked to the United Nations Framework Convention on Climate Change.

The major feature of the Kyoto Protocol is that it sets binding targets for 37 industrialized countries and the European community for reducing greenhouse gas (GHG) emissions. The Kyoto Protocol was adopted in Kyoto, Japan, in December 1997 and entered into force in February 2005; 184 parties have ratified its protocol to date.

Although the United States did not ratify the Kyoto Protocol, voluntary efforts were made to reduce GHG emissions here, even as 132 of the nation’s mayors pledged to meet Kyoto-like emission targets in 2005.

In 2003, some U.S. companies and cities agreed to participate in a legally binding voluntary carbon market – the Carbon Credit Exchange.

The CCX, like other cap-and-trade programs, set limits or caps on allowable emissions.

The CCX issued allowances for trading among the members that correspond to the emission cap. CCX members have agreed to reduce their emissions by 6 percent below their baseline for 2007 to 2010.

The publically traded CCX is about a $70 billion business that previously was somewhat limited to power producers and large industries.

A recent article in the New York Times indicated that within the next four or five years, this market is expected to grow to $500 billion as the country begins to work toward green and a cleaner environment.

Currently, the European Union has the largest and most famous carbon trading system.

The European Trading Scheme is a cap-and-trade system in which the government sets national emission caps based on its Kyoto and national targets.

Allowances, totaling the caps, are then distributed to individual firms for trading throughout the EU. If emissions are capped, for example, at 200 million tons a year, there are 200 million allowances distributed to firms for offsetting emissions.

These firms can then use the allowances to offset their own emissions, reduce their emissions and sell the allowances to other parties, or bank the allowances for future use.

If a firm does not have adequate allowances to offset its emissions, the firm must purchase allowances or pay a significant financial penalty.

The cost of allowances, if available, is generally less than the financial penalty. The buying and selling of allowances, trading, creates a market, thus the cap-and-trade program designation.

Due to the financial challenges companies face on an ongoing basis, recent studies have shown that Sector 3 organizations will have the most difficulty dealing with this metamorphosis.

Consequently, schools, churches, hospitals, and local government will be struggling to find the means to make the green transitions such as retrofitting lights, more efficient use of demand meters, voluntary curtailment, and the installation of efficient energy supplies utilizing renewable fuels, i.e. biomass combined heat and power systems.

E-CCAP is one possible solution to this nonprofit problem, an initiative that is funded through two prominent Pittsburgh Foundations led by the Pittsburgh Gateways Corp. and its partner in this project, World-Class Industrial Network.

They are working together to capture opportunities in the developing financial markets associated with energy and carbon reduction and general sustainable practices such as switching to renewable resources or investing in energy efficiency methods.

E-CCAP is working on a set of developmental and applied activities designed to define and demonstrate that nonprofit organizations, serving industrial, commercial and institutional based stakeholders, can leverage relationships with its constituents to both promote and financially share in the benefits of sustainable business activities.

In so doing, the nonprofit organization can better meet its core mission by exploiting new revenue streams not previously available.

E-CCAP is targeting a pilot project with industrial, commercial, and institutional based stakeholders, to aggregate the financial benefits of energy efficiency and renewable energy projects through the emerging markets for energy efficiency credits.

These green credits will be aggregated and traded to support the partnership and serve the participating third sector organization and their constituents.

They will specialize in the development of credit generating projects, have those green savings validated by an independent third party, and broker the credits.

(This blog post is also published as a feature article in the 2/21/09 edition of The Tribune-Democrat.)

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The Marketing Enigma

February 15th, 2009

As the economy continues to present its myriad of challenges nationwide, hospital executives are embracing a variety of cost-cutting measures at a very high rate of implementation. Delays or discontinuation of capital projects, employee layoffs, and a variety of other broad-based measures are currently dominating the healthcare environment.

Departments without direct patient contact are usually perceived to be the easier layers to peel in these expense reduction activities. Areas such as marketing, community, and public relations often become prime targets as they are significantly scaled back or even disbanded.

Historically, hospitals have implemented fluctuating sequences from one extreme to another as they have decreased and increased marketing department sizes and budgets through the various economic cycles. Unmistakably, in challenging economic times, marketing is nearly always more important than ever. Without knowledge concerning the various services available, the patients will not be aware of the nuances of each and how they could impact their health and wellness.

Having said this, however, many hospital executives are not experts in this area, and consequently, they simply move in lockstep with those individuals who see these programs as non-patient expense centers that merely drain the organization of its valuable resources even further.

BusinessDictionary.com aptly describes marketing as the management process through which goods and services move from concept to customer. As a philosophy, it is based on thinking about the business in terms of the customer, or in healthcare, patient needs and their satisfaction. As a practice, it consists of the coordination of four elements:

  • identification, selection, and development of a product
  • determination of its cost
  • selection of a distribution channel to reach the patient, and…
  • development and implementation of a promotional strategy designed to reach these goals

In order to avoid erroneous decisions that could lead to disastrous business consequences for the organization, marketing evaluations might be performed by professional marketing assessment companies specializing in this arena. Some of these firms can provide this service in economically viable risk-reward agreements that do not further complicate the financial challenges being addressed. They specialize in the evaluation of services that detail which marketing functions need to be continued and which functions should be restructured, and/or outsourced. The goal of these marketing evaluation firms is to:

  • help preserve the existing positive effects created by marketing
  • build better marketing practices, and…
  • cut the unnecessary associated costs

In two decades of observing the yo-yo phenomena described above, we have worked with numerous individuals and firms along the way, but none have been more valuable than the firms that specialize specifically in this area of marketing department analysis.

Firms that provide this specific service can be found through the American Association of Healthcare Consultants, The American Marketing Association, and the Society for Professional Marketing Services.

In our work, however, we have found at least one company that has continuously provided the necessary analytic and evaluation components required to complete this sensitive task. Corathers Health Consulting is a unique organization because it utilizes luminaries and unique specialty consultants through a team approach for most of their highly customized projects. What we observed when we worked with Corathers was that their distinguished consultation supplied an unparalleled differentiating factor over the other consulting companies with whom we had previously worked, but they are one of many such firms.

Regardless of the organization chosen, the concept is the key, and that is that you owe it to yourself and to your organization to understand exactly what can or should be eliminated or outsourced before the cuts are irreversibly implemented. The future of your organization may lie directly under that hatchet, and once the decision has been made, reverse is a costly gear to find on a very bumpy road of lost business, missing publicity, and absent advertising. The answer lies in cutting wisely and appropriately as you attempt to keep patients informed and to grow your business.

Linking a patient-Centered Approach to Quality Improvement & HCAPS

Nick Jacobs, FACHE addresses the 2008 Healthcare CEO Summit, co-sponsored by the Picker Institute and Planetree. Chicago, IL USA – Fall, 2008

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How Do You Keep the Music Playing?

February 9th, 2009

When civilizations are evaluated, there are numerous indicators that are used to demonstrate their relevance, their contributions to the world, and their donations to the future. As a young musician, one of my college professors predicted that our culture would begin to decline as a military, economic, and artistic world power. He pointed toward what he described as primary indicators of this decay, and he saw the decline of music in our schools as one of those indicators.

Overall, this professor was more than concerned about the role of public education in the future of our country and once described our form of public education as an experiment that would eventually prove to be ineffective. He saw the effort as a misguided attempt to squeeze all different shapes, sizes, and types of personalities, intellects, and skills into a single classroom, which he called a “melting pot of mediocrity.”

That professor also used to teach us about the writings of Marshall McLuhan from the University of Toronto who indicated that television would change the manner in which we lived our lives. His book The Medium is the Message made us all begin to look at the influence of television on society.

McLuhan described the fact that in visual space we used to think of things as continuous and connected. In either the auditory senses or the sense of touch, there are only resonances. There is no real continuity in our other senses. The fact that we have become the visual wo/man, through television, and that visual orientation has produced a collage that is neither continuous nor connected, has resulted in the reality that even our visual perceptions have lost their continuity.

It is well-known that music nurtures both the right and left sides of the brain, and that those who study music have intellectual opportunities that literally may not exist for those who don’t. The challenge is not just one of music as entertainment, but music as part of our intellectual training. So the question is, as in the James Ingram song lyric, “How do we keep the music playing?”

Young music teacher Nick Jacobs meets musical hero Maynard Ferguson What does this all mean? In 1972, my professor indicated that we were leaning toward a different type of society that would learn, participate, and act in a different way. One of his greatest fears though was that, due to this lack of continuous connection, those who would take charge of our educational systems would not recognize the importance of music as part of education and that music would begin to be downgraded, minimized, and even dropped from public education. Thus reading, writing, arithmetic, and the arts became reading, writing, and test scores.

If we look at the dramatic decline in participation in music education over the past 30 years, he was not far from wrong. The answer to the question of how this has impacted us as a society may not be totally clear for a few decades, but as we look across the overall educational landscape and see these chasms of deprivation from exposure to the arts that already exist, it seems relatively obvious that we have and will pay the price for ignoring those subjective, intellectually stimulating programs that spawn creativity and lead to new and better ways to form our futures.

Remember, from science fiction comes science, from dreams come creations, and from fertile minds come our professional careers. The high-quality drama teacher, vocal instructor, or orchestra director who helped many of us find our way to where we are today is many times not employed anymore, and last week we saw the arts cut once again from the stimulus package. In 1987, I read that more physicians had studied music as a discipline than any other single concentration in both high school and undergraduate work. Will tomorrow’s physicians be nurtured by music, and if not, at what cost to society?

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