Posts Tagged ‘hospice’

The Budget Impasse and Death

July 16th, 2011

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

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

David Brooks | Josh Haner/New York Times

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

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

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

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

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

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

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

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


Along the Way…Things Became Very Interesting

January 31st, 2011

Two years ago I began this new journey, but not until a few months ago did my work in consulting really begin to take shape in a way that could never have been predicted.

As the challenges of our present economic times have become increasingly daunting, my personal and professional journey has become even more dedicated to innovation and creativity. One goal has been to provide new alternatives to past practices that will create value for patients. This means making a contribution to saving and transforming lives, while producing cost savings and financial stability, and developing new markets to enable provider growth in their missions.

Olympic National Park, Port Angeles, WA - Nick Jacobs, FACHE - Healing Hospitals - SunStone Consulting

The driving force behind my exploration began with asking how we can begin to control those out of control expenses that are currently blurring the lines between continued care for our population, and rationing or elimination of services?  But, the answer(s) must enable us to continue to add healing opportunities for our patients at every turn.

Because my creative energies have always been focused on producing more ways to generate new monies for whatever organizations I have personally represented,  it seemed somewhat foreign to me to spend more time on fiscal issues than creative alternatives.  However, with literally millions of Baby Boomers coming of age each year, it was obvious that our entire culture is at risk both fiscally and socially. Consequently, after listening carefully to my peers, several opportunities presented themselves that would address all levels of these concerns.

Through the combination of their proprietary software and dozens of years of combined knowledge in the healthcare finance field, SunStone Consulting, LLC, spends each and every working day addressing the challenges of finding monies that should already have been captured by hospitals and physician practices, while also creating new opportunities that have heretofore not been explored. That’s where SunStone Management Resources comes into play.

SunStone Consulting - Nick Jacobs, FACHE

We have identified new companies, new entrepreneurs and new creatives who can not only improve healthcare, but also significantly improve the bottom line of those organizations willing to embrace their programs. One such company with whom we are partnering can increase Emergency Room productivity by as much as 35 to 50%.  They can also help do the same for cancer centers and operating rooms. They utilize robotic systems that communicate patient needs and simultaneously seek out the appropriate medical services required as soon as the patient is triaged. The patient’s condition and potential requirements are communicated to every individual who will or should have contact with them throughout their hospital stay.

We have also identified what I refer to as “no brainer” opportunities. By making otherwise locked fiscal percentages  a commodity, even small and medium sized organizations can save huge dollar amounts. How? By changing out only the electronic reading devices used hospital-wide. This simple change has resulted in huge fiscal savings for clients.

Add to examples like those above the introduction of  a new invention that, in the right hands, can help to extend some types of Stage 3B and Stage IV cancer patients’ lives from months to years through a relatively simple post-surgical procedure. Also consider the invention of new materials that would support bone growth, while virtually eliminating the need for casts or even slings. Imagine a series of protocols that have brought over 40 people out of deep, irreversible comas. Then, on a completely different path, consider having access to  the cumulative knowledge garnered from over a hundred million dollar investment in breast cancer care.  (This is about to be made available to small and medium sized hospitals across the world.)

These are but a sampling of  just some of the opportunities currently driving my passion in this new healthcare world order.

You may want to make a simple inquiry into what’s behind the innovative, practical, and incredible creations of the brilliant people doing this work.  It’s not just so many words on a page.  It is the future, and the future for you and your organization could be now.


Making Sense of Tucson

January 11th, 2011

It was 1991 when one of  my professors at Carnegie Mellon University began discussing health policy in the United States.  He told us about Arizona, where the state government had decided to stop paying for transplants.  Then he went on to explain that desperate families were moving from Arizona to Pittsburgh, just so they could establish residency in Pennsylvania, and their loved one could receive a transplant.

At around that same time, an outspoken politician from Colorado, former Governor Richard Lamm, who ran for President of the United States on the Reform Party, described the travesty of Medicare vs. Medicaid.   He described the older generation as committing “generational murder” because, even though many times there was no hope  for their survival, for extending their life or for having any quality to their life, we, as a nation, spend 60% of our Medicare dollars on the last  30 or so days of life.  He advocated being honest and allowing people to decide if they wanted palliative care.

What he also pointed out was that, as a country, we continue to have one of the highest infant mortality rates in the industrial world. The reason, he theorized, was because the seniors voted and the young mothers didn’t and no politician would dare vote against that senior coalition.  (This is not about death panels, it is about honesty in healthcare. It is about transparency and explaining the facts to the families so that they could make rational decisions.) None of his words were well received, but nevertheless, they were filled with candor and embraced very difficult ethical views.

Giffords Tucson tragedy - Nick Jacobs, FACHE - Healing Hospitals

The bottom line?  It is a very sad situation when we have to, in effect, sentence people to death at any age because resources are not available to save them, but this is emphatically not about rationing of care, because rationing infers giving everyone a little less.  This is about making a government decision to take away everything. So, this is about making rational  resource allocation, not based upon the number of votes needed to get re-elected, but based on the value of a life at any and all ages.

Finally, the elephant in the room?  Those people killed and wounded in Arizona were killed and wounded because of a man who is most likely mentally ill.  We, as a country, must begin to address this mental health issue with parity, with commitment and without judgment.  No family is without some member who is suffering from some mental health issue, but  this discussion is still ignored, hidden or buried.

So, when the pundits ask if it is about the rhetoric? We don’t know. When they ask if it is about the availability of weapons and ammunition?  The answer seems to fall under that same category. BUT, when the question is properly directed toward mental health?  The answer seems to be absolutely, yes without a doubt.

During this time of reflection, let’s get serious about the very real and very big challenges that this nation faces. We must, as a nation, take these challenges head-on and deal with “problem solving,” and if this Congress does not begin to take action and begin to solve problems, then we must vote again in May and November to continue to make our voices heard.

Unless we can begin to talk with each other with dignity and respect, we will not make progress.  Until we begin to respect the other person’s point of view and understand that debates are healthy again, we will not make progress. Our leaders need to debate, but at the end of that debate, it is essential that they walk out of the room together and agree that they are all here to do a job, and that job is to solve problems.

My heart goes out to all of those families who were impacted by this awful tragedy.


Engage With Grace

November 26th, 2010

Excerpts from: Chapter 18 of  Taking the Hell out of Healthcare

by Nick Jacobs

When Dying is Finally Enough

The Dichotomy of Death

On Thursday evenings from 1970 until 1975 there was a standing invitation to play pool at Jim’s Dad’s house.  Now, the truth of the matter was that, as young school teachers, most of us barely owned houses, let alone a pool table, so one of my colleagues parents’ opened their home to allow us to have some safe recreation. During those innocent days of my mid twenties, many of the world’s problems were solved. Jim’s father was a wise old philosopher in his early sixties,  a retired coal miner who loved to be around the kids.

One night, we began discussing religion, faith, and death as we mechanically yelled out lines like “16 in the side pocket.”  The discussion became particularly heated when it came to hypocrisy of our healthcare system. We kids or at least this kid listened in amazement as old Carl explained how life was in the old days. His relatives from the old country had salves and ointments, herbs and mustard plasters that took care of virtually every ailment known to man, and when they failed and death was inevitable, death was accepted. He used to laugh and say, “But now, everyone wants to go to heaven, but nobody wants to die.”

It was then that the subject changed to today where there was truly a cure for nearly everything, or so it seemed at age 23.  Get sick? Take a pill or get a shot. But then, a few weeks earlier, my father had been diagnosed with lung cancer and was given less than a three percent chance of survival. As Carl and I discussed this situation, he put his arm on my shoulder, and wished me luck. At 58, my dad was still a young man, and neither my education, my prayers, nor my love would be able to save him.

The American way of death seems to be that death is not acceptable at any age, at any time or for any reason. Death is rarely seen as the inevitable future that we all face. Our American system of death is that it should not  happen. Death is no longer accepted as part of life. Oh, yes, we hear those words, but when it is our loved one, they are very difficult to embrace or articulate.

Our medical schools, our nursing schools, our technology schools train  our students in most cases that death is failure. This is why we have a system of health care that is crumbling under our very eyes. Through drugs, machines, and other advances, we have the ability to allow individuals to live longer than ever in the history of mankind. It is absolute reality that more people will have an opportunity to live longer than 100 years of age than ever in history, but at what cost, and with what degree of quality?

Engage With Grace - The One Slide - Nick Jacobs, FACHE - Healing Hospitals - Taking the Hell Out of Healthcare

Because of our culture, we fight death until we are shocked by it, and the result is that we, as families miss the wonderful opportunity to allow our loved one a peaceful, beautiful, comforting transition.

Palliative care, a.k.a., hospice care, provides that transition.  In a hospice program, we experience love in all forms until death. Hospice provides a womb-like environment where love can replace fear, where family can be the center of that love, and where the transition can be a beautiful, healing journey for everyone involved so that it becomes a peaceful transition.

What Can You Do?

Do your personal homework. Begin to talk to your loved ones early on about their wishes.  Make those wishes as clear as you can. Do not be fearful that anyone will let you die before your time. Trust that your family or friends can support you in your intentions, and be sure that you put everything in writing that you possibly can. Most importantly, however, try to find peace with yourself.


Healthcare Reform. . . It’s only just begun

March 10th, 2010

This week’s Bloomberg Business Week magazine featured a phenomenal and very personal story of healthcare that actually captures many of the challenges around healthcare reform.  The author, Amanda Bennett, takes us on a journey that she has titled, “Lessons of a $618,616 Death.”  The true title, however, should have been, “How Do You Put A Price on 17 Months?”  In this article, Ms. Bennett takes us on the step-by-step, blow-by-blow journey that ended with her husband’s death.  She and a friend painfully reconstructed every page of his medical records, every dollar paid by her insurance companies, and every charge made by the various doctors and hospitals that treated him during the last years of his life.

Business Week end-of-life issue - Nick Jacobs -
Amanda Bennett and Terence Foley

She showed 1.) the grand total of charges, $618,616, 2.) the actual monies paid by the insurance companies to the hospitals after contractual negotiations, $254,176, and 3.) the total paid by her family, $9,468. In the article, she described the 30% overhead/administration costs, the costs of experimental drugs inside and outside of trials, and the 4,750 pages of medical records that were amassed during this time. For those of us who have “spent our time” trying to live within, cope with, and better understand America’s healthcare system, there were no surprises.  For those of us who have watched a loved one take this cancer journey with all of its mysterious unknowns, there were also no surprises. Ms. Bennett’s quote, “The system has a strong bias toward action,” was, I believe, the most poignant in the entire piece.

A few weeks ago, I had lunch with a very healthcare-savvy individual who, when I jokingly referred to death panels, almost came across the table at me.  She did not believe it was funny.  To say that she was passionate would miss the point.  Only the day before, I had spoken with another very intelligent healthcare reform advocate who indicated that the entire concept of death panels emanated from a payment code that reimbursed physicians for simply (or in some cases finally) talking to patients about their alternatives.  I had heard other explanations, but neither mattered.  What matters is that, in many instances, we are not discussing appropriate alternatives or revealing the quality-of-life issues often overlooked before beginning long courses of experimental drugs, or oncology drugs that may not have any positive impact on the health outcome of the individual.

Interestingly, Ms. Bennett did indicate that for all of the time, money, and pain invested in this journey, no one could confirm that her husband’s life was actually extended by these medical experiences.

Someone once described America’s healthcare system to me like this:  You walk into Nordstrom, order several three-thousand-dollar suits, a dozen shirts and some handmade, silk Italian ties, then turn to the person beside you and say to the clerk, ‘”He is paying for this.”  Our heroine Ms. Bennett did mention the fact that her husband would probably have questioned the use of all of these funds in this manner and the relationship that these expenditures might have had on all of the other people in the world who might have been helped by these dollars.

Taking the Hell Out of Healthcare by Nick JacobsWhen healthcare reform is discussed, it is personal.  It is also deep, and it is costly, but the bottom line always comes back to this: “How do you put a price on 17 months?”  In my book Taking the Hell out of Healthcare, I discuss the journey that my father and our neighbor took together over about a 17 month period.  Both diagnosed with lung cancer, my father decided to go for it all.  He had surgery, chemo, radiation, more radiation, and more chemo.  My neighbor, a man without significant health insurance coverage, decided to spend his time with his family.  They both died on the same day.  My father died in a cold, tertiary care hospital where no clergy was present, his family members were not all able to be there with him, and it was over.  In contrast, our neighbor died peacefully in his home, surrounded by his entire family.

Ms. Bennett did say that she was glad that she was not a bureaucrat having to deal with these issues.  Frankly, I wish that she was!


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.


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.


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)