Posts Tagged ‘reform’

Going “Rogue” – An Open Letter to Healthcare CEOs

October 17th, 2011

For the past three years, I have had a chance to dig heavily into the future, and I’m pretty convinced that the old saying, “Necessity is the mother of invention,” has never been more true than in today’s healthcare environment.  What was a given before in healthcare management may no longer be so in the future, and since most hospitals only Chief Innovation Officer is the President him or herself, their tasks of visualizing, understanding, deciding and directing the future of the organization will be shifting even more heavily from quantitative deciding-and-directing to the more qualitative visualizing-and-understanding side of this leadership equation.

Although I understand the reluctance of most CEO’s to be on the bleeding edge of creativity, my experiences at my former positions can significantly reduce or mitigate the majority of risk from any decision regarding innovation.

Our new competitive environment has an insatiable appetite for information, access and connectivity and it’s a well known fact that a periodic injection of chaos fosters creativity and forces your co-workers to leverage technology.   Because most organizations already have an environment that is built on trust and collaboration, injecting a little creativity can put their CEOs in more of a position to be the orchestrator and the inspirer.

That Used to be Us That Used to be Us is the new book by Thomas Friedman and Michael Mandelbaum in which they analyze four specific challenges Americans face as a nation—globalization, the revolution in information technology, the nation’s chronic deficits, and our pattern of excessive energy consumption—and spell out what they believe needs to be done to sustain the American dream, and achieve true supremacy based on innovation and excellence.

As an innovator and futurist,  several sections of this book captured my imagination and brought closure to a myriad of beliefs that I have instinctively embraced over the past few decades.  When my responsibilities revolved around the CEO position, I always saw my job as being a contributor to an environment where creative decisions were embraced allowed to happen and then those innovators were rewarded and inspired to keep going.

As the co-founder of a Research Institute, one issue that continually resonates with me is that  “We don’t have enough ‘rogue’ CEO’s in healthcare administration to take risks so that the rest can benefit from both their successes and knowledge.”

Well, fortunately, I’m your guy.

For the last several years I have been out there implementing unusual things, and many of these disruptive ideas are coming to pass in a big way.  I was the first hospital CEO to blog, starting in 2005 (, was an early Planetree board member, created the first breast cancer research center dedicated to the Department of Defense, and filled my hospital with Integrative Medicine, hotel amenities, and music.

Below, I’ve listed thirteen new examples of areas of innovation, in which we’ve been working for the past three years, as well as numerous ways to pay for these initiatives.

 Thirteen Examples of Disruptive Technologies and Practices That Hospitals Need to Understand 

  1. Robotic algorithmic software that improves emergency room flow by 37 to 50 percent.
  2. Financial transaction software that reduces electronic transfer fees exponentially (25% of health care income is from electronic transfers.)
  3. Utilization of nurses and actuaries as patient advocates to significantly reduce your employee health costs.
  4. Preventative medicine reimbursements that can double a physician’s income and add bottom line profits to hospitals.
  5. Treble growth potential of your organization through adding Integrative Medicine
  6. Diabetic retinopathy telemedicine for Family and Internal Medicine docs.
  7. Proteomic and genomic testing creating new “hospital income.”
  8. Peritoneal lavage that extends Stage 4 cancer patients from three months to five years or more.
  9. Bone scaffolding that supports bone growth and virtually eliminates bone infection.
  10. Special bandages that protect and stem cell cocktail sprays that heal burn wounds
  11.  Access to a cancer consortium that allows small and medium hospitals to become Certified Cancer Centers
  12. Hospitals paid “not to play” during an energy crisis as a back-up to the power grid.
  13. Green hazardous waste disposal costing 25% less than traditional methods

If you’d like to learn more about any adopting any of the concepts above, or receive a leadership presentation that will enable your staff to see the opportunities (rather than just the threats) in our current, uncertain environment, here’s where to find me.

Why Are Hospitals The Way They Are? from Nick Jacobs, FACHE on Vimeo.


Accountable Care Organizations

April 2nd, 2011

Avery Johnson of the Wall Street Journal wrote an excellent explanatory article this week about accountable care organizations – ACO’s. They’re a potential spin out from the Health Care Reform Act which are about to begin taking shape within the U.S. healthcare system.  The four hundred plus page proposal that was released this week is now being made available for comment, but those administrators and physicians who generally get the concept already are quietly pouring through the pages of this document to determine how it can become a part of their practices.

Donald Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services stated that ACOs were brought into effect with three major aims which are better care for individuals, better health for populations, and slower growth in costs through improvements in care.

Proposed Measures for ACO Quality-Performance Standards.

Scheduled to begin in January 2012, the primary goal of the ACO concept, not unlike other previous historical steps, such as PPO’s and HMO’s, is intended to extract about a billion dollars in costs from the existing Medicare system.  Theoretically, this model is not without merit.  Because most healthcare in the United States is still literally “a cottage industry,” simply having patient advocates help co-ordinate the care of those mega-users, the 18 Club of patients with nine physicians with whom they interact annually and nine different drugs that they take daily, should benefit tremendously.  If these patients can be directed to avoid those unneeded duplications, millions could be saved.

The government outlined rules for how doctors and hospitals can organize into new businesses to reduce Medicare costs and improve care are at the heart of the accountable-care organizations.  The new partnerships that could/should evolve from ACO’s would be aimed at controlling these costs.   They would be structured to coordinate care and their reward would be to share financially in savings with the government if they could come in lower than expected.  There is an alternative universe, however, where they would risk being penalized financially if they go over the anticipated costs.

There is no question that better synchronization of care could help to reduce both hospital readmissions and medical errors which in turn would produce Medicare savings.  In line with this, one of the primary reasons that ACOs might not work is that some of the largest health insurers in the country, including Humana, United Healthcare and Cigna, already have announced plans to form their own ACOs. Insurers say they can play an important role in ACOs because they track and collect data on patients, which is critical for coordinating care and reporting on the results.  As Jenny Gold quoted in her NPR report, “This could just be HMO in drag.” These partnerships of primary-care and specialists doctors with hospitals and clinics might help to produce a model that, although directed toward Medicare, could also have a positive impact on all of U.S. health-care.

Obviously, both hospitals and physicians are worried about ACO’s because they represent CHANGE, but it is common knowledge that if something is NOT DONE, our health care system will crash and burn.   Think of this, providers would get paid more for keeping their patients healthy and out of the hospital. What a concept.


Sometimes it’s Better to Punch a Bear in the Face

March 27th, 2011

I’ve tried to avoid controversy, but since my reading audience has dropped by a few thousand readers after departing my previous CEO position a few years back, I doubt that this will cause me any more problems as a consultant than I’ve already caused by expressing my opinions in previous posts. So, for those of you who are still dependent upon me for financial support, I apologize.

This morning, I read an article in the Pittsburgh Post Gazette by John Hayes entitled “Meet Your Neighbors: The Bears,” about black bears living in Pennsylvania. The essence of the piece is that there are about 18,000 bears living among the 12,000,000 citizens of Pennsylvania, yet there are only about 1,200 bear-related complaints to authorities a year. The bigger issue, however, is that there have been no reported deaths caused by black bears. They don’t eat people.

During this same period of time, I read a post by my friend and fellow patient advocate, Dale Ann Micalizzi, referencing an article about the former president of Beth Israel Deaconess Medical Center (BIDMC) in Boston, Paul Levy,  another nontraditional hospital CEO who espouses transparency. “Admiting Harm Protects Patients” is the article appearing in today’s Las Vegas Sun. In my book, Taking the Hell out of Healthcare, which Paul graciously endorsed on the cover page, we talk about patient rights, patient advocacy, and the need to have someone with you during your hospital stay to ensure that you are not going to become a statistic. In today’s article, Paul is recognized for the work that he did with his blog — a blog which I encouraged him to write and to keep writing — in which he challenged the hospitals of Boston to reveal their mistakes, to stop keeping the infection rates and other problem statistics secret.

Because he was trained as an economist and a city planner, Paul Levy was considered an outsider by his peers when he took over the troubled Deaconess hospital, but as he quickly turned it around, he did so through the eyes of an outsider. In December 2006, he published his hospital’s monthly rates of infection associated with central-line catheters, which are inserted deep into the body to rapidly administer drugs or withdraw blood. These central line infections, which can be caused by nonsterile insertion of the catheter or not removing it soon enough, are preventable. The Centers for Disease Control and Prevention estimate 250,000 central-line infections occur annually, costing $25,000 each and claiming the lives of one in four infected patients.

Dale Ann Micalizzi (L) and Paul F. Levy (R)  - Healing Hospitals - F. Nicholas Jacobs, FACHEHe then challenged the other Boston hospitals to do the same. He was accused of self-aggrandizement, egomania, and numerous other witchcraft-like things, but the bottom line was that the number of infections went down, and they went down because the staff and employees wanted to do better and wanted them to go down.

What else happened at Beth Israel Deaconess?

• Hospital mortality of 2.5 percent, which translates to one fewer death per 40 intensive-care patients.

• Cases of ventilator-associated pneumonia, from 10-24  per month in early 2006, to zero in as many months by mid-2006.

• Total days patients spent on ventilators from 350-475 per month in early 2006 to approx. 300 by mid-2007.

• The length of an average intensive care stay from 2005 through 2009, the average stay was reduced by a day to about 3 1/2 days.

(See my previous post on outrageous claims at my prior place of employment.)

Well, in today’s article about the bears, I read that “when bear attacks occur they are generally very brief, and injuries can include scratches and bites.”  Here’s the part I had not anticipated from the bear conservation officer: “Fight back, don’t play dead.  Unlike other North American Bears, black bears don’t consider people to be food.  When it realizes what you are, or gets a painful punch in the face, it is likely to go away.” I believe it’s a useful metaphor.

If you or your organization would like to hear a CEO or two speak about patient advocacy (and way better healthcare), I’m sure I know a former teacher/musician and a former city planner who would welcome the invitation.

Patient advocacy is in your hands!

Health 2.0 Leadership (1 of 2) from Nick Jacobs, FACHE on Vimeo.


It’s Not Just About the Passion

February 20th, 2011

Get up at 3:00 AM, get to the airport at four, fly out at five, arrive in Austin, Texas at 10:20 AM, wait until 1:30 PM to meet three other board members, rent a car and drive to the retreat center. Check–in, have a quick dinner and go to the first evening board meeting; in bed by 11:30 PM, up at 6:30AM and meetings on Saturday until 11:00 PM. Next day: Up at 6:30 AM, meet until 10:30 AM, drive to the airport and fly home through multiple cities; arrive at around 8:00 PM. That was my weekend. Why? Because I am the only non-physician member of the American Board of Integrative Holistic Medicine. More specifically, I am the not-so-token former hospital administrator, and that’s how much ABIHM cares about spreading the word.

This is my third year as a board member, and during that time, it has been my genuine pleasure to watch this amazing group of caring, integrative/holistic physicians build what is fast becoming the most important element in the U.S. healthcare reform movement. Most of them may not be seeing this the same way that I am (i.e., as not only life but also economic saviors), but it is absolutely a fact that their way of providing care is the only hope that we have in this country to contain health care costs and improve the quality of life in America.

As physicians, this group of humble yet brilliant men and women are true giants in their respective fields of endeavor, be it Family Practice, Internal Medicine, OB/GYN, or Psychiatry. They are “top docs” in combining traditional practice with integrative and holistic medicine. They come from prominent medical schools, and some eve teach residents at these schools. Some are in private practice and still others are working for large, prestigious health systems. They have literally written many of the books on integrative and holistic medicine, but the most important thing that I can tell you is that they are all unbelievably positive people; kind, caring, nurturing, thoughtful human beings who are “in it for all the right reasons.” No kidding. All of them.

Why am I so enthusiastic about these folks? They truly practice what they preach. Spending even 50 hours with them revives the soul and confirms my beliefs that every one of these holistic modalities can contribute to our well-being. I’ve heard their stories about the power of meditation, of vigor restored by appropriate diet and things like simple yoga stretching and walking. They casually discuss case after case of people who have been cured or healed of what would otherwise be considered debilitating maladies simply by altering a diet; cutting out the processed foods and sugars, walking a little every day and finding anywhere from 20 to 40 minutes a day to just step back and focus on themselves, their hopes, dreams and positive outcomes through internal journeys of self-exploration and meditation.

So, where do we go from here?

If you’re a doctor, look them up on the web at, attend their seminars and workshops, meet them, learn about their peer mentoring program, embrace them and their 1200 Diplomates, and, most importantly, get on board. Each and every one of these gifted, inspired physicians has one thing in common: they love their work; they love to go to work, and their patients and staff love to work with them. If for no other reason, look them up for yourself.

If you’re a patient, don’t settle for less. Search their website at and find physicians near you who are certified in Integrative Holistic medicine. Get off those medicine cabinets full of pills, start taking care of yourself, and begin to live the life that you and your loved ones deserve. It’s the only way. The promise of technology has not cured us. The skill of steel from our gifted surgeons has not prevented the malady from impacting us in the first place, and, finally, the pain and suffering keeps going on and on in our lives.

The solution? Find an ABIHM doctor and start the change today.

The American Board of Integrative Holistic Medicine (ABIHM) is pleased to announce an additional opportunity to take the 11th Annual Board Certification Examination, on-site at the conclusion of the iMOSAIC Conference in Minneapolis, MN.  Please take a moment to review the iMOSAIC conference schedule at, where you will see an impressive program of faculty and topics!

Date: Sunday, April 10th, 2011 at 1:30 PM. Sign in between 1:00-1:30 (preregistration required).

Location: Minneapolis Convention Center, Room 208 AB

Duration: 5 hours allotted; at least 50% of candidates finish by 2.5-3 hours


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.


Is Saint Vincent’s Just the Beginning?

November 9th, 2010

In an article in New York magazine by Mark Levine entitled, “St. Vincent’s Is the Lehman Brothers of Hospitals,” we are taken on an extremely in-depth and comprehensive review of the sickness and death of one of New York City’s oldest hospitals. It is not my intent to re-create or completely paraphrase this incredible article, but only to select a few of the most poignant facts that literally jumped off the pages and painted a reality for me that was not restricted to the hospitals of New York City.

Photo Credit: Associated Press via

A worker removes signage from now-closed St. Vincent's Hospital.

Mr. Levine’s research revealed that “In 2008, local hospitals spent $3 billion more delivering care than they took in.” He also found that New York hospitals carried twice as much debt in relation to net assets as hospitals around the country, and that, — this is no surprise, as various New York City hospitals close, “the health of low-income and minority residents will be most affected.”

In this commentary, he listed a myriad reasons why these facts represent reality. Included is the $600 per square foot construction costs, outrageous malpractice premiums that are double the national average, 15% higher staffing levels than in other areas, CEO salaries that in some cases have reached nearly $10M per year, daunting demographic challenges, a lack of private physicians living in most communities, lengths of stay that, once again, are at least a day longer than other U.S. hospitals, the 1.4 million New Yorkers who have no health insurance, decreasing Medicaid rates, and a private insurance network that makes considerably more on its New York hospitals than is the case in other geographic areas.

Interestingly enough, as we forged our way through this comprehensive history of how the City system has devolved over the past thirty or so years, we were taken on a journey that is not unfamiliar to many of us in hospital administration. As government swung from socialized (as Mr. Levine states…with a small “s”) medicine to shock-therapy free market, to increased costs in competition, physician recruitment, technology build-up (a build-up that he referred appropriately to as the “medical arms race“), and more movement toward outpatient care, it is very clear that New York City’s hospitals crisis is just one view of a dysfunctional healthcare system that is clearly on a path that could eventually lead to collapse for not only the system, but also for the economy of the country as well.

New York City’s hospitals crisis is just one view of a dysfunctional healthcare system that is clearly on a path that could eventually lead to collapse for not only the system, but also for the economy of the country as well.

This paragraph is one of the most telling paragraphs in the article, “The way forward seems perfectly, if brutally, clear. With private insurers under pressure to cover more patients yet not hike premiums, with federal and state governments facing record deficits, and in a local industry climate with free-market survivalism, many New York (substitute U.S.) hospitals won’t be able to generate sufficient revenue to restore themselves to financial health.”

Image Credit: - Nick Jacobs, FACHE -

Interestingly enough, the conclusions reached regarding survival embrace numerous ways of doing business that were not entirely foreign to many hospitals. Included were such concepts as: moving more toward outpatient care in less expensive locations, more follow-up care to keep patients from returning, reduction of unnecessary testing, employment of and profit sharing with physicians, and additional methods of dealing with “the tyranny of insurance companies.

Steps such as measuring nursing hours, housekeepers per square foot, food service people per meals delivered, and embracing the entire model of industrial efficiency were all suggested contributors to the bottom line.

Mr. Levine also granted partial sainthood to a profoundly bullying management style of one CEO who cut services that didn’t make profits, eliminated catering to the poor and “told doctors where to go.”

All of this plays perfectly into the story that I had lived and am currently telling across these United States and beyond; that dignity, prevention and wellness, attention to human and humane detail, the removal of autocratic leadership, and patient and employee-centered care — all enveloped in a spirit of entrepreneurship — can prevail.

That integrative and holistic medicine practices will contribute to taking us out of the current crisis and into a health care delivery system that will be the design for this century and beyond. Of course, we need malpractice reform; we need more control over big pharma and most importantly, we need to provide some type of safety net for those without coverage, but the path to survival is not simply one of a “business model.” It is a path to a humane model, a creative model that embraces people, embraces wellness, embraces humanness in creative, meaningful ways.

Perhaps hospitals are not being killed, but rather are committing slow suicide by following their “Calf Paths” from the past.


Bhutan’s Philosophy of “Gross National Happiness”

October 3rd, 2010

Not everything that can be counted counts, and not everything that counts can be counted.
—Albert Einstein

At a recent conference I had the opportunity to learn about the Himalayan nation of Bhutan. Most of us had not heard of this country, but we should have, because they have done something that is reminiscent of the Broadway Musical “Camelot,” or possibly “Brigadoon.” Their King introduced a philosophy of living that is intended to shape all of the government’s activities. According to Mr. Kuenga Tshering, Director of the National Statistics Bureau of Bhutan, Gross National Happiness (GNH) was promulgated as Bhutan’s philosophy of economic and social development by the Fourth King of Bhutan as soon as he came to the throne in 1972.

The reason I’m writing about this is because I believe it is an amazing idea, a wonderful goal, and a step toward embracing  idealism.  Many of you have heard my thoughts on change, and know that I do not believe that there is only one route to follow on this journey through life.

Takstan Monastery, Bhutan (image credit:

Takstan Monastery, Bhutan (image credit:

The Bhutanese philosophy of “living” refers to a set of social and economic interventions that evaluate societal change in terms of the collective happiness of people.  Further, these measures are also applied to the creation of policies that are aimed at that objective. Premised on the belief that all human beings aspire to happiness in one way or another, the concept promotes collective happiness of the society as the ultimate goal of development.  Now that would be a political platform!

The philosophy of Gross National Happiness considers economic growth as one of the means towards achieving happiness, but it also offers a holistic paradigm within which the mind receives equal attention. While GNH recognizes the importance of individual happiness, it emphasizes that happiness must be realized as a collective or societal goal and not be defined as an individualized or competitive good.

The philosophy should also not cause misery to future generations, other societies, or to other  beings, and it is important to the government of Bhutan that the efforts of this philosophy be distributed evenly across all sections of  the society.

They work at strengthening the institutions of family and community; the spirit of voluntarism, tolerance and cooperation; the virtues of compassion, altruism, honor and dignity, all of whose active promotion may be a contributing factor to Bhutan’s low crime rate.

Culture also provides a framework where an individual’s or society’s psychological and emotional needs are addressed. By preserving local, regional, and national festivals, the government attends to these needs and provides a forum for maintaining social networks and promoting the conviviality of public culture.

His Majesty, King Jigme Singye Wangchuck of Bhutan

His Majesty, King Jigme Singye Wangchuck of Bhutan

Bhutan treasures the extended family network as the most sustainable form of social safety net. Aware of the possibilities of family disintegration or nuclearization, the government makes conscious efforts to revive and nourish the traditions and practices that bond families and keep communities resilient and thriving.

Their environmental policy is predicated on the perspective that human beings and nature not only live symbiotically but are inseparable from each other. According to this perspective, nature is a partner in existence; a provider of sustenance, comfort and beauty.

Environmental preservation, therefore, is a way of life in Bhutan. Currently, 72% of the country’s area is under forest cover, 26% of the area is declared as protected areas, and the state has decreed to maintain 60% of its area under forest cover for all times to come. Environmental cost is an essential ingredient of evaluating new development projects in  Bhutan.

Finally, Bhutan launched parliamentary democracy 2008, becoming the youngest democratic country in the world. All this was initiated by the country’s leader – His Majesty, King Jigme Singye Wangchuck, thus fostering people’s capacity to make choices.

Well, we have generally been making choices as a country for some time now that generally do not embrace nature, family, our fellow man, or the environment.  On a recent boat trip up the Caloosahatchee River, I expressed a dream, namely that mankind would embrace a philosophy of “National Happiness.”

Now wouldn’t that ROCK?

Not everything that can be counted counts, and not everything that counts can be counted. — Albert Einstein

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Moving Through Healthcare’s Version of the BP Oil Spill

May 27th, 2010

Who could have ever guessed that the United States of America would fall so far behind in education, childhood death statisticsscientific research, manufacturing jobs, and even overall, general healthcare?  Yes, of course, we are still a wonderful, strong country with incredible resources, but somewhere along the line, the train seems to have jumped off the track just a little, or is that like being a little pregnant?  No one would ever have conceived that a spark plug would be worth more than GM stock, but that’s exactly what happened last year.  Or how about the fact that large investment banks responding to the mandate to increase home sales by spreading the risk internationally could have helped put this entire world on the verge of a national depression?

For years now I’ve written about the need to provide some type of safety valve for the uninsured, underinsured, and those struggling to make it from layoff at age 58 to Medicare at age 65.  Not unlike the Kennedy-Katzenbaum bill, (you know, that HIPAA bill that was just meant to provide health insurance portability), we have healthcare reform legislation.  The really challenging thing about this new bill is that it was primarily written by policy wonks fifty percent of whom will not be working in Washington D.C. in a few years, and worse than that, it will be interpreted by policy wonk lifers who will be there long after we are all dead.

So, the “Healthcare Oil Spill” has been addressed.  What will it mean?  What does it mean?  How will it impact all of us?  That remains to be seen.  The good news is that 30 million more people will finally have a safety net. The bad news is that there are still two wars going on that are draining our treasury.  There is still financial chaos among the countries lovingly referred to by the EU as the PIIGS (Portugal, Ireland, Italy, Greece, and Spain), and, along with this group,  spending in the United States  has been out of control for at least nine years.

What will happen is anyone’s guess.  How things will be interpreted is anyone’s guess.  How the law will be enforced is every one’s guess, but in  a recent round table discussion at the Mid-State HFMA meeting, we heard four CFOs discuss the challenges that they currently face and will continue to face as life becomes even more complex.  After that session, I’m thinking that lots of mud pushed in the head of the well might just be the cure!  Goodness knows there was enough mud thrown around during this last election cycle.  Maybe we could redirect it back to the source?  I do know for sure that one thing is clear: CHANGE is INEVITABLE, the train is back on the track, and it’s coming straight toward our physicians, hospitals, and nursing homes.

How do we cope with that change?  Make sure that every ounce of fat is cut from the system.  Take a look at the list below and contact SunStone Consulting for the next steps:


What’s Still Missing?

April 3rd, 2010
We are on a not-so-merry-go-round which, even after health care reform, continues to promote a system of illness incentives  that are improperly reimbursed, improperly addressed, and inappropriately segmented. We continue to consider body parts as if they are not connected to or a component of the whole.
Wellness Wheel - Image credit: Marquette University

Tort reform still has virtually no teeth.  This causes physicians to practice sometimes over-the-top medicine in self-defense. When will it be time to begin to throw the switch and teach patients what we already know so well; that wellness, wholeness, and health can change the quality of our lives completely? Our medical schools need to embrace wellness and prevention as a path to health. Not unlike indigenous man, it is time that we begin to realize that our brains do have something to do with our bodies.  We live in a commodity driven society which does not always promote the best, most healthful food, even miminal exercise, stress management, or self-nurturing. Instead, because of those quarterly reports to the stockholders, these companies promote what is the most lucrative and often the easiest to sell. - Health and Wellness - Nick Jacobs -  HealingHospitals.comWe know that drinking a soft drink with 10 teaspoons of sugar is not 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 our arteries. Fried and buttered everything, a total lack of exercise, and more stress than anyone can ever dream of will not extend our lives

One night a few weeks ago I couldn’t sleep, and at 3:00 AM, I looked up and saw an apparition… Oprah. There she was, talking about food. The person she was interviewing said, “Oprah, in the 1960’s, our food cost us 18% of our annual income. ” Maybe that’s why there weren’t more restaurants at that time. Families were stretched just eating at home. He went on to say that, “In the 60’s, healthcare costs us 9% of our income.”  Finally he said, “Now healthcare costs us 18% of our income, and food costs us 9%.”

So, that’s the trade off. We can buy good, farmer’s market-type healthy, organic food and have low healthcare costs, or we can buy manufactured, additive filled food, and pay more for our healthcare.  How much further down this cul de sac must we go as a country before we begin to realize the path to health and wellness or longevity?

Health and Wellness - Nick Jacobs -


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!