Just Got Word

Even if the U.S. Supreme Court unwinds part of health care reform law, the changes occurring now aren't likely to recede because all of the dominant players in the health care industry are staking out new ground.  The driving forces are: cost cuts, care improvement and federal health-care overhaul preparation.  In many cases, this has blurred the lines between businesses that have historically been separated. Hospitals are slowly bulking up into huge systems, merging with one another and building extensive new physician work forces.  This reflects a continuing trend that dates back to the 1990s.  Hospital capacity in the United States has steadily shifted away from independent hospitals and towards multi-hospital systems.  Hospitals are getting into insurance-like setups (e.g., ACOs), including direct approaches to employers that cut out the health insurer. Insurers certainly aren’t dormant.  They are buying health-care providers, or s

There is nothing simple about the composition of health care organizations.  This complexity comes from, among other things, a concourse of medical professions and other stakeholders (e.g., patients and government) usually with incompatible interests, perspectives and time frames.  Exacerbating the challenges for health care leaders is the well-known need to satisfy the insatiable demand for health care - with limited financial assistance.   Health care executives frequently face additional challenges because: they have disparate stakeholder groups health care organizations have multiple missions (e.g., provide health care to their communities, remain fiscally sound, and be a primary employer in the community) professionals such as physicians and nurses value professional autonomy, and their decisions have a huge influence on health care expenditures, and the information necessary to manage the change process is usually sparse and always insu

Managing On a Strategic Level Health care organizations operate in an environment of rapid change, complex and varying regulations and impending health care reform. Many health care organizations do not employ physicians and face problems getting their input and involvement in strategic planning issues. Quality expectations are continually increasing and data availability is generally limited.  At the end of the day, health care organizations must overcome a number of problems in order to manage on a strategic level. Lack of Physician Involvement Many hospitals do not hire physicians as employees; these health care settings serve as facilities where physicians have privileges to admit and treat their patients.  Under these circumstances, physicians must be treated like customers rather than as employees, with even less available time for non-billable tasks such as administrative meetings and policy decisions.  In either case, physician involvement is a critical component of effective

Just in case the emerging Republican ideology of massive deregulation (ne: libertarianism) has any impact on the impending political elections, the Democrats are on board with the recent rolling back of numerous hospital operations rules that are considered inefficient and obsolete.  In fact, not only does this demonstrate that the Democrats can play the "government as a friend of business" hand, it could very well pave the way for acceptance of Obamacare. For details on the changes, see: "US Moves To Cut Back Regulations on Hospitals" in the October 19, 2011 edition of the The New York Times.  As the article points out: "Many of the new proposals deal with Medicare and Medicaid rules that have not been altered in decades.  In general, the proposals do not affect the large number of rules issued under the new health care law, which set detailed standards for coverage offered by insurance companies and employers." How does this housekeeping give credibi

Healthy competition leads to endless improvements. Product quality and customer service improve. Innovation propels advances in the state and types of care. Quality adjusted prices fall, the market expands and more customer needs are fulfilled. The options expand as health care organizations work to distinguish their products or services from others. Excellent companies prosper while firms with low quality, poor service, or high costs decline or go out of business unless they make fundamental changes to the way they operate. This is how value-based competition works in virtually every field: retailing, airlines, financial services, aerospace and computer services.   However,   it is very different from what we see today in health care.   There are a number of reasons for this.   First of all, many practitioners consider the whole idea of competition to be suspect.   Physicians are taught that competition is wasteful, that it promotes self-interested behavi

Within many geographic areas of the US, many hospitals compete with each other for labor and patients.   Each hospital within such areas would surely find it useful to know how they compare to the other hospitals beyond government-mandated quality outputs.   This is why tPF is pleased to announce it will be soon launching a ground-breaking model for a competitive hospital study. The type of information we are after is within the realm of staff attitudes, perceptions, opinions and motivations.   Such information is particularly powerful when gathered all at the same time and compared within a competitive field.   Think of it as an employee opinion survey steeped in the aftermath of the fledgling Affordable Care Act, but within a competitive group.   This is unprecedented because although many hospitals do their own employee opinion surveys, or have a third party do them, they only look at the attitudes and opinions of their own staff.   They don’t look at how such opinions and attitu

Every health care organization in the United States now faces significant Electronic Health Record (EHR) challenges.  Some organizations have invested millions of dollars in new systems and have matters in hand; other organizations are dealing with patched together legacy systems and are scrambling to get the funds and plans in order to roll forward.  Either way, there is something to be said for understanding what you are getting into; specifically, what has to happen and who should be doing it.  The following questions and answers are designed to transfer important knowledge to you.  If you have a question we haven’t thought of, please post it in the comments and we’ll do our best to get you the information you need. What’s the value-add of a solid EHR? EHR technology is not just an exercise in automating a vital element of patient care and business operations; it’s also about transforming how hospital clinical and financial operations perform.  Properly implemented, an EHR syste

After celebrated success at Toyota, lean has made some forays into the health care industry, with some early successes.  Perhaps it makes sense for US hospitals to take a closer look at the Toyota Production System (TPS) because there was nothing wrong with their brakes after all.  No, that’s not the reason.  Fast forward to the Deficit Reduction Act war room, where legislators are busily hacking away at the Medicare and Medicaid programs.  Last time we checked, these were among the health care industries' biggest customers or payers.  While the lean/6-Sigma training necessary to empower employees and contractors does disrupt things to some extent, the payoff appears to be tangible; more importantly, we are facing lean fiscal times so a lean organization is an absolute necessity, no matter how achieved. Those health care practitioners who have already ventured into lean seem to agree on one thing, that their successes are only truly successful to the extent they are systemic.  Th

The Center for Medicare & Medicaid Services (CMS) has updated its US Department of Health and Human Services site to include a way for consumers to compare (see: http://www.hospitalcompare.hhs.gov/hospital-compare) three hospitals in their geographic area.  Although this new information is a terrific step in the right direction (i.e., transparency), what is presented is still rather rudimentary in terms of:  ease of locating -- unless you click on "Resource Locater," you won't find "Hospital Compare" -- there is nothing on the site to draw you to this new feature breadth of specific disease comparisons --there are only six choices of diseases to compare in terms of how well the three chosen hospitals have performed, and even here we are being generous with six, since three of the choices are 'heart failure,' 'heart attack' and 'chest pains;'  if you group these three, there are actually only f

Just whose responsibility is it anyway to fix the medical system in the US?  Is it the AMA? The AHA?  How about hospital administrators in the aggregate?  What about policymakers; that is, when their work isn't being ignored or used as the reason for not supporting a purportedly necessary change (e.g., the Affordable Care Act). This comes to mind because a hospital client has a terrible problem in the ER; like at 175% capacity and the other charity hospitals in this urban setting have even higher ER capacity rates.  The thing is, this is an incredibly cosmopolitan city with lots to do.  There's nothing appealing about hanging out in the ER; that is, if you can even get inside.  So that's certainly not reason for the big crowds.  If you ask the Chief of ER what the solution to the chronic overcrowding is, he'd tell you that there is some kind of discharge problem "upstairs."  He thinks that a whole bunch of inpatients tieing up beds should be moved into rehab

One of the cornerstones of the fledgling Affordable Care Act is the “minimum coverage requirement,” where American individuals must demonstrate that they have current health coverage or pay a financial penalty for such irresponsible behavior.  The backlash for this impending arrangement has been considerable and illuminates the boundaries designed to establish and preserve government power as set forth in the Constitution.  For example, the reaction has led to: considerable lobbying in pursuit of exemptions for select groups (e.g., unions) and individuals lawsuits filed against: -                       the anti-constitutionality of the idea based on Congress overstepping its bounds in terms of Interstate Commerce Law, that is, whether the minimum coverage requirement is a constitutional exercise of Congress’ commerce power and -                       courts' ability to enjoin in the collection of tax under the Anti-Injunction Act (i.e., enjoining the imposition of the ACA p