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-...

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 ...

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...

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 promote...

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...

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 i...