Download - Changing healthcare 2013
Technological
Cultural
"There's no question that the healthcare field is undergoing
a period of fundamental transformation in which the
very model of healthcare delivery is being changed in order to improve quality and
lower costs"
- Sharis Pozen, a partner at Skadden, Arps, Slate, Meagher & Flom, during testimony on behalf of the American Hospital Association for the House Subcommittee on Regulatory Reform and Commercial and Antitrust Law.
The United States' burgeoning primary care crisis amid the
rollout of health reform is akin to "handing out bus tickets when
the bus is already full"
-Perry Pugno, vice president for medical education at the
American Academy of Family Physicians
Republican senators led by Utah's Orrin Hatch have
said they will work to repeal the 2.3 percent medical
device tax that went into effect January as part of the
2010 Affordable Care Act.
The tax--intended to help pay for costs associated
with the healthcare reform law--is a point of
contention for many legislators, as well as device
makers, innovators and providers. Hatch, ranting
about the tax on Tuesday, referred to it as "one of the
stupidest aspects" of the ACA.
A March 2012 report published by AdvaMed concluded
that the tax could result in the loss of close to
39,000 jobs and $8 billion in economic output.
The medical device tax
would generate $30
billion over a decade to
support the tenets of the
Affordable Care Act - President Barack Obama
In fiscal year (FY) 2014, the Hospital
Readmissions Reductions Program will
withhold up to 2% of regular reimbursements for
hospitals that have too many patient
readmissions within 30 days of discharge
because of three medical conditions: heart
attack, heart failure and pneumonia.
Under the ACA, the maximum penalty will top
out at 3% by 2015 and be expanded to include
readmissions for other medical conditions,
including chronic lung disease and elective hip
and knee replacements.
The nonprofit organization--known as the Center for
Medical Interoperability--will be financially backed by the
Gary and Mary West Foundation, according to an
announcement. Founding Board Chairman Michael Johns
called medical device interoperability key to "unlocking
healthcare communications" in hospitals.
"By bringing hospital systems together, we can align all
stakeholder interests in a neutral forum to include
technology vendors, standards organizations, certification
bodies, government agencies and healthcare associations
under a common goal to improve healthcare," Johns said
in a statement.
Healthcare Business
Intelligence: A Guide to
Empowering Successful
Data Reporting and
Analytics"
by Laura B. Madsen, M.S., founder of the Hsummit.
Four things you absolutely should not, under
any circumstances do," which includes:
• Never make a consultant the leader of your
business intelligence program.
• Don't ignore or forget about you own staff.
• Don't believe the vendors who promise you
can install and plug in your data and be up
and running in a few days. If it sounds too
good to be true, it is.
• Never de-emphasize the importance of a
good data model.
Genome Sequencing Prosthetic Development
Stem cell research
Organ growth
Artificial
Hearts
Nanotechnology
The patient-centered medical home
(PCMH) continues to help healthcare
organizations achieve lower costs and
better care, as well as improve physician
and staff morale.
With such potential benefits, FiercePracticeManagement reached
out to Montefiore Medical Group in the Bronx, N.Y., to hear how
it has established a PCMH model and received
National Committee for Quality Assurance (NCQA) recognition.
“Value-based healthcare as a
"breakthrough that will change
the face of medicine." He said
the pay-for-performance model
will lower healthcare
costs, improve quality and
outcomes and eventually affect
every patient across the United
States.”
- Toby Cosgrove, M.D., in a blog post for the Harvard Business Review
Medical errors leading to patient
death are much higher than
previously thought, and may be
as high as 400,000 deaths a
year, according to a new study in
the Journal of Patient Safety.
I sure hope
they
remember
to wash
their hands!
There are about 250,000 C. difficile
infections a year in the United States
that either require hospitalization or
involve already hospitalized patients.
The bacteria kills 14,000 Americans a
year, the CDC says.
Focus on Ecological Sustainability
Healthcare Environmental Efforts
• H2E (Hospitals for a Healthy Environment) -“Making Medicine
Mercury Free” program.
• Recycling tons per year - shredded paper, beverage containers,
mixed paper, old linens and scrubs, batteries, and cardboard.
• The E-Waste (electronic waste) recycling program.
• Printer cartridges returned for reuse.
• Setting copiers to use two-sided printing defaults.
• Medical charity foundations and organizations receive medical
supplies and equipment.
• Implement a standardized temperature control policy.
Healthcare Environmental Efforts
• Movable shutters that promote passive solar heat reduction.
• Use digital radiology scans, reducing the use of water as well as
hazardous waste associated with traditional X-ray processing.
• Reprocessing is a key component in environmental sustainability
programs and is a proven means of not only decreasing the
quantity of waste going into incinerators and landfills, but in
decreasing the cost of providing safe, effective devices.
• Create food gardens on campus dedicated to general education
about seasonal grains, fruits and vegetables. Can be located on
building roofs and provide a source of fresh healthy foods for
patients and staff.
• Low flow fixtures to reduce water consumption. Using solar
power and dual-flush toilets.
Advanced Environmental Efforts
• Assuring facility finishes are free of polyvinyl chlorides (PVCs), have low-VOC
(volatile organic compounds) emissions and be sound attenuating to reduce
noise.
• Focus on passive strategies, such as utilizing narrow floor plates to maximize
exposures, creating an efficient thermal envelope and designing efficient
lighting.
• Address active strategies, such as the use of occupancy and daylight sensors,
fuel cells, renewable energy and water conservation.
• Environmentally preferable purchasing, integrated pest management and green
housekeeping.
• Sewage treated in an on-site membrane bioreactor.
• Building systems also include an integrated day-lighting system, naturally
ventilated stair towers, radiant heating and eco-roofs.
• Rainwater and wastewater are harvested for landscape irrigation.
Severe thunderstorms, such as this one
observed in Oklahoma in 2009, that could
create tornadoes will become more
common with global warming.
Build a bench of informal leaders
In early 2011, Maryann (the new CEO at the time) made it her personal mission to task a refreshed set of leaders with turning around the organization. Instead of looking outside the organization, she collaborated with trusted and loyal colleagues to understand the issues plaguing the organization and build a list of potential leaders.
The goal was to build a culture of transparency – difficult conversations, which previously happened behind closed doors, were held out in the open to build trust and acknowledge the organization’s shortcomings.
Weed out underperformers
Having identified a strong platform of potential leaders, the organization conducted “up or out” conversations with under performing leaders, recognizing that the long-term gains of having the right people steer the ship outweighed the short-term pains associated with turnover.
Quality, turnover, and manager effectiveness data from the engagement survey were used to identify these individuals, and they were confronted with one question – are you either unwilling or unable to lead effectively? Those leaders who were unable to manage their colleagues effectively were offered coaching, and those who were unwilling were asked to leave.
Strategically sequence improvement efforts
Perhaps most importantly, St. Elizabeth’s resisted the urge to tackle all of its performance improvement concerns at once. While many organizations stumble by spreading their focus too thin, St. Elizabeth’s began by shoring up quality metrics to ensure that employees felt they were working at an organization they were proud of.
After encouraging progress across 2011, St. Elizabeth focused primarily on engagement in 2012 and on patient satisfaction in 2013, sustaining previous years’ efforts and building an improvement-driven culture.
St. Elizabeth’s turnaround was driven by their CEO, Maryann Reese, and included three critical elements-Sarah Strumwasser.