A Doctor – Economist’s Solution for Health Reform

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

As President Obama spoke, prodded and cajoled for Congress to pass HR 3200-3400 in 2008, I believe that for any healthcare reform effort to work successfully for the American people – for the long term – we need to consider the following in no particular prioritized order:

  • Insurance portability uncoupled from patient employment
  • Health insurance regional exchanges with inter-state purchase competition
  • Doctor, drug, DME and hospital pricing and payment transparency for HSAs, and all of us
  • Modifying or eliminating AMA owned CPT Codes®; a huge money maker for them
  • Abandoning ala’ carte medicine for values-based outcomes
  • Reduce JCAHO influence; encourage competition from Norwegian Det Norske Veritas [DNV]
  • Reduce big-pharma influence thru-out the entire medical education, career and care pipeline
  • End DTC advertising from big-pharma
  • Promote wholesale drug purchase competition, MC bidding and generic drugs
  • Encourage evidence-based medicine, not expert-based medicine
  • Less pay for medical specialists with a  re-evaluation of the hospitalist concept
  • Advance the dying art of physical diagnosis, teach and embrace Paretto’s 80/20 rule for clinic issues
  • Reduce lab test, diagnostic imaging and testing
  • Encourage private 24/7/365 medical offices and clinics; and on-site and retail clinics
  • Abandon P4P, medical homes and disease management ideas
  • Give more economic skin-in-game to patients relative to health benchmarks
  • Concretize the “never-event” prohibitions and include a list of patient health responsibilities
  • More pay for primary care docs and internists
  • Adopt digital records and cloud computing for patients
  • Phase in true eHRs incrementally; and abandon CCHIT for open source SaaS
  • Promote Health 2.0 social media.
  • Augmented scope of practice, numbers and pay for NPs and DNPs, etc
  • Reduce pay for CRNAs and increase it for staff RNs
  • Develop step down triage and treatment units to reduce the number of full service ERs
  • Increase medical, osteopathic, dental, optometric and podiatric medical school classes
  • Increased practice scope for dentists, podiatrists and optometrists
  • Make some sort of catastrophic HI mandatory, much like auto insurance for all
  • End pre-existing conditon health insurance contract clauses
  • More choice  and end of life control for the terminally ill patient
  • Increase marketplace competition with fewer political and financial “externalities”.
  • Teach basic healthcare topics in school and encourage physical exercise
  • Health and insurance education should be, but is not, the “answer” for Americans
  • Protect borders and discourage undocumented illegals
  • Adopt medical malpractice tort reform
  • Make all stakeholders fiduciaries
  • No public “option” unless you like food stamps, Section 8 housing, public transportation and schools
  • Budget deficit neutrality
  • Slow down!

Assessment

Recently, while in the Baltimore/Washing area, I was asked by several reporters to opine on the healthcare debate; which I did so freely having never been known as the shy type. And, regular readers will note that many of these items have been used as posts or comments on this ME-P. Unfortunately, my “laundry list” interview was pre-empted by two local but boisterous town-hall meetings with respective passionate politicians. It was redacted no doubt, but never broadcast. Thus, I missed the potential for my “five minutes” of fame. C’est la vive!

Conclusion

There you have it; direct and straight forward. And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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What’s So Special About War Doctors?

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A Special ME-P Christmas Holiday Tribute

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

Back in the day, I did some trauma training at Martin Army Hospital in Columbus, GA. This 250-bed facility is the center for medical services at Fort Benning. Opened in 1958, it is one of the largest and most comprehensive community hospitals in the Army. The hospital is recognized as one of the best in the nation for quality of care as certified by the Joint Commission on Accreditation of Healthcare Organizations, and service to the community by the Army and TRADOC Communities of Excellence Evaluations.

MEDDAC

Fort Benning’s MEDDAC, a major subordinate command of the U.S. Army Medical Command, furnishes medical care to an eligible patient population in excess of 72,000 beneficiaries. Since the establishment of Fort Benning in 1918, medical services have always been available. In the early days, medical care was dispensed from tents, temporary wooden buildings, and leased space in the Columbus Hospital. In 1924, services were moved into what is now the National Infantry Museum, and in 1958 Martin Army Community Hospital was opened.

Martin Army Hospital 

Martin Army Community Hospital is named in honor of the late Major General Joseph I. Martin, Medical Corps. The hospital was opened in 1958 at a cost of slightly over $6 million. As the demand for outpatient health care grew, a 59,000 square foot ambulatory care wing was added in 1975 at a cost of $3.8 million.

To support the purchase of modern medical equipment and to ensure the compliance with the JCAHO standards, an extensive electromechanical upgrade project was completed in 1980. This was my era. The latest major construction occurred in 1990 when the Emergency Room underwent renovation at a cost of $835,000. The ER now contains the latest technology available to preserve life, and can provide these services more efficiently than in the past.

Professional Training Programs

In addition to its medical mission, the MEDDAC has an extensive professional teaching and training mission, and in 1972 established the Army’s first Family Practice Residency Program. This 3-year program maintains approximately 30 residents who provide medical services throughout the hospital.

Other specialty training programs include the clinical portion of the Army’s Physician Assistant Program, a residency in Health Care Administration, Podiatric Surgery internship, training in several enlisted specialties, and numerous clinical rotations or externships conducted in cooperation with local colleges and universities. Located near the Infantry Museum is the Army Substance Abuse Program, Exceptional Family Member Program, and the Early Intervention Program. In addition to these facilities, the MEDDAC operates four Family Practice Clinics, five on-post Troop Medical Clinics (TMCs), a Reception Station, and two satellite TMCs in support of Ranger School training in Georgia and Florida.

A New York Times Re-Post

As so, it is with some degree of pride that we reprint this story from the NYTs.

###

DOCTOR AND PATIENT

By Paulinwe W. Chen; MD

One morning as a medical student on the surgery service, I learned about a patient who had been hemorrhaging on the operating table the night before. The intern who had assisted during the operation took great pains to describe every detail of the failed efforts of several senior surgeons and the final, ultimately lifesaving, maneuvers of the department chairman. “He came in and just got control of the bleeding,” the intern concluded, waving his hands as if the chairman’s work had involved magic.

Assessment

“How did he manage that?” one of my classmates asked. “He’s one of the best,” the intern answered matter-of-factly. “He was a surgeon in Vietnam.” 

More Lesson from the War Zone: http://www.nytimes.com/2009/12/11/health/11chen.html?ref=health

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Conclusion

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The Medical “Do Not Use” Acronym List

Joint Commission Abbreviations Not Used

By Staff ReportersHDS

In May 2005, The Joint Commission first affirmed its “do not use” list of abbreviations. The list was originally created in 2004 by The Joint Commission as part of the requirements for meeting National Patient Safety Goal Requirement 2B [Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization].

Link: http://www.jointcommission.org/PatientSafety/DoNotUseList/

Official List [Updated 3/5/09] 

Link: http://www.jointcommission.org/NR/rdonlyres/2329F8F5-6EC5-4E21-B932-54B2B7D53F00/0/dnu_list.pdf

Assessment

In the era of twitter and other text messaging abbreviations, the list is similar to “never-events” and related conditions frequently discussed on this ME-P.

More info:  https://healthcarefinancials.wordpress.com/2008/01/16/never-event-payment-trend-continues/

Conclusion

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The Future of Hospitals

Between a “Rock and Hard Place”

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™rock-and-hard-place

A recent white paper by the Joint Commission suggests that hospitals must respond in new ways to meet the increasing complexity of patient care and to address rising health care costs. Duh! What an insight. Why did it take so long for them to declare same?

 

The Hospital Accreditation Competition Heats-Up

Was it because of competition from DNV Healthcare Inc? Was it their new ability to determine if hospitals are in compliance with Medicare Conditions of Participation [COP]? DNV joins the Joint Commission on the Accreditation of Healthcare Organizations [JCAHO], and the American Osteopathic Association [AOA], as the only national hospital accrediting agency approved by the Centers for Medicare and Medicaid Services [CMS].

Link: https://healthcarefinancials.wordpress.com/2008/10/03/hospital-accreditation

Recommendations

Nevertheless, the JCAHO report recommends action in five areas:

  • Economic viability and ROI
  • Technology adoption and use
  • Patient-centered collaborative care
  • Medical and human resources staffing
  • Hospital architectural design

Patient Centered-Philosophy

Of course, it is no surprise that patient-centered care should be philosophically at the core of any partnership between a patient and his/her hospital and medical providers. Yet, just think of the last time you saw your HMO doctor and tried to engage in a collaborative health 2.0 discussion with him/her? Na-da!

Health Information Technology

The Joint Commission, despite the interoperable eHR controversy often presented on this blog, suggests that technology adoption can play a major role in improving patient care, safety and quality.

Link: https://healthcarefinancials.wordpress.com/2008/12/19/the-case-against-inter-operable-ehrs

This transformation from paper to electronic records, according to the report, will involve:

  • Making the business case for ROI and funding
  • Redesigning business processes with HIT implementation
  • Extending the digital footprint to the “medical-home”
  • Engaging IT leaders for guidance on prior mistakes 
  • Improve workflow – minimize labor intensive activities

Of Hospital “Insider” Administrators

One local hospital administrator insider, here in Atlanta, confidentially tells us that a single hospital bed is currently worth about a million bucks a year to the institution; private or public. And, the mantra of most hospital CEOs to staff doctors, is: “fill the beds”; “schedule the procedures”; and/or “book the operating rooms.”  So, the priorities outlined in the report really don’t seem appropriate; do they?

IOW: Put the hospital first; not the patient? And, this echoed our experience in hospital administration two decades ago. Has anything changed?

Assessment

Nevertheless, it may be refreshing to see an approach to healthcare technology implementation that seems to leverage the experience and knowledge of other industries. Privacy concerns however, are the biggest obstacle to HIT and true inter-operable eMRs, in our opinion. Yet, it doesn’t need to be. Who cares if grandma has a bunion, or dad had his cataracts repaired. They aren’t running for public office; are they?

The road to the Hospital of the Future will be bumpy, but we are hopeful enough to trust the benefits will be great once we arrive.

Full report: hosptals-future 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are hospitals today “between a rock and hard place?” Is technology and business process reorganization being offered as a substitute for critical thinking and true collaborative medicine? Especially, in light of the healthcare capitalistic thrust to: “do more – in order to earn more.”

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Defining Medical Sentinel-Events

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Shedding Light on Unexpected Occurrences

[By Staff Writers]lighthouse2

According to the Joint Commission on the Accreditation of Healthcare Organizations [JCAHO]:

“A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.  Serious injury specifically includes loss of limb or function. The phrase, “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called “sentinel” because they signal the need for immediate investigation and response.”

About The Joint Commission

The Joint Commission on the Accreditation of Healthcare Organizations is an independent, not-for-profit organization. The Joint Commission accredits and certifies more than 15,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

Mission 

In support of its mission to improve the quality of health care provided to the public, the Joint Commission includes the review of organizations’ activities in response to sentinel events in its accreditation process, including all full accreditation surveys and random unannounced surveys.

Sentinel Event Glossary of Terms

Link: http://www.jointcommission.org/SentinelEvents/se_glossary.htm

Assessment

Of course, there are other accrediting organizations besides the JCAHO. These include DNV Healthcare Inc., a division of the Norwegian company Det Norske Veritas [DNV]. DNV has recently been charged with immediately determining if hospitals are in compliance with the Medicare Conditions of Participation [COP]. The company’s authority to accredit hospitals runs through September 26, 2012. DNV joins the American Osteopathic Association [AOA] as the only other national hospital accrediting agency approved by the Centers for Medicare and Medicaid Services [CMS].

Conclusion

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