Friday, October 20, 2006

How am I doing?

Former New York Mayor Ed Koch used to wander through the city yelling out to people, "How am I doing?" I am writing to ask the same question.

I know that hundreds of people view this blog every day, but most do not submit comments, and it is hard to know if people actually read the postings, much less find them enjoyable or interesting. Sometimes, writing this feels a little bit like being lost at sea and sending out messages in bottles, with the hope someone will pick up a bottle and respond.

So, here's your chance! Is this a good use of my time? Yours? Even if you have not commented before, please send feedback, ideas, and suggestions. I promise to post everything you send in (subject to normal rules of politeness and nice language). Thanks.

54 comments:

CLC said...

Dear Mr. Levy,

I am in the healthcare publishing business and I am always reading healthcare related news and blogs to find out what's on the mind of the people for whom I am writing and providing products.
I wanted you to know that I really like your blog. I find what you have to say very interesting, and I am encouraged that those in the "C-suite" are not too busy to let the people they serve and their colleagues know what is going on. Also it's nice to see a human face on what can seem like an inhuman machine (meaning here hospital administration and healthcare in general).
Lastly, I wanted to tell you that it makes me feel more comfortable (as a new Bostonian), if your leadership is any indication, that should I ever need to go to a hospital, I can count on good care at Beth Israel.
Thanks for writing.
CLC

Paul said...

Thanks very much. I'm not sure I have ever heard that expression, "C-suite". Does it stand for "complaint"? :)

Anonymous said...

Good Morning Paul,

I have worked here for about 1 year in an administrative role. Before this I work for another Boston teaching hospital. I see all the folks around me trying hard to make this a great place to work, and I think they are doing a very good job. As for how you are doing, well I think that's a hard question since many of the folks at my level don't really know how your job effects us. Could you talk a bit about that?

Thanks.

Paul said...

Thanks, I meant how am I doing with the blog, but I see you thought I meant more generally. Well, let me try to work on your request in future postings . . . once I figure out my job description!

topher said...

Yes, you're doing a good job. For the reader it's a story and for the author it's a conversation; I sympathize with the "message in a bottle" feel to the whole thing. I'll say that I enjoy your writing because it gives me hope that the folks running hospitals haven't been victims of Peter's Principle.

Paul said...

Thanks, but you shouldn't jump to that final conclusion. My competence has yet to be proven. The jury is still out on that: Check back in in a few years, and let's see how the hospital is doing. :)

jjm said...

Mr. Levy,

Your blog is excellent because it shows a refreshing level of transparency. Your dialogue is enjoyable and unique.

On a personal note, I am a midwest business school graduate with interest in healthcare. Currently I am getting my M.D. with the intent of someday dusting off the business degree and possibly finding myself in a role similar to yours. Any career advice you could give would be greatly apprecaited.

Keep up the good work.

Anonymous said...

Mr. Levy - I also read your blog and find it provides an interesting perspective. One thing that I don't understand, in one of your previous posts you complained about Partners getting better reimbursements from payors because of their market share. If I recall correctly, YOU were largely behind the break-up of Care Group and the Provider Service Network which gave you similar market share and negotiating clout with the payors. Why did you break-up the very thing that you are now complaining about that gives Partners the ability to get better reimbursements?

Paul said...

Good question, but you have a few misconceptions. First, CareGroup never had close to the market share of Partners. Second, it was a disfunctional attempt to create an integrated healthcare delivery system. Third, the PSN reflected that disfunctionality and could not negotiate contracts that even approached Partners'. Fourth, BIDMC ended up subsidizing other participants within the PSN. You can be sure I was happy to change that situation, and we do better on our own as a result.

CareGroup still exists, but solely as a holding company to carry out fiduciary responsibilities with regard to the debt that is jointly and severally the obligation of the remaining CareGroup hospitals, BIDMC, New England Baptist, and Mount Auburn Hospital. It no longer has clinical responsibilities and no longer has involvement in negotiating rate with insurers.

Hedgehog Librarian said...

Mr. Levy,

I come to your blog via a friend who is an information professional. Having worked in medical publishing...I was interested to see another side of the medical world--specifically management. Your entries are very accessible and enjoyable--even for one not in the medical profession.

Keep up the good work! i truly enjoy seeing your blog in my RSS aggregator!

Anonymous said...

Paul - You are contradicting yourself.... you say you get better rates on your own (compared to the network rates the PSN negotiated) while you complain that Partners gets better rates because of their network size. How can BIDMC get better rates as a stand alone entity while Partners gets better rates as a network? You complain that Partners' enhanced rates are a result of their market share yet you say you get better rates outside of the PSN network? This makes no sense. Further, Partners is no more "integrated" than Care Group ever was... they keep their network together largely for the purpose of getting better rates from the payors who can't survivie without their physicians and hospitals. Care Group had the same type of physician and hospital network that payors could not have sold their product without...payors could live without BIDMC alone (or even MGH alone for that matter) but they could not live without all of Care Group which I think gave you the same negotiating clout as Partners.

John said...

This is an intesting blog - keep it going.

I'd be interested in hearing about the topic of transparency of drug prices to the patient (it is rare that anyone under insurance plans has any idea how much the drug costs) and how that affects the choice of competing drugs. For most other products and services one can easily find information about how much they cost and find comparative reviews For example, there are a number of statins used for cholesterol control and their prices vary by a fair amount.
How do the physicians decide which drug to prescribe? Is the patient regularly involved in the decision? Is there a mechanim to share results and specific side effects so physician's decisions can be modified in the future?

Anonymous said...

Hi Paul,

I find your blog incredibly interesting because your point-of-view is not one to which the public has casual access. Thanks for taking the time to write.

Cheers,
Colleen

Anonymous said...

Good work! Keep it coming...

Anonymous said...

Mr. Levy,

My goodness, yours is a hard job!!!

You are doing a great job. You are educating me as a patient on what it takes for me to get excellent health services. This information should make me complain less about my doctors and hospitals or not be as quick to judge them.

fred trotter said...

Hi,
My name is Fred Trotter and I track your blog via RSS. So far, I have found nothing like it out there. I work in the world of Free and Open Source clinical EHRs. I work a little with the VistA system (they like my billing engine) but largely I have no insights into the world of hospital IT or hospitals in general. Your blog is a wakeup call for me to what kind of issues are at play in your segment. If you want to post on EHRs I will happy jump in with comments, but until I would assume that at least some of your lurkers are very interested in hearing what you have to say.

cali said...

Dear Mr. Levy,

I am one of those people who read your blog every day (well more like three times a day) but have never commented. I just never had the courage to post, but here you are presenting me with such an inviting opportunity =)

I think your blog is very interesting and I hope you continue to post! I am a college student interested in health policy and public health. It's wonderful to hear things from your perspective, and in such detail. The health care system is a tricky place to navigate. Despite having worked at the Longwood area last summer, I still cannot imagine the challenges and resources it takes to keep the area running. Open discussions like yours reassure me that good people are out there trying to make the system better. Thanks for writing!

Anonymous said...

Dear Mr. Levy,

I think your blog is a fascinating read. The topics, from the "big picture" topics, say about the transplants, to the small stuff, like the tv clickers, are great because it is appealing to a wide audience. A good balance so far. Also, I enjoy your writing style.

Lastly, I am a big fan of the BIDMC as I had my children there and had a wonderful experience. So it seems like you are doing a good job too, recruiting and retaining a great staff.

Anonymous said...

Mr. Levy,
As a BIDMC employee I find your blog a useful insight into issues of importance to the hospital. As we are not located on the main campuses, I find it a nice way to feel part of the community. I hope you continue!

J. Dinger said...

Mr. Levy,

I find your blog exceptional.

I am a VP for a health system in Nashville, TN and have been a reader since your first posting.

I find your writing personal, relaxed, and authentic. I feel your content is timely, ubiquitous to markets outside Boston, and a reflection on the thoughtful presence you must bring to your job on a daily basis.

We need more leaders like yourself in health care, and your willingness to participate in this experiment is a testament to your ability to do things differently. Which is the only way we're going to improve upon this public good we've been entrusted.

Thank you for taking the time.

Jason

Richard Dale said...

Hi Paul
I am a Boston based early stage Information Technology VC with an interest in the healthcare world (I was previously a co-founder of Phase Forward). I really enjoy your blog, and congratulate you on bringing a relaxed and open approach to sharing your thoughts on the issues you face.

By the way C-suite means the executive suite (C level officer is CEO, CFO, CIO etc).

Patient Dave said...

I can understand the "message in a bottle" feeling. All I can say, personally, is that every single thing you post is like a fresh-air breeze, a welcome bit of visibility into a world that's been entirely too opaque.

Personally I'm also so moved to see how humanly and humanely you face issues that are far beyond what I see in my workday life. And there's no drama to it - you just lay out the facts (and your views) for consideration. What a different nation and world it would be if all our leaders did the same.

I'm so heartened to see that people from around the country are reading here. Perhaps this is start of a new era of openness, with a community sense of "Let's see if we can understand each other and solve this together."

Paul said...

To the person who thought I was contradicting myself, not so. You will have to trust me that we get better rates as a stand-alone than as part of a so-called network that was dysfunctional and not very adept at negotiating.

And, you underestimate the degree of discipline and thoughtfulness that Partners has used in its contracting process over the years, notwithstanding variations within its network. They had a great business concept, and they executed it brilliantly.

Paul said...

To jjm, my best career advice is to find jobs where you are doing something worthwhile for the world, have a chance to learn something new, and share values with the people with whom you work. Don't settle for anything less, and the rest will follow.

Paul said...

To hedgehog librarian,

Your choice of books and movies indicates a true Libra!

Paul said...

Fred,

When you say -- "I work in the world of Free and Open Source clinical EHRs. I work a little with the VistA system." -- I don't understand most of the terms you use. Can you please translate for Hedgehog and me???

Paul said...

Thanks, Richard, and for the lesson in corporate-speak, too! With that explanation, I am even more confident that "C" stands for complaint!

And thanks to all others for their thoughts and ideas, as well.

Paul said...

John,

I am not sure I know enough to answer those questions (about prescribing drugs), but let me see what I can learn.

Richard Weissberg said...

Hi Paul --

Since you asked ...

I think what you're doing is great. You put a warm, caring, intelligent, articulate, open, human face on your office and your institution, and give the reader a look into the largely hidden jungle that is the business of medicine.

And for what it's worth, I think your sensitivity, common sense, and bold experiment in openness can only pay off big time for BIDMC and what you're trying to do there. (I'll be so disappointed if I turn out to be wrong about that. Then I'll have to be even more cynical than I already am.)

I've always had an interest in the business of medicine, and I've enjoyed reading your blog from the first posting.

Keep up the good work :-)

Nick said...

Dear Mr. Levy,

I think your doing an amazing job, I read your blog everyday and I find your insight very interesting. Im doing my undergrad right now, in the hopes of being an MD

On a personal note, I know the hospital workings quite well, from being a patient, though healthcare is a little different over here in Canada!

Keep up the great work!

Paul said...

Thanks, Richard and Nick.

Nick,

People here often point to the Canadian system as the exemplar in health care. Is it?

BC said...

I think you're doing a great job, and I check your blog frequently. I am interested in the business and economic aspects of healthcare including pricing transparency, electronic records, malpractice reform, performance metrics (where feasible) and any other ideas that could make the healthcare system operate more efficiently and cost-effectively.

As for future topics, I would love to hear a CEO's perspective on single payer (Medicare for all) healthcare vs building on the present system or some completely different approach. Also, your thoughts on the Massachusetts experiement to achieve universal health coverage for its citizens would be of interest, at least to me. Keep up the good work.

Paul said...

Thanks, bc,

I addressed the single payer issue below, but also check a bit of back and forth on the topic on the Health Care For All blog (link is on the side of my blog.)

I am sure there will be lots more to say on the MA experiment. Stay tuned.

Monica said...

I think youre doing a great job! I started a blog about being a nursing student at the same time you started this blog - my family (of fellow nurses) read both of ours! and while Ive embarassed myself with 3/3 comments Ive posted on your site standing correction by the blog author, I love the fact you are sincerely welcoming and engaging of many different voices. blog on =)

me said...

Paul, this is marvelous. You continue to inspire me - and, I'm sure, others - everyday, and have for all the years that I've known you. Your openness and honesty in welcoming questions and dialogue is admirable. Please keep writing, and I'll keep reading. It is always interesting to know what you are thinking. Thank you for taking the time to teach, as you always do!

Anonymous said...

Dear Mr. Levy,
I enjoy reading your blog. I am currently the Director of Pharmacy of a Hospital in Northwest IN. I would be more than happy to elaborate on the question posed by John regarding drug pricing. I think it is important for the public to understand that most hospitals function on a "closed" formulary system to help defray overall drug expenses. Institutions get reimbursed based on DRG so it is in our best interest to give the highest quality care and most cost effective medication therapy. This helps decrease overall patient LOS (length of stay) thus optimizing reimbursement. Pharmacists' through the formulary committee will work with physicians to choose the safest and most cost effective therapy. In a hospital setting there is a limited number of medications available. If we use your example with statins (zocor, lipitor, crestor, etc.) then it would be easy to demonstrate. An institution will typically pick one statin to place on formulary. We choose this based on drug interaction potential, look-alike sound-alike potential, safety profile, cost effectiveness etc. Hospitals utilize group purchasing organizations which in turn negotiate contracts with various medication companies to defray costs. Typically this will also guide the selection of one agent over another. There are several other factors that come into play such as DSH discounts and/or 340b status. It is quite different than in the retail arena where your physician can prescribe whatever he wishes and you have more of a choice with your therapy. You could almost say within the hospital setting it is set up much like Canada’s health care system or other form of socialized medicine. Please keep in mind if you have insurance in the outpatient setting then you also have a formulary driven system. This is why you may have different co-pays based on if the product is on or off formulary and if a generic is available or not.
Thank you for providing this enlightening narrative and we appreciate the time you take to post.
Bryan

margalit said...

I don't work in health care, but I'm a chronic care patient so health care administration is very interesting and important to me. I find your blog extremely relevant to things I am thinking about vis a vis health care, so I'm very thankful you're writing consistantly. This is a very good addition to the blog world!

BC said...

I wonder if you have considered or looked into the feasibility of adding an Ask The CEO A Question feature to your blog or through a link from your blog. Questions could include issues concerning general healthcare policy, management issues in running a hospital and the like but not questions concerning individual medical conditions.

If questions could be easily forwarded to the appropriate person in the organization with the expertise to answer it and the whole process were not unduly burdensome, it could be a useful source of future topics for the blog. You could limit the number of questions that are forwarded on for answers much as major newspapers limit how many letters to the editor they publish. Just a thought.

Syed said...

Hello Mr Levy,

I'm a resident (an oncology fellow to-be) and just stumbled on your blog. Your blog is a fascinating look at the innards of hospital administration. I never knew for instance that the bedside remotes were selected because of infection control reasons. Anyhow, I believe your blog does a great service, especially to us "grumpy" clinicians who remain woefully ignorant of the
"business of healthcare".

I, and some colleagues have wondered about careers in healthcare administration, and have toyed with the idea of doing executive MHAs. What has been your experience with physician executives? Does the clinical experience help or hinder thier careers. And finally, is the job of a healthcare executive, and endless frustrating series of putting out fires, or more rewarding . I'd appreciate your insight.
Thanks again for the blog. We annonymous folk read, but don't comment often, but your work is still appreciated.

Anonymous said...

Good blog, well done. Maybe add some essays from others in the field from time to time, not just links.

Paul said...

Thanks.

BC,
That's what I thought I was already doing, without calling it that.

Syed,
Some doctors make great administrators. Some are awful. But, no administrators make great doctors. :)

Follow your interests and inclinations. Both paths can be exceptionally rewarding.

BC said...

Paul,

I was referring to questions about topics away from those related to subjects you posted about.

For example, I would be interested in your perspective about how the system could reduce costs related to futile care at the end of life. Should Congress change the law to specifically allow Medicare to consider costs in determining what drugs and treatments to pay for and not pay for? Should we more aggressively try to get many more people to execute living wills and advance medical directives? Should we try to get the apparent default protocol of "do everything" when there is nobody to speak for a patient who can't communicate to a more flexiible approach that would allow doctors to apply common sense depending on circumstances without having to worry about being sued?

Paul said...

Oh, thanks. Lots of good ideas...

Paul said...

Monica --

Please keep writing! I don't mean to be correcting all the time. :))

Amy S. said...

Hi Mr. Levy,

I've been working at BI since last August, when I started as a new grad RN. I've been reading your blog ever since I think the Boston Globe did a story about it. I find it really interesting the different topics you post about, and your opinions about them. I'm not really sure how it is at other Boston hospitals, as this is the only one I've ever worked at, but one of the things I really like about BIDMC is I feel connected to what is going on in the whole hospital. I feel like everyone has a chance to participate and give input, and it makes me happy to be a part of it all. I went to my first nursing town hall meeting last month, and I really enjoyed hearing from you where the hospital is and where you would like to see it go. My point is, your blog is just another thing that I like to read, to feel connected to the place I work.

So thank you for having this blog, and giving us the opportunity to hear what you think is post-worthy, and to hear your thoughts. Keep them coming!

The Mommy Blawger said...

You've been blogging less than 3 months and you are getting hundreds of visits a day??? You're doing fine.

I am a non-practicing attorney who occasionally blogs about health care and policy-related issues. Thank you for adding a site feed link, which means I will now be reading your blog on a regular basis.

One note, though - the link was hard to find. Might want to put it off by itself instead of in your "links" section. Either near the top of the bottom of your sidebar would help people find it easier. I simply do not read blogs that I can't find a feed link for.

I don't know how it works, either.

Paul said...

Thanks, Amy, very much. I am really glad you like our place.

Can I ask you and others favor, though? Please call us "BID" instead of "BI". The New England Deaconess Hospital part of our tradition is very important, and people who worked there feel left out and a bit resentful when the hospital is referred to as "the BI".

This goes back to the days following the "merger", which was really a takeover of the Deaconess by the BI. It left many Deaconess people feeling demoralized and alienated. The folks are wonderful doctors and nurses and others, and I think it is important to acknowledge their long commitment to the institution.

I am not writing this to criticize: As a new staff memebr, there is no way you could know about this, and that is why I am mentioning it. If you feel comfortable doing so, please gently pass the word when you hear "BI" -- and, in any event, please set an example. Thanks.

Paul said...

Thanks, Mommy Blawger. I don't know how to put the site feed link in another place . . .

Anonymous said...

Paul,

thanks so much for the Deaconess reminder. I am a former Deaconess resident and staff MD, and this is one of my pet peeves!

I am very happy to know that the CEO of the institution is sensitive to this issue.

BI Deaconess Doc

Danny said...

First time reading your blog. Recommendation from my son. Looks interesting enough to come back

Paul said...

Thanks, Danny.

concerned heart said...

Dear Mr. Levy,

Are you aware of the research in the area of the paternal age effect. It seems like much of the sporadic genetic disorders such as autism, schizophrenia, diabetes 1, Alzheimer's, cancers could be reduced if men and women were taught the science of the male biological clock. If this area is unfamiliar to you, would you read and eventually comment on these findings. Thank you. Sorry to ask you to read so many papers and abstracts, I know you are very busy but overtime please check it all out. We have been going in the direction of older and older fathering and just one of the results in the increase in de novo autism.

http://www.sciencedaily.com/releases/2002/10/021018080014.htm

http://ebdblog.com/paternalage/

http://clinpsyc.blogspot.com/search/label/paternal%20age

http://www.webmd.com/content/article/70/80975.htm

http://en.wikipedia.org/wiki/Paternal_age

http://ageofthefatherandhealthoffuture.blogspot.com/

http://themalebiologicalclock.blogspot.com/

http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/03-15-2007/0004547169&EDATE=


http://how-old-is-too-old.blogspot.com/search/label/paternal%20ageing

http://www.dnaindia.com/report.asp?newsid=1080597

http://timesofindia.indiatimes.com/NEWS/India/Young_men_freeze_family_plans/articleshow/1746622.cms

Thanks much.

Scar said...

Hi Mr Levy,
I am a student in Las Vegas, I have no idea if you see this or not or whether I am the only one still looking at your blogs from 06' but I have to say... I love this blog site! I am a person that knows exactly what I want to do, but don't know how to get there. I have always had this strange fascination with hospitals and health care. However, providing healthcare isn't really my thing.. I started working at a small hospital when I was 19 just to be in the environment. I realized then that administration was the place for me. I have seen several bad managers and some very good ones. In response to several of your blogs, CEOs deserve what they earn if they do their jobs well. I had the experience of working under a CEO and chairman who not only had a large income but embezzled from the hospital, obviously with the fancy cars and boats they boat with their unlawfully earned money they were a negative presence in the entire organization.
I am working my way up.. I am 24 and already a supervisor in the business office, mainly working with government contracts. I actually came to Boston a few months ago and met with a director at MassHealth. While I was there I had the priviledge of walking the halls in three of the country's best hospitals (Beth Israel, BMC, and MGH). It was my first trip to boston and I had no reason to go to those hospitals other than my own fascination. I was like a kid in a candy store (wierd I know). I hope to someday work in an environment like that... while some kids dream of being a ball player or doctor, I want to run a hospital. Which leads me to my point... this is the first place I have ever seen that has answered so many of my questions, involving medical policy, administration, perspective, etc.

Do you have any suggestions as to how I can work my way into Administration? Classes I should take? I read your blog on the JD program, It made me a little discouraged because I am currently in a JD/MBA program (remember I mentioned I don't know how to get to CEO) I work during the day and school at night. How did you get into this gig anyways? I appreciate the blogs, keep em coming.

Thanks

Paul Levy said...

Please call me.