Way to go, legislators!

It is one of the enjoyable mysteries of legislative politics that last-minute bills often accomplish things that people have been talking about for months and even years. The MA Legislature goes out of session later today, and it is prepared to take an up-or-down vote on a comprehensive bill regarding health care costs, insurance premiums, and the like. I have just read the conference report. I can't say that I fully understand all the provisions, but there are some that are in the knock-your-socks-off category for those of us who care about transparency of rates, costs, and clinical outcomes. It is clear from these and other sections that the Attorney General's report on payment disparities among the various providers issued earlier this year had a major impact on the structure and scope of the bill.

Congratulations to the Senate and House leadership for moving things along and reaching this agreement!

[Saturday night addition: The bill later passed the Senate unanimously, 40-0, and likewise the House, 153-0.]

A recitation of a few sections:

Public reporting of relative prices -- Notwithstanding any special or general law to the contrary, the division of health care finance and policy, in consultation with the division of insurance, shall promulgate regulations on or before October 1, 2010 to establish uniform methodology for calculating and reporting relative prices paid to hospitals, physician groups, other health care providers licensed under chapter 112 of the General Laws, freestanding surgical centers by each private and public health care payer under section 6 of chapter 118G of the General Laws. The uniform methodology for calculating and reporting relative prices under this section shall, at a minimum: (i) specify a method for basing the calculation on a uniform mix of products and services by payer that is case mix neutral; (ii) specify a uniform method for including in the calculation all non­claims related payments to providers, including supplemental payments of any type, such as pay-­for­-performance, care management payments, infrastructure payments, grants, surplus payments, lump sum settlements, signing bonuses, and government payer shortfall payments; (iii) permit reporting of relative price in the aggregate for all physician groups whose price equals the payer’s standard fee schedule rates; and (vi) designate and annually update the comprehensive list of physician groups for which payers shall report relative prices.

Establishing uniform methodologies for hospital cost reporting -- Notwithstanding any special or general law to the contrary, the division of health care finance and policy, in consultation with the division of insurance, shall promulgate regulations on or before October 1, 2010 to establish uniform methodology for calculating and reporting inpatient and outpatient costs, including direct and indirect costs, for all hospitals under section 6 of chapter 118G of the General Laws. The division shall, as necessary and appropriate, promulgate regulations or amendments to its existing regulations to require hospitals to report cost and cost trend information in a uniform manner including, but not limited to, uniform methodologies for reporting the cost and cost trend for categories of direct labor, debt service, depreciation, advertising and marketing, bad debt, stop­loss insurance, malpractice insurance, health information technology, medical management, development, fundraising, research, academic costs, charitable contributions, and operating margins for all commercial business and for all state and federal government business, including but not limited to Medicaid, Medicare, insurance through the group insurance commission and federal Civilian Health and Medical Program of the Uniformed Services.

Outcomes reporting -- The department of public health shall promulgate regulations under section 25P of chapter 111 of the General Laws by December 31, 2010 requiring the uniform reporting of a standard set of health care quality measures for each health care provider facility, medical group, or provider group in the commonwealth hereinafter referred to as the “Standard Quality Measure Set.” The department of public health shall convene a statewide advisory committee which shall recommend to the department by November 1, 2010 the Standard Quality Measure Set. The statewide advisory committee shall consist of the commissioner of health care finance and policy or the commissioner’s designee, who shall serve as the chair; and up to 8 members, including the executive director of the group insurance commission and the Medicaid director, or the directors designees; and up to 6 representatives of organizations to be appointed by the governor including at least 1 representative from an acute care hospital or hospital association, 1 representative from a provider group or medical association or provider association, 1 representative from a medical group, 1 representative from a private health plan or health plan association, 1 representative from an employer association and 1 representative from a health care consumer group.....

At a minimum, the Standard Quality Measure Set shall consist of the following quality measures: (i) the Centers for Medicare and Medicaid Services hospital process measures for acute myocardial infarction, congestive heart failure, pneumonia and surgical infection prevention; (ii) the Hospital Consumer Assessment of Healthcare Providers and Systems survey; (iii) the Healthcare Effectiveness Data and Information Set reported as individual measures and as a weighted aggregate of the individual measures by medical or provider group; and (iv) the Ambulatory Care Experiences Survey.

Man's best friend

Apropos of nothing at all usually seen on this blog, I offer this very funny -- and oddly moving -- video as the weekend approaches:

(If you cannot see the video, click here.)

Helping patient-run organizations

This is a request for modest financial help, directed to my hospital colleagues.

In recent years, we have seen a burgeoning of small patient-run organizations. They are working hard to improve the quality, safety, and responsiveness of the health care system. Many of these organizations arose out of personal tragedy or injury, like Linda Kenney's MITSS. A common characteristic is that the founder has been able to get past the trauma and anger of his or her medical experience and has devoted time and effort to education, training, and advocacy.

But many of these organizations are tiny and do not have the financial wherewithall to reach their potential. So a small group of us have decided to try to help, under the auspices of the Institute for Healthcare Improvement.

Here's how it will get started. IHI wants to invite 35 to 50 patient advocates to its Annual Forum this December in Orlando, FL. The invitees will attend a special session at the beginning of the conference, and then they will attend the entire Forum as the week progresses. Their conference fee and travel expenses will be completely borne by IHI.

Our hope is to provide these folks with a terrific educational experience, but also use this first get-together as an organizational session for a "trade association" of patient advocacy groups. With planning and luck, we think we will be able to build an organization that will provide technical, educational, and marketing support to these small non-profits.

Here's the pitch. We need about $100,000 to get this up and running, and I am asking hospital CEOs across the country to consider making a contribution of $5 or $10 thousand from their hospitals towards the cause. BIDMC will do its part, and I am hoping that ten or twenty others of you will do the same. This is surely a good way to demonstrate our commitment to patient-run organizations.

If you are interested in joining in, please contact Sara Kolovitz at skolovitz [at] smithbucklin [dot] com. Thanks for considering this.

Them's fighting words!

A friend decided to help settle the dilemma-dilemna question below by sending a note to the etymologist at the Oxford English Dictionary. Here is her note:

To: Anatoly Liberman
Oxford Etymologist
Oxford University Press

Dear Mr. Liberman,
Reading your delightful blog makes me wonder this: many Americans -- highly educated ones -- between the ages of 50 and 65 were taught to spell dilemma with an n, "dilemna." It appears to be most common in the Northeast.

Do you have any idea why? Or thoughts?
Curiously yours,

The reply:

I Googled for DILEMNA!

My goodness! DILEMNA is known all over the English speaking world, from America to Australia, and no one has an idea where it originated. On the other hand, I am not alone: lots of people have never heard that this idiotic spelling exists.

MassINC exposes imaging

MassINC is a public interest research foundation that publishes Commonwealth magazine, an excellent public policy journal. The current issue has a fascinating article by Jack Sullivan about MRI imaging, entitled "Overexposed." Here's the link.

Here is a teaser, from the introductory passages:

Gov. Deval Patrick in April took the unprecedented step of rejecting double-digit rate increases being sought by most of the state’s health insurers for their small business plans. It was a popular move politically, but the governor was basically shooting the messenger because he didn’t like the message being delivered. He may have even shot himself in the foot because an appeals board within his administration later said the decision was wrong.

It was another reminder that rising health care costs are not subject to easy solutions. Health insurance rates keep rising because costs keep going up, and one of the biggest cost drivers in Massachusetts is medical imaging, the use of devices such as x-rays, MRIs, CT, and PET scans to take internal pictures of the body. These machines have revolutionized the practice of medicine, but their use in Massachusetts has grown faster than anywhere else on the planet.

Massachusetts, in fact, has become a medical imaging mecca. MRIs, or medical resonance imaging units, cost $1.5 million or more to purchase and an estimated $800,000 a year to operate. Massachusetts has 42 MRIs for every million residents, dwarfing the national average of 26, which is already higher than any other country. There are now more MRI units serving the 6.5 million residents of Massa­chusetts than there are for the 55 million residents of Australia and Canada combined.

At least $2 billion was spent on medical imaging in Massa­chusetts in 2008, up more than 20 percent from 2006. After medical procedures, imaging is the fastest growing health care expenditure in the state, exceeding the rate of increase for prescription drugs and administrative expenses.

From Helen

During my tenure here, I have always been able to count on Helen Fuller, RN, to send me emails when she saw things that were awry or could be done better -- either for patients or members of the staff. For example, she pointed out a need for an automatic door between two of our buildings because the ramp connecting them was making it difficult for patients in wheelchairs to open the connecting door. (We installed the door.) She also noticed that we were having fewer town meetings than we should to keep nurses informed. (We scheduled more sessions.) She was inevitably on target, the ultimate "caller-outer" who made life better for all.

Here is a note recently sent by Helen to our chief nursing officer that codifies her view of the world. We are so lucky to be in a place with people like her!

Dear Marsha,

I am about to retire. My last day is July 30. I will have missed 54 years by one month, and I must say the last ten years have been my best.

I have done many aspects of nursing and enjoyed every minute. I can never remember thinking "Why am I a nurse?" I always knew why. I was always proud of what I did, I always felt I was contributing to the well being of others, both staff and patients. I learned a long time ago that people respond to you as you respond to them.

I must say, you as administrators should be so proud of your staff. They are the greatest. It is truly a family. I was privileged to have had a party given in my honor last evening and as I looked around, I couldn't help but think, I am going to miss these friends. I am going to miss what they have given me through the years.

People look at retirement as a time to go off, enjoy and have fun. Oh, I will do that, but my heart will always be with the Case Management Department, the Farr 6 CIVCU staff, and with the folks I met in the corridors of BIDMC.

I will always cherish the 10 years I spent here and the people I have met. No one can match their wisdom, their ability to care for others and their fun loving ways. This includes all departments, from housekeeping to administration.

Thank you for letting me be a part of it.

Helen Fuller, RN, case management.

Request for links

It has been a long time since I have updated the links I post on this blog. Yes, over there ----> on the right.

If you know of any, including your own, that would be of general interest to readers here, please let me know. I am particularly interested in expanding the category of patient-centered blogs.

The illusion of security

Back in June, I suggested that corporate policies that block social media on company computers and networks were doomed to failure because they would simply be bypassed by staff members using their iPhones and other portable devices. Now comes an article on The HR Capitalist that proves the point with a lovely example:

I'm strolling through the office of fine, employment-focused government agency one recent morning, and what did I see?

A government worker hitting Facebook from her iPhone within her cube. So I did what any visiting HR pro would do - I asked her if the agency blocked Facebook and other social sites.

She said, "Mmm hmm. All of 'em. And Hotmail too".

... It seems wireless networks trump corporate will when it comes to an employee’s use of social networks in the workplace... If you’re still blocking access and patting yourself on the back, remember the image of your employees dialing their favorite social network up on their smart phone. You’re not managing liability, you’re transferring it to a network that you don’t control. The illusion of security.

(With appreciation to Mark Graban of Lean fame for forwarding the link to me.)

Can CMS be a venture capitalist?

Lisa Suennen, a venture capitalist, writes this post about the provision in the national health care reform act that created the Center for Medicare and Medicaid Innovation (CMI). This agency has $10 billion to “research, develop, test and expand innovative payment and service delivery models that will improve the quality and reduce the costs of care" for patients covered by CMS-related programs. Lisa notes, "What is great about CMI is that they have the authority to run their programs much more like a business would without many historical governmental constraints. "

I don't want to be a stick in the mud, particularly as my able friend Don Berwick takes charge of CMS, but I want to point out that previous efforts by the government to be innovative in other fields have failed because:

(1) Venture funding embodies risk-taking. Government usually does not do this because there is a political imperative never to be blamed for misspending taxpayer money. The bureaucracy, therefore, systematically eliminates ideas that are untested.

(2) Alternatively, the leaders of such agencies get seduced by good-sounding ideas that have not been able to meet a market test and whose efficacy is subject to the normal variations in markets. Then, they will persist with unsound investments because the concept of sunk costs is politically difficult to acknowledge. Private firms consider past investments as fiscally "gone" for purposes of evaluating future investments. But the government often behaves as if investments have a carry-forward risk of embarrassment, so it is more likely to throw good money after bad.

(3) Worse yet, agencies are encouraged to invest in those ideas that have political connections.

My favorite example of all of this was the Synthetic Fuels Corporation, created by Congress to move research and development of synthetic fuels out of the Department of Energy and into a public-private partnership that would hurry along new energy sources. And here is another more recent Massachusetts case. Let's hope these examples are inapposite to the vision for CMI, but history does provide warnings.

Joe Newhouse lays it out

Joe Newhouse is a very thoughtful professor of health care policy at Harvard. He recently published this article in Health Affairs, "Assessing Health Reform’s Impact On Four Key Groups Of Americans." It should be required reading for legislators and other public officials, plus the rest of us interested in the regime for financing health care.

Here is the summary:

Health reform can be assessed from the perspective of four groups that collectively include most Americans. For those who are now in Medicaid or who are uninsured, reform will be a major gain. For those who obtain health insurance in the individual and small-group markets, reform should bring improvements. For those who have health insurance from midsize- and large-group insurers, reform will bring little change. Finally, for Medicare beneficiaries, reform promises to bring positive change. However, financing future health spending overall, and Medicare spending in particular, poses a formidable challenge. Although not a panacea, all-payer rate setting, in which a federal or state agency establishes standard payment rates for each class of payer, may be the only feasible alternative, at least in the short run.

The article is too detailed to go through all of the logic behind Joe's conclusion here, but let me give some snippets to give you the color:

The bad news concerns paying for Medicare going forward. The discussion can best be framed with two quotes. The first is from Peter Fisher, undersecretary of the Treasury in 2002: "Think of the federal government as a gigantic insurance company ... which only does its accounting on a cash basis—only counting premiums and payouts as they go in and out the door. An insurance company with cash accounting is not really an insurance company at all. It is an accident waiting to happen."

...There appears to be little appetite in the current electorate for a major tax increase. ... Clearly, if Medicare payment cuts in the law are avoided when future administrations and Congresses flinch at the prospect of losing the votes of the elderly, there will be a collision between force and object, with reverberations outside of health policy to the entire economy.

...Assume, however, that a substantial portion of the Medicare reductions called for in the health reform law are not made, and that further borrowing is off the table. If commensurate cuts cannot be made elsewhere in the budget, the immovable object will be forced to move. Taxes will need to increase to finance Medicare. Going out well past 2020, however, the implied tax increases are simply not plausible.

...In short, it is hard to imagine that reductions in the rate of Medicare spending growth will not be made at some point. One way or another, the steady-state growth rate will fall; the curve will be bent. But it is equally hard to imagine cutting only Medicare spending while spending by the commercially insured under age sixty-five continues to grow at historic rates, which would lead to a marked divergence between what providers are paid for treating the commercially insured relative to what they are paid for Medicare beneficiaries. This gap could jeopardize Medicare beneficiaries’ access to mainstream medical care.

...If Medicare payment cuts are just as problematic as allowing Medicare payments to continue growing unabated, what is the alternative? There is one, of course: reducing the rate of growth not just of Medicare spending, but of total health care spending. At some point this will be unavoidable.

...Ultimately, there is no panacea. Despite all of the substantive and political problems of price setting, some sort of all-payer regulatory regime may be the only feasible alternative. The other choices would be to allow a much larger discrepancy between commercial and Medicare rates than at present, raising the likelihood of access issues for Medicare beneficiaries, or keep Medicare rates within striking distance of commercial rates, allowing Medicare spending to claim a much larger share of GDP as time passes. To finance that larger share, however, taxes would have to rise—probably by a substantial amount. What to do about Medicare going forward is a boulder that remains at the bottom of the hill.

Camp Wamsutta Reunion

As we approach what would have been parents' visiting weekend, I write this as a remembrance that might appeal to those of a certain age, and on the off chance, too, that other alumni from this camp will read it and offer comments.

As a boy, I joined many of my fellow New Yorkers in attending a summer camp in Charlton, MA. This was when summer camp meant spending 8 weeks outside virtually all the time playing baseball, basketball, tennis, and swimming (at least 2 hours per day). It meant inspection of your bunk every day and winning double portions of ice cream if you had straight 10's -- floor swept clean, hospital corners and penny-bouncing tight blankets on your bed. It was boys only.

Camp Wamsutta was founded and run by Sam and Leah Sleeper, Worcester residents who decided in the late 1940's that they wanted to run a boys camp. They bought an old farmhouse, barn, chicken coop and land in Charleton. It had a small pond, and a river ran through the land. Ten years later, the Army Corps of Engineers built the Buffumville Dam, and the Sleeper's then had 100 acres of lakefront property, enabling them to have a real swimming and boating program as part of their camp activities.

Sam taught at Classical High School in Worcester. To get his job in the Worcester Public Schools in the 1930's, being Jewish, he had to change his name from Goldstein to Sleeper.

The Sleeper's had three sons, of whom the middle one, Marty, was most involved with the camp. In later years, Marty would become the beloved principal of Runkle School in Brookline, MA, and he now works for Facing History and Ourselves. My birthday greeting to him (courtesy of Facebook) led to a small reunion this week with four of the campers. A video follows with highlights.

The crowd included Howie and Eddie Gaynor, brought up in Framingham, MA. Their dad, Doctor Sidney Gaynor, was the mohel for the Boston Jewish community, conducting virtually every circumcision for miles around for several decades. Sidney, like Sam, changed his name (from Ginsburg) so that he could get into medical school in Philadelphia. Ironically, as Howie points out, "Gaynor" is now considered a Jewish last name in Framingham.

The other party at the dinner was Mike Sack, my boyhood (and lifetime) buddy, who was one of four brothers from his family to attend Camp Wamsutta.

Our first year at camp was 1959, when Howie, Mike, and I were 9 and Eddie was 8.

In the video below, you hear Marty explaining how the camp came to house so many Jewish campers. Sam would visit Central Massachusetts rabbis and ask them for names and address of boys in their community. One of them had a friend in New York, and from then on, the camp was dominated by Jewish boys from Long Island and Westchester.

Watch and listen as Eddie explains how Howie took away his double ice cream portion because his parents wanted the younger brother to lose weight, getting weighed every week by the camp nurse. Mike and Marty describe the special train from Grand Central Station that made unscheduled stops twice a year in Oxford, MA to drop off and pick up the campers. Howie, meanwhile, talks about how far away the camp seemed to be from Framingham (47 miles!).

And then there are images of the camp yearbooks from two years, 1959 and 1962, which provide a nostalgic view of the simple life of kids at the time. Also, there is a list of campers, so if you see someone you know, please forward this to him. Thanks.

If you can't see the video, click here.

Dilemma or Dilemna?

Within minutes of my previous posting, one of our very experienced press people sent an email with the terse subject line: headline typo. I wrote back and said, "No, that's how I learned to spell it."

He replied, "Never saw that before. Poses a real dilemma, dilemna, er, problem for me :-)"

(Even now, as I type this, Blogger desperately gives me a squiggle underneath "dilemna" courtesy of the automatic spell check!)

I asked my assistant, who is somewhat younger than I, how she spells the word. "D-i-l-e-m-m-a, of course."

My general counsel appeared for a meeting. She, of more comparable age, immediately included the "n". When I brought up the alternate view, she said, "It is wrong without the "n". I know that in my heart. I learned it that way."

Wanting to know the story, I sought the wisdom of the crowd (aka, the Internet). I found interesting theories there. There is no etymological reason to suggest that "dilemna" is correct. The Greek origin of the word is apparently lemma, which clearly lacks an "n".

But Wordwizard goes on to present many examples of "dilemna" from the near past and further back. The commenter who produced these noted:

I did note with some interest that all the 19th-century quotes I found . . . seemed to have their origin in publications from the U.S. Northeast (New York, Pennsylvania, and Connecticut), so there is a chance that this is the area in which the errant spelling was born. . . . .

[T]he nonstandard spelling was not just used by doofuses and the ignorati, but by very respectable folks . . . in journal articles, newspapers, magazines, etc., all of which I assume had editors to catch this type of thing. Well, it seems, many editors were similarly misinformed.

My best guess as to how this came about . . . is that on the model of such words as condemn, column, indemnity, and solemn someone mistakenly substituted an N for an M in a popular 19th-century school spelling book or guide and the misspelling propagated. It’s hard to imagine how, other than with a scenario similar to this, such a spelling, which appeared in no dictionaries, could have so thoroughly infiltrated the system and been so convincing to so many people who normally should have known better. But until a smoking gun is found, no one will be able to say for certain how this came about. In the mean time, I would definitely rate this up there as a great English orthographical mystery.

Finally, I had dinner tonight with a close boyhood friend who grew up with me in New York. He, without hesitation, used the "n", and we both remember being corrected in spelling bees when we failed to spell the word this way.

To return to my press guy, after a bit of back and forth on all this, he cried, "Uncle!"

To which I replied, "Umcle!"

The insurers' dilemna

This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think that is just a sign of the times. Hospitals face a similar issue, too. Doctors are certainly next in line.

But the Massachusetts insurers have an additional problem. As we have discussed here, they have been participants in creating a very large disparity in payment rates among hospitals, rate differentials based mainly on providers' market power. They are now under pressure to limit rate increases to hospitals, but the ones that come up for renewal are not necessarily the ones that have received higher rates.

Nonetheless, insurers are telling those who are up for renewal that they should expect no rate increase at all, or at best, an increase well below the rate of medical cost inflation. Those hospitals, by definition, are the ones without market power. So if the insurers hold them to low rate changes, the disparity between the have's and the have-not's will grow. This enhances the market power of their competitors, allowing them to poach doctors into their networks and gain still more market power. This increases the percentage of patients who go to the high-rate providers, aggravating the overall health care cost situation.

Thus far, I have seen no effort by insurers to cut this Gordian knot. One company promotes capitation, or global payments, as an answer to the problem. But capitation based on embedded reimbursement patterns does not solve the problem of rate differentials. Indeed, it perpetuates the problem.

Transparency with regard to rates could create a moral imperative that would help lead to a shift in the negotiations that would move things in the right direction. I see no move on the part of the insurance carriers, either individually or collectively, to ask the state to publish existing rates.

Transparency with regard to quality and safety could help create a marketplace for insurance products based on outcomes rather than market power. I see no move on the part of the insurance carriers, either individually or collectively, to ask the state to publish useful data on this front -- or to use their own commercial authority to require such publication as part of their contracts with providers.

Properly constructed and implemented administrative rate-setting likewise could help resolve disparities over time. I see no move on the part of the insurance carriers, either individually or collectively, to ask the state to engage in rate-setting.

So, while I am sympathetic to the unfair attacks on insurers that are part of the political environment, I am left to wonder. What is it that they are in favor of to help resolve an uncontroverted problem, a problem that itself aggravates the very situation facing the insurance industry?

Sausage making: Fast food version

Continuing my occasional series for out-of-state readers.

Even for Massachusetts, this is hard to keep up with. The leadership of the House of Representatives has issued a comprehensive bill that would introduce rate setting for payments from insurers to hospitals. The plan is to ask for a vote tomorrow.

Here's the summary from Jim O'Sullivan at the State House News Service:

STATE HOUSE, BOSTON, JULY 20, 2010……Health care cost control legislation the House expects to debate Wednesday would limit insurance premium hikes, curb the practice of convenience insurance purchases, and seek to spread premium increases over multiple years.

The House rewrite of Senate President Therese Murray’s proposal drops her plan to impose an assessment on large hospitals and ignores Gov. Deval Patrick’s effort to reopen provider contracts, which Patrick proposed in February as an offset to his “soft cap” on insurer rate hikes.

Authored by Assistant House Majority Leader Ronald Mariano, the House leadership draft authorizes the state’s Division of Health Care Finance and Policy to tax 50 percent of the savings in provider rates of reimbursement for deposit in a trust fund devoted to hospitals that provide a disproportionate share of care subsidized by the state, for which they receive lower reimbursement. The remaining proceeds would go toward premium savings for employers.

The bill also offers patients access to prescription drug discounts.

The Massachusetts Hospital Association offered this preliminary analysis to its members.

The House bill is extraordinarily complex and appears impossible to model. The bill proposes sweeping regulation of every hospital's rate of payment from every insurer, as well as numerous other new regulatory changes from Determination of Need to massively increased data reporting requirements. Without any public input or hearing process, in less than 48 hours, the House will be voting on an entire overhaul of the Commonwealth's healthcare regulatory system. Definitions and specifications are left to state regulators -- the impact of the bill is impossible to accurately predict.

Regular readers know that I am sympathetic to the idea of rate-setting. (Most of my colleagues are not.) And I also think it is important to reduce the differential paid to different hospitals for doing the same thing. But, I am also sympathetic to the idea of doing all this thoughtfully and correctly. It is hard to imagine how a bill that has traveled so quickly without public review and comment is likely to get it right.

But wait, maybe it is not meant to be adopted. Another excerpt from State House News:

Mariano has described the House bill a sort of conversation-starter for the 2011-2012 legislative session, for which the state will have either reelected Patrick or chosen another governor, and when at least 34 of the 200 legislative seats will have new occupants.

Time with the chief residents

I had the pleasure today of conducting a small seminar for our Department of Medicine chief residents. These are the people who were the cream of the crop as residents, and as a "reward," we give them even more extensive teaching and administrative responsibilities! It was a pleasure to spend time with them and together explore the elements of effective leadership.

From left to right, you see Dan Meyer, Kelly Graham, Suma Magge, Ethan Ellis, Jed Gonzalo, and Janice Hwang. The picture behind them is of Howard Hiatt, a former chief of medicine at the Beth Israel Hospital, who is still active around town on many issues.

Author in the Room

I am pleased to post this announcement:

IHI and JAMA Announce Author and Article for the July 21st Call

Kenneth J. Mukamal, MD, MPH, author of A 42-Year-Old Man Considering Whether to Drink Alcohol for His Health.

Join the Institute for Healthcare Improvement (IHI) and The Journal of the American Medical Association (JAMA) on Wednesday, July 21, 2010,from 2:00 PM - 3:00 PM Eastern Time for “Author in the Room,” an interactive conference call aimed at closing the gap between knowledge – what is published in an article - and action – how much of this knowledge is put into practice to improve care. This interactive call will help readers consider the implications of the study results for improving their practice. To read more and access this month's article, click here.

To help launch this unique collaboration between IHI and JAMA, IHI's Don Berwick, MD, MPP, and JAMA Editor Catherine D. DeAngelis, MD, MPH, co-authored a JAMA editorial.

There is no fee for this innovative initiative but enrollment is required. Enrollment grants you one telephone connection and unlimited participation at your site. Please note there are limited lines available for this call so early enrollment is encouraged. A free audio recording of the call will be posted to the "Archive" tab of the program web pages after the call.

Enroll now for the July 21st "Author in the Room" call.

A soccer field emerges at Fenway Park

I dropped by Fenway Park today to get an update on the preparations for tomorrow night's soccer match between Celtic and Sporting.

In the video below, the penalty box and goal box have been painted, and the end line and touch line were in progress. Dave Mellor, Director of Groundskeeping, gave me permission to walk on the grass to provide you the panorama of the view from the middle of the field. Eat your heart out, Jimmy Fallon! ("How did the grass feel? Kinda spongy?")

If you cannot see the video, click here.

Pathologists helping in Haiti

Von Samedi is a fellow in our Department of Pathology who has figured out how to allocate some of his time to assist with the rebuilding of the Haitian health care system. This article in the Journal of the American Society of Clinical Pathology documents the work being done by Von and his colleagues. Excerpts:

Near the collapsed presidential palace and the sprawling tent-and-tarp city across the street, sits the diagnostic laboratory at the State University Hospital of Haiti, the largest public hospital in the country. The lab operates under two large white tents shaded by several large trees. Six months after an earthquake brought Haiti to its knees and in the middle of the rainy season, the dirt all around the lab had become mud.

...Everyone knew this assignment for ASCP’s volunteers would not be simple. After all, one of the laboratories is operating under a tent. But more broadly, the laboratories were affected just like everything else here by the Jan. 12 earthquake.... Some laboratory technicians had died, or moved out of Port-au-Prince. Many who remained were living in tents themselves. And Haiti, a country of 9.6 million people, had just 10 pathologists, only three of them clinical pathologists.

...The volunteers produced reports that included recommendations for lab procedures, organizational charts, workflow charts, employee position descriptions, policies for orientation and competency testing, a form and schedule for the preventive maintenance of equipment, and checklists for keeping track of the functions of the lab.

The volunteers also ran safety procedure trainings on topics such as why it’s important to wash hands and what to do if there were a fire or if a technician were punctured.

Other recommendations included streamlining the clinical-order-to-result process to eliminate steps that do not help patients; eliminating interaction among staff and the public; registering tests in the morning and issuing test results in the afternoon; and reducing the amount of time the laboratories hold samples of urine, blood, and stool from seven days to three days.

“The space issues are tremendous,” Dr. Samedi said. “Plus, these samples just become bacterial time bombs.”

ACL survey for soccer coaches

Speaking of soccer, Susan Sigward, Assistant Professor of Clinical Physical Therapy Director at the USC Community Health and Wellness Research Center, is conducting a survey of soccer coaches. She writes:

USC’s Division of Biokinesiology and Physical Therapy is dedicated to preventing knee injuries in female soccer players. Please take a look at this link describing ProjectPrevent.

We have come to realize that we do not have enough information from a very important source…COACHES. As coaches on the front lines with your athletes, you have valuable information that we need. Please share this information with us by taking this short, anonymous, online survey asking you what you know about these injuries and what you need or want to help prevent them.

We need as many coaches as possible to give us feedback. We would appreciate it, if you could take 10 minutes to complete this online survey. It will be open for the next two weeks. Thank you for your time.

Getting ready for soccer at Fenway

I just had a chance to watch the initial stages of a unique Fenway Park makeover. The baseball field has to be rebuilt as a soccer pitch. Why? This Wednesday, July 21, at 8pm at "America's Favorite Ballpark," perennial Scottish Premier League contender Celtic Football Club will take on the storied Portuguese futebol club Sporting Clube de Portugal.

This is a good remedy for those of us suffering World Cup withdrawal. I also have a feeling that, for the huge Portuguese speaking constituency in New England, this will be the place to be on Wednesday night.

And for Scots who are Rangers fans? A great opportunity to root against an old rival.

How do you transform a baseball diamond into a soccer pitch? Here are some of the scenes from shortly after the crowd left the ballpark at the end of the fourth Sox-Rangers game.

In this video, you see only the early stages of the transformation. The man in charge of the conversion, Dave Mellor, Director of Groundskeeping, reminds us that attention to detail is the key. The pitching mound is removed and carted away. Bases and base mountings are likewise removed. All surfaces are flattened to a high tolerance. Later, new grass will be laid down to fill in the infield and other dirt surfaces. Lines will be painted. Goals will be erected and corner flags will be placed.

If you cannot see the video, click here.