A number of local Girl Scouts were invited to participate in the Fenway Park NHL Winter Classic hockey game on New Year's Day. But, it was really hard for all the parents to get seats for the game. Our good friends at the Red Sox helped us get seats for some of our staff who had daughters in the celebration.
The other day, I received this thank-you note, along with Thin Mints (my favorite!) Girl Scout Cookies, from Megan Canney.
If you can't make out the note in the video, it says:
Dear Mr. Levy, My parents and I would like to thank you for the ticket to the winter classic. We all had a great time. Please enjoy this box of girl scout cookies.
Sincerely,
Megan Canney
Troop 74674
Monday, February 01, 2010
Sunday, January 31, 2010
Keeping it going for Haiti
A note last week to the BIDMC staff. Readers of this blog can join in, too!
To: BIDMC Community
From:Eric Buehrens, Chief Operating Officer and Executive Vice President
Lisa Zankman, Senior Vice President, Human Resources
Subject: New Team Fund Raising for Haiti Relief
Earlier this week, our Development staff presented a check for $33,616 to Partners in Health for relief efforts in Haiti. Thanks to the almost 150 members of the BIDMC Community who donated through Grateful Nation.
It has become clear that supporting the Haitian people is going to be a long-lasting labor of love, determination and hope. The lives of our colleagues who lost family members and friends have been changed forever. Over the coming months and years, BIDMC clinicians and other relief workers will no doubt return again and again and still find so much that needs to be done.
To help with the ongoing efforts, BIDMC has been inspired by a group of medical residents, unit nurses and other staff, and their supporters who have started a little friendly competition to raise money for Haiti relief.
We’ve built a space on Grateful Nation for their efforts. In addition, anyone at BIDMC can now start a team to track fund-raising, seek other supporters and spread the competitive spirit.
To start a team, join one or support one that is already started, click here. Thank you for all your generosity.
To: BIDMC Community
From:Eric Buehrens, Chief Operating Officer and Executive Vice President
Lisa Zankman, Senior Vice President, Human Resources
Subject: New Team Fund Raising for Haiti Relief
Earlier this week, our Development staff presented a check for $33,616 to Partners in Health for relief efforts in Haiti. Thanks to the almost 150 members of the BIDMC Community who donated through Grateful Nation.
It has become clear that supporting the Haitian people is going to be a long-lasting labor of love, determination and hope. The lives of our colleagues who lost family members and friends have been changed forever. Over the coming months and years, BIDMC clinicians and other relief workers will no doubt return again and again and still find so much that needs to be done.
To help with the ongoing efforts, BIDMC has been inspired by a group of medical residents, unit nurses and other staff, and their supporters who have started a little friendly competition to raise money for Haiti relief.
We’ve built a space on Grateful Nation for their efforts. In addition, anyone at BIDMC can now start a team to track fund-raising, seek other supporters and spread the competitive spirit.
To start a team, join one or support one that is already started, click here. Thank you for all your generosity.
High School Quiz Show
WGBH, our public television station, is starting a new show based on the old College Bowl theme, a quiz show for high school students. It is called -- tah dah! -- High School Quiz Show.I went with friends today for the taping of one of the segments. We arrived to find kids making posters to cheer on their school team, and we enjoyed watching the healthy competition as kids tried to answer questions in math, science, literature, history, social studies, and the like.
The show's MC is one of my former MIT students, Dhaya Lakshminarayanan. I am not quite sure what aspect of her MIT training prepared her for this career, but she is terrific in this role.
The show will be broadcast on Monday's starting on March 22, at 7:30pm.
Saturday, January 30, 2010
Scenes from Plum Island
On a very cold day, ice takes on unusual forms at the Plum Island beach near Newburyport, MA. Meanwhile, a resting seal looks on.
The end of an era
For generations of students and families, Chef Chang's House in Brookline has been a comfortable place for delicious Chinese food. It is informal and warm, with friendly waiters and welcoming hosts. The owners, Tony and Su-Mei Chan, have decided that three decades is enough, and the place is closing tomorrow.I went by yesterday (twice -- lunch and dinner) for a last taste. The restaurant was packed with people wanting to do the same and to thank the family for years of service. Tony told me of a customer who had called from Tennessee to say he was flying up for one last meal and and to say goodbye. The place had meant that much to him during his college years.
There were so many customers in the last few days that they ran out of Peking duck, the house specialty. A special shipment was brought in, and they spent overnight last night roasting the ducks to have some available today. A week's worth of other supplies likewise only lasted two days. If you decide to go by, please expect to wait some time for a table.
The Chan's were genuinely surprised at the outpouring of affection. Those of us who know them are not in the least surprised.
Run, Kelly! Run, Eric!
Kelly Bodio and Eric Davis, two of our Medicine residents, will be running the Boston Marathon this spring. They decided to use the race to raise funds for the Melanoma Foundation of New England, and they hosted a party this week as part of their development efforts. You can contribute even if you couldn't attend the party. Here's the website for donations.
Friday, January 29, 2010
Progress in the ICUs
Our Medical Executive Committee recently received a report from our Critical Care Committee. I cannot be more proud of our staff and the progress they have made to reduce harm and improve quality of care in our ICUs. I include two of the charts.Let me translate the implications of the reduction in Ventilator Associated Pneumonia (VAP). Preventing 744 cases over three years -- at a treatment cost of about $20,000 per case -- translates into a societal savings of $14.9 million during this period.
The rate of central line infections also dropped from 4.14 to 0.52 cases per 1000 patient days between FY2003 and FY2009, a reduction of 83%.
This probably reflects lost revenue for the hospital under the fee-for-service reimbursement system. So why do we do it? First, because it is the right thing to do and saves lives.
Hundreds of lives.
On the business front, it has contributed to a reduction in length of stay in our ICUs. We were able to avoid the multi-million dollar capital cost of expanding our ICU capacity. Indeed, we were able to create capacity out of the existing facilities and improve throughput.
I hope that those who argue that global payments (i.e., capitation) are a necessary condition to create societal cost savings and improve patient care will read this. I do not deny that such a payment methodology may be worth implementing for other reasons, but there is a lot that can and should be done under the current payment system.
While the state debate goes on about cost control, why can't we get all of the hospitals in Boston to release information like this about their quality improvement efforts to provide the public and public officials with a sense of confidence that we care about these matters and are willing to be held accountable.
So happy!
During one of our prayer meetings shortly after the earthquake, we learned that one of our beloved staff members, Kelly Brice, had not heard anything from his 20 relatives in Haiti, that he had no way to get in touch with them, and he feared them dead.
Then, this email arrived late this week:
"hi uncle,
we are all ok. i can't call u so i write u to tell u that's all is ok for us. so please take a good care of u.
sincerly Eliezer.
luv u."
Then, this email arrived late this week:
"hi uncle,
we are all ok. i can't call u so i write u to tell u that's all is ok for us. so please take a good care of u.
sincerly Eliezer.
luv u."
Toussaint helps you get Lean
Here's some news from fellow Lean-er Mark Graban. On February 24, John Toussaint is presenting what promises to be an excellent two-part learning event entitled, Strategy Development, the Key to Leading the Lean Enterprise. Here's the link.
This is a cooperative program of the Lean Enterprise Institute and Thedacare's Center for HealthcareValue. LEI and the ThedaCare Center are both 501(c)(3) non profits. This event ($500) helps fund their network and Lean promotion activities that are often offered at no cost to institutions.
Summary: This is an interactive video learning experience. You and your team will be able to view two video sessions. The first is a recorded video featuring the Strategy Deployment process in use at ThedaCare, a community health system in Wisconsin that is a leader in the application of Lean management in health care. The second is a live question and answer period with John, in which he will answer your questions about Strategy Deployment and the ThedaCare Improvement Sequence.
This is a cooperative program of the Lean Enterprise Institute and Thedacare's Center for HealthcareValue. LEI and the ThedaCare Center are both 501(c)(3) non profits. This event ($500) helps fund their network and Lean promotion activities that are often offered at no cost to institutions.
Summary: This is an interactive video learning experience. You and your team will be able to view two video sessions. The first is a recorded video featuring the Strategy Deployment process in use at ThedaCare, a community health system in Wisconsin that is a leader in the application of Lean management in health care. The second is a live question and answer period with John, in which he will answer your questions about Strategy Deployment and the ThedaCare Improvement Sequence.
Vote for best medical blogs
It's time again to vote for the best medical blogs in the MedGadget Weblog Awards. I have linked to some of the contenders in posts here.
For example, Celebrity Diagnosis is in the Best New Medical Weblog category and Medical moments in 55 words is in the Best Literary Medical Weblog category.
As they say in Boston (or was it Chicago?) vote often and early!
For example, Celebrity Diagnosis is in the Best New Medical Weblog category and Medical moments in 55 words is in the Best Literary Medical Weblog category.
As they say in Boston (or was it Chicago?) vote often and early!
Thursday, January 28, 2010
Heartbreak and heroes
Bill Shore is founder of Share our Strength. He wrote this dispatch after a mission to Haiti with Jeff Swartz, CEO of Timberland. They flew down in the company plane with relief supplies. Then, make sure you read the post just below, too, which confirms Bill's point about heartbreak and heroes.
Haiti’s general hospital looks like the world’s largest battlefield MASH unit. Patients are being transported from all directions and vast numbers of wounded and recovering wait on the ground. Doctors in makeshift operating rooms are so cool and professional you’d expect them to someday be played by George Clooney and Meryl Streep.
“Sixty to seventy percent of the hospitals’ buildings have been damaged” explains Doctor David Walton, a 12 year veteran of Paul Farmer’s Partners in Health, who splits his time between Haiti and Boston. He walks us past the green open air wound care tents. He then leads us through white tents crammed with cots where post-operative care is provided to many of the poorest people in the world by a handful of the best doctors in the world, with the least amount of modern medical equipment.
This hospital is a microcosm of many issues converging in Haiti today: the challenge of coordinating individuals from numerous institutions, the lack of basic infrastructure, the heartbreak of so many children left to survive on their own and in the street, the resilience of the Haitian people who are playing a major role in their own recovery. Mostly it underscores the need for taking a long view and making an almost unimaginably long term commitment.
For example, one of the unique and terrible legacies of this disaster will be the large number of people who needed to have limbs amputated. Many were lying quietly on cots after surgery, between 12 and 20 to a tent, some sutured but not bandaged. Some were soon to be released, but of course not to their home which no longer exists, but to the sidewalk or a tent city erected in parks and on hillsides across Port au Prince.
The day after visiting I called former U.S. Senator Bob Kerrey, who lost his leg in Vietnam, had nearly a dozen surgeries, and eventually returned there to help establish prosthetic clinics. I used to be his chief-of-staff and knew how well he understood the need. This is what he explained: “Making prosthetics is not complicated, but there is artistry involved. A five year old girl that needs to be fit for prosthesis will need to be fit for another when she’s seven, and again when she’s 12, and then every six months for awhile. She’ll need prosthetic services for the rest of her life.
“In the US that would cost at least $15,000 a person, but it can be done less expensively in Haiti and elsewhere. We wouldn’t have enough expertise here in the U.S. to ship to Haiti even if we wanted to. What we need to do is build training centers for prosthetic technicians so we can help kids but also employ Haitians.” Kerrey offered to chair a national committee to bring such expertise and resources to Haiti.
When we returned to the air field in Port au Prince to head back home, helicopters of all sizes were touching town and taking off as quickly as commuters getting their morning coffee at a McDonald’s drive through window. Relief workers from different organizations were shouting over the noise of the engines, introducing themselves, helping each other load or unload. Some who’d been since right after the quake were hitching flights that might somehow get them home from Haiti, like weary refugees looking for letters of transit to leave Humphrey Bogart’s Casablanca.
The longer we traveled through Haiti over the last couple of days, the more Timberland’s Jeff Swartz and I found ourselves feeling this paradox. Everything we saw reinforced how blessed we were in our comfortable lives and why we should never want for more.
But at the same time it was impossible to not keep adding to the list of people we wished we were or want to be when we grow up: the soldier from the U.S. Army’s 82nd Airborne who carried a woman in his own arms from the street into the general hospital because there was no stretcher and no time; the 35 year old doctor from Grand Rapids who left for Haiti a week ago on two hours notice and ran a hospital 10 miles outside of Port au Prince where he had nothing but farm tools to perform everything from amputations to delivering a baby; the mother of three who opened her home to us in the hills high above Port au Prince and had more than a dozen people she’d never met until that evening sleeping on her floors and in the bed she and her husband gave up. They are the kind of people who are not only making Haiti better, but us better too.
Heartbreak and heroes never seem to be too far from one another in this world. Each has their own way of seeming to appear out of nowhere. We saw both at every turn on this journey. Thank you for the commitment to what we do at Share Our Strength that enables us to support and sustain such heroes whether in Haiti or here at home.
Haiti’s general hospital looks like the world’s largest battlefield MASH unit. Patients are being transported from all directions and vast numbers of wounded and recovering wait on the ground. Doctors in makeshift operating rooms are so cool and professional you’d expect them to someday be played by George Clooney and Meryl Streep.
“Sixty to seventy percent of the hospitals’ buildings have been damaged” explains Doctor David Walton, a 12 year veteran of Paul Farmer’s Partners in Health, who splits his time between Haiti and Boston. He walks us past the green open air wound care tents. He then leads us through white tents crammed with cots where post-operative care is provided to many of the poorest people in the world by a handful of the best doctors in the world, with the least amount of modern medical equipment.
This hospital is a microcosm of many issues converging in Haiti today: the challenge of coordinating individuals from numerous institutions, the lack of basic infrastructure, the heartbreak of so many children left to survive on their own and in the street, the resilience of the Haitian people who are playing a major role in their own recovery. Mostly it underscores the need for taking a long view and making an almost unimaginably long term commitment.
For example, one of the unique and terrible legacies of this disaster will be the large number of people who needed to have limbs amputated. Many were lying quietly on cots after surgery, between 12 and 20 to a tent, some sutured but not bandaged. Some were soon to be released, but of course not to their home which no longer exists, but to the sidewalk or a tent city erected in parks and on hillsides across Port au Prince.
The day after visiting I called former U.S. Senator Bob Kerrey, who lost his leg in Vietnam, had nearly a dozen surgeries, and eventually returned there to help establish prosthetic clinics. I used to be his chief-of-staff and knew how well he understood the need. This is what he explained: “Making prosthetics is not complicated, but there is artistry involved. A five year old girl that needs to be fit for prosthesis will need to be fit for another when she’s seven, and again when she’s 12, and then every six months for awhile. She’ll need prosthetic services for the rest of her life.
“In the US that would cost at least $15,000 a person, but it can be done less expensively in Haiti and elsewhere. We wouldn’t have enough expertise here in the U.S. to ship to Haiti even if we wanted to. What we need to do is build training centers for prosthetic technicians so we can help kids but also employ Haitians.” Kerrey offered to chair a national committee to bring such expertise and resources to Haiti.
When we returned to the air field in Port au Prince to head back home, helicopters of all sizes were touching town and taking off as quickly as commuters getting their morning coffee at a McDonald’s drive through window. Relief workers from different organizations were shouting over the noise of the engines, introducing themselves, helping each other load or unload. Some who’d been since right after the quake were hitching flights that might somehow get them home from Haiti, like weary refugees looking for letters of transit to leave Humphrey Bogart’s Casablanca.
The longer we traveled through Haiti over the last couple of days, the more Timberland’s Jeff Swartz and I found ourselves feeling this paradox. Everything we saw reinforced how blessed we were in our comfortable lives and why we should never want for more.
But at the same time it was impossible to not keep adding to the list of people we wished we were or want to be when we grow up: the soldier from the U.S. Army’s 82nd Airborne who carried a woman in his own arms from the street into the general hospital because there was no stretcher and no time; the 35 year old doctor from Grand Rapids who left for Haiti a week ago on two hours notice and ran a hospital 10 miles outside of Port au Prince where he had nothing but farm tools to perform everything from amputations to delivering a baby; the mother of three who opened her home to us in the hills high above Port au Prince and had more than a dozen people she’d never met until that evening sleeping on her floors and in the bed she and her husband gave up. They are the kind of people who are not only making Haiti better, but us better too.
Heartbreak and heroes never seem to be too far from one another in this world. Each has their own way of seeming to appear out of nowhere. We saw both at every turn on this journey. Thank you for the commitment to what we do at Share Our Strength that enables us to support and sustain such heroes whether in Haiti or here at home.
Grateful Nation delivers to Haiti
Here is a picture of two of our Grateful Nation staffers, Phil Massano and Kelly Wallace, delivering a check for $33,616 yesterday to Merra Sarathy of Partners in Health. This money was raised via Grateful Nation from employees and friends of the BIDMC to support the work of Partners in Health in relief of the victims of the Haitian earthquake. We're continuing to raise funds - and to support our own physicians, nurses and support staff on the ground in Haiti and the Dominican Republic working on providing care for those affected - but we wanted to get the balance of funds raised to date to PIH as soon as possible.
Wednesday, January 27, 2010
Judy gave the patient her own insulin
Here is an email from Dr. Selwyn O. Rogers, Jr, Division Chief, Trauma, Burn, and Surgical Critical Care at Brigham and Women's Hospital to our chief of surgery and me:
Dear President Levy and Dr. Hurst,
As part of a multidisciplinary multihospital team, I had the honor and privilege to work alongside one of BIDMC's outstanding nursing professionals as part of the first wave of Partners in Health medical response to the earthquake relief in Haiti. As a trauma nurse, Judy was invaluable as she courageously worked under the most austere environment to provide care to the impoverished who suffered open fractures, compartment syndrome, and sepsis. Equipped with little more than a stethoscope, some drugs, and an indomitable spirit, Judy provided indefatigable care to countless patients in the postoperative recovery unit.
Her greatest gift to her patients was her compassion. One selfless act stands out among many. One of our patients had blood sugars that were so high that they were unmeasurable on the glucometer. There was no insulin available. Judy gave the patient her own insulin. With nursing professionals like Judy, it was a privilege to serve the people of Haiti.
Sincerely,
Selwyn O. Rogers, Jr, MD, MPH
Dear President Levy and Dr. Hurst,
As part of a multidisciplinary multihospital team, I had the honor and privilege to work alongside one of BIDMC's outstanding nursing professionals as part of the first wave of Partners in Health medical response to the earthquake relief in Haiti. As a trauma nurse, Judy was invaluable as she courageously worked under the most austere environment to provide care to the impoverished who suffered open fractures, compartment syndrome, and sepsis. Equipped with little more than a stethoscope, some drugs, and an indomitable spirit, Judy provided indefatigable care to countless patients in the postoperative recovery unit.
Her greatest gift to her patients was her compassion. One selfless act stands out among many. One of our patients had blood sugars that were so high that they were unmeasurable on the glucometer. There was no insulin available. Judy gave the patient her own insulin. With nursing professionals like Judy, it was a privilege to serve the people of Haiti.
Sincerely,
Selwyn O. Rogers, Jr, MD, MPH
Take your pills, please
This is Eran Shavelsky, CEO of MedMinder, holding his company's product. I think it is really interesting and wanted to share it with you. It is billed as an "intelligent pillbox system" and is designed to help patients be more likely to take their medications as prescribed. Scott Kirsner at the Boston Globe wrote about this last summer.Then pillbox has an embedded cellular phone that can send reminders by phone call, text message, or email. It also has lights that blink and sound alerts that beep. You can program it to send reminders in any or all of these formats -- but not just to the patient. The reminders can also go to a trusted family member and/or the provider. These can be easily programmed on the company website. You load up a month's worth of medications, and on you go. Or, if you forget to load up the medicines, you can have an alert about that.
As an example, here's the simulated email it sent me:
This is an alert from MedMinder. You are receiving this alert because you are listed in the system as a patient or caregiver who should be notified of this event. The system reported the following event on 1/27/2010 12:17:45 PM (EST):
Reminder: The patient has not yet removed the Wednesday Noon medication cup.
Eran and his folks are in the midst of trials with physicians and patients with hypertension and also post-surgical patients who need protracted doses of medication. They are looking for other interested provider groups.
Comments to Division of Insurance
The MA Division of Insurance is conducting a review of why health care premiums in the state continue to rise. Some observers complained about the lack of participation by providers in the public hearings on this matter, ignoring the fact that the Division had provided very little advance notice of the specific dates.
Meanwhile, a number of us in the provider community have submitted written testimony. In the absence of news coverage of those comments, I offer mine for your review and thoughts. As you will note, it is within the power of the state government to take steps right now that could help "bend the cost curve," but it has been unwilling to date to exercise that authority.
Mr. Kevin Beagan
Deputy Commissioner
Division of Insurance
One South Station
Boston, MA 02110
Dear Mr. Beagan:
On behalf of our physicians, nurses, volunteer Boards of Directors and Trustees, and the entire Beth Israel Deaconess Medical Center (BIDMC) community, I want to thank you for the opportunity to submit written comments to the Division. I understand that your goal is to examine the reasons for significant increases in small business health insurance premiums and to explore how we -- policy makers, hospitals, health insurers, physician practices, community health centers, employers, employees, consumers and others -- can work together to address these rising premiums.
I am grateful to the Division for posing this question directly. Our ability to address these issues will have profound implications for the Commonwealth’s job growth and economic future as well as the sustainability of providing universal access to health care coverage in Massachusetts.
We have been pleased over the last year to have worked with many stakeholders on key components of this effort, including our hospital colleagues in Massachusetts and throughout the country, the Massachusetts Special Commission on the Health Care Payment System, policy makers, Legislative leaders, and others.
I have four major sets of recommendations and observations to share with you, based on the eight years I have served as President and Chief Executive Officer of BIDMC:
Make Quality and Transparency Count. There is simply no substitute for transparency of data on the quality and safety of patient care. Thus far, this information is of limited use by consumers and purchasers, although that is likely to change over time. In the meantime, and perhaps more importantly, the value of transparency is as a management and process improvement tool. As I said in an article in Business Week in September of 2007:
There are often misconceptions as people talk about "transparency" in the health-care field. They say the main societal value is to provide information so patients can make decisions about which hospital to visit for a given diagnosis or treatment. As for hospitals, people believe the main strategic value of transparency is to create a competitive advantage vis-Ã -vis other hospitals in the same city or region. Both these impressions are misguided.
Transparency's major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.
At BIDMC, we have been publishing quality information for several years. During this same period, we have steadily improved our performance. We know that we are saving hundreds of lives and millions of dollars in health care costs as a result of the quality and safety initiatives we have carried out. An indication of our institutional commitment to this direction is that the governing bodies of our hospital -- the Board of Directors and Board of Trustees -- took audacious votes last year to eliminate all preventable harm at BIDMC by 2012 and to be transparent about our progress and results. This information is published quarterly on our website at www.bidmc.org.
Improve Public Payer Reimbursement and Rationalize Payment for all Health Care Services. Levels of public reimbursement are a contributing factor to higher-than-necessary private insurance premiums. Medicaid, Medicare, and the Health Safety Net Trust Fund reimburse hospitals – on average -- at significantly below the cost of providing care. These payment inequities are particularly acute for services to some of our most vulnerable patients, such as for inpatient mental health care. Because of this, we are forced to identify alternative revenue sources to cover our operating costs. One such source is our reimbursement from private insurers. The overall reimbursement we receive from private health insurers ultimately subsidizes our losses from public payer contracts that fail to cover our costs. State budget reductions for academic medical centers over the last two fiscal years have had a sustained, significant negative impact on our fiscal health. But these two years have been different only in degree, not in direction. For years, public payer losses have also damaged our ability to keep up with the capital investments needed to maintain our facilities on an annual and long-term basis.
In addition, for many key services that are central to our non-profit mission, private health insurer reimbursement also fails to cover our costs. This means we are forced to invest in higher cost services that command higher reimbursements and cross-subsidize services for which we are drastically underpaid. The Division should work with health insurers and other stakeholders on strategies to improve public payer reimbursement, rationalize payment for health care services, and eliminate the need for cross-subsidization.
Correct Market Dysfunctions. We have to acknowledge that the manner in which reimbursement rates are established in this state is not related to the quality of medical service provided. Instead, market power seems to be the predominant factor in the rate-setting environment. Thus, we have the odd result that, for example, the reimbursement rate for the very same colonoscopy performed on exactly the same type of patient will vary by large percentages depending in which contracting network a doctor happens to be situated. I will tell you frankly that BIDMC and our physician contracting organization, BIDPO, is sometimes a beneficiary of this process. At other times, we are put at a competitive disadvantage. In both cases, this is a result counter to sound public policy.
There are two solutions to this problem. The first would be to return to a rate-setting environment, in which the Commonwealth would establish the reimbursement rates for each insurance company and each provider organization. I personally would not have a problem with such an approach, in that health care can viewed as a “utility-like” function, in which reliance on competitive forces is unlikely to produce economic efficiency and equity.
Short of rate-setting, I believe the Commonwealth should use its existing authority to make reimbursement contracts public. Allowing sunshine to reach the current reimbursement arrangements would provide moral and political pressure from subscribers, public officials, and the public on the insurance companies to equalize payments across provider groups. I believe this would result in rate-setting methodologies that are more tied to the quality of service provided.
Embrace Innovation in Health Care Delivery with Accountability to Consumers. At BIDMC, we recently teamed up with the state’s largest physician group practice, Atrius Health, to establish a new model for health care delivery in the Commonwealth. We are using shared electronic medical records to improve our efforts to provide the right care at the right time in the appropriate setting. We have also embarked on a robust agenda for quality improvement and cost-efficiency strategies. Our collaboration will be built around a strong emphasis on primary care, and a continuum of care from the ambulatory setting to the hospital and beyond. Among our strategies:
Putting primary care at the center of patient’s care;
Ensuring that physicians work together as a team with nurses, technicians and other allied health professionals;
Enhancing and further integrating electronic medical records;
Advancing health equity and ensuring a diverse, culturally competent interdisciplinary workforce;
Preventing and reducing medical errors and being transparent about results;
Improving the efficiency of health care delivery by continuous process improvement as exemplified by the LEAN methodology; and
Empowering patient involvement in the design of the health care delivery system through advisory councils, secret shoppers, patient satisfaction surveys, and other mechanisms.
We are confident that these innovative strategies – put into practice – will have a meaningful impact on quality, access and the cost of health care in Massachusetts.
I hope that the foregoing comments are helpful, and I would be glad to discuss these with you in the future.
Very truly yours,
Paul F. Levy
Meanwhile, a number of us in the provider community have submitted written testimony. In the absence of news coverage of those comments, I offer mine for your review and thoughts. As you will note, it is within the power of the state government to take steps right now that could help "bend the cost curve," but it has been unwilling to date to exercise that authority.
Mr. Kevin Beagan
Deputy Commissioner
Division of Insurance
One South Station
Boston, MA 02110
Dear Mr. Beagan:
On behalf of our physicians, nurses, volunteer Boards of Directors and Trustees, and the entire Beth Israel Deaconess Medical Center (BIDMC) community, I want to thank you for the opportunity to submit written comments to the Division. I understand that your goal is to examine the reasons for significant increases in small business health insurance premiums and to explore how we -- policy makers, hospitals, health insurers, physician practices, community health centers, employers, employees, consumers and others -- can work together to address these rising premiums.
I am grateful to the Division for posing this question directly. Our ability to address these issues will have profound implications for the Commonwealth’s job growth and economic future as well as the sustainability of providing universal access to health care coverage in Massachusetts.
We have been pleased over the last year to have worked with many stakeholders on key components of this effort, including our hospital colleagues in Massachusetts and throughout the country, the Massachusetts Special Commission on the Health Care Payment System, policy makers, Legislative leaders, and others.
I have four major sets of recommendations and observations to share with you, based on the eight years I have served as President and Chief Executive Officer of BIDMC:
Make Quality and Transparency Count. There is simply no substitute for transparency of data on the quality and safety of patient care. Thus far, this information is of limited use by consumers and purchasers, although that is likely to change over time. In the meantime, and perhaps more importantly, the value of transparency is as a management and process improvement tool. As I said in an article in Business Week in September of 2007:
There are often misconceptions as people talk about "transparency" in the health-care field. They say the main societal value is to provide information so patients can make decisions about which hospital to visit for a given diagnosis or treatment. As for hospitals, people believe the main strategic value of transparency is to create a competitive advantage vis-Ã -vis other hospitals in the same city or region. Both these impressions are misguided.
Transparency's major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.
At BIDMC, we have been publishing quality information for several years. During this same period, we have steadily improved our performance. We know that we are saving hundreds of lives and millions of dollars in health care costs as a result of the quality and safety initiatives we have carried out. An indication of our institutional commitment to this direction is that the governing bodies of our hospital -- the Board of Directors and Board of Trustees -- took audacious votes last year to eliminate all preventable harm at BIDMC by 2012 and to be transparent about our progress and results. This information is published quarterly on our website at www.bidmc.org.
Improve Public Payer Reimbursement and Rationalize Payment for all Health Care Services. Levels of public reimbursement are a contributing factor to higher-than-necessary private insurance premiums. Medicaid, Medicare, and the Health Safety Net Trust Fund reimburse hospitals – on average -- at significantly below the cost of providing care. These payment inequities are particularly acute for services to some of our most vulnerable patients, such as for inpatient mental health care. Because of this, we are forced to identify alternative revenue sources to cover our operating costs. One such source is our reimbursement from private insurers. The overall reimbursement we receive from private health insurers ultimately subsidizes our losses from public payer contracts that fail to cover our costs. State budget reductions for academic medical centers over the last two fiscal years have had a sustained, significant negative impact on our fiscal health. But these two years have been different only in degree, not in direction. For years, public payer losses have also damaged our ability to keep up with the capital investments needed to maintain our facilities on an annual and long-term basis.
In addition, for many key services that are central to our non-profit mission, private health insurer reimbursement also fails to cover our costs. This means we are forced to invest in higher cost services that command higher reimbursements and cross-subsidize services for which we are drastically underpaid. The Division should work with health insurers and other stakeholders on strategies to improve public payer reimbursement, rationalize payment for health care services, and eliminate the need for cross-subsidization.
Correct Market Dysfunctions. We have to acknowledge that the manner in which reimbursement rates are established in this state is not related to the quality of medical service provided. Instead, market power seems to be the predominant factor in the rate-setting environment. Thus, we have the odd result that, for example, the reimbursement rate for the very same colonoscopy performed on exactly the same type of patient will vary by large percentages depending in which contracting network a doctor happens to be situated. I will tell you frankly that BIDMC and our physician contracting organization, BIDPO, is sometimes a beneficiary of this process. At other times, we are put at a competitive disadvantage. In both cases, this is a result counter to sound public policy.
There are two solutions to this problem. The first would be to return to a rate-setting environment, in which the Commonwealth would establish the reimbursement rates for each insurance company and each provider organization. I personally would not have a problem with such an approach, in that health care can viewed as a “utility-like” function, in which reliance on competitive forces is unlikely to produce economic efficiency and equity.
Short of rate-setting, I believe the Commonwealth should use its existing authority to make reimbursement contracts public. Allowing sunshine to reach the current reimbursement arrangements would provide moral and political pressure from subscribers, public officials, and the public on the insurance companies to equalize payments across provider groups. I believe this would result in rate-setting methodologies that are more tied to the quality of service provided.
Embrace Innovation in Health Care Delivery with Accountability to Consumers. At BIDMC, we recently teamed up with the state’s largest physician group practice, Atrius Health, to establish a new model for health care delivery in the Commonwealth. We are using shared electronic medical records to improve our efforts to provide the right care at the right time in the appropriate setting. We have also embarked on a robust agenda for quality improvement and cost-efficiency strategies. Our collaboration will be built around a strong emphasis on primary care, and a continuum of care from the ambulatory setting to the hospital and beyond. Among our strategies:
Putting primary care at the center of patient’s care;
Ensuring that physicians work together as a team with nurses, technicians and other allied health professionals;
Enhancing and further integrating electronic medical records;
Advancing health equity and ensuring a diverse, culturally competent interdisciplinary workforce;
Preventing and reducing medical errors and being transparent about results;
Improving the efficiency of health care delivery by continuous process improvement as exemplified by the LEAN methodology; and
Empowering patient involvement in the design of the health care delivery system through advisory councils, secret shoppers, patient satisfaction surveys, and other mechanisms.
We are confident that these innovative strategies – put into practice – will have a meaningful impact on quality, access and the cost of health care in Massachusetts.
I hope that the foregoing comments are helpful, and I would be glad to discuss these with you in the future.
Very truly yours,
Paul F. Levy
Glenn goes to Medicare?
Rumor mills. I don't find confirmation anywhere else, but the RPM Report says:
Our understanding is that Geisinger CEO Glenn Steele will be nominated as the next Administrator of the Centers for Medicare and Medicaid Services.
A colleague writes:
Our understanding is that Geisinger CEO Glenn Steele will be nominated as the next Administrator of the Centers for Medicare and Medicaid Services.
A colleague writes:
The President is planning on mentioning him in the State of the Union address and formally offer him to the Congress later this week or early next week.
Glenn, who runs the Geisinger Health System, would certainly be very qualified for this post.The Pizza Turnaround
As several of us in the hospital world pursue our own versions of transparency and accountability to achieve high standards of performance, it is interesting to view how people in other industries do the same. Here is a video produced by Domino's Pizza about the voyage of discovery they went through. I found it intriguing and hope you do, too.
Click here if you cannot view the video.
Click here if you cannot view the video.
Tuesday, January 26, 2010
My goal today was to provide you with outstanding service
Jeffrey Goldberg at The Atlantic offers a video version of "If Air Travel Worked Like Health Care." Watch it here, or below:
Monday, January 25, 2010
Medical moments in 55 words
I just learned of this blog from a friend. It is lovely, and I recommend it.
Dr. Smith's Sunday report
Here are excerpts of an email report received yesterday from Dr. R. Malcolm Smith, Chief of the Orthopaedic Trauma Service at Massachusetts General Hospital, hard at work in Haiti with the team there and with support folks back in Boston. (Embedded links are mine.)
Thank you everyone. We are all fine. No time to txt much.
Things here working. Coming off critical triage mode but masses of work to do. Essentially started putting people back together again. You can't imagine the emotion that creates. Morale soared yesterday as patients were coming out of OR fixed. Then 2 deaths during evening rounds, one massive PE and one medically sick baby. The reality of poverty and what's happened here hits you again.
Understand the USS Comfort is working. Had contact and heard evac helos flying. Hoping for first evac today for ICU (young woman has tetanus). Reinforcements here essentially enough to run hospital and teach local staff. Don't need more staff now after second PIH (Partners in Health) team from California arrived. Had major problem with arriving Docs etc in uncoordinated groups who want to work. Good will has to be organised.
Port au Prince still sounds very bad. Damage there terrible. Found cracks in tile in our OR Floor after aftershock and had to stop work 2 days ago. But checked by US structural engineers sent by PIH and all OK. Damage clearly old on reflection.
Have mesher but urgently need skin graft knife and blades. Electric dermatome best as no air power and will need lots of big grafts. Old hand knife will be difficult. Mark/Jeanette can you help? Thank you for tourniquet already saved life. Country will need thousands of vacs.
Coordination around the place is nightmare and have problem with patients. With infected open fractures that are not reconstructable, refusing surgery in case they need amputation. They are just frightened and know there is no limb fitting service. Heard of same problem all over. Families take them away for second opinion which will be the same. Next phase needs limb fitting/prosthetics please! James Toussiant joined us yesterday (our Haitian ortho resident). Gem of a guy solving many problems immediately, but the amputation problem is still real despite the communication. Hoping to do 20 cases today in 2 rooms but also have enough staff to do dressings under sedation on wards! Kindness in care as well.
First wave expecting to be done by Saturday. Will need different team ortho/plastic surgery, nursing PT and lots of admin. Community will need lots of trained nurses. Specifically need loads of Haitian/American nurses and doctors to bridge the gap. So fortunate to have had some.
Robin and Mary, thank you so much for all the work you have been doing at home. You can't imagine how much it means.
Thank you everyone. We are all fine. No time to txt much.
Things here working. Coming off critical triage mode but masses of work to do. Essentially started putting people back together again. You can't imagine the emotion that creates. Morale soared yesterday as patients were coming out of OR fixed. Then 2 deaths during evening rounds, one massive PE and one medically sick baby. The reality of poverty and what's happened here hits you again.
Understand the USS Comfort is working. Had contact and heard evac helos flying. Hoping for first evac today for ICU (young woman has tetanus). Reinforcements here essentially enough to run hospital and teach local staff. Don't need more staff now after second PIH (Partners in Health) team from California arrived. Had major problem with arriving Docs etc in uncoordinated groups who want to work. Good will has to be organised.
Port au Prince still sounds very bad. Damage there terrible. Found cracks in tile in our OR Floor after aftershock and had to stop work 2 days ago. But checked by US structural engineers sent by PIH and all OK. Damage clearly old on reflection.
Have mesher but urgently need skin graft knife and blades. Electric dermatome best as no air power and will need lots of big grafts. Old hand knife will be difficult. Mark/Jeanette can you help? Thank you for tourniquet already saved life. Country will need thousands of vacs.
Coordination around the place is nightmare and have problem with patients. With infected open fractures that are not reconstructable, refusing surgery in case they need amputation. They are just frightened and know there is no limb fitting service. Heard of same problem all over. Families take them away for second opinion which will be the same. Next phase needs limb fitting/prosthetics please! James Toussiant joined us yesterday (our Haitian ortho resident). Gem of a guy solving many problems immediately, but the amputation problem is still real despite the communication. Hoping to do 20 cases today in 2 rooms but also have enough staff to do dressings under sedation on wards! Kindness in care as well.
First wave expecting to be done by Saturday. Will need different team ortho/plastic surgery, nursing PT and lots of admin. Community will need lots of trained nurses. Specifically need loads of Haitian/American nurses and doctors to bridge the gap. So fortunate to have had some.
Robin and Mary, thank you so much for all the work you have been doing at home. You can't imagine how much it means.
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