tag:blogger.com,1999:blog-49252717087146057182024-03-13T07:15:35.246-07:00Health and AdministrationThoughts and observations regarding modern healthcare administration in the context of policy reform.Unknownnoreply@blogger.comBlogger94125tag:blogger.com,1999:blog-4925271708714605718.post-30406457868880342512014-01-28T08:24:00.003-08:002014-02-19T06:18:17.263-08:00Assignment 3 for my students - The plot thickens<p>My personal learning network fed me many ideas recently. Tonight President Obama will make his annual State of the Union address. We will certainly hear more calls for cooperation between the political parties in Congress, particularly as related to healthcare reform. The major provisions of the Affordable Care Act are taking effect now. CMS (Centers for Medicare and Medicaid Services) and the Department of Health and Human Services (HHS) are quite fully engaged now in efforts to implement the new law.</p>
<p><a href="http://www.cms.gov/" target = "_new2">http://www.cms.gov/</a></p>
<p><a href="http://www.hhs.gov/" target = "_new2">http://www.hhs.gov/></a></p>
<p>This article in Modern Healthcare helps scope out the issues right now.</p>
<p><a href="http://www.modernhealthcare.com/article/20140111/MAGAZINE/301119978/outlook-2014-obamacare-sgr-repeal-icd-10-and-payment-cuts-top-the" target = "_new2">http://www.modernhealthcare.com/article/20140111/MAGAZINE/301119978/outlook-2014-obamacare-sgr-repeal-icd-10-and-payment-cuts-top-the</a></p>
<p><a href="http://en.wikipedia.org/wiki/Medicare_Sustainable_Growth_Rate"" target = "_new2">http://en.wikipedia.org/wiki/Medicare_Sustainable_Growth_Rate</a></p>
<p>The heat is on. Physicians and other providers are under financial pressure, legal requirements, and the need to integrate information technologies. People will begin to experience the new "system" as patients very soon. There will be problems. Anything this big and complex is going to have problems. Many states, including Georgia, are not expanding Medicaid coverage. Doing so was part of the "magic," but the Supreme Court ruled that the federal government cannot force the state governments to expand Medicaid, even if most of the money comes from the federal government.</p>
<p>Students, in commenting to this post, please review the information in this post (including the links above) and address at least one aspect of what is going on right now. Watch or listen to the President's address if possible. It will be available on YouTube. The President's concern has to be that a sufficient number of Democrats in Congress and going to get "cold feet" and begin to side with Republicans on some of these issues. It is difficult to "see the entire picture." At least take one aspect of it and comment about how you see things here, please.</p>Unknownnoreply@blogger.com6tag:blogger.com,1999:blog-4925271708714605718.post-60050839568715282852014-01-21T07:43:00.002-08:002014-01-21T07:46:34.328-08:00Assignment Blog 2 for my students<p>"Modern Healthcare" recently reported the closure of Interfaith Medical Center in Brooklyn, New York. Interfaith Medical Center, like Grady Memorial Hospital in Atlanta, is/was a large "safety-net" hospital. Interfaith primarily treated patients on Medicaid and uninsured patients. It has been in financial strain for some time.</p>
<p><a href="http://www.modernhealthcare.com/article/20140118/MAGAZINE/301189967?AllowView=VXQ0UnpwZTVDL1dXL1I3TkErT1lBajNja0U4VUMrZFZFQk1HQXc9PQ==">http://www.modernhealthcare.com/article/20140118/MAGAZINE/301189967?AllowView=VXQ0UnpwZTVDL1dXL1I3TkErT1lBajNja0U4VUMrZFZFQk1HQXc9PQ==</a></p>
<p>The question, of course, becomes, where will those patients now received needed medical care. At least two things catch my attention in this regard. The first is that this hospital may have survived had "Obamacare" been implemented sooner. In other words, by participating in the exchanges and tapping federal revenues available to help people afford health insurance, the patients served by Interfaith would have had more resources to be spent for medical care. Also, the hosipital itself apparently could have sponsored its patients by paying their premiums for insurance under the new laws and policies. </p>
<p>The article notes that hospitals with high debt, low occupancy and less acutely ill patients are more likely to close. Well, under the new law, if Interfaith Medical Center had become part of an Accountable Care Organization, perhaps more of its revenues whould have come through capitation and its low occupancy rates would not have been a major problem.</p>
<p>This bring up the question of the role of hospitals (and safety net hospitals in particular) in the future of healthcare delivery in the United States. Many people see hospitals as the "hubs" of Accountable Care Organizations (ACOs). Others see a more fluid situation in which ACOs are not dependent upon hospital systems as "hubs."</p>
<p>It seems to me that to effectively protest the closing of a major safety net hospital requires more than a wish to return to the past. An effective protest, I think, requires an understanding of the future of healthcare delivery in the United States. Without that understanding, then it is not possible to anticipate how existing institutions can fit into the new realities and survive.</p>
<p>Students, please see what you can find regarding safety net hospitals and Accountable Care Organizations and then reflect upon the situation reported in this recent article in <i>Modern Healthcare</i>. Comment here, as before.</p>Unknownnoreply@blogger.com10tag:blogger.com,1999:blog-4925271708714605718.post-32780073827855466142014-01-15T07:29:00.002-08:002014-01-15T07:35:26.842-08:00New Post 1 for my new students<p>There was a report issued in Modern Healthcare yesterday titled, "AMA fears privacy loss as Medicare moves to reveal Doc pay." I became aware of this because my own personal learning network brought it to my attention this morning.</p>
<p><a href="http://www.modernhealthcare.com/article/20140114/NEWS/301149951/medicare-to-disclose-physician-reimbursement-data?AllowView=VXQ0UnpwZTVDL1dhL1IzSkUvSHRlRU9vamtnZEErTmM=" target="_new2">http://www.modernhealthcare.com/article/20140114/NEWS/301149951/medicare-to-disclose-physician-reimbursement-data?AllowView=VXQ0UnpwZTVDL1dhL1IzSkUvSHRlRU9vamtnZEErTmM=</a></p>
<p>In the article Joe Carlson discusses the balance between the privacy interests of physicians and the value of transparency regarding the incomes that physicians receive for services provided to their patients who have Medicare benefits. When values are in competion with each others reasonable people can certainly disagree about the nature of the "balance" between or among the values. The following statement in the news report caught my eye.</p>
<p>"The American Medical Association is warning that the Obama administration could violate physicians' privacy rights if it poorly implements its new policy for informing the public how much money Medicare pays to individual doctors."</p>
<p>The part of that statement that I notice in particular is the, "if it poorly implements" its new policy.</p>
<p>There is, of course, wide-spread and strongly felt opposition to the entire policy commonly known as "Obamacare." Some of that opposition is grounded in personal philosophies about the nature of freedom and the role of government. There is a substantial fundamental mistrust of central government that goes back to prior to the founding of our nation. A part of that is a pervasive belief that large governments do not have the capacity (ability and competence) to implement complex programs. Even those of us who generally favor what the new Affordable Care Act intends have concerns about the ability of "bureaucrats" to make it work well. The clumbsy roll out of the healthcare.gov website is an example that for various reasons government agancies often appears to be able than other kinds of organizations. Basically, what I see is a vicious cycle of public mistrust creating constraints upon agencies which cause agencies to appear inept that then feeds back into public mistrust and perceptions that government employees are less than fully competent.</p>
<p>The facts are that policy implementation is often very difficult and that implementation of "Obamacare" is a minefield of challenges because of its complexity.</p>
<p>I honestly don't know how to balance the privacy concerns of physicians with the need for the system to be "transparent." I do think that to the degree that being a physician is becoming more "bureaucratic," physicians are opting for early retirements. I am concerned that going forward the shortage of physicians is likely to increase.</p>
<p>I am here asking my students to repond to this post by sharing their opinions and insights about these things. How do the competencies of administrators affect the ability of medical providers to deliver care to large populations of people? Is it possible that "Obamacare" is so bold an initiative as to be impossible to implement effectively? I ask that my students include a link in their reply to some other relevant online resource.</p>Unknownnoreply@blogger.com7tag:blogger.com,1999:blog-4925271708714605718.post-5498166974278297722013-09-22T08:39:00.000-07:002013-09-22T08:40:25.388-07:00Post assignment 5 for my students<p>It will be interesting soon to see how people (and employers) respond to the opening of the insurance exchanges soon. It is evident that even with financial help for those who really cannot afford even the cheapest plans, some people will not participate. Some people will not participate for ideological reasons; making a decision to go without medical insurance rather than becoming part of something they oppose for political, philosophical or, perhaps, for religious reasons. Others may not sign up because they don't know what is happening and may simply fail to respond, for lack of knowledge or, perhaps, lack of literacy.</p>
<p><a href="http://money.cnn.com/2013/09/20/news/economy/obamacare-penalty/index.html?source=cnn_bin">http://money.cnn.com/2013/09/20/news/economy/obamacare-penalty/index.html?source=cnn_bin</a></p>
<p>To my students: do you think some hospitals and other medical care providers may pull back on providing care (beyond what they are legally obligated to provide, such as under the EMTALA law), to people and families that have decided to pay the fine rather than to buy insurance? Will it become more "ethical" or acceptable to say "no" to individuals with no insurance under the new circumstances? There are people and families who use emergency departments of hospitals as their primary care providers and do not pay for the services they continue to receive in emergency departments, by choice. Do you think the availability of the insurance exchanges will change the point at which hospitals say, "no more" to those without insurance?</p>
Unknownnoreply@blogger.com18tag:blogger.com,1999:blog-4925271708714605718.post-31908060868013904252013-09-20T06:48:00.002-07:002013-09-20T06:55:48.645-07:00Module 4 assignment for my students<p>I am finding that using a blog as a way to create assignments for you, my students, is a bit challenging. The nature of most blog posts is to write reflectively, as if in one's own personal diary. Creating assignments is something else. :-) In one case, the issue is when an idea seems "ready" to be expressed. The other case is a matter of the calendar and the clock. I am a little behind in posting assignments right now, which suggests that this is still a blog, which is good.</p>
<p>I read a lot and our course is the theme of most of what I am currently reading. I have recently discovered Joseph S. Bujak as an author. He is a physician who has become an administrator. I am learning from the insights he has derived from his experiences. I often don't like what he has concluded, but the world is not necessarily what I would like it to be and I find his perspectives thought provoking. I am, perhaps, too much a idealist. As a physician who has become an administrator he, perhaps, has a "license" to say or suggest some things that those who are not physicians cannot say or suggest.</p>
<p>The gulf between hospital administrators and many physicians is frequently reported. Policy experts seem to be of the opinion that the only way Accountable Care Organizations may work is if they are led by administrators who are also physicians. I am sure that there are instances in which administrators and physicians have good and constructive relationships. But I question that administrators who are first physicians necessarily have a greater ability to work with other physicians. I read somewhere that the gulf is about the battle of the apostrophe. In other words, administrators by training and dispostion are primarily concerned about patients' interests; while physicians by training and disposition are concerned primarily about the interests of particular patients. In my idealism (a luxury of teachers) I want to believe that people can change and that it is possible for people of good will to learn from each other's perspectives. I want to believe that even as people age they can remain pliable. Yet in professional cultures (such as medicine and higher education) people cling tightly to the values acquired during training and years of practice. I believe that Bujak somewhere wrote, "Everyone is always 100% in agreement with his or her own perspective." That is especially true of professionals, including physicians and professional administrators. In the classroom I have the luxury of pretending to "see" everyone's perspective. In life, as a professional I see things from "where I sit" and who I am.</p>
<p>In the book <i>Leading Transformational Change: The physician-executive partnership</i> Bujak and Atchison include the following parable.</p>
<p>A scorpion wants to cross a pond and asks a frog for its help. The scorpion asks to ride across the pond on the back of the frog. The frog initially does not trust the scorpion not to bite him. But the scorpion explains that it would not be in his own interest to sting the frog because doing so would kill the scorpion. The frog agrees. Half way across the pone the scorpion stings the frog. Before dying the frog asks, "Why did you sting me? Now we will both die." The scorpion replies, "I am a scorpion. I have to sting you -- it's my nature!"</p>
<p>Ouch! The authors go on the write that effective leaders accept that they cannot change people; that effective leaders find ways to build upon what people already are and by helping others become more of what they already are. That parable haunts me because it challenges what I want to be true. And yet I expect that there is some truth or wisdom in it; otherwise it would not remain in my mind.</p>
<p>Okay, my students. What do you make of this? If it is true that one cannot easily modify professional cultures, then what are the implications for leadership in perilous times? Can we only trust others to be their essential selves? Are notions of personal and organizational learning just empty exercises in academic idealism? Please take whatever you can of this, reflect upon it, and share your journey as a comment to this blog post.</p>
Unknownnoreply@blogger.com26tag:blogger.com,1999:blog-4925271708714605718.post-8722668628700128842013-09-12T12:08:00.003-07:002013-09-12T12:08:59.289-07:00Module 3 assignment for my students
<p>This is in response to a post by Dr. Kimberly Manning of Grady hospital. I believe she is a hospitalist at Grady
Hospital in Fulton County, Georgia. In other words, like many other modern physicians she is employed by the hospital to
provide primary care for patients while they are in the hospital. This frees up community physicians with admitting
privileges from having to come to the hospital frequently. It is part of a management strategy that may work for everyone
involved. It is not the "old days" when your personal physician came to see you in the hospital every day. </p>
<p><a href="http://www.gradydoctor.com/2013/08/dr-no.html" target="_new2">http://www.gradydoctor.com/2013/08/dr-
no.html</a></p>
<p>I have been following Dr. Manning's posts on her blog occasionally for several years. A surprising number of health care
professional (and hospital administrators) have blogs. Dr. Manning posts frequently and share a lot about her experiences
at work and with her family. She really writes well.</p>
<p>In this particular post she reports an event relevant to the cultural environment of medical care. It is no secret that
many patients are dissatisfied with their care in part because of cultural insensitivities. There are so many potential
barriers including, for examples, languages and religious differences. Hospital administrators and medical care
professionals have always faced such challenges. Patients are not always reasonable. Under new policies financial revenue
flows will be linked directly to patient satisfaction scores, because patient satisfaction is a proxy measurement of
quality of care.</p>
<p>Please reflect on the situation Dr. Manning faced with this patient. Did she handle it well? It is easy to "blame"
patients who may appear irrational or unreasonable. In your opinion, is the use of patient satisfaction scores "fair" to
hospitals and physicians in the assessment of quality of care? Include a working link to another web page or video that is
relevant to your thoughts.</p>Unknownnoreply@blogger.com17tag:blogger.com,1999:blog-4925271708714605718.post-13977533273608086942013-09-03T07:04:00.000-07:002013-09-03T07:04:19.587-07:00Module 2 assignment for my students (and for other readers)<p>The usual notion regarding market competition is that in the long run it will result in the efficient production of goods and services as "better" companies win out over "not so good" companies in the marketplace. While some scholars argue that competition is the solution to rising costs and the need for higher quality in medical care, others say, "no," medical care is different.</p> <p>A medicine that I take daily became available in a generic form recently. I use the pharmacy at Walmart on Ledo Road. They informed me that they were out of the generic form and that I had the choice of waiting a few days for the generic, going across town to the Walmart on the East side for the generic, or getting the version that is not generic for an out-of-pocket cost of $30, compared to out-of-pocket for $10 for the generic version. I asked what the non-generic form would cost my insurance company for 30 days. The answer was $186. I drove across town to get the generic in order to save both myself and my insurance company some money.</p> <p>Here are my questions of you. Was my behavior rational? How many people (as patients) would have cared in the least what a prescription costs their insurance company? Why do we have the complicated system at all? Why not just charge patients the cost of things and not bother with government agencies and insurance companies at all? What would you have done in my situation? How "should" people make economic decisions about medical care? Based on your reading of chapter 2 of our textbook by Marcinko and Hetico do you think competition alone is the solution to the quality crisis and rising costs of medical care?</p><p>I am looking for at least one solid paragraph as a reply to this post. You don't have to answer every part of the question. Please remember to include a link to a relevant Web page or YouTube video.</p>
Unknownnoreply@blogger.com23tag:blogger.com,1999:blog-4925271708714605718.post-18583290344330159762013-08-29T07:30:00.001-07:002013-08-29T07:35:37.066-07:00Reflections on first chapter -- Inside the Physician's Mind<p>I am writing this primarily to you, my students, as an example of the kind of reflective posts you will write in your own blogs soon. I just now read the first chapter of the book, <i>Inside the Physician Mind: Finding Common Ground with Doctors</i> by Joseph S. Bujak, MD. This post is not an attempt to summarize the chapter. It is only a reflection on some specific things in the first chapter that caught my eye. Bujak affirms the value that physicians place in their professional autonomy. They don't want to be told what to do and they avoid presuming to tell other physicians what do to. This makes the role of a Chief Medical Officer in a hospital difficult. This also makes the tasks of CEOs and other administrators difficult. To physicians, time is money -- in many cases a lot of money. Administrators would like to work with physicians in groups to conserve effort and time/money, but physicians prefer one-on-one one relationships with administrators. In group settings, physicians (according to Bujak) prefer a vote to the drawn-out discussion that might (possibly) lead to some kind of consensus. When a (premature) vote is taken it is likely that most if not all of the "participants" will be unhappy with the outcome.</p>
<p>The most shocking statement (to me) by Bujak in chapter 1 is that physicians tend to be linear thinkers and, therefore, do not understand the complexities of administration. Wow! If that is true, heaven help us. If they are only linear thinkers how can physicians diagnosis medical problems correctly, given the complexity of human bodies, and the complex relationships among subsystems within our bodies? I pray that Bujak means that physicians may not appreciate <i>the complexity of administration</i>; not that they tend to be linear thinkers in all domains, including medicine.</p>
<p>In summary, I find this first chapter surprising, interesting, and provocative. I look forward to what I may learn in the other chapters.<p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-83771783568221114532013-08-28T12:08:00.002-07:002013-08-28T12:09:49.708-07:00Resource for my students and others<p>MedicalBillingandCodingOnline.com is committed to providing comprehensive, up-to-date resources on the medical coding industry. As the health care grows and processes evolve, the demand for medical billers and coders will remain strong. We’ve developed these free online courses that cover every aspect of medical coding and billing to help students keep up and remain competitive in the workforce.</p>
<p>It has a compilation of resources including articles that will let students learn everything they need to know about this specialized field. This includes learning about billing and coding, discovering their scholarship options, and knowing what they need to become a certified medical coder or biller.</p>
<p>The directory lets them discover medical billing and coding programs in different schools in each state. This will help them filter the best program/s that will meet their educational and career goals.</p>
<p>Specifically, the project -- http://www.MedicalBillingAndCodingonline.com/ICD-10/ -- is a comprehensive database that provides current and prospective college students with abundant information about the new coding system that will be implemented on October 2014. It also has a conversion tool that you and your peers can use.</p>
<p>Here is the relevant link.</p>
<p><a href="http://www.MedicalBillingAndCodingonline.com/ICD-10/" target="-new2">http://www.MedicalBillingAndCodingonline.com/ICD-10/</a></p>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-4925271708714605718.post-75652557729655527092013-08-23T11:16:00.003-07:002013-08-23T11:25:36.167-07:00Module 1 post for my students (and other readers)<p>This is my Module 1 post for students which you/they are to reply to in a substantial way, including a link to a relevant online resource, by Sunday, September 1. I read every day but I don't often exactly "enjoy" reading books. I read mostly because I want additional knowledge to share with others, especially my students. At the moment I am reading, <i>Charting the Course: Launching Patient-Centric Healthcare</i> by Nance and Bartholomew. It is a recent book book about hospital administration. So far I actually am enjoying the conversations it contains, almost like a novel. At the point where I am into the book now, "Will" has accepted a position as CEO of a hospital in Las Vegas but is presently working "under cover" in departments within the hospital listening to the conversations of people who will soon be working under his administration. My thought is that they are going to be really angry when they realize what he has done by working among them without letting them know who is really is. (But I think readers are suppose to accept that what he is doing is necessary to really gain "situation awareness.") </p>
<p>What he is finding is that the culture of the hospital is characterized by fear and authority, and that he has taken on a major challenge. The authors of the book write that this is the culture in most hospitals today. CEOs come in with their "visions," and employees struggle for their sanity and survival within "sick" organizational cultures. I suspect that there is substantial truth in this perspective. It is not limited to hospitals. </p>
<p>To my students -- please think about the meaning and importance of culture in large modern organizations. What does organizational culture include? How does it relate to the goods, services, or experiences produced by organizations? Without talking about any particular organization, share (if you can) how you have experienced organizational culture. Realize, of course, that culture can be good and that what you may share may be your memory of a good experience, either as an employee or client of an organization.</p>
<p>It is possible to try to "paint" the appearance of a good, healthy culture on the reality of a culture characterized by (dis)stress and/or fear. Fast-food enterprises, for example, are very stressful work environments, and yet employees are required to create the appearance of joy and harmony. As a manager or administrator, how could you address the culture of an organization? (This is not necessary an "essay" question in which you have to respond to every part of the question. Please write at least a paragraph that is relevant and that may be instructive to people reading this blog. Use only your first name, or make up a name and let me know the name you are using. Remember to include a link to a relevant Web page, or perhaps a YouTube video.)</p>
Unknownnoreply@blogger.com17tag:blogger.com,1999:blog-4925271708714605718.post-44425839039756769762013-08-09T11:43:00.002-07:002013-08-09T11:43:21.830-07:00Beginning of PADM 5322 in Fall of 2013It has been a while since I have posted anything here. I spent the summer teaching an online course and completing an internship in the Master of Public Health program at Georgia Regents University. My intent now is to use this blog for learning purposes in the context of a course in foundations of healthcare administration at Albany State University this fall of 2013. Each week I plan to post one or more new items here and ask my students to each reply. I hope that each reply will be a substantial contribution and will include at least one link to a relevant URL. Each reply (or set of replies) will be due by a specified Sunday evening.
The course home page will soon be available at this URL.
<a href="http://www.robertcat.net/fall2013/padm5322/">http://www.robertcat.net/fall2013/padm5322/</a>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-86766233689003682612012-05-17T18:25:00.000-07:002012-08-29T04:52:42.339-07:00Atul Gawande addresses ACO formation<p>The following link is to a lengthy presentation by surgeon and author Atul Gawande which is well worth watching. You may want to skip over the first seven minutes or so which includes the introduction of Dr. Gwande to the audience at Cleveland Clinic.</p>
<p>One hour and one minute into the presentation he responds to a question from the audience regarding the future of healthcare delivery in the United States and says that, in his opinion, the prospect of who is going to lead the way forward is being battled now among three kinds of players. They are the insurers, the physician groups and the hospitals. He believes that it is the physician groups that are most likely to lead in making the changes necessary to address our nation's healthcare needs.</p>
<p><a href="http://www.youtube.com/watch?v=VSWQtOjsiXo">http://www.youtube.com/watch?v=VSWQtOjsiXo</a></p>
<p>Begin at the one hour mark. Atul Gawande addresses the question of who will lead the way forward and survive in the new policy and market realities.</p>
<p>This post was edited on August 29, 2012.</p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-71872503134474910132012-05-17T18:17:00.003-07:002012-05-17T18:20:07.116-07:00Transforming sickness care to health care<p>Rebecca Onie at TEDMED 2012 made the case that college and university students can become organized to make a very significant difference helping link patients with community resources. She concluded saying, "I believe that we all have a vision for health care in this country. I believe that at the end of the day when we measure our health care it will not be by the diseases cured but by the diseases prevented. It will not be by the excellence of our technologies or the sophistication of our specialists but by how rarely we needed them. And most of all, I believe that when we measure health care it will not be by what the system was but by what we chose it to be."</p>
<a href="http://www.tedmed.com/videos-info?name=Rebecca_Onie_at_TEDMED_2012&q=updated&year=all">http://www.tedmed.com/videos-info?name=Rebecca_Onie_at_TEDMED_2012&q=updated&year=all</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-16900383634537050802012-05-12T15:26:00.000-07:002012-05-12T15:28:59.028-07:00Publication of avian flu virus research?CNN reported today that a science journal is poised to publish a study that some experts believe could give a recipe to bioterrorists. This takes the responsibility of peer reviewers to a whole new level.
<p><a href="http://www.cnn.com/2012/05/12/us/journal-avian-flu/index.html?hpt=hp_t1" target="_new2">http://www.cnn.com/2012/05/12/us/journal-avian-flu/index.html?hpt=hp_t1
</a></p>
I don't think such research results should be published. An argument can be made that humanity faces a threat in an "arms race" between human ingenuity and viral adaptations that may cause pandemics. But our existing method of sharing most scientific knowledge through publication does not limit the scope of knowledge distribution. The usual defense of publishing such information is that no bioterrorist is irrational enough to unleash a deadly virus that could destroy the very people whose interests motivate the terrorist. To trust the fate of mankind upon a belief in the sanity and rationality of every potential bioterrorist in the world who may have the skills and resources to design a deadly virus is to trust a very thin thread. Who, if anyone, will be legally responsible if the information published is used by bioterrorists to unleash a pandemic, assuming enough people survive to consider possible litigation?Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-37041849070838978222012-04-28T18:30:00.000-07:002012-05-02T00:51:14.095-07:00Scaling Care through Digital Health CoachingDr. Vic Strecher of the University of Michigan addresses the important topic of digital health coaching in the video below. When addressing TEDMED recently he spoke of the potential to create personalized online messages for patients to help then change their health-related behaviors. While this may not qualify as "rocket science" it is <i>huge</i> as our nation's healthcare delivery system becomes increasignly financed by capitation and as we try to scale up delivery of services to larger numbers of people. The bottom line in the presentation is that people are more likely to pay attention to (and act upon) highly personalized messages even if those messages were in fact computer-generated.<br />
<br />
<iframe allowfullscreen="" frameborder="0" height="233" src="http://www.youtube.com/embed/bxMGuGUROiA" width="400"></iframe><br />
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Additional information about Dr. Strecher is available here. <a href="http://www.ur.umich.edu/update/archives/100122/innovator" target="_new2">http://www.ur.umich.edu/update/archives/100122/innovator</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-19936951258300586872012-04-15T07:07:00.004-07:002012-04-15T07:21:50.541-07:00Forgiveness, Trust and a Culture of QualityIn this video presentation, Paul F. Levy, recent CEO for the Beth Israel Deaconess Medical Center in Boston, makes a case for forgiveness in the culture of a medical institution striving for quality care. I suppose that to somehow punish a physician or other care provider for a serious mistake may be safe behavior for an administrator. People tend to admire active administrators who can make decisive decisions. But the quality of the services provided by a caregiver is more evident in the pattern of his or her work than in the exception. Physicians tend not to identify the mistakes and near-misses of others, realizing that they each are imperfect and may someday make a mistake. A culture of punishment does not promote a culture of trust, which is necessary to create continual learning and improvement. <br /><br /><iframe width="400" height="233" src="http://www.youtube.com/embed/69sMwY7vNFo" frameborder="0" allowfullscreen></iframe>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-27580319698798261852012-04-05T16:16:00.004-07:002012-04-05T19:07:14.027-07:00From social networks to social robotsAt her recent TED Talk Sherry Turkle describes how she believes our electronic social and communication devices are becoming problems as we try to substitute connections for real relationships. About half way through her presentation she refers to the use of social robots in a nursing home. <br /><br /><iframe width="420" height="243" src="http://www.youtube.com/embed/t7Xr3AsBEK4" frameborder="0" allowfullscreen></iframe><br /><br />I have not yet digested the relevance of her thoughts to health and administration. But I wonder if the connection (no pun intended) may be to the notion of, "patient centered care." Medical care is now team-based and individual patients sail through an entire trajectory of teams in an episode of acute care. Sooner or later someone will probably invent some charming robot that patients can carry with them through the experience and perhaps even carry home with them. It will be programmed to help the patient understand what is happening to them now and why. It may even become the repository of some data useful to medical caregivers along the way and may monitor the patient's vital signs. Those of us who remember the joys of early social technology in the era when Turkle wrote her book <em>Life on the Screen</em> remember fascination with live online communications. The very idea that a computer could reproduce the sound of a baby's cry or the gesture of person on the other side of the earth was exciting. <br /><br />Now I observe my students who almost always have their mobile telephones in hand. I share a concern that we may be losing more than we are gaining. If someday I slowly walk or roll the corridors of a nursing home I want good meals and broadband internet access! But I hope for myself and others for more than a cute robot to talk to as I reflect upon life and circumstances. The healthcare delivery system is not friendship service. But I do believe that "patient centered" is about being person centered and that we may have used the phrase, "patient centered" to gloss a dimension that cannot scale through technology or process design.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-51455355555169446642012-03-09T18:00:00.009-08:002012-04-01T18:49:44.871-07:00Digital records and costsAn article in <em>The New York Times</em> by Steve Lohr published March 5, 2012 reports on a study using existing data that concluded that availability of digital records may not cut health costs. Someone expressed doubt in the findings because they were based on correlations in existing data rather than a controlled test intended to test the hypothesis regarding electronic records and costs. <br /><br /><a href="http://www.nytimes.com/2012/03/06/business/digital-records-may-not-cut-health-costs-study-cautions.html?_r=1" target="_new">http://www.nytimes.com/2012/03/06/business/digital-records-may-not-cut-health-costs-study-cautions.html?_r=1</a><br /><br />In my opinion, not every study requires a method like that of a clinical trial and it is both valid and cost-effective to make use of existing data in responsible ways. Correlation certainly does not prove causality, of course. But I believe the discovery of interesting correlations resulting from hypothesis-based research can be worthy of the attention of professionals. I am not advocating for just mindlessly searching available data for any possible relationship among variables and then pretending to have completed disciplined research.<br /><br />It is reasonable to anticipate that computerized medical offices have the potential to both save money (by reducing the need for repetition of tests already taken) and to spend additional money as the availability of data stored in electronic records drives the propensity of physicians and patients to want still more data. The new iPad 3 with its high resolution screen is likely to push the, "let's get more images" propensity further. Medical providers want to do what is possible and the availability of higher-quality data easily accessible extends what is possible.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-41551655040557397922012-02-08T16:48:00.000-08:002012-02-08T16:52:17.493-08:00Using multimedia in personalized health educationIn the following TEDMED video Alexander Tsiaras, Founder of The Visual MD, discusses and demonstrates how multimedia can be used to make a patient's lab report come alive to the patient in ways that plain text cannot.<br /><br /><iframe width="400" height="233" src="http://www.youtube.com/embed/UX884TNaCNM?rel=0" frameborder="0" allowfullscreen></iframe>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-79357125957928651762012-02-08T04:15:00.000-08:002012-05-02T00:46:50.372-07:00The leadership challenges of transformationDr. Ricardo Azziz, President of Georgia Health Sciences University (GHSU) and CEO of Georgia Health Sciences Health System, has made a blog post dated February 4, 2012 regarding the consolidation of GHSU and Augusta State University.<br /><br /><a href="http://azziz.georgiahealth.edu/archives/406" target="_new2">http://azziz.georgiahealth.edu/archives/406</a><br /><br />The decision by the Board of Regents of the University System of Georgia will surely test the leadership of both those at Augusta State University and Georgia Health Sciences University. Twenty-five years from now I doubt anyone will credit or fault the Regents' decision based on levels of spending for higher education in Georgia. The consolidations will be judged by whether or not campus administrators and others found synergies in new realities.<br /><br />From what I can observe as a student the leaders of both insitutions are accepting the new reality as opportunity. I think Dr. Azziz' blog post sets the right tone. He and others worked very hard to implement the institutional name change of GHSU to emphasize the mission of the historic institution. Now he is accepting the leadership challenge of adapting his vision to the new opportunity. The entire field of higher education in the United States is in transition and the need for adaptive leadership is everywhere. I appreciate Dr. Azziz for his leadership and his willingness to share his concerns and hopes through his blog and by other means. This is not just about the metropolitan Augusta area. The implications of this particular decision by the Regents regard the entire state of Georgia and beyond because of the scope of medical education and patient services provided by Georgia Health Sciences University and Georgia Health Sciences Health System.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-84088552867375880232012-01-20T19:19:00.000-08:002012-01-20T19:25:39.878-08:00Nanotechnology to the rescue?Ray Kurzweil offers an exciting vision of the future and we learn to engineer alternative biological structures at the molecular level. Think how "positively disruptive" such abilities may be to our existing medical care systems. <br /><br /><iframe width="420" height="315" src="http://www.youtube.com/embed/abr0oP4pW0c?rel=0" frameborder="0" allowfullscreen></iframe>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-55704020676275147852012-01-20T08:07:00.000-08:002012-01-20T08:14:14.533-08:00The promise and challenges or more personalized medical interventionsIn this video Ger Brophy highlights exciting opportunities to improve medical care for individuals and possibly reduce aggregate costs. Success will require a combination of advancements in medical knowledge and advancements in information technologies.<br /><br /><object width="400" height="360225"><param name="movie" value="http://www.youtube.com/v/dYTI0VnXH_w&hl=en_US&feature=player_embedded&version=3"></param><param name="allowFullScreen" value="true"></param><param name="allowScriptAccess" value="always"></param><embed src="http://www.youtube.com/v/dYTI0VnXH_w&hl=en_US&feature=player_embedded&version=3" type="application/x-shockwave-flash" allowfullscreen="true" allowScriptAccess="always" width="400" height="225"></embed></object>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-49882532069937145012012-01-16T17:31:00.000-08:002012-01-16T17:34:57.640-08:00Emory Nurse donates kidney to patientThis an an amazing story of care and triumph. <br /><br /><a href="http://bcove.me/rs8koj7q" target="_new">http://bcove.me/rs8koj7q</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-39604711105346714282012-01-13T03:28:00.000-08:002012-01-13T04:47:46.159-08:00Merger of GHSU and Augusta State University in GeorgiaIt was recently reported in <em>The New York Times</em> that several pairs of colleges and universities in the University System of Georgia are being merged, including Georgia Health Sciences University (GHSU) and Augusta State University (ASU).<br /><br /><a href="http://thechoice.blogs.nytimes.com/2012/01/11/georgia-university-merge/">http://thechoice.blogs.nytimes.com/2012/01/11/georgia-university-merge/</a><br /><br />I earned the MBA at Augusta State University years ago and am presently a student in the Master of Health Informatics degree program at GHSU. I think two valid reasons to merge institutions are the benefits of synergy and the possible savings of money. Higher education is costly and the desire to reduce costs is understandable. My guess is that the motivation of the Regents for this merger is primarily based upon an anticipation of cost savings. Synergy can be achieved through shared services and cooperation among institutions.<br /><br />It seems to me that mergers are more likely to be successful if the missions of two institutions are similar. Given that educational services are increasingly being delivered virtually (online), perhaps decisions about mergers should be based upon mission statements rather than geography. And, in any case, I wonder about the hope for cost savings. The resulting complexity of merged institutions may in fact lead to more costly operations. If institutions with different missions are merged, costs may actually increase while the focus of the institutions may be diffused.<br /><br />In my experiences, both Augusta State University and Georgia Health Sciences University are good and valuable institutions. ASU is more a general-purpose state university, offering a wide variety of kinds of degrees. Augusta, Georgia is certainly large enough to need and merit such an institution. GHSU is, of course, focused on medicine and the administration of health care institutions. There are a number of valuable state universities in the Georgia system similar in mission to ASU. GHSU is a more specialized institution and is already complex in its administrative structures. There is going to be a period of adjustments and transitions resulting from the merger. I wonder if in the short term the quality of health care delivery in the state of Georgia and beyond may be affected while attention is diverted to some degree from mission to adjustment at both existing institutions.<br /><br />In the long run, is the ASU campus going to become medically oriented throughout its existing degree programs and research? Is GHSU going to become less focused on medicine and healthcare administration? Or will the two institutions each remain pretty much as they are but operate under a single (highly stretched) administration? For starters, there is going to be a struggle to decide who who stays and who leaves among the administrative ranks. And what will the new entity be named? Will selected programs be merged at the college and departmental levels? GHSU just went through the process of changing its name from the former name, "Medical College of Georgia." The new name is intended to emphasize the mission and focus of the University. As a citizen of Georgia my major immediate concern regarding this merger is the continued quality of medical education and the continued quality of medical care. I wonder if in fact any cost savings will be realized by this merger and if the possible synergies might have be realized through the sharing of services rather than merger.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4925271708714605718.post-29684232511616463802012-01-10T18:42:00.000-08:002012-01-10T18:48:52.515-08:00Financial challenges of private practiceI am posting this hoping that it will spark some interest and conversation in the foundations of healthcare administration course I am teaching this spring semester.<br /><br /><a href="http://money.cnn.com/galleries/2012/smallbusiness/1201/gallery.doctors-broke/index.html" target="_new">http://money.cnn.com/galleries/2012/smallbusiness/1201/gallery.doctors-broke/index.html</a>Unknownnoreply@blogger.com0