Post assignment 5 for my students

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.

http://money.cnn.com/2013/09/20/news/economy/obamacare-penalty/index.html?source=cnn_bin

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?

Module 4 assignment for my students

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.

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.

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.

In the book Leading Transformational Change: The physician-executive partnership Bujak and Atchison include the following parable.

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!"

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.

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.

Module 3 assignment for my students

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.

http://www.gradydoctor.com/2013/08/dr- no.html

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.

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.

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.

Module 2 assignment for my students (and for other readers)

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.

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.

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?

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.

Reflections on first chapter -- Inside the Physician's Mind

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, Inside the Physician Mind: Finding Common Ground with Doctors 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.

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 the complexity of administration; not that they tend to be linear thinkers in all domains, including medicine.

In summary, I find this first chapter surprising, interesting, and provocative. I look forward to what I may learn in the other chapters.

Resource for my students and others

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.

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.

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.

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.

Here is the relevant link.

http://www.MedicalBillingAndCodingonline.com/ICD-10/

Module 1 post for my students (and other readers)

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, Charting the Course: Launching Patient-Centric Healthcare 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.")

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.

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.

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.)

Beginning of PADM 5322 in Fall of 2013

It 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. http://www.robertcat.net/fall2013/padm5322/