Boston, there's a new predator in town

it, I’d prefer a non-profit whose chain can be yanked over a for-profit with no public service requirements at all.

I was reminded of my concerns this week when I heard about the two hospitals Cerberus Capital Management agreed to acquire this week.  It’s picking the hospitals up from Essent Healthcare, another for-profit.  Cerberus, a New York-based private equity firm, just spent $900 million for the six-hospital non-profit chain Caritas Christi. That gave them a nice foothold in Boston, an incredibly competitive but opportunity-rich environment.

Really, both of deals the two-headed guardian of the afterlife has chosen seem to be good ones — for them.  While I’m not privy to much financial information on any of the eight hospitals, we do know that Caritas Christi was in big trouble financially.

I’d wager that the other two hospitals, which lie in the Boston suburbs, are in bad need of a capital infusion to prop them up during these bad times.  This situation allows the firm to swoop in, buy equipment, get things shipshape and get their money many times over.  Oh, and probably do a nice job of squeezing the health plans, now that they’re getting critical mass. Again, good for them.

The thing is, I strongly doubt that any private equity firm is going to have the interests of the community in mind.  One way or another, in most of the private equity buyouts I’ve followed, all of the extra money generated by improvements ends up in the bulging bank account of the PE guys.  They’re not in ANY investment for the long term; that’s just not what they do.  They’re there to pillage, however, legally, and get the hell out.

Far too often, PE players get into a deal, drag the hospitals down financially and then more or less shrug their shoulders when the facility plunges into the red.

The PE firm doesn’t give a rat’s patoot — they’ve made their money. The often-struggling community is left with, well, not a whole lot.

I’d argue that this is a travesty.  We need, as professionals and healthcare consumers, to keep hospitals as community asset with a strong bank account and a long-term view.

So, my question to you is this. Is it inevitable, during this period of transition to full-out reform, that community hospitals get decimated?

Related Articles

• Caritas Private Equity Owner Expanding to Buy 2 More Community Hospitals in Massachusetts (ducknetweb.blogspot.com)
• Caritas owner to buy 2 more Mass. hospitals (boston.com)
• Caritas Sale Closes (hcfama.org)
• AG Mandates Consumer Protections in Sale of Caritas (hcfama.org)

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The other day, I read a tweet from the estimable Matthew Holt in which he summarized what hospitals have been telling him.  In short, they seem to want bigger, badder, newer facilities.  In fact, if I recall correctly, they feel they’re in deep mud if they don’t get these  upgrades and/or new facilities soon.

OK, usually I take such statements with a grain or two of salt. After all, who  – in any industry — doesn’t want the latest and greatest, from the toys we squabble over on up into adulthood?  But in this case, I think we should be taking Holt’s feedback quite seriously.

After all, despite the fact that I’m not an architect, hospital CEO, designer  or any variation on same, I can immediately think of a few very important reasons for a massive buildout of hospitals to improve care and meet today’s process standards:

*  Shared rooms are right out.  There are already a fair number of hospitals (no stats to hand but this IS happening) who are converting all shared rooms to single rooms within their facility.  Their main rationale is infection control, but I think they’re also hoping to streamline the care process by allowing nurses to think rationally, about one patient a time.

*  Older physical plants are a huge liability. When you’ve got a house full of sick people, the last thing you want is a drip from that 20 year old pipe, asbestos to remediate, mold in ancient ducts and so on.  While maintenance will be an issue for any facility, we’ve learned a lot since the first wave of current hospitals were built. Let’s get rid of ‘em ASAP.

*  If you’ve ever owned a house from the 70s (and I have) you know that they leak air conditioning and heat out at a ferocious rate.  Sure, you can weatherstrip and insulate and hang curtains to seal out air from the windows, but eventually, it starts to cost so much that it’s a big waste.  A new place — or hospital — is much cheaper over the long run.

*  And while they’re at it, hospitals newly-designed hospitals can be planned with green energy usage in mind — a trick which might not work out in a clumsy plant from decades a ago.  That not only helps to save the earth, it can save big bucks too.  Again, I don’t have a case study handy but Google “green hospitals” and  you’ll find some heartening stories.

* Oh, and I almost forgot…old hospitals can be a nightmare for techs to work around.  Whether you’re talking about simply making sure Wi-Fi gets to every corner of the building or rolling out an EMR, nobody needs to live with design flaws from the 60s.

So, though I’m surprised to say it, it seems to me that bigger, better, faster hospitals are indeed what the doctor ordered.  We’re not talking self-glorifying projects approved by boards to prove they’ve got the juice to make it happen, we’re talking simply about getting with the times.   Let’s hope plenty of hospitals find the means to do so.

Related Articles

• Hospitals: Showcase Your Technology (customerthink.com)
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What if healthcare coverage sizzled like this?

With all due respect to the talented people who work (and have worked) at Modern Healthcare magazine, I’m here to kick it in the butt, not praise it.

Now, I have to admit that there’s a reason nobody’s put MH to sleep yet; in short, it’s probably a very successful business.  If nothing else, as an industry figurehead,  it’s deeply entrenched with the “I’m so geriatric I’ve forgotten the names of my colleagues” set.

After all, any new ideas the aforementioned reporters cleverly slip into their stories are buried in an avalanche of dull corporate-speak, and sadly, there’s usually an audience for mind-numbing jargon. I think maybe the corporate-speak makes the pointy-haired bosses feel all important and meaningful.

But tell me, folks, have you ever read a Modern Healthcare story and said “wow!” or “hmmmm” or even “I’m mildly amused”?   Do you ever change your plans based on something you’ve read in this insipid journal of record?  Or do you skim the half-baked parts (again, baked by editors when all is said and done, so don’t blame my editorial colleagues) and just drop your copy of the darned thing?

I say it’s time for a new healthcare industry publication, one which goes FAR beyond this humble blog.  I want to see an industry magazine/Webzine/podcast/TV show/you name it which covers healthcare the way it is — as one of the most critical industries in the world with a hornet’s nest of issues to address.  I want to see color, life, snark, attitude, vigor, curiousity and most of all, passion.

I say we can build such a service for our industry.  In fact, I’m immodest enough to say that *I* and a team of stalwarts can build such a resource, one which would transform healthcare to some modest degree just by existing.  I’m talking Wired and Fast Company and Forbes and Modern Healthcare’s good bits mixed into the insider smarts of the New York Times Deal Book and Heard on the Street.  Yup, you heard me — we’re talking about a paradigm changer.    And if you’re wondering why this editor thinks she can pull such a big idea off I say, with apologies for the obviousness, “Why not?”

So, are you going to help me?  Do you want to have a voice in changing how healthcare looks at itself?  I know for sure I can’t do it alone, and I doubt anybody could.   I need money, yes — details on request — but as much as anything I need people to decide that our current way of covering healthcare just doesn’t cut it.

If you’re with me, let’s go for it.  Call 571-484-4056 or write to me at anneczieger@gmail.com. I’m ready to move if you are.

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Folks, I’ll never forget that night.  Led gently by my worried husband, who was a bit concerned about my ability to keep breathing, I walked into the lobby of a mid-sized, plain-vanilla 100-odd bed community hospital in my neighborhood.

I already knew, from phone calls to my PCP, that I probably had pneumonia. And I knew that while I probably didn’t need an admission, I definitely needed a hand.  My temp was 104, my cough was in the Black Plague range  and I could barely walk.

So, then medical reality collided with nice, warm, compassionate medical theory.  The details aren’t important — basically, since the ED staff had nowhere appropriate to put me while I waited, and demanded I wear a mask I simply could not tolerate  – I ended up sitting on the floor inside the glass box between the outside and inside doors to the facility.  At least the cold from the winter night kept my temp down a bit.

I’m sorry, but I absolutely cannot fathom why even a not-so-rich community hospital can’t do more to make very, very uncomfortable and scared people feel safe when they enter an ED door.

Why are hospitals spending SO much energy advertising their abbreviated ED wait times?  Customer service, right? Well, guys, I can assure you that it makes more sense to start with EDs that aren’t a nightmare to visit. Get people through quickly? Sure. But for the time they’re in the lobby, much less in case, make that time welcoming and safe.

Yes, I realize not every hospital will spend enough to put Pottery Barn-style couches and deluxe coffee and tea service out there, but what bothers me is that comfort doesn’t seem to be anyone’s aspiration when patients arrive.

The nursing staff in the emergency departments I’ve visited are largely abrupt and impatient, refusing to make the slightest human connection with patients.  The lobbies themselves stack uncomfortable institutional chairs and horrible lighting on top of one another in a graceless manner which rivals sitting in the New York City subway at 2AM.  And if you want food or drink you often have to go on a hunting expedition you’re in no position to conduct.

My take? This is not acceptable. No. Not for a second.  I don’t want to hear any excuses about it.

If your hospital can’t afford high-toned decor, maybe get a volunteer to serve as a concierge to help make people comfortable. Rent a goddamned cot or two for patients who aren’t dying but feel like they want to.  Provide some hot liquids, for Christ’s sake — it’s not going tap out the budget for a mid-sized community hospital.  Remind your front-desk nurses that people are in pain, and base part of their pay on the reports you get from patients.

You know, evidence is piling up that patient satisfaction correlates pretty strongly with profit.  If compassion and common sense aren’t enough to convince the hold outs that it’s time for them to make their front door inviting, I guess nothing will.

Related Articles

• Hospital cuts wait times in half (theglobeandmail.com)
• El Camino Hospital Emergency Departments Keep Waiting Times Low (eon.businesswire.com)

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EMTs collect a lot of data on their trip to the emergency department — and usually, data treating ED physicians will want pretty badly when they see the patient. But in virtually every case, most of that critical info transfer takes place on paper or in a hurried conversation amidst much noise and distraction.

Community medical centers collect as much data on patients as private primary care practices do,  but how often are they connected with hospitals — even those that have done a big ambulatory EMR rollout?

And what about blood banks?   Independent clinical labs like LabCorp.?  School medical offices?  Is anyone paying attention to their data, or is it just being ignored?

Look, I don’t mean to be a dunce here. It’s not as though hospitals and medical practices are sitting around buffing their nails and waiting for something to happen, data-connection wise.

But it’s worth remembering, despite the labor involved in hooking up hospitals and primary care practices, that there are data leakage everywhere.  Until we look the flow of data more wholistically, whole workflows will be designed as though such relationships didn’t even exist — and that’s a Bad Thing.

I say, start with the EMT data, as it’s the closest to the point of care, but regardless of how you expand your clinical data source map, expand it. Otherwise, you’ll be left with a nasty information design problem and finding a workaround will be a nighmare.  Think about it.

(This editorial’s content draws on a speech given by Vivian Funkhouser of  Motorola at a trade show held last week by Everything Channel.)

Related Articles

• Health IT Group Tackles Data Exchange (informationweek.com)

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Meaningful Use?  Whoa! Good God y’all! What is it good for?  Very, very little. Sing it again…

OK, maybe it’s the greatest idea in the history of health IT, or maybe it’s a good idea gone terribly, terribly wrong (my theory), but it it’s not going to move hospitals along any faster than they are already toward smart, sophisticated IT use that saves lives.  There are efforts out there that do stand a chance of improving IT use (take your pick from dozens, which I’ll get to in another post), but has anyone provided clinical, social science or other data suggesting that going to MU first was the best way to spend all of this time and money?

After my months-long absence from the blog that I love (<grin>) I’m freshly charged up with looks to me like another major distraction from improving quality.

Here’s my logic: check me  out here and see if you agree. The harder the government comes down on hospitals, the more dust will get swept under the rug.  And when that “dust” is inefficient processes that stand a chance of killing people,we’re not talking any kind of joke here.

Want an idea of why I’m so skeptical?  Here’s a few (why not a  couple of bonuses):

*  Just got off the phone this week with a children’s hospital CEO, who’s found that 20 percent or less of his colleagues are ready for meaningful use.   And check out an Information Week article below, which reports that just 40 percent of hospitals  meet 5 MU criteria. Wow.

*  Why has it suddenly become a priority, in recent years, to automate processes at the bedside before the processes themselves have been perfected?  When Your Editor attended a conference this week on healthcare IT topics, the bedside came up a lot, but not much talk on whether we’ll be running into a GIGO problem.

* Medical groups and hospitals are under great pressure to form Accountable Care Organizations, a new entity for which there are some precedents (decades of capitation) but no clear-cut model.  With doctors and hospitals struggling to create the most basic levels of partnerships, is now a good time to pressure them to form their work habits around their IT investments? Yeah, yeah, they’re suppposed to fund and find EMRs and HIEs that meet their needs but really, how often will that happen?

If you’re a big MU fan, well, I’m sorry if I offended you.  But I’d much rather you flame the heck out of me here so we can have a nice dialogue on the subject. This is important stuff, people.

Related ArticlesSome Hospitals Meeting Meaningful Use Criteria (informationweek.com)
Hospitals Ready to Meet Some Components of Meaningful Use (medicineandtechnology.com)
Why EHRs aren’t meaningful to doctors and hospitals (kevinmd.com)
Atlas Medical Launches Nationwide Network Connecting EMRs to Labs Instantly (eon.businesswire.com)
Healthland Launches Meaningful Use Program at Annual Users Conference (eon.businesswire.com)
Meaningful Use Core Requirements For Healthcare Providers (informationweek.com)

]]> http://nexthospitalmanifesto.wordpress.com/2010/11/19/meaningful-use-what-is-it-good-for-still-a-lot-of-smoke-and-mirrors/feed/ 1 azieger EHR Adoption Framework_AD http://nexthospitalmanifesto.wordpress.com/2010/09/02/did-hospital-kidnap-patient-who-wanted-to-leave/ http://nexthospitalmanifesto.wordpress.com/2010/09/02/did-hospital-kidnap-patient-who-wanted-to-leave/#comments Thu, 02 Sep 2010 01:50:00 +0000 azieger http://nexthospitalmanifesto.wordpress.com/?p=734 Continue reading →]]>  

Hospital? Or prison?

 

OK folks, I don’t know any more about the following story than you do, but if true, it’s an absolutely insane breakdown in hospital systems — one, I’d argue, that might not have happened in a hospital which had its, uh, finances and operations together.

The beginning of the tale sounds pretty routine. Apparently, Joseph Wheeler and his wife Felicia Ann, both in their mid-40s, were in a car accident in June and brought to Cheverly, MD-based Prince George’s Hospital.  In theory, this should have been a relatively simple case, as neither was gravely injured.

Now, let’s take a pause. Prince George’s is part of the Dimensions Healthcare System, a financially troubled institution which brought on a new CEO and an interim EVP  last month. The system, which has been forced to accept funding from the state in the past, expects to begin a restructuring plan in coming weeks.  It’s also looking for capital sources, natch.

So, back to the Wheelers.  Joseph Wheeler spent the night of June 23rd at the hospital, being treated for blunt torso trauma without other acute injuries.  The next morning he wakes up, finds a woman’s ID badge on his wrist, and is told he’s getting surgery “to have a potentially cancerous mass removed from his chest,” according to ABC News.   Need I tell you that he freaked out?

Well, all hell broke out at that point, according to the Wheelers, who have since filed a $12 million lawsuit against the hospital for false imprisonment, assault and battery and infliction of emotional distress.  According to Mr. Wheeler, he couldn’t get hospital staff to take an interest in the fact that the badge was for a woman 13 years younger than himself, so he and his wife decided to leave. 

Unfortunately, when they tried to leave the campus, they were accosted by security guards with a big chip on their shoulder. Two guards cursed the two out, then beat Mr. Wheeler severely, while attempting to take the incorrect ID bracelet away from him, the suit claims.  Ultimately, the facility let him go when Wheeler signed a form admitting he was leaving against medical advice.  He was treated at a nearby hospital with several new injuries, his suit recounts.

So, is this just an unbelievable aberration?  Has the financial strain the hospital faced left it with scared, poorly trained employees who simply got out of control?  What do you think?

Related Articles

• Local Governments Abandon Public Hospitals (foxnews.com)

]]> http://nexthospitalmanifesto.wordpress.com/2010/09/02/did-hospital-kidnap-patient-who-wanted-to-leave/feed/ 0 azieger hospital_~hospital http://nexthospitalmanifesto.wordpress.com/2010/09/01/hospitals-can-you-afford-to-crack-down-on-pharma-payouts/ http://nexthospitalmanifesto.wordpress.com/2010/09/01/hospitals-can-you-afford-to-crack-down-on-pharma-payouts/#comments Wed, 01 Sep 2010 02:11:01 +0000 azieger http://nexthospitalmanifesto.wordpress.com/?p=716 Continue reading →]]> This week, a very interesting (and important) question courtesy of the indefatigable KevinMD.com:  Can hospitals afford to shut down the lucrative relationships doctors have with pharmas?  To quote his blog:

“A recent case at Boston’s Brigham and Women’s Hospital [has] raised some eyebrows. Apparently, an asthma specialist was so dependent on drug company money, that he chose to quit the hospital [rather than give up extra income]. According to the Boston Globe, “Out of thousands of US doctors hired by drug-maker GlaxoSmithKline to talk about its products, [this physician] was the highest paid during a three-month period last year, the company recently disclosed: He made $99,375 for giving 40 talks to other physicians last April, May, and June, almost one every other day.”

When it comes to hosptials like Brigham and Women’s, which have the kind of resources and reputation many others would kill for, it’s not likely there will be any lasting damage to the organization.

But what about community hospitals?  Can they afford the hit?  What if a single invasive cardiologist took their patients with them to a rival hospital next door?

After all, according to a study done earlier this year by Merritt Hawkins, that invasive cardiologist typically generates $2.2 million per year, a sum few hospitals can let go lightly.  And if you really want to cringe, look at the other top specialties and what they bring in each year. For a smallish hospital this is a VERY scary game.

Looking a chess move ahead, does this mean that pharmas can play hospitals against one another, or even hospital systems, if they  play the right incentive games?  Not sure where it all ends, but it’s not pretty.

]]> http://nexthospitalmanifesto.wordpress.com/2010/09/01/hospitals-can-you-afford-to-crack-down-on-pharma-payouts/feed/ 0 azieger pharma image http://nexthospitalmanifesto.wordpress.com/2010/08/22/nycs-shame-psychiatric-nightmare-continues/ http://nexthospitalmanifesto.wordpress.com/2010/08/22/nycs-shame-psychiatric-nightmare-continues/#comments Sun, 22 Aug 2010 23:55:52 +0000 azieger http://nexthospitalmanifesto.wordpress.com/?p=690 Continue reading →]]>  

Alan Aviles: Don’t stay in his psych ward

 Since psychiatric patient Esmin Green died, ignored, on the floor of King’s County Hospital in 2008, I’ve repeatedly argued that far too few heads have rolled.  If it were in my power, I’d particularly like to show the door to Alan Aviles, head of the city’s Health & Hospitals Corp.  But some may have thought I was too quick to condemn Mr. Aviles, who, admittedly, has one hell of a job on his hands.  

Now, tell me again that the psychiatric mismanagement and patient violence at King’s County are nobody’s fault.  

It’s 2010, and the leadership at King’s County has allegedly been shaken, stirred and rocked. But once again, staff have again been found to have hidden very seveve deficiencies in their behavioral health unit. Need an example? Here’s an ugly one. One particularly unlucky patient was left alone long enough, often enough, to attempt suicide, get sexually assualted and attempt suicide again.  

In theory, these things shouldn’t be able to happen any more. When HHC settled a suit brought the the U.S. Department of Justice, it agreed to be supervised by a judge for five years. Perhaps the judge and Aviles are old golfing buddies?  Seriously, folks, this just isn’t funny.  

Anyway, don’t take my word for it:  read this well-researched piece  from the New York Daily News and tell me why there’s a single senior manager still in place at HHC, much less King’s County.  While it was published in April,  somehow I doubt things have changed much. I’d be embarassed to work there.

]]> http://nexthospitalmanifesto.wordpress.com/2010/08/22/nycs-shame-psychiatric-nightmare-continues/feed/ 0 azieger aviles http://nexthospitalmanifesto.wordpress.com/2010/08/21/data-from-the-kaiser-rollout-better-than-expected/ http://nexthospitalmanifesto.wordpress.com/2010/08/21/data-from-the-kaiser-rollout-better-than-expected/#comments Sat, 21 Aug 2010 02:28:49 +0000 azieger http://nexthospitalmanifesto.wordpress.com/?p=677 Continue reading →]]> As promised…

OK, before I get rolling, let’s back up a bit. To those that didn’t see my earlier feature, I’ve been dredging up the days when Kaiser caught a lot of heat for what was reputed to be a $3 billion EMR installation. Today, after four more years,  Kaiser’s EMR rollout is old news. But even though it hit full stride in 2006 or so,  it was such big news that the echoes still remain. So here you have what may be some data from those tumultuous times.

Below, consider the first set of data from (what appears to be) a Kaiser report on its Epic EMR performance. This coincides with the period during the period when whistleblower Justen Deal took his complaints about its performance. Of course, a little bird gave it to me, and as noted previously, I’m fairly sure it wasn’t Justen.

This report, which spans August through November of 2006, looks at a bunch of measurements of network and application performance.  I’m not a technical expert, so I can only guess, but truthfully, it looks like the organization did pretty well, especially since nobody, more or less, knew how to scale an EMR for such as large installation.

Not only that, it seems to me that if only 580,000 user hours were blacked out during those four months, vs. almost 63 million potential hours, it’s pretty good performance.

My main question here, having seen this doc, is whether these are cherry-picked network stats. Personally, I’d like to know more about how the application performed on the ground, what latency/response times were, whether the interface took eleventy-odd months of training to use, whether Kaiser did a good job of integrating other data silos, and perhaps most critically, whether clinical care took a disproportionate hit.

What data would you have wanted to see if you were running the show?  Check below and tell me what you think.

P.S.  By the way, if you want to lighten things up, feel free to check out this video of George Halvorson looking august and scholarly. But I digress…back to the data.
_________________________________________________________________________

Topline Data from August through early November 2006 for KP HealthConnect

Usage Based User Availability: 99.09%
This represents (Potential User Hours- User Impact Hours)/Potential User

Unique Incident reports: 429
These are incidents which affected the deployment, regional or national totals.

Average Concurrent Users: 8,481
Average number of users on the system during a given month

Potential User Hours:  62,895, 096
Average concurrent users * the total hours in the month

User Impact Hours: 572,241
Calculated for every incident by multiplying the actual number of users affected by the duration of the incident.  

 

 

 

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