The great sucking sound: For-profit buyouts a drain on communities

Few have spent more time than I calling out non-profit hospitals on their inadequate charity care levels.  But when it comes down to

This picture shows a panorama of Boston (USA).

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?

Bigger, better, faster hospitals are a great idea

Nagoya City University Hospital in Kawasumi

Image via Wikipedia

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.

The death of the old healthcare magazine? A public challenge


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 I’m ready to move if you are.

Would you feel safe in this ugly lobby?

A patient having his blood pressure taken by a...

Image via Wikipedia

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.

So many blank spots on the clinical data map!

Emergency medical technicians evacuating an in...

Image via Wikipedia

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.)

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Meaningful Use: What is it good for? A lot of smoke and mirrors

EHR Adoption Framework_AD

Image by andyde via Flickr

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.

Did hospital “kidnap” patient who wanted to leave?


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?