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 anneczieger@gmail.com. I’m ready to move if you are.

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

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.

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)

Oops, he did it again; Rick Scott’s history repeats itself

For those who have followed the rise and fall of Rick Scott, former CEO of hospital chain Columbia/HCA, you may find the following to be  amusing.

If you’re  a Scott fan, you may see the allegations below as a setup. But if you thought the Columbia/HCA scandal was his misdoing, however, you may wonder how the man keeps this stuff up.

Not long ago, Scott bought a lot of media attention by running an anti-health reform organization, “Conservatives for Patients Rights,”  spending $5 million of his personal fortune to promote his message.  Now, it seems, he’s hoping to parley his renewed high profile into a role as governor of Florida.

The problem is, there’s the teeny little  issue of what’s going on at the company he runs today.  Just two weeks before the Florida primary,  his urgent care company Solantic has been accused a string of improper practices, including Medicare fraud and misuse of physician licenses.

None of the Medicare fraud allegations have been proven, and a series of physician suits against the company have been quietly settled, but these problems have cast a cloud over Scott’s gubernatorial bid nonetheless. And in reality, they should probably raise deeper questions as to Scott’s personal culpability — though to date the state hasn’t gotten involved.

The rise and fall of the Columbia empire

As many readers will know, Scott was kicked out of office CEO of Columbia/HCA hospital chain, an organization he’d helped to build with the backing of Texas billionaire and GW Bush financier Richard Rainwater. (Rainwater’s wife Darla was the one who fired him.)

Looked at one way, Scott and lieutenant David Vandewater (now CEO of Ardent Health) did a spectacular job. With  hustle, muscle and an eye for undervalued properties, they built Columbia up from two dinky hospitals in El Paso to the world’s largest health care organization. At its peak, Columbia/HCA had $20 billion in annual revenues, and more than 340 hospitals, 130 surgery centers and 550 home health locations in 38 states and two foreign countries.

The  problem is that the whole sprawling empire seems to have been rife with billing fraud.

It’s important to note that throughout the Columbia/HCA mess, Scott was never charged with a crime or deposed. Still, the meltdown happened on his watch, and after his departure the company paid out a stunning $1.7 billion fine to the feds.

By the way, Solantic CEO Karen Bowling headed up advertising at Columbia Healthcare Corporation, the company Scott built and merged with HCA. By no means do I want to suggest that she did anything wrong, either, but it is a bit curious that someone goes from marketing to a complex healthcare administration role.  (Not sure what that means — just putting it out there.)

The Solantic chapter

Anyway, regardless of who actually pulled the trigger on the Medicare and Medicaid shenanigans at Columbia/HCA, what’s up this time around? If nothing else, I don’t buy Scott’s “bad things just happen around me” line, do you?

As with Columbia/HCA, Solantic been accused of systematic, deliberate Medicare  billing fraud, a charge which was also leveled at him as leaders  of the Columbia/HCA empire.  For example, Solantic has purportedly  been in the habit of billing Medicare 100 percent of scheduled fees for unsupervised nurse practitioner visits, when rules require that it bill 85 percent.

Solantic is also accused of adding its doctors’ names to state filings and billing forms, seemingly in an effort to falsify how much physician coverage if had in place.

For example, former Solantic physician Dr. Randy Prokes, who worked there from 2004 to  2009, says he found his name on billing forms and medical records at company clinics he’d never visited and for patients he’d never treated, according to The Florida Independent.

Another plaintiff, Dr. P. Mark Glencross, filed a lawsuit in 2008 asserting that Solantic used his name to license six clinics without his knowledge.  Glencross began work  at Solantic in 2003 as chief medical officer, but left in 2004 after he allegedly discovered the misuse of his name and medical license, the Independent reports.  Solantic settled with Glencross this year, under a confidentiality agreement which keeps Glencross from chatting up the press any further.

No “Governor Scott”?

What makes all of this explosive, of course, isn’t the allegations themselves. As readers know, many healthcare organizations make it through accusations  that forms weren’t filled out properly or that Medicare was billed incorrectly.

But given Scott’s fight for the Republican gubernatorial nomination — he’s (yuck) the Tea Party’s candidate — the Solantic accusations are nasty, corrosive and who knows, might even derail his bid.  His primary opponent, State Attorney General Bill McCollum, has pulled ahead  in the polls since the allegations went public.

McCollum has been pounding on Scott to voluntarily disclose the video of the deposition he gave in the case filed against him by Dr. Glencross (one of the two MDs claiming Solantic misused their licenses and names).  Scott, to date, has refused to do so.

At this point, with so much questionable behavior at issue, one has to ask:  Would you want Rick Scott to run your healthcare organization, much less your state?    Seriously folks, would you?

P.S.  I can’t vouch for the accuracy of the content, but you might want a look at this post, which purports to offer a detailed map of Scott’s relationships over the last decade or so.  Intense stuff.

Proposition 8: A warning to hospitals

Sadly, it seems that unless the Supreme Court kills California’s anti-gay-marriage Proposition 8 dead, and that creates a domino effect nationally, hospitals will be slow to treat gay and lesbian families with dignity and provide similar levels of support.  

As far too many sad incidents illustrate, hospitals have treated gay couples as though their relationship gave them no rights — even when they’d signed a stack of legal papers which should have closed the matter.

One recent example is the case of Janice Langbehn, who was barred from seeing her dying partner Lisa Pond because the two weren’t married.  According to Langbehn, who sued Miami’s Jackson Memorial Hospital over the incident, the staff refused to even take a medical history on Pond from her, despite the fact that Pond was unconscious. 

The incident, which happened in February 2007, drew national attention. But it still took Jackson until April of this year to institute an official policy naming same-sex partners as “family” for vistation purposes.

Now, Jackson Memorial may be an outlier —  other hospitals have already clarified their policies to offer equal protection and access to all families — but it’s also a county facility.  Apparently, governmentally-sanctioned discrimination was just fine with the city fathers and mothers until just this year.

That kind of foot-dragging has to stop. Regardless of how you feel about gay marriage, there’s a lot of momentum behind the movement, and it’s not likely to go away.  So even if you’re unmoved by appeals to fairness or the suffering of gay spouses, try legal reality on for size. 

Hey, hospitals are terrified of blowing HIPAA rules, and only a couple hundred violations have been cited since its inception. (Criminal convictions? Counted easily on your fingers.)  Don’t you think gays and lesbians are going to see to it that you get some very serious heat if  you treat them like second-class citizens?  That’s a more serious threat than a possible Britney Spears leak.

Hospital leaders, it’s time to begin training your staff that discriminatory treatment of gays and lesbians won’t be tolerated, any more than they’d be permitted to kick Latino dads out of their wives’ rooms or refuse to take medical histories from Asians.  Their politics, feelings and preferences are fine, but they have to stay at home (or go elsewhere with them to a different institution).  This is going to be a really tough one, sadly, so be prepared for some blowback. But go ahead anyway.

P.S.  For a little treat, I give you “Summer of Loving,” a sweet and memorable tune comparing the battle over Proposition 8 to Loving v Virginia, the case in which the Supremes struck down laws against interracial marriage.

Video/satire: The real health plan business model

The following song, by brilliant social and political satirist Roy Zimmerman, offers his view of health plans’ real business model. His take?  As far as health plans are concerned, sick patients would (literally) be better off dead:

Dear Number 1036924053887
Have you considered suicide?
It’s a healthcare plan you haven’t tried.
Enclosed please find a tab of cynanide…for your perusal
You’re getting to an age where your potential need for medical
Attention even intervention isn’t hypothetical
So, do it quick!
And solve this nation’s healthcare crisis
By not getting sick.

To hear more incredibly elegant rhymes (hey, there’s a reason Tom Lehrer likes this guy) here’s the full song:

Now, I’ll confess that I simply get a massive kick out of Mr. Zimmerman, whether in health parodist mode or not, but I think you’ll  be amused by this one too.  Maybe you’ll be inspired to lampoon some bad actors too.  Street theater, anyone?

BONUS: While we’re having a bit of fun, here’s blast from the clinical world:  Emergency Depatment rap!  Seems there’s quite a trend going on here — maybe a dozen ED hip-hop videos cropped up on YouTube when I recently checked — but this group, from the University of Alabama’s Birmingham hospital, seems to be the Grandmaster Flash and Melle Mel of the bunch.

Time to demand charity program disclosures

Here’s a quick thought for the day:  What if the federal government made non-profit hospitals meet specific standards for publicizing their charity/free care programs?

As we all now, hospitals have to put their EMTALA notice front and center in the emergency department entry area.  I don’t know if the feds set a specific size for the notice, but in my experience as a patient, it’s usually a pretty big sign.

When it comes to charity care, on the other hand, there’s few if any standards for informing the public of their options. And far too often, hospitals don’t get the job done.

While some hospitals offer charity care notices on every bill they send out, post signs alerting patients to the option, tag every electronic transaction with a charity-care reminder — hell, they write it in the sky — others make rather perfunctory efforts.  Either they’re hiding something, or more likely, they just aren’t sure how to get the point across.

So, let’s make things simple. Let’s set a federal standard for displaying information on charity programs, something along the lines of EMTALA public display rules.
That way, financial managers won’t be forced to think like marketing communications types, and every hospital will be forced to follow the same rules.

Seems to me that would even the playing field; hospitals wouldn’t be rewarded for dodging their responsibilities, but instead, could compete on how well they performed.

So, why do I think this would be wildly unpopular? Am I right?

Video: How public reactions rip hospital buyouts apart

   In theory, selling a hospital should be a fairly routine matter, at least if no unusual legal issues are involved. Often, the acquisition solves some serious problems by bringing in much-need capital.

But just as often, things get extremely messy. Communities like things the way they are, and go nuts.  Nurses strike. Regulatory issues mire down transactions for years and political debates get very ugly. In fact, after 20 years of watching hospitals get acquired, I can’t tell you how many times I’ve seen such deals go down in flames.

Just how bad can it get?  Well, consider this video , a slickly-produced political statement challenging the sale of Houston’s Memorial Hospital Southwest to a county entity. The deal involved fell apart late last year, but the way it went down is worth a look.

When Harris County announced plans to buy Memorial Hermann,  at least 200 doctors vowed to walk off the job if the facility changed hands. Their grievances were many, but the CEO’s position really cheesed them off. From the text accompanying the video:

 [CEO Dan Wolterman says] that Memorial Hermann has exceeded profit expectations for nine straight years, but the system still laid off many of the system’s top people this year. Now they want to dump Memorial Hermann Southwest and are asking for a $165 million taxpayer bailout from the Harris County Hospital District, whose history of Medicare/Medicaid fraud should be a source of concern for all taxpayers. Can we really trust these two greedy executives?”

And then they get to what seems to have been the real issue. “They want to get rid of urban hospitals and build palaces in the suburbs. And they want us to pay for it!” the announcer warns sternly. So this particular battle had a “haves vs. have-nots” feel.”

OK, I’m going to get cruel here. I’m not convinced that doctors were really worried about saving an urban hospital.  They don’t make much money there and their patients are often indigent. But sometimes power struggles don’t need any real  justification.

The bottom line is that this kind of protest plays out in some community every day — and can get even hotter if a for-profit company rolls into town and starts shopping.

In fact, during Columbia Hospital Corp.’s acquisition spree in the early 90s, I attended a closed-door meeting on a proposed buyout in south Miami. One doctor said that he’d better drop his pants now because of, uh, what would happen next. Bear that in mind as you’re shopping, investors. And watch this video once or twice.

News nuggets: Provocative news briefs from around the Web

Here’s the first of my occasional posts sharing news briefs of interest (directly or indirectly) to the hospital world.

For future issues, please free to pass along interesting items if you see fit.  Just  drop me an note and I’ll take a look.

This Week’s Updates and Info

Aussie hospital proposes use of Tasers to subdue violent patients
http://bit.ly/czSxqw

Great McKinsey case study w/ chart:  Tracks how need for heart surgeons fell in the UK
http://bit.ly/aas21P

2009 Health Insurance CEO Compensation Study
http://bit.ly/9tleD3

The Pitfalls of Accountable Care Organizations
http://bit.ly/9giVya

AMA: One in five claims processed inaccurately by health plans
http://yhoo.it/dt6IAM

Union organizing at Beth Israel Deaconess a sign of times to come

Here’s a story of a routine, if high-profile, labor dispute that ended with little bloodshed and few aftereffects. All told, the whole thing doesn’t mean a whole lot. Or does it?   Read on and see if you still think so by the end of the tale.

The class-action suit, which covers about 9,000 current and former employees,  accused  Beth Israel Deaconess Medical Center (BIDMC),  Beth Israel Deaconess-Needham, Mount Auburn Hospital and New England Baptist Hospitalof denying workers overtime pay for working past shift’s end or through lunch breaks.  The four, known collectively as CareGroup Inc., have agreed to pay out $8.5 million to settle the dispute.

So, what’s going on here? On the surface, all we have is some large hospitals paying out a comparatively small settlement to put a lawsuit to bed. Business as usual, basically. Hey, Beth Israel Deaconess alone chalked up $1.37 billion in consolidated revenue during its 2009 fiscal year — so I’m guessing that $8.5 million between the four is a fairly reasonable cost of doing business. Case closed, right?

Maybe not. If you check out the BusinessWeek story on the settlement, you’ll read that “officials with a union attempting to organize CareGroup workers called the settlement a “tremendous victory.”  That would be officials with the Service Employees International Union, an extremely aggressive labor group which seems to be gathering momentum daily. 

While labor unions exist to hassle employers into making changes — and I mean that respectfully, having been, well, an employee — the SEIU has been particularly hard-assed in this case.  The union has been pulling tactics out of thin air which I’ve never seen tried in my 20 years as a healthcare analyst. 

Beth Israel Deaconess is taking most of the SEIU local’s wrath, almost certainly because it’s a Harvard-affiliated teaching hospital with an international rep.

For years, SEIU leaders have hurled charge after charge at BIDMC, including allegations that the leadership wasn’t meeting federal standards in permitting “free and fair” secret ballot elections for employees. (Guess organizers were hoping to get the National Labor Relations Board involved, something most of us would like as much as, say, needless oral surgery.)

When that (seemingly) didn’t stick, the union kicked things up a notch. In 2008, the SEIU made an argument that since BIDMC board members also sit on public-company boards, the medical center should follow the same strict audit disclosure rules as public companies.

And they’ve only stepped things up since then.

Not only are SEIU organizers working to bring BIDMC’s staff on board, they’re maintaining an extensive surveillance, intelligence gathering and publicity campaign focused solely on that facility.   If you want to know just how hard the Boston SEIU branch is hitting, check out www.eyeonbi.org — it’s loaded with accusations.  Financial discrepancies.  Patient problems. Conflicts of interest.

To the SEIU, it seems,  BIDMC is doing pretty much everything wrong.  I’m not here to choose sides — no business or organization is spotless — just pointing out that these union organizers are playing with live ammo. It’s still not clear whether these tactics work or not, but man, they’re not playing here.

Now, imagine this large and well-funded union going ballistic on major hospitals across the U.S.  Get the picture?

Pfizer CEO slams hospital care, denies role in keeping it mediocre

Well, folks, I’ll pretty much let this one stand on its own feet. Apparently, Pfizer’s CEO was a bit miffed when he had to pass through the hospital system, but not miffed enough to, uh, help fix things.

Pfizer CEO’s Hospital Stay Was a Kafkaesque Prison of His Own Making

Hey, we all want our hospitals to be the best in the world.  But if political forces line up against the industry, it can only do so much. Maybe we ought to put pharma execs in a scanty johnny-gown more often — and force them to give anti-reform speeches dressed only in the gown.