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January 2, 2012

ACO Proves Major Political Turning Point For Boston Hospital Chain

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Transforming a hospital system into a fully-functioning ACO is a huge project, and one which requires a big commitment.  It’s hardly surprising that going through the process would change how its leaders think about their business.  But the following is the first case I’ve heard of in which a hospital system made a major break with its peers over its ACO status.

Apparently,  for-profit Steward Health Care System has just resigned from the Massachusetts Hospital Association, bringing its 10 hospitals (and 11 percent of the MHA’s revenues) with it.  Steward, which was created by the acquisition of six-hospital Caritas Christi Health Care Chain a year ago by VCs, has since picked up four hospitals and done a host of doctor deals.

Not surprisingly, Steward seems to have bruised some competitors’ feelings along the path to ACO-hood, which probably has something to do with its MHA departure, but Steward isn’t copping to that of course.

At this point in its evolution, Steward’s leaders say, the MHA’s positions on politics don’t represent its needs anymore. Particularly when it comes to health reform, Steward’s leaders feel it now has a different take than other members of the MHA, which has to advocate for shared positions across almost 100 hospitals with varied approaches.

As for me, I’m not sure what those differences are; in fact, I’d think that a “real” ACO would be an inspiration for, and partner to, other hospitals on the path to health reform.  In fact, this raises some questions as to how the growing ACO trend will affect hospital relationships this year:

* Are IDNs that work hard at building a true ACO going to upset their peers so much that it will create a drag on their business overall?

* Most healthcare business models have some detractors and some fans, but is this one of the few that can actually divide the industry?

*  Are ACOs a direction every IDN can take, or are there resource constraints (such as the size of a local market or number of unaffiliated doctors) that will prevent some from building one? Will the coming rush create ACO “haves” and “have nots”?

What do you think, folks?  Have you seen anything happening in your markets that might answer these questions?


April 28, 2011

There’s no good excuse for stifling physician-owned hospitals

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When health reform was passed, part of the law forbid physician-owned hospitals from expanding or undertaking new construction.  The rules affected roughly 300 hospitals in 34 states, offering services ranging from acute care, women’s, rehabilitation and psychiatric care.

You won’t be surprised to hear that the trade group representing such hospitals, Physician Hospitals of America, continues to fight for removal of this restriction, found in section 6001 of the Patient Protection and Affordable Care Act.

I’ve got to say I’m with the PHA on this one. Why on earth must we block the development of physician-owned hospitals?  Yes, there have been a couple of horror stories where specialty physician-owned hospitals –lacking an emergency department — failed to address patient needs.

But from where I sit, those stories are no more common, proportionately, than they are amongst traditional acute care hospitals. Besides, if the main concern legislators had was emergency department care, they could have mandated that all physician-owned facilities have one.

No, it’s clear that physician-owned hospitals make traditionally-structured facilities nervous, and that they’ve worked hard to put them in their place.  Other than protecting the profit stream for themselves, however, I don’t think they have a leg to stand on.




August 21, 2010

Data from the Kaiser rollout – better than expected?

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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:
Calculated for every incident by multiplying the actual number of users affected by the duration of the incident.  




July 21, 2010

Health plan doctor ratings: Will they ever be fair?

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Here’s a tough assessment of doctor-ratings schemes by my buddy Joe Paduda of blog Managed Care Matters:

“Some physicians and physician groups are quite upset about insurers’ recent moves to offer employer customers tight, small networks of providers based on quality and cost criteria. In an effort to block these new plans, the AMA and other groups are focusing on the few problems with ratings and avoiding the larger issue – some physicians are just bad actors.

What they should be doing is working closely with health plans and regulators to ensure the rating process is transparent, fair, and objective.”

I’m not sure I agree with Joe, though he is, to be sure, a guy one should take very seriously when it comes to healthcare strategy. I think a lot of the talk about “quality” is just an excuse to squeeze out expensive or challenging doctors and practices.  But what about you?

July 14, 2010

Can Priceline-style tactics transform medical practice?

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Yes, I realize the above is a pretty extravagant headline — the “real” Priceline isn’t involved here — but follow me, and tell me  if you think the question is on point.

Yesterday, I spoke to Alex Fair of, a New York-based company which lets patients and doctors directly negotiate a “fair deal” on services between themselves.  Physicians give (presumably big) discounts on services in exchange for getting cash on the barrelhead once the service is delivered.  The site is in beta but still worth a look;  seems the key pieces are in place.

Fair, a former scientist who’s been a serial entrepreneur for many years, once designed software helping doctors successfully beat claims denials, so he definitely knows the territory. And he’s obviously right that if they get cash up right away, doctors can easily beat the “retail” prices they’re sometimes forced to charge to cover health plan collection costs.

Fair’s (reasonable) assumption is that FairCareMD will be a lifesaver for patients with high deductibles or no insurance at all, as well as giving them a way to get procedures the insurance industry won’t cover.  Not only will patients have access to deeply-discounted fees, if the patient can’t find the deal he or she wants, they can push for a better price at a number they can live with. That is indeed along the lines of’s “name your own deal.” (I’m here to tell you that *that* mechanism works very well indeed.)

On the surface, the concept makes sense. And there’s precedent for it.  For example, a thriving market in cash-for-surgical-services, much along these lines, already exists in the bariatric surgery industry, as many health plans refuse to cover such procedures. Ah, the power of capitalism to work around other capitalists!

In his first month since launch Fair reports over 5,000 searches for care on his site, though only about 1 in 200 visitors requested a deal from a provider.  On average these deals have saved 47 percent off “list prices” so far. Fair’s surprised that so few consumers are making requests.  On the other hand, it’s only a few weeks after launch, and other sites have millions of such requests, so he’s in wait and see mode.

My guess is that a) people don’t see the value of shopping for prices just yet — so thoroughly has the health insurance industry hornswoggled them and that b) they’re likely to see more valuable in accessing such services if they pay a subscription fee. Just a human nature thing.

So hey, folks, what do you think? What will it take for consumers to feel comfortable paying doctors directly again?  Fair isn’t the only company banking on this notion  — in fact, there are several, including some with a national presence  — but my instincts suggest they haven’t won consumers over completely yet either.

An even bigger question:  Do you see the broad mass of consumers developing those sorts of relationships with hospitals anytime soon?  Now *that* would be a neat trick.

NOTE:   If you’re in the NYC region, or plan to be next week, you can meet Fair and other local social media/health entrepreneurs  at a Manahattan-based Health 2.0 meetup (details at  Looks like it’s going to be a very nice group. I’ll be moderating a panel, so if you’re there please stop by and say hello!


July 10, 2010

Video: Accountable care organizations, the Steve Jobs way

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This video, by healthcare consultant Anthony Cirillo, offers a neat suggestion — why not sic Steve Jobs on the accountable care organization model?  As Cirillo sees it, Jobs is one of few execs out there who really understands how to build complex things in a lean, functional way.

“When we develop products, we’re about putting as many features into them as possible, and hospitals, as many services as possible,” Cirillo says. “But Steve Jobs…wouldn’t just build an accountable care organization, he’d build your accountable care organization, where you would get just the amount of care you needed at the right time in the right place.”   More below:

Don’t be distracted by the guitars hanging on the wall in the background — they’re just symbolic of Cirillo’s other passions, singing and songwriting.  What he has to say on this subject is definitely worth a listen.


July 6, 2010

Doctor-patient speed dating: a good idea

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 At first, I wasn’t sure what I thought about this, but I’ve decided that we’ve looking a  good    idea here. As the following    NPR piece describes, some hospitals have arranged a form of    “speed dating” giving doctors and  patients to meet each other in a friendly, relaxed    atmosphere. God knows this is a more sympathetic approach than the mechanical, soul-less  one already in use, n’est pas?  Both doctors and hospitals appear to win here.

Hospital attracts patients with “speed dating”

“[These programs] aren’t just about marketing to patients. They’re also a tool to reach out to physicians and encourage them to refer their patients back to the hospital.

“Physicians drive health care, period,” says Travis Singleton, a senior vice president at Merritt Hawkins, a physician placement firm. “Ninety percent of the health care dollars that are spent in today’s marketplace are through the physician’s pen, whether that’s patients they admit, whether that’s tests they administer, whether that’s procedures they order, whether that’s insurance they bill.”Do you think this is a good idea?  Why or why not?


July 2, 2010

Why don't doctors care what you say?

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Your job depends — at least in part — on communicating with doctors, right?  You need to make sure you  know what your physicians want, see that your business goals are matched with theirs and make sure you win  as much loyalty as possible. And you certainly need to make sure every deal you do with them is kosher, legally  and financially, something that requires just a bit of trust.

And how do most healthcare organizations establish this warm-and-fuzzy connection?  Well, we’re probably talking about a few meetings, a few e-mail messages, some paper mail and maybe a party or two. It’s irresistable!

OK,  sarcasm off.  The truth is, while healthcare organizations do a decent job of reaching out to consumers, I’d give most a C-, at best, at communicating with clinicians.  Executives may attempt to speak to doctors, but it’s from some sort of ivory tower which, as I see it, usually isn’t compatible with straight talk.

So, what to do?  Well, I’ll admit it:  as a media and community dev specialist, I’d argue that it’s time to bring some professional media smarts to the doctor-exec relationship.  A few on-point newsletters with zero fluff, a complete and intelligently designed Web site, thoughtful tweets or a slick magazine — any of these can work.

The bottom line is that whether you go the media route, or just get someone with a gift for plain speech to take a look at your communications strategy, it shouldn’t be an afterthought.  There’s just no excuse for trying to rule by fiat — or pomposity.

And another thought…

You can find videos like these all over the Web:

But how often do you see a video that addresses physicians’ daily needs?  Their business plans?  Their professional expectations?  Seems to me that the communications department doesn’t touch that stuff.