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August 19, 2010

Possible Kaiser data, tomorrow, straight from the whistleblower's mouth

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OK, guys, if you know anything I don’t about the machinations around the $3 billion (or $5 billion, name your number) installation of Kaiser’s Epic EMR, now’s the time to share. 

I say that because tomorrow, I’m going to pull together what an anonymous source sent me from the early days of the Epic installation.  We’ll go over it, reader and editor, and see if there’s any news left.  Hope you’ll join me.

If you have anything to add, please do feel free to toss another log onto the fire.

Admittedly, even if genuine — and I have no way of proving that it is — it’s at least four years old. Still, I’m pretty intrigued by it and I hope you will be too.  (By the way, the e-mailer says he’s not the (in)famous Justen Deal, the young man who e-mailed 180,000 Kaiser employees with his EMR concerns. I’d tend to believe Mr. X, since I’ve met the actual Justen and he’s not the anonymous type.)

I’ll catch up with y’all tomorrow.


August 9, 2010

If hospitals aren't adding patients, they're screwed

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About a week ago, Standard & Poor’s reported that hospital finances looked better last year than they did 2008.  Hospitals are showing “signs of stabilization,” thanks in large part to three factors:

  • Aggressive cost-cutting
  • Improved revenue cycle performance
  • Better returns from their investment portfolios

For any hospital leader reading this, I’m happy for you.  Props to all for improving kicking revenue cycle management up a notch.   Great to hear that cost-cutting has stabilized your financial picture. And getting more out of your investments — after a period of stunning drops in their value — is nothing but good.

OK, fine — your ship is in order. Now where are your new customers going to come from?

After all, you can only do so much by making use of the resources you’ve got. You can  squeeze more money out of billing existing customers and boosting investments — and cut costs, too, t hough that might be your toughest assignment, but without new patients where are you?

Getting new patients, and just as importantly, retaining them,  is three-alarm fire important these days.

*   Without a new source of income, how will you resume your capital investment program? After all,  real estate isn’t going to plunge again in the near future, health IT needs are pressing, and new, cutting edge medical devices going to get cheaper. You can avoid doing some of this spending, but  not forever.  Then, despite all of your cost-containment work, you’re out of the black and into the red.

By the way, though CMS recently decided that FY 2010 capital payments were OK, the HHS Office of the Inspector General is breathing down CMS’s neck urging it to make further capital payment cuts. I’m not in the loop, in all candor, as to how likely further cuts may be, but I would take this quite seriously.

* Longer term, you need to be thinking about health reform and how that can build business.

While 2014 is a long time from now for patients, it will come almost overnight for hospitals.  If you’re planning for that phase of reform, I hope you’re figuring out how to capture the loyalty of the uninsured who will get insurance then.

Maybe it’s a radical idea, but I’d argue that you need to sell your facility even to uninsured patients w ho don’t seem like good bets now.  I’ve long argued that in addition to personal touches when patients are at your door, this will take building online communities that link patients to outpatient services, community education and even provide physicians and nurses to answer questions.

After all, even if patients aren’t coming in your doors right now, they can come in your virtual doors and become very comfortable with who you are.


Unfortunately, most hospitals aren’t going to shift gears much; they’re just to addicted to business as usual. I’m not suggesting  this blog’s readers are careless or brain-dead, by any means….but I am suggesting that the hidebound facilities they work for may be.

For hospitals who start looking at new revenue streams, and dig out of the bunker mentality of 2007 to 2009, it won’t be a moment too soon.  Wait six more months without much effort, and you’ll have your posterior  handed to you by nimbler competitors.  That won’t be fun, will it?

P.S.  Could hospital parking be a meaningful revenue stream?  Here’s some thoughts from Dr. Wes.

August 2, 2010

What if our national credit rating was tied to our health?

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Folks, as part of nextHealth’s broader mission, we research some aspects of the Wall Street world — and in the process, we come up with some offbeat ideas. See what you think of this one.

Recently, when poring through items in the financial press, I ran across a discussion of whether the United States’ credit rating would suffer in the wake of the recent market failure. (The answer seems to be “Almost, kinda sorta totally unlikely.” )

Whether the idea of the U.S. losing its gold-plated credit rating is realistic or not, I can’t say.  Not only am I not an economist, I’m not even a garden-variety financial know-it-all.  But the discussion of national credit measures — such as debt, growth in the GDP and employment levels –did get me thinking about how a nation’s productivity and creditworthiness should be determined. 

And then it occurred to me. What if our credit was tied to some sort of national health score? 

After all, while it’s not clear which measures predict where the economy will go, it’s fairly clear which measures to use if we want to get predict where population health is headed. And healthier populations are obviously more productive, resilient and adaptable than sicker ones. (By the way, I’m well aware that the federal government, as well as state agencies, already do a lot of this kind of measuring — but I’d argue that most officials aren’t smart enough take their work seriously.)

Of course, health leaders and politicians argue as to which specific measures are most important, but it wouldn’t be too hard to pick a few baseline measures (such as, say, incidence of obesity, vaccination rates and number of primary care providers per 1,000 residents ) and run them.  Perhaps we’d do that once a quarter.

Then, if I were Standard & Poor’s, I’d begin factoring those scores in when I assigned a rating to U.S. financial obligations, such as outstanding bonds.  Ultimately, I’d probably end up demanding similar data from other nations, too. After all, those guys aren’t worth much if the comparisons they make aren’t reasonably consistent.

Of course, officials and planners are already focused on making communities healthier. But if our country’s financial security depended on people staying or getting well — and officials got big money and praise for upping health indexes — state and local governments might be more focused on health results.  And the notion that health is patriotic could reach people where appeals to consider their own wellbeing might not, sad to say.

So, what do you think?  Crazy idea?

July 19, 2010

Patients don't care enough to write online hospital reviews

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Seems like a good time to consider the following data, drawn from the Pew Internet and Life Project Report, which makes it pretty clear how little engagement consumers have with hospitals.

According to Pew data from  blogger Nicola Ziady, 60 percent of e-patients engage with social media (sidestepping for now the question of how to *really* define an e-patient). What do they do online? According to Ziady’s data:

  • 33% have gotten information about how to lose or control their weight
  • 27% have gotten information about health insurance
  • 24% have consulted rankings or reviews online of hospitals
  • 12% have gotten information about how to stay healthy on an overseas trip
  • 24% have consulted rankings or reviews of doctors
  • 19% have signed up to receive updates about health or medical issues
  • 13% have listened to a podcast about health or medical issues
  • 5% have reviewed a doctor

And right at the bottom of the list we find this stat:

  • 4% have reviewed a hospital

I don’t know about you, but that looks like a danger sign to me.  Hospitals require such a HUGE investment of resources from patients  — sometimes money, and sometimes just loyalty and energy — that you’d think they’d be raring to comment.  Seemingly, they’re not.

To me, that’s much more striking than the low rate of comments on physicians, given that many of those encounters are routine.

I guess what I’m saying here is this, guys:  What are we doing to leave patients so untouched, unconnected and unimpressed (maybe not disappointed, but not impressed) by their hospital stay that they do nothing to communicate about it on their own? Isn’t this death, at least, for services like labor and delivery where the gossip factor rates very highly in choosing a facility?   Hey, in this situation, complaints may be better than silence.

July 20, 2009

Theory #2: nextHospitals must provide primary care–*on site*

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Conventional wisdom breaks the healthcare system into two big silos.

There’s acute-care hospitals, which tend the acutely ill, and there’s primary care providers, which handle the sniffles,  hives, chronic disease management and anything else that isn’t likely to kill a patient within a few hours.  In between, there’s a big black hole where patients pretty much sit around feeling like hell and wondering just how much worse things are going to get.

This bifurcation is absolutely insane and has got to end.  It makes an assumption which is absolutely counterintuitive–in fact, which is simply crazy–which is that hospitals have no business treating anyone who isn’t at death’s door.  The nextHospital has to completely shatter this assumption by providing appropriate care, from throat cultures to the crash cart, for anyone who shows up at its door.  

Not only is the only sane, humane and appropriate way to treat the human beings who enter your doors, it’s the cheapest way to treat those who don’t need intensive services; after all, an all-night walk in clinic is almost 50 percent cheaper than ED care! Kinda sounds like a good idea, doesn’t it?

What makes hospitals’ failure to offer step down care even more foolsh is that all they’d have to do is invite Walgreens or CVS to bring in one of their TakeCare or MinuteClinics, which I’m pretty darned sure they’d be happy to do. No fuss, no muss, virtually no overhead. Everyone wins. Explain to me why this isn’t a good idea?

The current system assumes that if the healthcare system is falling apart, it’s all the fault  of nughty patients who come to an emergency department and somehow don’t know that they aren’t that sick after all.  Remember, the learned papers that castigate patients who show up in the ED and somehow fail to need lifesaving treatment aren’t any kinder to those who simply overestimated their acuity than those who use the ED as a primary care center.

Now, I’m not suggesting that primary care physicians shouldn’t exist, and that hospitals should take over their place in the community. But I am suggesting that hospitals accept their role as caring for people, not emergencies, and govern themselves accordingly.  It’s more efficient, it’s more effective, and it’s more appropriate.  Anything else just wastes time and money, while scaring away patients who need your help.