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Demystifying Medicine One Month at a Time

Category: humor (page 1 of 7)

Medicine and Business: An Odd Mixture

Dr. Martin Samuels

Twitter is in the news frequently these days, because it’s a primary source of presidential communication. I like Twitter because I follow various health care practitioners and pundits and they often link to interesting articles.

I came across a link to an article (blog post, really) from Martin Samuels, Chair of Neurology at Brigham and Women’s Hospital in Boston and a Professor at Harvard Medical School. The whole post is worth a read if you’re interested in the evolution of American medical education over the 20th and 21st centuries. [The post originally appeared on The Health Care Blog.]

What really stood out to me was a long paragraph of his culled from phrases he’d overheard in various meetings with hospital leaders and business types.

Certain overtones of, well……jargon to say the least.

[I’ve broken the looong paragraph up for you for ease of reading. – ed.]

I’m afraid that if we don’t drill down on our brand equity on the front end, we’ll have to model it out on the back end to align our seemless incentives or pad our ask regarding the co-branding deliverables on the horizon.  As an FYI, this empowerment is going to require an elbow to elbow champion getting under the covers for a 360 of the eRoom to facilitate a paradigm shift in order to achieve buy-in among the stakeholders if we’re going to tip our toe into that water and get the low hanging fruit before our clients incentivize the burning platform with new metrics.

After all, you are the process owner who needs to reach out in the proper bandwidth to push back on the KOL’s or we’ll have to sunset your blue ribbon committee for not trimming the fat on the real-time escalation project.  We need to do more due diligence before we hitch our wagon to that indexed outcome measure, and let’s be careful how we message it and roll it out to the core constituency. We can model that projected gap, but we don’t want to get out ahead of our audience before sensitizing them to the moving target.

Let’s not drop the meat in the dirt but rather vet a pause point, collapse it up to a high level statement and assess the current state in order to connect the dots to achieve the ideal state and have you weigh in at the portal for service oriented architecture.  After all, at the end of the day, we’ll have more skin in the game and be in a better space if you walk the stakeholders though it so that they can leverage their halo to birddog that from 10,000 feet.

If you could create a placeholder to move the needle in the continuous quality improvement initiative, some heavy lifting might give us a report card so that there can be the accountability for a decent ROI, unless the co-branding produces a choke point so severe that the balanced score card causes a culture change, one by each.  Just between you and I, you need to parking lot that issue, take the deep dive and put the rubber to the road with a degree of commonality that will re-engineer a sea change in our SWOT analysis so that we bake it into the budget of the high level implementation group.  We have to move the ball down the field and prevent leakage.  Net-net there is value added for a win-win, rather than a zero-sum game.

You can manage the matrixed organization on the frontline and in the back office. With central discipline and local control we can achieve savings and margin, while penetrating that segment of the market.  A lot of what we have to do to reduce our trend is blocking and tackling in different spaces. Bottom line on top, if I don’t report to myself, we could really take a haircut before we can trim the fat out of the box and shift the culture beyond this pilot demonstration program.  That having been said, the PEST analysis shows that if you step up to the plate and evangelize the brand, we can be about the business of creating a placeholder of new buckets with more vertical silos so that we can finally tell whether we are on foot or on horseback.

Comparing apples to apples, it is clear that this is not a plug and play culture, so that you’ll have to hold your nose and jump in order to filter the noise and incentivize the process owners in a more granular fashion before it becomes a major mission drag.  A bread crumb has been forming so let’s put some stakes in the ground to leverage our insights as enablers of change to circle back on a more granular view, and tee up our clinical levers to mine insights from the benchmarks and beat the waste out of this process.  We will cleanse our application platform and get ready for the first wave of ambulatory e-care care go-live across the family and take advantage of the elbow-to-elbow support of the super-users and be back to 100 percent productivity by the second week.

Having said that, we traffic-lighted that report so you can optimize the outcome metrics.  If we can get the whole group on board in this arena we can try to boil the ocean with a six sigma culture change.  We mean to hit this one out of the park and get some substantive returns in the coin of our realm to avoid any mission creep.  It’s a non-starter to analyze the dashboard for crosswalking noise, so we need to slice and dice our organic growth, peel the onion and hardwire the initiative with more boots on the ground. If this could be the pause point for a new value initiative, that’s where the metal meets the road.

Let’s reach out, using our optimized tool kit to go anything north of zero and put a hard stop on this turn-key operation. If you would like to get some trend lines and traction from this piece, I can ping you a copy of my deck.

Oy vey.

How to Age Better: Live somewhere that combats Loneliness, Helplessness, and Boredom

At GlassHospital we strive to bring you interesting ideas about improving health and health care from places far and wide:

An article in the Saskatoon (Saskatchewan) StarPhoenix features Suellen Beatty, CEO of the Sherbrooke Community Centre in Canada.

Sherbrooke is a community centre, but it also is home to more than 250 residents — the kind of place we might call a ‘nursing home’ in the U.S. I love that in Canada they’re called Community Centres. That’s what any facility or neighborhood should strive for.

Suellen Beatty rejects the idea that nursing homes are places where people go to await death. Her team’s philosophy is to make old age more fun. Sherbrooke readily acknowledges the big three elements that compound the infirmities of aging: Loneliness, helplessness, and BOREDOM.

By loading up the day with activities, by listening to their residents and families, and by hosting hundreds of volunteers who see their job as providing fun and emotional sustenance to resident and day-visitor elders, Sherbrooke attracts visitors from all over the world who marvel at its success.

It reminds me a of a piece we ran a few years ago about a pretty special elder care facility in Arizona–one that put its residents’ happiness and comfort above all else — even when it means deviating from ‘standard’ protocols of elder care like eating bland food.

Take a look at what’s going on in Saskatchewan. We can all learn.

Marching for Science

Another piece I recommend: This time from Vox, in their First Person section.

It’s an essay by someone close to me who appreciates the scientific advancements which will help her survive the breast cancer she’s just been diagnosed with.

Costs of Care

Getty Images

Getty Images

Ever received a bill for a health service that troubles you? Does it seem too much?

Is it hard to understand what you owe from what insurance pays? Does it seem like the share you pay always goes up?

Medical costs are a universe unto themselves. How doctors and medical facilities (hospitals, radiology practices, etc.) come up with their charges seem to lack any rational basis.

Famously, in his article that became a book, author Steven Brill challenged the CEO of a big health insurance company to explain his ‘explanation of benefits’ (the bill-like statement you get that is NOT A BILL), and the CEO couldn’t do it. Here Brill recounts the story in an interview with Minnesota Public Radio. Context — Brill had a big operation for an abdominal aortic aneurysm, so he decides to use himself as a test case:

After I got home, about 2 or 3 days later, I received in the mail 36 different explanations of benefits from my insurance company, in 36 different first class envelopes, which tells you something about how inefficient the system is.

As I started to open them, I thought to myself: I’m the world’s leading expert on hospital bills and insurance bills, this is going to be fun. When I opened the third envelope, it said the following. This is an explanation of benefits from United Healthcare, which is headquartered in Minnesota: Amount billed: $0; amount paid by insurance: $0; amount you owe: $154.20. I looked at it and I looked at it. If nothing was billed, how could I owe $154.20? I turned it over, I tried to decode it, I couldn’t figure it out.

As it happened, before I went into the hospital, I had scheduled an interview with the CEO of United Health out in Minnesota … So as soon as I was able to travel, I went out to Minnesota and I did the interview. … And then at the end, I reached into my pocket and took out that explanation of benefits and handed it to him. I said: “I’m wondering if you could just help me understand this, I’m having trouble figuring out what this means. How could I be billed $154 if nothing was billed?”

He looked at it and he looked at it, he turned it over, he looked at the coding, and finally looked up and said to me: “I could sit here all day and I could not explain that to you. I have no idea what it means. I don’t know why they sent it to you.”

I said, “Aren’t you they?

That explanation of benefits is the single most common form that consumers receive in what is by far the largest industry in the United State: The healthcare industry. Tens of millions of those explanations of benefits go out from United Healthcare every year, and the head of the company can’t even understand what it means, so how are the rest of us supposed to understand what it means?

As an entree to discuss the issue of health costs in the U.S., and people’s disparate reactions to them, I share with you the story of Mrs. Sutton, a patient of mine who had a somewhat atypical reaction to the cost of her colonoscopy — even though she owed nothing out of pocket. I also want to emphasize how poorly doctors do in helping patients anticipate their costs of care. Reliable pricing information is hard for us to come by, too — as some commenters note. But some new companies (apps, of course) are trying to tackle this issue head-on.

Click on the box below to read it. Feel free to add your own story to the mix.

Evidence shows that in spite of mutual doctor-patient desire to discuss drug costs, we docs usually shirk the duty, writes Dr. John Henning Schumann.

Posted by NPR on Saturday, January 16, 2016

Thanks for reading.

Why Many Docs Are Griping of Late

dosequisicd10October 1st marked a national transition to a new classification scheme for diagnostic codes in medical care and treatment. These codes are used to translate a diagnosis like strep throat into an alphanumeric code that can be used for

  1. research purposes, and of course
  2. billing (the most important aspect!).

When you visit a health care professional, the diagnosis is translated by a biller (now most often done by computer software) into one of these specific codes, which is then submitted to the insurance company for payment. You receive an explanation of benefits (“EOB”) with this information on it (which the insurance company is sure to remind you is “not a bill”), which is usually indecipherable.

The new scheme (ICD-10) has almost 70,000 diagnostic codes, many of which are of a level of specificity that seems absurd. The old scheme, ICD-9, had only about 13,000 codes.

Not only are there more codes, but they come with a wholly different alphanumeric system attached to them. Luckily, the software lets us ‘translate’ the old codes into the new ones, but often, there isn’t adequate specificity in the old codes to be valid with the new ones. This is where the headaches result.

If you follow health media, you’ll see some funny articles about the tranisition. NPR ran a cute story headlined “Struck by a Macaw? Now There’s a Code for That.” The Wall St. Journal‘s explainer was headlined, “70,000 ways to Classify Ailments.” Among my favorites: V91.07 — Burn due to water skis on fire. Or W56.11 — Bitten by a sea lion.

It gets weirder than that. There are codes for ‘injuries from falling space debris.’ Doesn’t seem all that likely, but you never know.

Contagion of Yesteryear

Ebola seems to have taken up a significant portion of the news stream as of late.

sars-2003_custom-1ec2de788947040b25f2065b83f3b0e087fe0768-s40-c85

NPR–>Kevin Frayer/AP

It’s understandable, given the breadth of the epidemic (largest ever), the fact that it’s hit our shores, and that it’s so frightening: hemorrhage! death!

I wrote a first-person account of the time I was asked to evaluate someone for SARS, a 2002-2003 novel disease outbreak that originated in China and spread quickly to the West (in the end, only 27 U.S cases and no deaths; in Canada, 251 cases and 44 deaths).

SARS is a descriptive name: Severe Acute Respiratory Syndrome. We subsequently learned that it’s caused by a corona virus and that it’s spread by contact and respiratory droplets.

The outbreak died down as quickly as it flared up, and it’s nary been heard from since.

Here’s the concluding graf from the story–as true for Ebola as it was for SARS:

Today’s Ebola crisis makes clear what the many of us were slow to accept in 2003. It takes clear thinking, painstaking preparation, flawless execution and clear communication to protect the public health.

We can only hope that Ebola recedes and becomes a distant memory, also.

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