New Antibody Treats Squamous Cell Carcinoma

Head and neck cancers typically occur in smokers and for years has required extensive surgery with lots of disfigurement to have much of an attempt for a cure.

But recently, there is a new type of monoclonal antibody (Erbitux, ImClone Systems Inc. and Bristol-Myers Squibb Company) that has been approved by the FDA for the treatment of these types of cancers.

This antibody inhibits the function of a special molecular protein called epidermal growth factor receptor that has been tied to tumor growth.

With the FDA approval, the antibody can be used in combination with radiation therapy for the treatment of this type of head and neck cancer. It could help minimize the amount of disfigurement that many of these patients accept for the possibility of a cure.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels:
Wednesday - 6.8/Medium

Today's predominant pollen:
Grass, Mulberry and Hickory/Pecan.

HPV

There is currently more and more publicity on Human Papilloma Virus 16 (HPV 16) and its related vaccine. What is the bottom line on the vaccine?

HPV 16 accounts for about half of all cervical cancers in women in the United States. Recent studies have shown the vaccine to be effective in preventing infection in women who were seronegative at entry into the study. The only women to turn positive were those in the placebo group that did not receive the vaccine.

HPV infection of the genital area is a sexually transmitted disease (STD). HPV-16 is one of the viruses in the HPV family that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect nearly any part of the genital area in men and women. It usually has no symptoms and rarely do the individuals know they are infected.

Some strains are categorized as high risk because of their propensity to cause cancer and others are low risk. Some strains cause the typical genital warts which can be single or multiple and may grow like a cauliflower.

Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.

The types of HPV that infect the genital area are spread primarily through genital contact and most infections have no signs or symptoms to indicate the person is infected. It has been reported that a pregnant woman can pass HPV to her baby during vaginal delivery although this is thought to be rare. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.

Genital warts are diagnosed by visual inspection. Visible genital warts can be removed by medications the patient applies, or by treatments performed by a physician.

Most women are diagnosed with HPV on the basis of abnormal Pap smear. A Pap smear is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. There is also a specific test available to detect HPV DNA in women and this test may be used in women with early or questionable changes on her exam. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary.

There are currently no good HPV tests available for men.

There is no "cure" for HPV infection, although in most women the infection goes away on its own. The treatments are directed at treating the skin or mucous membrane changes caused by infection.

All types of HPV can cause mild Pap test abnormalities. Only about 10 of the 30 identified genital HPV types can lead to development of cervical cancer.

A Pap smear can detect pre-cancerous and cancerous cells. In 2004, the American Cancer Society estimated that about 10,520 women would develop invasive cervical cancer and about 3,900 women would die from this disease. The majority of women who die do not have regular cervical cancer screening with Pap smears.

The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual.

Individuals choosing to be sexually active should strive for a long-term, mutually monogamous relationship, with an uninfected partner.

Abstinence is the best policy for unmarried individuals. Monogamy is the best for married individuals and, overall, the fewer partners, the lower the risk.

Condom use has been associated with a lower rate of cervical cancer, but it is unknown if they are truly effective in preventing HPV infections. In addition, there are casual ways to become infected with the HPV virus, but most authorities agree that sexual contact is by far the most common leading to genital HPV infection.

QUESTIONS:

Knowing that infection with HPV is the leading risk factor for later developing cervical cancer, the question remains; should we immunize adolescent girls for this sexually transmitted disease?

What message are we sending girls if we encourage this vaccine?

What are the moral questions related to this vaccine or other vaccines that are primarily directed against high risk behaviors?

Since the morbidity of teen pregnancy is so much higher than the morbidity and mortality of HPV, why don’t we just require all females at time of menarche to begin Depo-Provera every 3 months to prevent pregnancy?

The rationale is similar!!

Memorial Day

In memory of all of our Soldiers, Seamen, Airmen, Marines and Coastguard who continually fight for our freedoms.

I am the Flag
by Ruth Apperson Rous

I am the flag of the United States of America.

I was born on June 14, 1777, in Philadelphia.

There the Continental Congress adopted my stars and stripes as the national flag.

My thirteen stripes alternating red and white, with a union of thirteen white stars in a field of blue, represented a new constellation, a new nation dedicated to the personal and religious liberty of mankind.

Today fifty stars signal from my union, one for each of the fifty sovereign states in the greatest constitutional republic the world has ever known.

My colors symbolize the patriotic ideals and spiritual qualities of the citizens of my country.

My red stripes proclaim the fearless courage and integrity of American men and boys and the self-sacrifice and devotion of American mothers and daughters.

My white stripes stand for liberty and equality for all.

My blue is the blue of heaven, loyalty, and faith.

I represent these eternal principles: liberty, justice, and humanity.

I embody American freedom: freedom of speech, religion, assembly, the press, and the sanctity of the home.

I typify that indomitable spirit of determination brought to my land by Christopher Columbus and by all my forefathers - the Pilgrims, Puritans, settlers at James town and Plymouth.

I am as old as my nation.

I am a living symbol of my nation's law: the Constitution of the United States and the Bill of Rights.

I voice Abraham Lincoln's philosophy: "A government of the people, by the people,for the people."

I stand guard over my nation's schools, the seedbed of good citizenship and true patriotism.

I am displayed in every schoolroom throughout my nation; every schoolyard has a flag pole for my display.

Daily thousands upon thousands of boys and girls pledge their allegiance to me and my country.

I have my own law—Public Law 829, "The Flag Code" - which definitely states my correct use and display for all occasions and situations.

I have my special day, Flag Day. June 14 is set aside to honor my birth.

Americans, I am the sacred emblem of your country. I symbolize your birthright, your heritage of liberty purchased with blood and sorrow.

I am your title deed of freedom, which is yours to enjoy and hold in trust for posterity.

If you fail to keep this sacred trust inviolate, if I am nullified and destroyed, you and your children will become slaves to dictators and despots.

Eternal vigilance is your price of freedom.

As you see me silhouetted against the peaceful skies of my country, remind yourself that I am the flag of your country, that I stand for what you are - no more, no less.

Guard me well, lest your freedom perish from the earth.

Dedicate your lives to those principles for which I stand: "One nation under God, indivisible, with liberty and justice for all."

I was created in freedom. I made my first appearance in a battle for human liberty.

God grant that I may spend eternity in my "land of the free and the home of the brave" and that I shall ever be known as "Old Glory," the flag of the United States of America.

Flag picture: http://daveandpeg.com/DPCreations/USFlagsJPG/JFlag.htm

Dirt and Allergies

The question arises as to why we are seeing so much more allergy and asthma in both kids and adults. Ask anyone over 50 and they usually say they never went to the doctor for either of these problems. Now we seem to be seeing more and more.

In 2004 there was a study published in the April 30 online issue of the British Medical Journal that offered additional evidence for the hygiene hypothesis of atopic dermatitis. Atopic dermatitis is a skin condition we usually associate with patients that have allergies.

Christine Stabell Benn wrote "Epidemiological studies have consistently shown an inverse relation between number of siblings and allergic diseases." She is from the Danish Epidemiology Science Centre of Statens Serum Institute in Copenhagen, Denmark. She went on to say "The association between infectious diseases and allergic diseases has not been consistent."

The study showed that before six months of age, 13,070 children (54%) had at least one clinical infection, and by age 18 months, 2,638 children (10.8%) had atopic dermatitis.

Contrary to the common belief that infections early in life may protect against the development of allergic diseases, this study showed the risk of atopic dermatitis (allergies) in this population increased with each infection before age six months

In contrast, the risk of atopic dermatitis (allergies) decreased with each additional exposure to three or more siblings, day care, pet ownership, and farm residence. This protective effect persisted after adjusting for number of infections, suggesting that it is established independently and very early in life, according to the authors.

Although these findings support the importance of microbial exposure for preventing atopic dermatitis (allergies), they challenge the hypothesis that infections in infancy protect against its development, the authors conclude.

In an accompanying commentary, Geoff Watts, science editor of the BMJ, in London, U.K., explains how these findings support various interpretations of the hygiene hypothesis. One effect of hygiene may be to decrease regulatory T cells and to allow the emergence of allergies.

So the question remains; are we sparing the dirt and spoiling our children's immune systems? Has our national trend of spending more time indoors with air conditioning robbed our immune systems from protecting us?

Should we let our kids go outside more, play in the woods, eat dirt and all of those things we did as kids? Time will tell and more studies will be performed. For now, encourage your kids to enjoy childhood and take advantage of the great outdoors. The evidence does not support some of the fears.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels:
Friday - 5/Medium

Today's predominant pollen:
Grass, Mulberry and Hickory/Pecan.

HSAs

A recent article in the ACP Observer speaks to the pros and cons of Health Savings Accounts (HSAs). [ACP Observer, May 2006 - Will HSAs lead to smarter spending or sicker patients?]

The article states “Consumer-directed health plans emerged in recent years win response to employers’ demands for premium relief.” Employers can no longer foot the bill completely for employees. It has just become too expensive. In addition, by doing so over the past 20-30 years, the actual value of what patients receive has been de-valued as mentioned in the article. "A major problem in the health system is that the actual value of what doctors do is incredibly devalued because people don't pay for it," said Dr. McLean, a member of ACP's Health and Public Policy Committee. "When a doctor's opinion is, to them, just a $10 co-pay, it loses value."

The downfalls listed in the article are:

• 
  Not funding accounts
  Putting off diagnoses
  Avoiding tests and treatments
  Getting enough cost information
  Using HSA money for non-medical expenses

All of the downfalls listed in the article result from personal choice and responsibility. If the HSAs are utilized as they are designed, I believe they can be the beginning of a revolutionary change in our Healthcare environment.

But then, I believe in personal choice and responsibility. I believe patients should choose how to spend their money and how they make healthcare decisions. We cannot afford everyone receiveing everything available without paying for it. This is where the major disagreements lie.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Thursday - 6.3/Medium

Today's predominant pollen:Grass, Mulberry and Hickory/Pecan

Medicaid changes

Here is a novel idea to fiscally help with our insurance crisis in Indiana. At the present time, we spend 4.386 billion dollars on Medicaid. According to the 2003 census, there were ~650,000 Indiana residents living in poverty. This included adults and children in single living conditions and families.

If we would eliminate all the government agencies associated with the Medicaid program and just have one simple application process to enroll the eligible residents, we could eliminate a huge amount of overhead and bureaucracy.

The money currently spent amounts to over 6000 dollars per individual that falls into the poverty range. You can certainly purchase a private health insurance policy or a family policy for less than this amount.

The State could solicit bids from the major insurers and allow them to provide the coverage just like others who have insurance through their companies. The best bid would receive the contract. I am sure that if you offered 3-4 billion dollars to the company, they would jump at the opportunity.

These indigent patients would have the same type of coverage as the rest of Indiana residents with private insurance and would save the State money in ways other than just the Medicaid expenditures.

We have overly complicated the system with bureaucracy and red tape. There is plenty of money to insure everyone with near equal coverage. We need legislatures who are willing to make some radical changes.

The New ER

So how many readers have visited the new Emergency Room at Floyd. It opened earlier this month and is now in its 3rd or 4th week.

I have heard ongoing patient complaints about continued wait times and over the weekend, at least one patient ended up leaving and going to Clark where they had an emergency procedure done.

The new ER has around 40 beds but is only utilizing about half of them because of staffing issues. The ER docs are frustrated. The nursing staff is frustrated and patients remain frustrated. All this is continually reflected in the patient satisfaction surveys.

But, the patients get to stay in some pretty nice rooms as they endure their waits.

Today's allergy levels: Tuesday - 8.0/High

Today's predominant pollen:

Grass, Mulberry and Hickory/Pecan.

Another Negative Trend

Most people in the healthcare field know that hospitals make their largest profit in the outpatient arena. Negative trends in outpatient exams will certainly have serious financial implications on hospitals.

Outpatient exams are impacted by the relationships outlying physicians maintain with the hospital. It should come as no surprise that we are seeing a negative trend in the amount of outpatients that Floyd Memorial is seeing.

From January through April of 2006, Floyd Memorial is performing fewer outpatient x-ray procedures than it did in 2005. With a $65 million expansion, this should be raising some red flags with the Board. Inpatient x-ray procedures are actually up, but because of DRG’s, most of these procedures are bundled with the hospitalization and cannot be billed for separately.

Here are the numbers:

2005 Inpatient exams totaled 11001
2006 Inpatient exams totaled 12352

Increase of 1351

2005 Outpatient exams totaled 31451
2006 Outpatient exams totaled 30318

Decrease of 1133

Many outpatient tests are done as a result of emergency room visits which are also up. Logically, if the ER is busier and many of the outpatient x-ray exams originate from there, you could conclude that even fewer outside physicians are referring patients to Floyd for outpatient x-ray exams.

I wonder why this trend is occurring.

Will anyone else notice and begin asking some tough questions?

We’ll get responses that the new outpatient radiology center is the reason, but that would only partly explain the decline in the overall numbers. With the population increasing along with utilization, we should be seeing much higher numbers.

This is just one more negative trend that was predicted.

Who’s listening???

Top 10

One of our readers posted a comment yesterday relating to a very nice and insightful opinion on healthcare.

It is very much worth reading. It is short, concise and very applicable to our recent discussions. The link is:

[The Top 10 Reasons for Soaring Health-Care Costs: The Naked Economist - Yahoo! Finance]

The introductory excerpt is as follows:

What's the most intractable public policy problem the U.S. faces? Health care. I don't think any other issue even comes close. Health care has all the ideological fireworks of social issues like abortion or gay marriage (e.g. is health care a right or a privilege?). Yet the system itself -- the process of providing care and allocating those costs -- is also stunningly complex.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels:
Friday - 7.1/Medium
Today's predominant pollen:
Grass, Hickory/Pecan and Mulberry.

German Doctors go on Strike

The recent article shows that the socialized healthcare system is also wrought with problems. [Thousands of German doctors strike over pay - Netscape News]

Patients in Germany I’m sure will feel the impact of 12000 plus physicians going on strike.

Reform of our healthcare system is needed, but socialized medicine is not the answer. Recent Canadian data is also showing some very bad trends in access to care and what exactly what care patients can actually receive.

We need legislatures who are willing to make some radical changes.

Today's allergy levels:

Thursday- 6.8/Medium

Today's predominant pollen:Grass, Hickory/Pecan and Mulberry.

CMS interim report to Congress is out

The “INTERIM REPORT TO CONGRESS ON PROGRESS TOWARD IMPLEMENTING THE DRA PROVISION AFFECTING SPECIALTY HOSPITALS” has been released and is available for review at the following site:
[Physician Self Referral - DRA Report to Congress]

This is the report that was to be completed after implementing the Federal Moratorium on specialty hospitals a couple of years ago. Many thought and hoped it would be the end of specialty hospitals and physician investment in these types of entities, but it does not appear to be the case

Everything I have read so far from the articles appear to be very good news for the competing hospitals that are planned in and around Floyd and Clark Counties.

There were 4 recommendations made by the Administrator of CMS to congress. These included:
1) Reform payment rates for inpatient hospital services through diagnosis-related group (DRG) refinements.
2) Reform payment rates for ambulatory surgical centers
3) More closes scrutinize whether specialty hospitals meet the definition of a hospital contained in section 1861(e) of the Social Security Act
4) Review procedures for approval and for participation in Medicare.

The administrator also announced that CMS would consider how EMTALA should apply to specialty hospitals.

Overall, as you read through the articles, CMS admits that defining a particular institution as a “hospital” is difficult when it comes to differentiating one from another. They therefore are making no concrete decision on how to define a specialty hospital and will take each on a case by case basis.

This appears to be another major hurdle overcome by the competing hospitals and places more strain on Floyd.

Will the County Commissioners and Board continue to spend hospital money challenging these legal questions?

Wouldn’t it be better to move forward and try to work harmoniously with the competitors and maybe even offer to help manage any overflow of heart cases etc.?

Continually destroying any possible working relationship because of the shortsightedness of the CEO will be another devastating hurdle to overcome.

When this other hospital comes, there will be a need for overflow of heart cases. They will be referred to Jewish or Floyd depending on relationships established. Without a change at Floyd, our community will once again lose.

Change needed

It is critical that our Hospital Board and County Commissioners take their responsibilities seriously.

With the previous quarterly financials being posted and the ongoing problems being seen at Floyd, we must seriously be thinking about what the future holds for Floyd.

The continued loss of outpatient services to other institutions and private entities will be the hospitals downfall. These ongoing losses continue to be in large part because of the mistrust with the current administration. Few, if any, want to enter into any type of financial relationship under this current administration. Many, who have done so, have regrets. How many more opportunities need to be lost before we make a change?

Will the current Board and Commissioners wait until the hospital is in financial ruin before they see the light? With a simple verbal pronouncement, the County Commissioners could add physicians back to the board creating balance and accountability that appears to be missing. If the CEO really wanted physicians on the Board, he would be more vocal and outspoken as he is with other issues; like opposition to competitors. He has certainly kept that issue in the forefront with the Commissioners.

Surgeons shun Floyd

Last week, a group of twenty-eight surgeons decided to partner with a different consulting/investment firm and build their own outpatient surgical center. This comes after nearly a year of work and thousands of dollars that Floyd spent trying to garner support to build a surgical center on the hospital campus.

This comes as another shocking blow to the potential future success of Floyd and should cause Commissioners and Board Members to be asking some tough questions.

The CEO had virtually assured the Board that the plan was a win-win for both sides and it was an equitable and fair arrangement for all parties involved. He assured the Board that the surgeons wanted the surgical center on-campus and therefore he had little concern they wouldn’t partner with Floyd.

The bottom line for the decision was not entirely financial as the CEO is going to be telling everyone. One of the major issues is and always has been trust. Physicians do not trust this administration and are extremely leery of entering into any financial business arrangement.

They are willing to partner with an outside entity, even unknown, rather than partnering with Floyd under this current administration. This surgical center will now compete directly with Floyd for procedures that have been almost entirely done at the hospital before this time.

This is just one more example of how more and more outpatient procedures are being lost. With the quarterly financials being on the downward trend, news like this cannot be good.

The CEO was reportedly angry with the news of the surgeon’s decision and even reportedly called one and accused him of being the ring-leader. This type of behavior certainly doesn’t lend itself to building any kind of trusting or workable relationship.

Serious questions need to be asked and some serious changes need to be made before it is too late!!

Mumps outbreak

We have had a lot of phone calls about the mumps situation that has been on the news. Parents want to know what they need to do and if there is a concern.

At the present time, most of the 1000 or so cases that have been reported are in Iowa. There have been some but much fewer cases in Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin. Most of the cases have occurred in the 18-25 age group and those in college or health care situations.

General Information on Mumps:

Mumps is a virus, not a bacterial infection; therefore, it can not be treated with antibiotics. It is transmitted by respiratory droplets from coughing, sneezing and breathing. From the time a person is exposed, the symptoms may not develop for 10 days to 3 weeks and those with mumps can be contagious 1 week before the symptoms up until 10 days after the symptoms.

Persons contracting the mumps virus usually have poor appetite, muscle aches, fever and headaches before the actual classic symptoms develop. The classic symptoms are acute swelling of the parotid glands on one or both sides of the face. This occurs in only 30-70% of cases and about 20% may have few other symptoms. Worrisome symptoms can include meningitis and in older males may produce an inflammation in the testis resulting in sterility.

The current prevention is to be sure the immunizations are up to date. This is the best prevention, but does not give 100 percent protection. Current recommendations are to have 2 separate MMR vaccines. The first is given at 15 months of age and the second at the time of kindergarten (4-6 years of age). Persons who have 2 documented MMR vaccines are assumed to be immune. If there is a question, blood can be obtained to document immunity.

If someone is thought to have mumps based on their history and physical exam, blood can be taken for Mumps IgG and IgM titers which are antibodies to the mumps. In addition, swabs from the cheeks, urine cultures for mumps and specialized blood tests called PCR’s should be obtained.

Treatment for mumps is basically supportive. It includes analgesics like Tylenol or Advil for pain and fever, and adequate fluid intake to prevent dehydration from fever and the poor appetite. If the patient cannot swallow, I.V. fluid replacement may be used.

Limiting activities is advised for the duration of the fever. Ice packs or heating pads may ease the pain of swollen glands.

For males with testicle inflammation called “orchitis”, doctors may prescribe stronger pain medication as well as steroids to reduce inflammation.

If your child’s shots are up to date, there is nothing else to do. If your teenager or college student is unsure, they should be tested or receive a booster MMR vaccine.

Sports Physicals follow-up

As a follow-up to Tuesday’s blog, the sports physicals for the Floyd Central Renaissance was another successful event.

Bobbi Bickers led the event and garnered the support of all the parent volunteers and physicians. She is a wonderful coordinator and motivator and should be commended for her continuing efforts to be an outstanding academic booster for the students.

We had ten physicians donating their time and professional services. These included:

Dr. Richard Medley
Dr. Stuart Eldridge
Dr. Phil Johnson
Dr. Steve Karem
Dr. Greg Philpot
Dr. Christy Minrath
Dr. Mark Winders
Dr. Mark Bickers
Dr. Tom Andres
Dr. Dan Eichenberger

The final numbers are not yet tallied, but we had at least 112 students from Floyd Central and nearly that many from Highland Hills for a total of 200 or more.

The event went very smoothly with all being completed in about 2 hours and each student being completed in about 15 minutes or so.

Again, a big thanks to Bobbi and all of the volunteers.

Cochran Letter

Here is a letter receieved from Representative Cochran. It certainly gives physicians some hope that we may have a voice and may be able to get some things accomplished if we continue to voice our concerns.

Physicians at least feel better about speaking out on these very important issues. We will continue to campaign for the issues that are important for our patients. If our practices cannot survive in the current healthcare environment, patient care and access to physicians will continue to be problematic.

Hopefully, this is the start of some positive changes.

Sports Physicals

Many of you may not know that Floyd Central High School is a Renaissance School.

What is Renaissance?

The Renaissance Education Foundation was started as a way to motivate students to attain a higher level of academic success. FCHS began in the 1993-94 school year to join more than 2,000 other Renaissance schools in the United States. These schools, through this program, are attempting to break through the paradigms of today's educational system by offering numerous recognition and incentive programs to reward both student and teacher performance.

Part of the program consists of a Student of the Month program and a program to recognize outstanding faculty or staff. Sr. high success cards, which recognize grade point average, attendance, and/or improvement, are issued to deserving students. These may be given to a student that has brought a D up to a C grade. They are incentives for all successes. These cards entitle the holder to various privileges and discounts at school and at local businesses. There are anywhere from 40-60 "students of the month" each month and each month PTO/Renaissance recognizes a teacher from the Sr. High as "Teacher of The Month." This teacher is given balloons, gift certificates, and goodies as well as having his/her picture displayed in the Sr. High offices.

Renaissance is a cooperative effort between parents, teachers, administration, and business partners.

There are many other things that PTO/Renaissance assists with during the year. Parents assist with test proctoring and registration. Parents serve on several committees at the school and help apply for grants and reward programs. They supply refreshments for Open House and Building Committee meetings, and they work closely with the Student Renaissance committee and sponsor some other activities.

Just as all of the sports programs have parent boosters, the Renaissance consider themselves academic boosters. They want every student to reach or exceed their potential.

With these goals, come financial needs. About 8-9 years ago, I offered to do sports physicals for the Floyd Central High School Students with all of the proceeds going to the Renaissance Program. We have arranged to have anywhere from 8-12 physicians working out of my office usually the second Tuesday in May from 6-8:00 pm. In about 2 hours, we perform about 200 complete athletic physicals based on IHSAA standards.

The PTO/Renaissance helps coordinate the event and supplies all of the parent volunteers. The physicians all donate their time and services. The $20-25 fee is basically all profit for the PTO/Renaissance and is used to support all the academic Renaissance programs.

It has become their single major source of funding over the years. The event is tonight at my office and we again look to have 200 plus students take advantage of this opportunity.

We are very lucky to have these dedicated parents supporting this program in a time when sports seem to take most of everyone’s time, efforts and money.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Tuesday - 9.1/High

Today's predominant pollen:Oak, Mulberry and Grass.

Fair and Balanced

To be "fair and balanced" as one of the bloggers mentioned, I am including the other indicators from the quarterly report. The Board Members and others are given a "Dashboard" report that list the indicators, the target, the prior year's value and the current value.

There is also a spider graph attached that gives a very quick overview of where we stand. Everything inside the spider graph is bad (below target values) and everything outside is good (above target values).

The March dashboard showed only 3 values outside the graph or in the "good" range.

These three indicators were the:

• Average length of stay was 3.78 with the target of 4.16
• Employee turnover rate was 7.0% with a target of 8.5%
• Patient fall rate was 4.22 with a target of 5

All of the other goals were at or below the target and included the ones already mentioned:

• Operating margin is at 62% of the projected goal
• Total Margin is at 64% of the projected goal
• Day’s cash on hand is at 57% of the projected goal
• Days in A/R is at 87% of the projected goal
• Inpatient satisfaction is 63% with the goal being 75%
• Outpatient satisfaction is 34% with a goal of 75%
• Outpatient surgery satisfaction is 41% with a goal of 75%
• ER satisfaction is 47 % with a goal of 75%

And a few others:

• FTE per adjusted occupied bed was 4.64 with a goal of 4.64
• Cost per adjusted discharge was $6004 with a goal of $5883
• Debt service coverage ratio was 3.22 with a goal of 4.00

The majority of these are all below last years values and trending downward. Commissioners and citizens should remember that if certain of these key indicators hit a specific level, the hospital can be taken over by the bond insuring agency.

The County could essentially lose control of the hospital!!

Quarterly Financials

The quarterly financial reports are out from the hospital. Overall, things have continued to decline. Projections on the number of heart procedures are also lower than predicted. The results are as follows

Operating margin is at 62% of the projected goal
Total Margin is at 64% of the projected goal
Day’s cash on hand is at 57% of the projected goal
Days in A/R is at 87% of the projected goal
Inpatient satisfaction is 63% with the goal being 75%
Outpatient satisfaction is 34% with a goal of 75%
Outpatient surgery satisfaction is 41% with a goal of 75%
ER satisfaction is 47 % with a goal of 75%

These are far worse than last year, but they continue to get marginalized. When the issue is brought up, there are always excuses but rarely accountability. Blame is shifted everywhere except for the top.

All of these numbers are significantly under the projected budget even though we were told the budget was conservative.

Physician satisfaction has not been recently measured, but with the surgeons choosing to build their own surgical center and others waiting for the new hospital to be built, and the OB’s really struggling, these ratings would also be low.

All of this data means that the CEO is going to be “putting the word out” through his indirect channels that end of the year bonuses will be minimal at best. Employee satisfaction will suffer at that point. Most employees have no control over most of these operational figures, but they will certainly feel the impact of poor management. The Board continues to allow these declines because of a reluctance to make needed changes. The financials will have to continue to worsen before some will be forced to finally act.

I can hear the spin already in regard to these numbers. It will be the fault of everyone except the administration. If some of these numbers decline too much lower, the bonding insurer will have to be notified based on the stipulations made in the contract.

It is Derby Weekend and for everyone heading to the Oaks or Derby, good luck on your picks!!

Hospital Smoking Ban

Floyd Memorial Hospital like most others in the area is going smoke-free. The date at Floyd is July 1, 2006.

The policy has caused lots of discussion, policy changes, frustration and discontent. Many smokers feel their rights are being violated and others are ecstatic for the stance. The overall reaction is much the same as you see in every other venue.

The hospital has sent out a “Tobacco-Free Policy Feedback Form” that employees can complete and turn in anonymously about their feelings. It is typical that this form is being sent out after the policy and the date has already been decided. Responses from the form may allow employees to vent, but it is doubtful that any policy change will occur because of them.

Responses have included some apparent hypocrisy in hospital support of certain behaviors while choosing to oppose others like smoking. Questions arise whether smoking is any worse than alcohol or obesity when it comes to health. Responses on the forms have asked why alcohol is readily served at hospital functions, why weight and certain foods are allowed and encouraged when smoking is being targeted. Employees and others have certainly seen some in administration over-imbibe on a few previous Hospital supported events. Is this healthy or setting an example worthy of respect?

Rumors are circulating that employees may be fired if they leave the hospital grounds on their breaks. They may be fired for abandoning patients. Some have been told they cannot smoke in their cars even though this is considered private property.

Implementation of this policy should be better explained and administration should attempt to define what is acceptable or prohibited so there is better understanding and acceptance with the employees.

As a physician, I wish everyone would quit smoking but I certainly understand the intricacies involved in this corporate decision. I also see the hypocrisy in some of the examples that have been given.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Thursday - 8.5/High

Today's predominant pollen:Oak, Mulberry and Grass.

Newest Aggravation

Here is the newest aggravation created by the drug companies.

Our practice found an internet company called Preferred Time that manages the scheduling of drug reps. We tell preferred time how many reps we want to see in a day and the times we want to see them, and they provide the scheduling free of charge. They also schedule the lunches and send emails out to all of the reps when there are cancellations.

They have two types of service for the drug reps. The free service allows the reps to sign up for either one visit or one lunch. As soon as that visit or lunch is completed, they can immediately schedule the next one. For a small fee, of less than 30 dollars/month, they can become a “pro” member. Being a “pro” member allows the reps to sign up for more than one visit and also allows them to access slots that get reserved when the schedule is nearly full.

Our office has typically scheduled 4 reps in the morning and 4 in the afternoon and 1 at lunch. For years, we have seen 9 reps a day, every day. It took a tremendous amount of staff time to schedule these visits and lunches and keep track of cancellations etc., all while trying to be fair to each of the reps. Some companies and reps did not always follow the rules and guidelines set making it unfair for others. This service levels that playing field as well.

Now there are at least 3 companies unwilling to allow their reps to use this service. They were told they cannot use a third party vendor to schedule appointments. Pfizer, Bristol Myers Squibb, and Sanofi are companies so far unwilling to allow the reps to use this service that saves my office staff time and money. We have informed them they can either use the free service or we will not see their reps.

The drug companies fear losing some control and evidently do not like third parties interfering with their turf.

We’ll see what happens when their reps cannot come in the office after a few months.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels:
Wednesday - 9.7/High

Today's predominant pollen:
Oak, Mulberry and Grass.

Progress on New Hospital

Not much has been in the news recently on the new hospital, but things are proceeding very well. The site has been chosen and is located off of Veteran’s Parkway right next to I-65. Soil samples, perk testing and other procedural matters are being completed. Investors continue to quietly join and excitement is growing.

Our County Commissioner’s decision on this issue cost New Albany another business and another opportunity to bring jobs, tax revenue and income to our city.

It is frustrating to see how a handful of poorly informed, misguided and integrity-lacking individuals continue to stymie progress that the majority of people know is good for the city and our community.

On this Election Day, I am hopeful we can make some substantial changes to overcome this situation.

Antitrust lawsuit

Ever since overturning the Clark County and Floyd County moratoriums in January, things have been quiet. But what many people don't realize is that there were two separate components to the original lawsuit.

Having an injunction and overturning the moratoriums were the initial component. But there is also an antitrust component directed against Clark County, Floyd County, Clark Memorial Hospital, Floyd Memorial Hospital and Jewish Hospital.

The above document shows that the Clark County Commissioners have taken a deal that releases them from any further liability related to the antitrust lawsuit. Clark County Commissioners basically agree not to appeal or impede the building of a new facility in Clark County.

Floyd County Commissioners and the Hospital have not taken this same step and could be potentially liable for an approximate $20 million lawsuit if they were to lose.

The recent Tribune article gives some additional insight to the case.
http://www.news-tribune.net/local/local_story_119134729.html

Having knowledge of both sides of the case, I would have to disagree with some of the comments made.

Floyd County Commissioners have erred in judgment once again and sealed New Albany and Floyd County's fate related to bringing new business and tax revenue to our area. We lost a wonderful opportunity for another business and jobs. I've stated before that competition will come. We can either embrace it and learn how to effectively deal with it, or we can continue to allow our Commissioners to doom our future and our kid's future.

Continuing to fight this legal battle and having Floyd Memorial Hospital foot the bill is also wrong. It potentially jeopardizes the hospital's own future if it were to actually lose the antitrust lawsuit.

Let's review some of the recent legal challenges related to the Hospital. They were challenged on releasing the CEO's contract information and lost. They were challenged on releasing certain notes from meetings and lost. They were challenged on the moratorium and lost. They are being challenged with antitrust and Clark County has already dropped out and settled. Who here really has the "vendetta"? The judge ruled against them initially and she will also be hearing the second part of this lawsuit. I'd be a little concerned after reading her original opinion.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels:
Monday - 5.5/Medium

Today's predominant pollen:
Oak, Mulberry and Grass.