Pertussis Outbreak

A few weeks ago I posted on the problem with parents not wanting to vaccinate their children because of various concerns. One of the problems by not doing so was stated that we would begin seeing more and more cases of these preventable diseases.



Seen here is the announcement sent to all local physicians related to the recent increase in the number of Pertussis cases in Floyd County and surrounding areas.




It is imperative that we do a better job of educating our parents to the real and devastating consequences of electing not to follow the immunization guidelines.



The above image is the current recommendations.

ISMA follow-up

Here is a copy of the follow-up letter sent to physicians regarding the Medicaid situation.

It still appears like the State is continuing with the plan to change Medicaid providers by January 1, 2007.

Physicians in southern Indiana believe this is next to impossible to implement in this time frame.

We will actively oppose this change as it will impede access for patients and disrupt patient care.

Here is the link on information to the upcoming meeting:
http://www.in.gov/legislative/interim/committee/jcmo.html

A CEO that understands

Here is a CEO that has figured out the paradigm shift and has embraced the new and different relationships that must occur if hospitals want to continue to succeed in this ever changing healthcare environment.
[ UO Magazine > Playing the Odds Page 2 ]

This particular CEO had this to say in the article:
The secret? A total lack of ego within its administration and a willingness to allow doctors an equal partnership in making important decisions, says Tom Crawford, the hospital’s chief operating officer.
“I wish I had something that was really complex that I could sell, but it’s really all about respect,” Crawford says. “If we are going to do anything at this hospital, or change anything, we give our physicians a call and we solicit their input because we don’t want to make any decisions that make their professional life worse or frustrate them.”
Crawford would not disclose what he pays his physicians, but says it is below the median income outlined in salary surveys conducted by organizations like the American Medical Group Association.

Here again, the perceptions that everything is about money is just inaccurate. Physician relationships with hospitals have to be focused on trust and control. Hospitals in the 21st Century will have a difficult time surviving if the same mentality of the past 20 years is allowed to continue.

Physicians want control of their personal time, family time and work time. This is no different than any other profession.

My opinion continues to be that our CEO and his ego cannot or will not be able to embrace this paradigm shift and we will therefore continue to fail financially.

Be looking for some financial numbers to publicly be announced that will continue to validate the concerns.

Not-for-profits prosper so why isn't Floyd

The latest report from the financial side of Modern Healthcare shows that the majority of not-for-profit hospitals are prospering and the report further states that those that are not should be doing some serious soul-searching. It also talked about the S & P ratings and how they also continue to improve for these hospitals. [Not-for-profits prosper]

How good a year was 2005 for not-for-profit hospitals? Market conditions were so favorable to the sector that any hospital that performed poorly financially should probably do some serious soul-searching about the future.

Although there are "a whole host of smaller incremental issues" of concern to the sector, the favorable performance of recent years is continuing longer than anyone expected, said Martin Arrick, a managing director with S&P. "There is no catastrophic shock coming until at least the (next presidential) election," he said.

Arrick noted that at the same time that the financial performance of not-for-profit hospitals has been positive, credit trends have also turned positive this year and last.

For the first six months of 2006, S&P raised 24 ratings and lowered 20. More important, the sector reflected stability: 83% of the 265 rating actions during the period were affirmations, S&P noted. Upgrades have outpaced downgrades this year at Fitch, with 12 healthcare providers receiving upgrades year-to-date while only eight were downgraded. Fitch affirmed 63 ratings during that period.

Given the above reports, I continually strive to understand why our leadership at Floyd is allowed to continue on this downward financial trend.

It continues to be my belief that the decisions made and the relationships damaged by our current administration is harming our once excellent hospital.

How much lower do we have to sink financially before the needed changes are made?

The Marathon

As a physician, I have always admired those individuals who choose to exercise and stay in shape. It takes a lot of discipline and sacrifice to maintain the regimen.

I encourage all my patients to exercise and maintain their ideal body weight, but only a small percentage actually accomplishes it. What truly amazes me are my patients who are at the other end of the bell curve. These patients not only run regularly, but some are fanatical and run marathons. I do not recommend this from a medical standpoint and have always wondered what motivates them.

And while pondering this question, has anyone ever wondered why a marathon is 26.2 miles and where it originated from.

The answer begins with the 1896 inaugural Olympic Games. They chose to commemorate a soldier by the name of Pheidippides who ran from the battlefield of Marathon, Greece to Athens, Rome around 490 B.C. He was spreading the news of the Greek victory over the Persians. The sad part is that he collapsed and died at the end of his run. This may be one of the medical reasons why marathons may are not particularly healthy.

The original race at the Olympics was 40,000 meters or 24.85 miles covering the distance from the Marathon Bridge to the Olympic stadium. Twenty-five runners started this race and only 9 finished. Eight of these were Greek making the host nation very proud.

The original Boston Marathon was in 1897 and it was 24.7 miles. In 1908, the Olympic Games were held in London and the distance was changed to 26 miles to cover the ground from Windsor Castle to White City stadium. An additional 385 yards were added on so the race could finish in front of King Edward VII's royal box creating the 26.2 miles.

Much debate occurred, but the 26.2 miles was finally established as the official distance at the 1924 Olympics in Paris.

I admire anyone who chooses to do this, but I still have my reservations on whether it is truly healthy.

HIPPA ten years later

It is sometimes hard to believe it has been 10 years since the institution of HIPPA, commonly referred to as the HIPPO because of the tremendous burden, paper work, increased hassles, legal concerns, and excess costs it has created for the average physician and other healthcare providers.

There are pro’s and con’s on both sides of the debate but from most physicians, it just created more headaches.

A recent review with comments from both sides can be seen here: [HIPAA, 10 years after]

I cannot say my patients are any better off or that their care has been improved because of the government rules that were implemented, but it certainly has raised the concern of privacy. For the tremendous cost to private physician offices, I do not see any major advances that it added to the healthcare system.

One paragraph states:
"I'll make the argument and say we'd not be having what we're having with Dr. Brailer and the push for EHRs without HIPAA," he says. "For all its flaws, it was the catalyst that started the IT movement in this country. It opened the doors for a new relationship between providers and payers and trying to save money throughout the system."

I am not sure that HIPPA was the catalyst. I believe the information technology age itself has been and continues to be the impetus behind electronic health records and improved cost savings ideas.

Either way, it is here to stay and just one more hurdle in the Healthcare game!

Loving Care

Here is an excellent article on what health care should strive for.
[Delivering 'loving care']

The article is certainly direct and to the point about how current CEO’s and hospitals have lost their focus on what is important in delivering healthcare. The article comments; "In hospitals, technology and business have become monstrous gods crushing first-line workers and converting them, in the eyes of many leaders, into automatons or units of expense," he writes in Sacred Work. He cites the results of a survey by the American College of Healthcare Executives, as reported in this magazine (Jan. 9, p. 8). Hospital CEOs overwhelmingly (67%) stated that "financial challenges" were their No. 1 worry, while "quality" ranked fifth (23%) and "patient safety" sixth (20%). "The mission of `loving care' for patients did not make the list at all.

In addition, the article refers to an author/lawyer/CEO by the name of Chapman who feels that most hospitals have fallen into a rut. With tongue in cheek, he suggests that most hospitals should replace their mission statement with these lines or something akin to: "Welcome to St. General's Hospital. Got a problem? We'll take our best shot at fixing it. You can stay in one of our rooms at a nightly rate higher than any hotel in the country. Note: There may be a stranger in the room with you, and we are not responsible for any noises he or she might make. We will decide what you wear to bed. Note: Don't even think about wearing your own pajamas. Do expect to lie on a stretcher for a long time in a long hallway half-naked. Enjoy the fluorescent ceiling lights. We expect to get paid as much as we can for what we do to you. If we make a mistake, we'll try again -- and we'll charge you again, too. If you're unhappy, talk to our customer relations people in the basement. Although they may have no power, authority, or medical training, they will probably smile. Alternatively, you can sue us. Have a nice day and night."

We cannot provide loving care when we are continually short-staffed and have our nurses, techs and aides continually stressed, overworked and having to worry too much about paperwork and administrative garbage.

Chris Morris interviews the CEO

Since many readers evidently want to discuss the interview in the Tribune with the Hospital CEO, here is your opportunity. http://www.news-tribune.net/floydcounty/local_story_231190701.html?keyword=topstory

I believe Chris Morris attempted to ask good questions, but the CEO is very good at not giving the entire picture when answering questions. If Chris had a better understanding of how things really worked at the hospital, he could have asked several follow-up questions to really elucidate the rest of the story.

Question #1
The heart program is off to a good start, but he failed to mention that it was more than 3 months later than projected. In addition, the numbers are not where they were projected to be at this time in the year, but considering the late start, we are almost on track. This delay put the budget in jeopardy as we had counted on the revenue of these cases during the first 3 months.
The ER having growing pains is a huge understatement. Yes there are 42 beds, but what he failed to mention is that we are only utilizing about the same number of beds as in the old ER. There is not enough staff to cover the additional beds. So now, the real difference is that patients get to wait in a nicer area.

Question #2
We agree on this. The hospital has not gotten a bad rap. It has gotten what the CEO’s decisions have led to.

Question #3
Whether competition is needed will always be debatable, but we certainly disagree here. These other facilities will offer services more efficiently and effectively. Yes, if they are physician owned, there will be some revenue going to the investors. That does not make them inherently bad. Competition does equate to lower costs in virtually all aspects of the marketplace.

Question #4
The new hospital is supposed to have an Emergency Room and I believe he misspoke in answering this question. Floyd does take care of the indigent as a community hospital should. They are also not-for-profit and paying no taxes. Chris should have asked the CEO if he would be willing to give up the not-for-profit status and therefore be on a level playing field as he repeatedly complains about. The benefits of being not-for-profit are huge financially and they know it. They “want their cake and eat it too.”

Question #5
He pretty much avoided answering this question as he knows we have not done enough to recruit and retain nurses. We got started too late in the process to fill the needed positions even though the Board repeatedly questioned him on this issue. Currently, our nurses and staff are understaffed.
Diversion was very rarely ever because of staffing issues until the new addition opened up. Now that we do not have enough staff for the beds, we are seeing diversion for this issue as well. There is an overall shortage of beds as he admitted. Why we spent 65 million dollars and did not add any significant overall beds is still haunting us. This is more support for the need of another hospital and additional beds.

Question #6
This answer on the relationship between physicians and the CEO is just wrong. We have surveys that have shown major trust issues, we had a consultant spend nearly an entire day during a strategic planning retreat because this issue was a huge sticking point and was hindering any type of progress. That consultant was never asked to return after her initial phase was completed. Most of the doctors he refers to are not the ones who spend their time primarily at Floyd. They come in quickly, make rounds, eat and leave. They are not involved in any of the critical committees or governance.

Questions #7
Basically, his answer appears as if he has no clue about the future needs and until he hires the next consultant to come in and tell him what to do, he will not commit. Yes the community needs more beds. There will be increasing demand for all services and since physicians are reluctant to partner with the hospital, as long as he is the CEO, the hospital will not be expanding much off of the current campus. The shell space he refers to on the 3rd and 4th floors was something he was opposed to and the Board voted in favor of building it. I ask the architect and builder the question: “In all your years of building, if the facility had the capability of building additional floors after the initial project, how often did they do this.” The answer was almost never. You either build it at the start or it doesn’t get built.

Question #8
The physician number he refers to from 125 to 500 is very misleading. Yes there are about 500 physicians, but about 400 of these are consultants from Louisville who have privileges but rarely if ever step foot in the hospital. The amount of primary care doctors and surgeons has not grown substantially and we are still short in several areas. If you look at their website, you will see the following because we do not have enough primary care physicians.

Physician Practice Opportunities

Specialty physician opportunitites currently available at Floyd Memorial include:

o Family Practice o Cardiology o Interventional Cardiology o Internal Medicine o Pulmonary Medicine o Hospitalists

For more information on practice opportunities at Floyd Memorial, please contact:

Robert L. MackinVice President of Managed Care and Marketing
Phone: (812) 949-5596

The 500 number he quotes is very misleading. Some physicians have to maintain privileges at a hospital because one person in their group comes here or because certain insurances require it. It does not mean these physicians are actively participating in anything at Floyd.

As you can see, we could discuss each of the issues in great length.

There is a lot more than Chris was told and readers were led to believe.

Unfortunately, Chris didn’t ask him about the current financial situation, the freeze on hiring even though we are short-staffed, the failure of Joint Commission Accreditation, or the failure in partnering with the surgeons on the new outpatient surgical center.

Meeting with Senator Sipes and Congressman Cochran

Attendees:

Senator Connie Sipes
Rep. Bill Cochran
Pediatricians representing all practices in the surrounding 5 counties were present
Representatives from Molina
Representatives from Harmony Health
Chris Morris from the Tribune
One local Cameraman from a news agency

Summary:

Beginning around 2005, the State of Indiana took about 90% of the dollars it spent in 2004 and paid it to 5 Managed Care Organizations (MCO’s) in order to have them manage the Medicaid population. These 5 MCO’s competed with each other for both patients and for physicians to be part of their provider panel.

A few months ago, the State asked for current MCO’s in Medicaid as well as others to submit a “Request for Services” proposal for 2007. They were told that there would be one MCO selected statewide.

When information was evaluated and completed, the committee selected three MCO’s and Harmony, Molina, and Care Source were excluded. Anthem was one of the three selected even though they have never provided for Medicaid services.

This has serious implications for Southern Indiana as the vast majority of patients on Medicaid are either in Harmony or Molina.

Harmony and Molina are both appealing the selections and therefore the final recommendation to the State by the committee is placed on hold.

The State has already been on a corrective action plan by CMS because of access problems for patients and this proposed change will only make access a much larger problem.

The major problems discussed at the meeting dealt with the concerns of how 220,000 Medicaid patients and every physician in our area will be able to meet, negotiate, contract with the three MCO’s that currently do not serve our area. It takes an absolute minimum of 3 months to contract with an Insurance company if everything goes perfectly. It will be impossible to do this in the time frame the State has set.

The goal was to have patients choose the MCO rather than the provider and the State wanted every provider to sign up with each of the three MCO’s. But the consensus at the meeting was that physicians would only sign up for one if they even elected to continue in the program. These MCO’s each add a tremendous cost to the office overhead because of all the restrictions in what you can order, formularies, etc. None of the physicians planned to sign up with all of them.

Therefore, patients will normally want to see which MCO their doctor is with before they choose. If the MCO’s have to contract with physicians first before they start enrolling patients, it will be impossible to complete this by January. This will leave patients with no provider and no knowledge of how to access their care. Many will continue to over-utilize the Emergency Rooms and Urgent Care Centers adding more cost to the already overburdened system.

The additional concern is that these MCO’s have consistently been slow to pay and getting a consistent cash flow from them has been difficult. Changing to another new MCO will exacerbate this problem and for some of the practices that have 50% or more of Medicaid as their patient base. Medicaid rates are already the lowest and have not been changed since 1989. None of the proposed new MCO’s pay rates are as good as Molina or Harmony and this cut in addition to the other problems will cause many pediatricians to financially fail. Some stated they could not make payroll if this were to happen.

Mr. Cochran and Senator Sipes listened and asked several questions trying to get a better understanding, but in the end stated there wasn’t much they could do legislatively at this point. We did discuss filing a legal injunction to hold the implementation of the proposed change.

Results of the meeting were as follows:
• Mr. Cochran and Senator Sipes were to speak with the Commission Chairman and ask for a meeting where he would come to Southern Indiana and speak with us.
• Get dates for the Medicaid Oversight Committee where physicians could attend and testify.
• Mr. Cochran and Senator would speak with the Governor personally
• Physicians would contact the ISMA and AAP for their assistance and would also inform the local hospitals of the potential problems that will affect them through lack of coverage for Medicaid patients.

Miller not beer

Our friends over at New Albany Confidential would certainly agree with this particular judge when he dismissed a case involving selling beer to a minor.

The judge ruled that “Miller Genuine Draft” may not really be beer.

[NBC10.com - Local News - State Court Rules Miller Genuine Draft Is Actually Beer]

The case was later overturned by the Superior Court Judge.

Maybe the original judge just likes microbrew.

The importance of sales

The article listed below is a very good summary of how our society is influenced by sales:
[Age-old sales lessons]

One excerpt states:
The selling profession is a complicated business, and it is often misunderstood. Trying to make sense out of why people buy from one organization as opposed to another can be mystifying, especially when the products and prices are similar. In the end, however, it's not that complicated. It comes down to trust and relationships. No matter how many so-called experts try to take feelings and perceptions out of the selling equation, they can't.

The basic underlying principle applies to physicians and hospitals as well as every other aspect of our society. The two principles are trust and relationships. I have re-iterated this many and have stated it is the primary reason more physicians are choosing not to partner with the current administration at Floyd.

Maybe the book listed in the article, The Giants of Sales by Tom Sant, should be required reading for the current administration and Board.

Trustee Article and trust issues

In a recent Trustee magazine, there is a very good article on the hospital-physician relationship. [Trustee: the magazine for health care governance]

The article compares this relationship to a marriage, just as I did in a post months ago. It also stresses the importance of trust between administration and physicians, just as I did months ago. (See postings from February 1, and February 3, 2006)

Some notable quotes from the article are:

This ties into what Kaufman describes as the need for “radically open communication” with physicians. “Physicians always assume first that hospitals want to control them … that they [hospitals] are a business that doesn’t care about physicians,” he explains. By “overcommunicating” what the hospital is doing and why, repetitively and through multiple avenues—from newsletters to one-on-one conversations—the rapid changes hospital leadership are being forced to make have a better chance of being understood, he believes.

“And, once you are caught in a half truth, that’s it. Their trust in you is your credibility.”

“You have to ask for input from physicians ahead of making a decision and then communicate with them during [the process] and afterward,”

Kaufman adds that hospital leadership “should always invite dissent—a lot of good projects have developed because physicians pushed the hospital when it didn’t want to do something.” He says that the board should know what those dissenting opinions are and what those who disagree are saying.

“Ego doesn’t require us to control [our physicians],” Bjelich says. “How do we both succeed? Without trust, you don’t have a relationship, you have a contract … we don’t need to review our contract. If we do, our marriage is in trouble.”

These are the same things I voiced to the administration and the Board as a Board member and the things I continue to voice now.

In my opinion, if the rest of the Board cannot begin to understand the impact of this trust and relationship issue and make the needed changes, our hospital will continue to succumb to the poor decisions that are characterized by the current leadership.

How many more opportunities need to be lost before they understand our current leadership is costing more than they are benefiting the hospital.

More physician cuts from Medicare

The CMS released information on August 8, 2006 and said physicians are scheduled to receive a 5.1% Medicare rate cut in 2007 under current law. This would mean that most 3rd party payors also would follow with similar cuts.

CMS anticipates that spending through Medicare will be approx. $61.5 billion on physician services in 2007 under the proposed physician fee schedule. The proposed regulation also stated that it will expand coverage of preventive services and add 14 Medicare-approved procedures for ambulatory surgical centers in 2007 and expand the list further in 2008.

When you look at this proposal, what is going to happen is that the overall Medicare payments in 2007 will be less than 2006. If they truly expand preventative services and add 14 additional procedures, the cuts will have to occur in other areas currently being offered. This will be extremely bad news for some physicians.

Many more physicians will have to limit or stop seeing new Medicare patients if they are to survive. We cannot continue to run a medical practice with ever-increasing costs and continual decrease in revenue. It is economically impossible.

Access to healthcare will be further limited and patients who cannot find primary care physicians will obtain their needed care through emergency rooms and Urgent Care Centers which will then cost the taxpayers even more money.

Legislators need to grasp the bigger picture and better understand that these are very poor and short-sighted solutions to the much larger problem. At least one republican congressman understands and has introduced a new bill to eliminate this cut and actually fix the Medicare payment system to keep up with real costs of providing care.

Health Insurance for working and low income families

One of the readers of this blog sent me an email and asked if I would post some information about health insurance for children with working parents but no access or financially unable to afford insurance.

The pictures listed here are general information and guidelines on how to qualify for Hoosier Healthwise.

In addition, the main website is here: [Main]

Hoosier Healthwise [Hoosier Healthwise]

Enrollment Centers [Enrollment Centers]

The Application for Food Stamps, Cash Assistance, and Health Coverage can be downloaded and printed out from the following website: http://www.in.gov/fssa/family/forms/index.html

Hoosier Healthwise Helpline toll-free at 1-800-889-9949

In addition, I spoke with a friend at Ricke and Ricke Associates here in New Albany.812-944-4461 and they gave me some additional information.

Families who do not qualify for Hoosier Healthwise, those who do not have insurance through their employers or those who choose to buy something on their own can contact a number of local agents including the one listed here and obtain individual, children only, or family coverage.

The price for family coverage for two parents age 30 and two children with a $500 deductible can range from $200 range to $600 range with an average around $405.

I hope this is helpful for the reader and anyone else that may be struggling with obtaining coverage.

Lunar phases

In many different cultures and mythologies, the moon is related to everything from violence, hormonal changes, melatonin changes, to fertility, pregnancy and delivery.

There have been numerous studies correlating lunar phases with each of these topics, but never consistently showing statistical significance.

From our practice, we definitely believe that the moon plays a significant role in individual’s emotional and psychological health. As a general rule, we do not follow the lunar phases on a proactive basis, but during certain weeks, we can definitely relate our patient’s complaints and their psycho-emotional states to the moon phase.

We consistently see more emotional distress and emotional lability during the week preceding the full moon and then again the week preceding a new moon although it is less dramatic. Our office staff can pretty much always confirm the difference in the patient’s behaviors during these weeks.

From an observational standpoint, we truly believe that the lunar phases have a direct impact on psycho-emotional issues we see in the office. We may try and eventually develop a survey tool to better elucidate the changes noticed.

New Coding dilemma

There continues to be ongoing talk and increasing resistance to a proposed transition from our current coding scheme called the ICD-9 to a new proposed system called ICD-10.

The transition is scheduled to be implemented by 2009. If this happens, it would involve increasing the number of codes we currently use from 24,000 to about 207,000.

This increase would cause a significant additional burden to physicians and their offices. It would also allow insurance companies to find new ways to impede their payment of claims. It would allow these companies to require different codes for the same overall condition and thereby placing increasing burdens on our offices.

An example is a patient with a simple sprained ankle. Currently there is a simple code that covers this injury. With the new system, it would have the options of specifying right vs. left, and the degree of swelling and pain. One insurance company may require all of these things to be listed whereas others may not. If you do not fill out everything they want, they will deny or withhold payment.

Physicians should not have to provide this specific of information to the insurance company. It does not affect the overall degree of the office visit. It just allows the insurances more ways to deny payments.

This is a very simple example and you can just imagine when it comes to complex problems difficult this problem could become.

We do not need to allow the medical coding to follow the same path as our tax codes have followed.

When are politicians going to learn??

Moral Relativism

I am continually puzzled by those who always seem to deny objective moral reality. Not being able to define an entity does not mean it doesn’t exist and given that we all acknowledge infinity, we should agree that some things are unknowable for our finite minds and bodies.

There are unknowable things that exist outside of us.

Objective moral truth is one example. It does exist and should be acknowledged.

Moral Relativism is our current cultures attempt to rationalize bad behaviors and poor choices. Moral relativism holds that moral and/or ethical beliefs do not reflect absolute and universal moral truths and are instead based on personal, historical and cultural preferences of the individual or society. This becomes a very slippery slope and one that ultimately leads to chaos.

Moral categories become meaningless if relativism is true and any attempts at moral discussions become an exercise in futility. The only rational course of action truly consistent with moral relativism is complete silence.

When the moral relativist speaks, he/she surrenders his/her relativism.

Complete silence and not speaking up about obvious injustices and evil is inhumane and could be considered “evil by proxy.” This is detrimental for any society or organization.

I believe the picture above says it all. There is evil and it's tiring to see and hear the media rationalizing the behaviors of the radical terrorists in Lebanon and elsewhere.

More on compensation

Modern Healthcare has also listed the compensation averages for key executives in Hospital systems and is shown in the charts here.

The company performing the analysis shown in these charts is the same company the Board has used to evaluate CEO compensation.

The Board has kept our CEO’s salary in this midrange and these numbers correlate very well with the current salary structure.

What do the readers think about these numbers??

Should salaries and compensation be managed like other areas in healthcare to control the rising costs?

Newest Compensation Charts

Modern Healthcare has their annual compensation report available. It is posted at the following site. [Controversy, salaries rise]

The 1.7 million stock options that UnitedHealth bestowed on McGuire last year pushed his total to 35.2 million options, valued at $1.78 billion -- a figure that has turned the 57-year-old executive into critics' poster child for exorbitant corporate pay in recent months




People continually complain about exorbitant healthcare costs and usually blame those who are most easily targeted. But this article shows that we have a system that is way out of balance when it comes to paying for services that are actually performed.

Sooner or later, if affordable healthcare is truly an item of mutual concern then we will have to address these kinds of issues. If free market is to rule, then we need to eliminate the restraints on select individuals in the healthcare field and require individuals to dictate healthcare by their pocketbooks and wallets. This means individuals will need to take responsibility for the cost of their healthcare rather than abrogating it to third parties. Third party payers are destroying our access and quality of care.

On the other hand, if we decide to govern and legislate healthcare, then we need to reform issues like these outrageous salaries and perks. We will need to simplify the methods and payment structures and place limitations equally. The current situation, as shown in the charts, is sucking our system dry.

We cannot have it both ways.

Preventative services

In a recent study conducted by Partnership for Prevention, they ranked the health impact and cost effectiveness of 25 preventive services recommended by two nationally recognized sources: the U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices.

In this study, they identified:

• 
  Preventive services that are most valuable
  Highest-value preventive services that are most under-utilized, and
  Preventive services that would provide the most gains in health were utilization rates increased.

The article here shows which services we should focus our efforts. Certainly public education would also be of significant benefit.

Diabetes and Alzheimers

More and more studies are validating the link between Alzheimer’s and Diabetes. This recent article summarizes some of the key points. [Link Between Diabetes and Alzheimer’s Deepens - New York Times]

The article states “The connection raises an ominous prospect: that increases in diabetes, a major concern in the United States and worldwide, may worsen the rising toll from Alzheimer’s. The findings also add dementia to the cloud of threats that already hang over people with diabetes, including heart disease, strokes, kidney failure, blindness and amputations.”

This is a concerning association because we know the American diet and associated obesity of our culture is leading to an increasing number of type II diabetes cases. If the trend continues and the association is correct, we will be seeing even more Alzheimer patients.

Any family who has dealt with this illness knows the devastating effects it has on families.

Studies are still out, but control of blood sugars may be an added benefit to reduce the risk of the disease.

Some of the new diabetic drugs that are currently available are also being studied for their effect on helping slow down the progression of the disease.

This is another good reason to watch your weight and diet and make some lifestyle changes that will be of benefit.

Worthless meetings

Another physician this week commented he attended the recent Physician-Board breakfast meeting. He commented that with as much controversy over the outpatient surgical center that the physicians have elected to build without the hospital, he would have thought that at least one of the three Board members would have brought up the topic and asked why the deal fell through with the hospital.

He further commented that the Board members did not ask any significant questions about any particular topic.

There are legitimate concerns from physicians and the Board has been informed of them, so the question remains; why do they choose to pass on an opportunity to hear directly from physicians?

This particular physician stated that they really don’t want to know and they really don’t care.

I actually believe that to be incorrect.

I believe they really don’t like conflict and if they asked the tough questions, the answers would come back to an area they refuse to address; the CEO.

I pushed for these meetings with physicians to be held off the hospital campus and to be held without the CEO present. I also pushed for the Board to have a list of questions to ask directed at some of the known problems we are facing. This recommendation never received the majority of votes.

Few physicians or Board members want to begin a difficult conversation, in the lounge, knowing you only have a spare 10-15 minutes, all while other people are coming and going.

The current meeting structure is a waste of time for everyone involved, but at the end of the year, the CEO always lists these meetings as one of his completed objectives.

It doesn’t matter that they are worthless and a waste of time. For him, it is part of his bonus structure.

Meetings like these do give physicians the perception that the Board doesn’t care and that it is all for show, but it doesn’t have to be that way!

Will someone step up to the plate before it is too late?