Friday, December 29, 2006

Mad Dash


So, picture this scene.

It's 2AM, and already a massive horde is forming outside of the local Target and Wal-Mart stores, fighting to be first in line before the doors open at 7:00 am.

What seems to be the attraction? Is a celebrity coming to visit, or is there a mad frenzy over the latest fashion design? Maybe they heard there was a “blue light” special and thought something was awry since they are not at K-mart.

No the attraction is the rumor these stores are receiving a limited shipment of the new Nintendo Wii.

These individuals are enthralled with everything that has been written, posted and fantasized about for the last few months.

They are addicted to gaming or have someone in line that is enabling an addiction.

Is it healthy for our society to become addicted to gaming?

Where are our priorities?

How is gaming hurting relationships and interpersonal skills?

The worst incidents reported during these rushes into stores include people being shot waiting in line as seen in the following post. Thugs shoot man in Playstation 3 waiting line in Connecticut - Boston.com

But the injuries don’t end while waiting in line either.

In recent weeks, the Web has been inundated with reports of excited gamers losing their grip on the Wii's controller or smacking their arms into nearby objects.

Nintendo has responded by issuing a general "calm down" to its customers and by beefing up the controller's fabric wrist strap.

The lawsuits, offbeat stories, and repeated injuries certainly haven't hurt sales. The market research company NPD Group estimates that U.S. consumers bought 476,000 Wiis in the two weeks following its Nov. 17 launch. That beat Sony Corp.'s PlayStation 3 console, which sold just fewer than 200,000 units in roughly the same period amid widespread shortages.

Because of the nature of the Internet, one or two occurrences becomes 2,200 experiences that are easily read about on the “net”

The company is hoping that some initial information showing that gamers seem to be blaming each others' klutziness more than they're criticizing Nintendo's design will help prevent too many lawsuits.


**Source of cartoon found on the web. Author unknown

Thursday, December 28, 2006

Glimmer of hope

As we finish up the year, we face many tough challenges for 2007. Floyd Memorial has struggled more this year than any year I can remember since I began with Staff privileges in 1992.

But there is good news amongst all of the negatives we have seen and heard for the past few years.

The reports coming out of Floyd are saying the CFO at Floyd Memorial has been terminated even though the official report will state a resignation!!

Why now is a question being raised?

The answer in my opinion is very plain to those who have been following the situation. The finances are poor, the leadership is lacking and the CEO is trying to save his own hide by "sacrificing the lambs".

He has terminated a 40 plus year tenured nurse, now the CFO and many are wondering who will be next.

This is all to make it appear like he is taking control of the sinking ship and to shift blame to others while attempting to divert attention from his own failures.

This in my opinion also demonstrates the character of the individual. His survival mode is taking over so everyone will need to be extremely cautious.

I've been saying for several years that it didn't have to be like this. We could have had a smooth transition if some on the Board would have taken their responsibilities more seriously.

These recent events are in addition to the fact we have a new County Commissioner (Mark Seabrook) who seems truly concerned with what is happening to our local hospital.

He will now be the second Republican and hopefully he and Steve Bush will begin the paradigm shift and transition from appointing friends or political advocates to appointing the best qualified individuals for these very important positions.

Chuck Freiberger will be in the political minority for the first time in his career. We will be anxious to see how he handles this new reality.

The new Commissioner will be replacing Bob Kleehammer and Darryl Mills with two additional Board Members. One or both should be physicians.

Darryl Mills will be embarking on his new job as Sherriff and Bob Kleehammer has served two terms and will unlikely be given another.

All of these recent events plus the addition of two new Board members along with the recent two just added certainly gives physicians and staff something to look forward to. There may finally be enough “new blood” to make some appropriate changes.

I still encourage any interested party to submit a letter to the Commissioners for consideration in either of these two Board appointment positions.

The Commissioners have received at least two recent letters from employees in management validating the things posted on this blog for the past year.

I am confident we have made a difference and facilitated some of the changes we are seeing. Getting the information out and informing those in positions of leadership does make a difference!!

Wednesday, December 27, 2006

Leadership change on the Hill

There will be serious ramifications in the aftermath of their midterm elections with the Democratic sweep. This will be felt especially in the area of Healthcare. Some changes have the potential of improving some situations while others could be devastating. Some Democrats will reclaim certain key roles in the influential healthcare panels in the House and Senate while others will lose.

Pete Stark (D-Calif.), will be taking over the chairmanship of the Ways and Means Health Subcommittee which Rep. Nancy Johnson (R-Conn.) had chaired. She was one of the architects of the Medicare Part D prescription-drug bill and a force behind the healthcare information technology bill H.R. 4751. The House Energy and Commerce panel will be taken over by Rep. John Dingell (D-Mich.).

Sen. Chuck Grassley (R-Iowa), who currently chairs the Senate Finance Committee, will trade places with former ranking member Sen. Max Baucus (D-Mont.) and on the Senate Health, Education, Labor and Pensions panel, former ranking member Sen. Edward Kennedy (D-Mass.) will switch with Sen. Mike Enzi (R-Wyo.).

Republicans who lost their seats include Rep. E. Clay Shaw Jr. (R-Fla.), who pushed for medical malpractice reform and broadening insurance coverage options, and Sen. Rick Santorum (R-Pa.), a member of the Senate Finance healthcare panel.

The American Hospital Association (AHA) states they are committed to working with the new committee chairs and expects a smooth transition from one party to the next. Of course money can influence both parties as we all know.

Specialty hospitals are unsure of how the new leadership will impact them but it is unlikely there will be any major changes very quickly.

Hopefully, the recent Bill proposed reversing the 5.1% Medicare rate reduction will lead to some serious and well needed changes, but the rest of the Bill that passed could cause more problems. We will keep our fingers crossed, but we remain skeptical.

Thursday, December 21, 2006

Christmas Blessings



Wishing everyone a very Merry Christmas and a Blessed Holiday Season.

I will be taking a few days off over the holidays to celebrate and spend time with family. Hope to hear your ongoing comments when I return.

Success guaranteed





Although this cartoon is poking fun at the situation, the feelings of many people is that it accurately portrays the current environment.

Surgeons are making statements that with the current cuts in staff and scheduling difficulties, the administration is actually pushing the Medical Staff away.

Once these other facilities are completed, you can bet that many on the current staff will at least be trying these facilities to determine if they are more receptive and facilitating to the needs of physicians and our patients.

The costs to Floyd will be even greater as more competition means less revenue.

It is looking like a spiral staircase that only goes down!!

Wednesday, December 20, 2006

ER wait times

This recent article sent to me by a friend defines a problem not uncommon to any local hospital. Hospitals work to improve ER wait times - Nightly News with Brian Williams - MSNBC.com “The wait can seem unbearable when you need help. Across the country, the average emergency room wait time is now 222 minutes — that's 3 hours, 42 minutes.”


The facts are clear. Emergency rooms are busier than ever and patients are waiting longer than ever before in most hospitals. The problem is compounded when you have a bed shortage on the floors, the OR’s and other outpatient centers and cannot efficiently move patients from the ER.


The problem therefore is not just an emergency room issue, but a system wide hospital problem that has to be addressed in a multidisciplinary approach.


Fast-tracking, color coding, appropriate triaging, increased staffing and bed expansion are all part of the immediate ER fixes, but every other area and department in the hospital has to do their part to turn over the beds and become better utilizers of limited resources.



Since ER is one of the areas quoted by the CEO as being overstaffed, cuts in this department at Floyd will assure us that wait times here will be increased.

Tuesday, December 19, 2006

Commissioner's last regular meeting

Today is the last day of the regularly scheduled meeting for the County Commissioners. John Reisert will be attending the last meeting of his political career.

This is where the concern lies.

The commissioners have voted to approve the addition of two additional Board Members to the hospital. They asked for interested parties to submit letters for consideration and to have them in before the 15th of December. They are planning to appoint these two individuals without actually interviewing those who submitted letters. It seems irrational that they could make the best informed decision without actually interviewing the candidates unless they already know who is to be selected. I know of at least 4 individuals who submitted letters and none of them have been contacted.

The question remains; will the commissioners make these appointments tonight or will they allow the new Commissioner (Mark Seabrook) to choose the board members after he takes office in January.

Appointing them without the diligence of interviews etc. has all the earmarks of a political maneuver.

With all of the issues at Floyd and the potential staff reductions (layoffs), the Commissioners need to take their time, evaluate the potential candidates, and make the best informed decision.

Rushing the process and making a political appointment could cause further declines in oversight of the Hospital’s administration and decisions. We could wind up losing the Hospital as a County asset.

I would hate to see Dr. Reisert end his political career making appointments purely on political grounds when so much is riding on this decision. He has had a distinguished career in Education and as a Commissioner and this could alter the image many have of him.

Monday, December 18, 2006

Tribune putting on some heat

Big headlines in the tribune on Friday reported that Floyd will be cutting staff in 2007.
The News and Tribune - Floyd Memorial Hospital cutting staff hours in 2007

The reporter asked some very good questions, but still did not push for definitive answers in some areas. The reporter also attempted to contact the CEO on more than one occasion but was eventually directed to Mike Ford, the newest VP who was moved into this “VP” position this year while other departments were asked to cut their budgets. Once again, the CEO is avoiding the reporters when the news isn't good.

Here are some of the comments from the article along with commentary:

  • No layoffs are planned at the moment, said Mike Ford, the hospital’s vice president of human resources, but “in a couple of months, if we’re still over budget, then there could potentially be some reductions in force.

They need to tell this to the managers of certain departments that they have directed to cut their FTE’s. Just be sure you don’t use the term “layoff”.

  • Ford replied, “To be honest, we don’t know. We don’t know how effective this (part-time reduction) will be.”

I agree with the term “we don’t know”. That pretty much sums up this administration.

  • Projections show the hospital must eliminate man-hours equivalent to about 90 full-time employees to balance its budget, Ford said.

This seems to disagree with his first statement. The reductions in force are anticipated and already being planned. Just ask the managers who are trying to figure out how to cut their staffs.

  • Incoming Chief of Staff John Grief described “a lot of talk going around the hospital” about potential staff reductions.
  • “We have not been told anything definitive,” Grief added. “I know some of the employees of the hospital are concerned, but I have not heard of any staff or positions that are in danger.”

Dr. Grief is a better diplomat. The key word is “definitive”. He was at the same meeting as I where the CEO specifically stated we need to cut approximately 130 FTE’s (full time equivalents) to meet the projected 2007 budget. The CEO did not give specifics about where or who needed to be cut.

  • Bob Kleehammer, chairman of the hospital’s board of trustees, said Chief Executive Officer Bryant Hanson is “pretty adamant” that “we’re not going to have any layoffs.”

This statement here pretty much epitomizes the Board’s knowledge of what goes on at Floyd and how much accurate information they are receiving. What does the CEO tell them and how is that information sugar-coated. If they are receiving the information, how far is the Board willing to go to protect the CEO in the face of evidence to the contrary? Maybe its time for a change in Board composition.

  • Board of trustee’s member Von Marshall said he expected to be briefed on staffing at the board’s meeting Tuesday afternoon.

Mr. Marshall is one of the minority of Board members who has challenged this administration and has voiced concerns in the past. I am sure he is anxious to get the truthful and accurate information.

  • Scaling back hours on all part-timers would close the budget gap, Ford said, but could leave some services wanting.

This is a gross understatement. Cutting hours will leave services wanting as Mr. Ford has said.

  • Care would not be affected by staff cuts, Ford said

Which is it Mr. Ford. Will the cuts affect patient care or not. It seems your statements are contradictory.

  • We’re really hoping that our volumes go up so we need the extra staff,” Ford said.


The employees are the ones hoping. The administration is supposed to be proactively doing things to make this a reality. Where is the plan to increase volumes? How do you increase volumes by cutting Operating Room hours, Interventional hours and support staff that make these things happen? Administration should be doing more than “hoping”.

  • “Anytime you start cutting jobs, especially from a county hospital, that’s not good, especially when you have a $65 million expansion,” Bush said Thursday.

This is correct Mr. Bush. Now we expect you and the other County Commissioners to do what is right. You need to wait on appointing any new Board members until the newly elected Commissioner (Mr. Seabrook) takes office in January. Do not allow a special session to take place before the end of the year so that 2 political appointees can be named before Commissioner Reisert leaves office. The hospital, staff, physicians and community are relying on you to do what is right.

Friday, December 15, 2006

Season's Greetings

Here is a little greeting that I found humorous. Not sure where it originated but it was emailed to me by a friend.

For My Democrat Friends:

"Please accept with no obligation, implied or implicit, our best wishes for an environmentally conscious, socially responsible, low-stress, non-addictive, gender-neutral celebration of the winter solstice holiday, practiced within the most enjoyable traditions of the religious persuasion of your choice, or secular practices of your choice, with respect for the religious/secular persuasion and/or traditions of others, or their choice not to practice religious or secular traditions at all. We also wish you a fiscally successful, personally fulfilling and medically uncomplicated recognition of the generally accepted calendar year 2007, but not without due respect for the calendars of choice of other cultures whose contributions to society have helped make America great. Not to imply that America is necessarily greater than any other country nor the only America in the Western Hemisphere, and without regard to the race, creed, color, age, physical ability, religious faith or sexual preference of the wishes. By accepting these greetings you are accepting these terms. This greeting is subject to clarification or withdrawal. It is freely transferable with no alteration to the original greeting. It implies no promise by the wisher to actually implement any of the wishes for herself or himself or others, and is void where prohibited by law and is revocable at the sole discretion of the wisher. This wish is warranted to perform as expected within the usual application of good tidings for a period of one year or until the issuance of a subsequent holiday greeting, whichever comes first, and warranty is limited to replacement of this wish or issuance of a new wish at the sole discretion of the wisher



For My Republican Friends:



Merry Christmas and a Happy New Year

Labels:

Thursday, December 14, 2006

Manipulation

I was asked what the CEO thought about the recent election results, both in the Medical Staff as well as in the Commissioner’s race.

Although I can only speculate as to what he is thinking, his actions have certainly shown many people his true colors.

Since the two elections, he has taken a much more aggressive role to have the current commissioners expand the Board of Trustees to nine members. This was requested months ago, but just by coincidence it never was acted upon until after the elections.

In addition, at the Board meeting in November, he convinced the current Board to pass a new amendment to their Bylaws that would prevent a physician from serving on the Board of Trustees and the Medical Executive Committee at the same time. Again, this came up after the election results did not go in the way the CEO would have liked.

This was done even though some Board members asked for it to be discussed with the Medical Executive Committee first. It passed without ever having physician input by the general staff or the Medical Executive Committee.

The reasoning that is given is to prevent conflict of interest. But I guess there is no conflict to have a bank president on the Board when the hospital keeps several million dollars in his bank, or insurance agents who the hospital uses for services, or having the mother of one of the surgeons and the Mayor serve on the Board. I guess there are no problems as long as these individuals continue to vote the way he wants.

In many people’s opinion, these are more examples of the underhanded, manipulative tactics that we continue to witness.

Who’s ready for change??

Wednesday, December 13, 2006

Collaborative relationship--We think not


As reported in Modern Healthcare, the aggregate profits at community hospitals hit another all-time high last year at $28.9 billion. This was up from 2004 and is predicted to be up again this year. The aggregate profit margin for the registered community hospitals like ours was 5.3% and was the highest margin in seven years. Our margins are below this and trending downward.

These hospitals reported aggregate net patient revenue of $505 billion in 2005 which was also an increase. The AHA reported that the total number of hospitals in the U.S. dropped even though their total inpatient admissions rose to just over 37 million.

Since 1977, the total number of hospitals has declined and the number of licensed hospital beds also fell. This has created the increasing crunch we are now seeing with the ever-frequent diversion issue. The AHA also reported that Medicare reimbursement to hospitals has stayed about the same for the past 2 years.

All of this begs the question as to if we are doing the right things at Floyd to anticipate and make plans for the future needs of our County. With the addition of the Heart program, all the consultants say it will lead to many other types of surgical procedures and medical admissions.

So why are we considering building a new surgical floor in the unfinished addition that will provide fewer beds than we currently have? Even if some of the surgical beds are now being used for medical admissions, the next 10 years will certainly see a rise in surgical procedures if we are to remain financially solvent.

The physicians don’t think it is a good idea but there has been no open forum for discussion up to this point in time. The architects have already given preliminary blueprints to administration with little to no input from the Medical Staff. I have contacted administrationour and hopefully we can give some needed input and direction before any final decision is implemented.

Does this sound like a collaborative working relationship with the Medical Staff? Physicians should be involved with these decisions before blueprints and other decisions are made. We shouldn't continually have to approach the administration after the fact to try a prevent another bad decision.

Tuesday, December 12, 2006

IN shape Indicana

One of my college professors emailed me a link he thought we should highlight. INShape Indiana

The 2006 INShape Indiana Health Summit took place on Monday, November 27 and was an incredible success. The Summit brought together 748 individuals from 82 counties, all of whom were committed to reinforcing the INShape Indiana message

The summit covered topics such as tobacco, meeting current healthcare needs, health initiatives, and Fort Wayne’s one million mile campaign.

Indiana is at or near the top of every negative health measure, including obesity, smoking rate and the many afflictions that accompany them: high blood pressure, diabetes, cancer, heart problems and stroke.

The above web site covers many topics related to health and fitness and how we can all get involved.

Our local college (IUS) is also helping with mapping trails in Clark County for healthy walks.

Monday, December 11, 2006

More concerns

There is more and more concern from all medical organizations about what the new congress will or won’t do related to Medicaid and Medicare.

Recent articles include Modern Healthcare Online that states “An ambitious new proposal from an HHS-appointed panel to revamp the Medicaid program is unlikely to prompt much action from Congress now that Democrats will control both the House and the Senate.”

And in another article Modern Healthcare Online they state “The Government Accountability Office said Congress must act to reform Medicare and Medicaid or both programs may be fiscally unsustainable in the long run. Suggesting areas of action for the 110th Congress, GAO Comptroller General David Walker said the federal government should modernize Medicare payment policies to reward quality and efficiency. Walker also said lawmakers should assess the CMS’ managerial oversight of Medicare and reform Medicaid to curtail states’ use of inappropriate financing schemes to boost their federal matching funds. Federal Medicare spending represents about 3.2% of the gross domestic product currently and could rise to 7.3% of the GDP in the next 30 years without congressional action, Walker said in a letter earlier this month to congressional leadership”

The AMA and most other organizations feel like, with the election of the new congress, most of these changes will be placed on the back-burner. This will lead us further into access problems for patients and poorer quality patient care. It will increase the use of emergency rooms and actually cost more money in the long run.

Friday, December 08, 2006

Times of trouble



Where have we gone with politically correct speech??

Thursday, December 07, 2006

Work hours



In a recent article from Medical Economics they report that physician productivity is down again. Exclusive Survey—Productivity: Work hours up, patient visits down - Documentation, insurance, and compliance issues are keeping many doctors in the office longer. - Medical Economics

This continues to show a consistent trend and some key passages from the article are:


What's going on here? It's the paperwork, say practice management consultants. One, Ginny Martin of Health Care Consulting Associates of Northwest Ohio in Waterville, attributes the longer hours to the steady rise in coding documentation requirements and the need for more physician involvement in the administrative side of running an office. Another explanation, she points out, is the aging population. Patients are presenting with more complex medical histories and problems, requiring additional physician time.


Also, doctors who are switching from manual record-keeping to EHRs might find that they have to put in more office hours to get the new system up and running. "We've seen EHR implementation dig deeply into physician productivity until the practice members are adept at using the system," says Judy Bee of Practice Performance Group in Long Beach, CA.


In addition, the report showed that female physicians still work fewer average hours compared to men but the gap is narrowing. The reason given is that more female physicians are available in the workforce and practices do not have to accommodate part time physicians if they don’t want to. Even with the gap narrowing in work hours, the number of patients being seen by female physicians is still markedly different on the average with females physicians seeing fewer numbers.

Wednesday, December 06, 2006

Non-profit growth


In this recent article from Modern Healthcare Online it is clear that although the hospital industry remains fragile, the overall outlook for non-profit facilities like Floyd has looked very good. The 2005 numbers posted in the article are very good with projections for 2006 to be as good or better. We then have to question why Floyd is financially struggling.

Some key excerpts from the article are:

"As anyone can tell, things are getting better," said Marcelo Olarte, an analyst for Fitch Ratings, which scrutinizes the performance of 240 not-for-profit hospitals.

Much better, by many measures, according to the trade group's yearly snapshot of nearly 4,900 hospitals' aggregate finances and operations.

Revenue growth -- which held steady at roughly 7.3% -- outpaced expenses in 2005 to deliver a $28.9 billion profit and the highest margin, 5.3%, in seven years, the hospital association figures show.

Actual revenue totaled a record $544.7 billion last year. Expenses climbed to $515.7 billion, up 7.1%. That's a slight uptick from the 6.9% rise a year earlier. Despite that increase, efforts to curb expenses such as labor, supplies, capital-intensive technology or construction have fueled recent financial gains, credit analysts said. That success, combined with favorable, or "benign," reimbursement from private and public insurers, including Medicare, buoyed budgets, they said.

Some questions that need to be asked are:
As of the end of september,
Gross revenue is only down about 1% from the budget projection
Net revenue is only down about 0.5% from the budget projection
FTE’s paid are actually down 1.4% from the budget
Operating expenses are up ~2%

Yet the reported net income is actually down 50% from the budget.

It is very difficult to see how this happened if the budget approved for 2006 was correct. Where is the money?

Tuesday, December 05, 2006

Budget crisis

At a recent meeting, the CEO told us that they are looking to cut 130 FTE’s in order to make the budget for 2007. He refuses to use the term “layoff”.

Rather, he creates phrases like “we are going to grow with less”, we will “cut through attrition”, or some may need to find new employment.

The bottom line is this:

When we built the new $65 million dollar addition, the CEO stated we hired about 160 new employees. Now to meet 2007 budget, we need to cut 130 FTE’s. This means we will have the huge addition, the new heart center, the new ER with only 30 additional employees.

It doesn't take a rocket scientist to figure out that when you add this huge addition, hire 160 employees, but only add a handful of beds, this abstract ratio of FTE/adj. occ. bed is going to change significantly.

I’m concerned, the physicians are concerned, and the staff is really concerned.

The public, the Commissioners and the Board had best be showing more concern if we want to maintain the quality and reputation we desire.

Monday, December 04, 2006

Terminology is important

Terminology is only meaningful when everyone agrees on the definitions. The CEO at Floyd is using terminology to justify more bad decisions, but he gets very defensive when asked to define the terms.

So what is an FTE/adj. occ bed (Full Time Employee per adjusted occupied bed)?

This is the question.

Every hospital calculates this number differently and telling managers, physicians and the Board that our ratio is higher than Clark, Jewish, Norton’s etc. is not only misleading, it is deceptive in many ways.

Here are the variables:

  • Does each hospital include the ER beds, OB beds, Nursery beds, Urgent Care beds, and rehab beds that are part of their hospitals?

  • Does each hospital include personnel in departments like marketing, laundry, security, medical records, transcription, and many other departments? This is vitally important because many hospitals contract these as outside services.

  • How does each hospital define a FTE?

  • Do part-time employees get counted and if so how?

He is currently using the numbers to justify cuts in certain departments that he says is overstaffed. Two of these departments are the ER and the OR.

Has anyone had to wait in the ER or has any surgeon had difficulty scheduling cases. I am quite certain that overstaffing is not the problem.

Until we know with certainty that everyone is defining the term in the exact same manner, NO comparison is valid and cuts are unjustified.

Friday, December 01, 2006

Outsourcing Medical Care


Blue Ridge Paper Products Inc. located in Canton, NC is embarking on a new idea to save money in this difficult healthcare environment. The company is evidently self-insured and in its 101st year of operation. They recently sent an employee to New Delhi to have his gallstones removed and his rotator cuff repaired.

It costs them less to send the patient 7800 miles to New Delhi than nine miles to the closest hospital. The estimated cost of the procedures locally would have been around $100,000 compared to roughly $20,000 in India.

The company paid for the travel expenses and gave the patient a $10,000 bonus for choosing this option.

More and more overseas hospitals are asking for JCAHO accreditation and to become providers in numerous health plans.

This will certainly raise questions in the medical-legal realm and challenge some of the current practices here in the states. Follow-up care, complications, medical standards, surgical training and a whole host of other issues will need to be considered.

In the meantime, outsourcing is now a reality for healthcare.