Monday, April 30, 2007

The Indiana Health Workforce

Here are the statistics from 2000 about how Indiana compares nationally related to certain areas in Healthcare. There will be revised numbers coming out soon.

Medicine

• There were 10,175 active patient care physicians in Indiana in 2000. With 167 physicians per 100,000 population, Indiana was lower than the national ratio of 198 physicians per 100,000. Indiana ranked 38th among states in physicians per capita.

• Indiana had 57 active primary care physicians per 100,000 population in 2000, lower than the rate of 69 per 100,000 for the entire country.

• Medical schools in Indiana graduated 264 new physicians in 1999-00. Indiana ranked 21st among the 46 states with medical schools in number of medical school graduates. Indiana graduated fewer new physicians per 100,000 population (4.4) than did the entire United States (6.4) and ranked 37th among the 46 states with medical schools in medical school graduates per capita.

• There were 424 physician assistants practicing in Indiana in 2000. This was equal to 7 physician assistants per 100,000 population, less than half the national rate of 14.4.

Nursing:

• There were nearly 61,000 licensed registered nurses (RNs) in Indiana in 2000; over 46,200 were employed in nursing. This was equal to 759.1 RNs per 100,000 population in Indiana in 2000, slightly less than the national rate of 780.2.

• Indiana ranked 12th among the states in the per capita employment of Licensed Practical/Vocational Nurses (LPNs), with 309.1 LPNs per 100,000 population as compared to the national rate of 240.8 per 100,000. Indiana ranked 14th in the number of LPNs employed in 2000 with 18,830 workers.

• Indiana had 722 nurse practitioners in 2000. This was equal to 11.9 nurse practitioners per 100,000 population, substantially below the national rate of 33.7. Indiana had the lowest ratio of nurse practitioners per capita in the nation.

• With 36 certified nurse midwives in 2000, Indiana had 0.6 certified nurse midwife per 100,000 population, lower than the national rate of 2.9. Indiana had the lowest ratio of certified nurse midwives per capita in the nation.

• With 170 certified registered nurse anesthetists in 2003, Indiana had 2.8 nurse anesthetists per 100,000 population, well below the national rate of 9.3. Indiana had the second lowest ratio of nurse anesthetists per capita in the nation.

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Friday, April 27, 2007

CFO Selection


A group of 8 physicians had the opportunity to interviews the three CFO candidates over the past several days and make recommendations to the Board on our assessment of the individuals. It was a very good experience for some physicians who have never had an opportunity like this before. We were able to meet after the interviews and rank each of the three candidates and pass along our assessment to the Chairman.

Each candidate had pros and cons and since we were unclear as to what the Board’s plans were about whether this person was to be long-term, short-term, a potential replacement for CEO, or just filling a vacancy, we gave varying comments related to our ranking scheme.

The next board meeting is Tuesday night and they are planning to make a determination on the candidate for CFO.

No matter who they choose, the candidate will have their work cut out for them. The outside audit is underway and is likely to find more problems then the ones announced previously. The current processes on revenue cycle management needs an overhaul and it will not be an easy task to break through some of the barriers that have been created over the years under the current leadership.

The Board could also choose to not accept any of the candidates and look at hiring an outside firm to manage the revenue cycle for a period of time. This also has benefits but is unlikely to be considered as the bond rating is scheduled for review in June. It is imperative that some stability be shown in the financial aspects of the organization to prevent a further lowering of the Bond rating. Having a CFO in place appears to be the option the Board considers best at this time.

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Thursday, April 26, 2007

Free Thought??

Whether we are talking about local politics, the City Council, Floyd Memorial Hospital or the Cultural Worldview, there is a common thread to the thoughts. We are influenced by what we allow ourselves to see, hear, and believe.

We are constantly bombarded by the media and they really control much of the thought and beliefs in our society. Those who control the media, control the culture.

Although we have much more freedom than most other nations, we are still heavily influenced by only a small percentage of individuals and their agendas.

Other thoughts on this topic come from a variety of individuals but the theme remains very similar. Here are a few:

If you want to change the culture, you will have to start by changing the organization.
Mary Douglas

The control of information is something the elite always does, particularly in a despotic form of government. Information, knowledge, is power. If you can control information, you can control people.
Tom Clancy

When we, through our educational culture, through the media, through the entertainment culture, give our children the impression that human beings cannot control their passions, we are telling them, in effect, that human beings cannot be trusted with freedom.
Alan Keyes

The range of debate between the dominant U.S. [political] parties tends to closely resemble the range of debate within the business class.
Robert McChesney, author and media critic

In a dictatorship, censorship in used; in a democracy, manipulation.
Ryszard Kapuscinski, journalist

They just don't come in contact with people not in their [income] bracket. They've lost touch with their community.
Stan Opotowsky of ABC News, about the journalistic elite - On Bended Knee

The conscious and intelligent manipulation of the organized habits and opinions of the masses is an important element in democratic society.
Edward Bernays, "father" of modern public relations (PR), on government propaganda

One of the intentions of corporate-controlled media is to instill in people a sense of disempowerment, of immobilization and paralysis. Its outcome is to turn you into good consumers. It is to keep people isolated, to feel that there is no possibility for social change.
David Barsamian, journalist and publisher

To keep information from the public is the function of the corporate media.
Gore Vidal, Perpetual War for Perpetual Peace

The media serve the interests of state and corporate power, which are closely interlinked, framing their reporting and analysis in a manner supportive of established privilege and limiting debate and discussion accordingly.
Noam Chomsky, American linguist and US media and foreign policy critic

The modern susceptibility to conformity and obedience to authority indicates that the truth endorsed by authority is likely to be accepted as such by a majority of people, who are innately obedient to authority. This obedience-truth will then become a consensus-truth accepted by many individuals unable to stand alone against the majority. In this way, the truth promulgated by the propaganda system - however irrational - stands a good chance of becoming the consensus, and may come to seem self-evident common sense.
David Edwards, author of Burning All Illusions

In the United States, both the Republican and Democratic Parties, with only a few prominent exceptions, have been and are in the pay of the corporate media and communication giants.
John Nichols and Robert McChesney

The purpose of commercial [media] is to induce mass sales. For mass sales there must be a mass norm ... By suppressing the individual, the unique, the industry ... assures itself a standard product for mass consumption.
John Whiting, writer, commenting on the homogenization of corporate media program content

Anyone who challenges the prevailing orthodoxy finds himself silenced with surprising effectiveness.
George Orwell, author of the book "1984"

I know of no country in which there is so little independence of mind and real freedom of discussion as in America.
Alexis de Tocqueville, 1805 - 1859, French political thinker and author of Democracy in America

... the airwaves belong to the people.
from the 1934 Communications Act

The range of debate between the dominant U.S. [political] parties tends to closely resemble the range of debate within the business class.
Robert McChesney, author and media critic

If you want to know about the world and understand and educate yourself, you have to dig; dig up books and articles, read and find out for yourself.
John Stockwell, former CIA official and author

To accept opinions is to gain the good solid feeling of being correct without having to think.
C. Wright Mills - from the book The Power Elite

When everyone is thinking the same, no one is thinking.
John Wooden

The media serve the interests of state and corporate power, which are closely interlinked, framing their reporting and analysis in a manner supportive of established privilege and limiting debate and discussion accordingly.
Noam Chomsky, American linguist and US media and foreign policy critic

We are willing to accept lies if they make our lives easier.
Producer from the TV series "People's Century"

One of the intentions of corporate-controlled media is to instill in people a sense of disempowerment, of immobilization and paralysis. Its outcome is to turn you into good consumers. It is to keep people isolated, to feel that there is no possibility for social change.
David Barsamian, journalist

The internet and blogs have allowed much more openess and an ability to publish thoughts and views without significant challenges. We still live in the greatest country on earth, but don't be fooled by believing the media doesn't control much of the agenda.

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Wednesday, April 25, 2007

Business First reports on new Hospital


According to Business First Construction finally set to start on physician-owned hospital - Business First of Louisville: the hospital in Clarksville is underway and will be completed sometime next year.

It has come at a fairly high price with legal issues that delayed the start. There were many reasons for the legal issues, but some feel it was partly done as a measure to delay the opening and allow Floyd’s Heart program to get up and running.

Will the delay ultimately hurt the new hospital or did it help? It did help convince the owners to use the Clark County location over the Floyd County one. This I think will ultimately pay off. The location off veterans parkway is a huge growth area and the hospital and its developments will bring some balance to the mostly retail area.

At this point, in little more than a year, there will be more competition to both Clark and Floyd. Physicians and patients will have another option for their medical care and with the continued diversion problems at Floyd; it will be a welcome change for many.

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Tuesday, April 24, 2007

To Catch a Thief


Many read the recent article on the alleged embezzlement at a local OB/Gyn office and wondered how things like this happen. http://www.courier-journal.com/apps/pbcs.dll/article?AID=/20070330/NEWS02/703300465/1025/NEWS02

Embezzlement is usually noticed with a few missing checks, a shrinking profit margin, and a sneaking suspicion that something is wrong.

Most physicians are busy with patients and rarely take the time to review their own accounts. Some have too much trust in their staff and managers.

Employee embezzlement has continued to increase and is estimated to cost U.S. businesses some $652 billion annually. This is according to the Association of Certified Fraud Examiners.

As they say, the best defense is a good offense for preventing such crimes. Physicians need to know their enemies and their friends

Common physician errors are not looking at credit card statements and giving office managers full signing privileges on the bank accounts.

There needs to be a healthy level of trust, but not full reign. Consultants in the Forensic consulting services believe physicians are at greater risk for being cheated than most other businesses largely because physicians rely on office managers and other employees to run their clerical business for them. Many fail to take the necessary precautions to keep their practices safe. One consultant said “Physician practices are the No. 1 choice victim [for embezzlers].” “There are just too many areas of opportunity.”

Knowing the most prevalent types of embezzlement will help safeguard the practice. The bulk of thefts occur at the front desk where employees simply pocket the cash paid for copays and other fees and with these rising, there is usually a lot of money in an office on a daily basis.

Some of the more common embezzlement schemes in medical offices include:

• Bad checks: An employee writes company checks for personal use and then records them in the check register as legitimate practice expenses.
• Secret accounts: Employees open a completely separate account in the practice name and deposit money into it using a signature stamp. They then treat it like their personal account.
• The ATM scheme: Patient refunds are another favorite among petty thieves. Especially in larger practices, this occurs when an employee process 5 or 6 fictitious accounts with their own name or an alias. The employees then take the falsified refund checks and deposit them into their own account using an automated teller machine (ATM). Crooks have learned that they almost always get away with it because by using the ATM machines there is not a teller to check it.
• The invisible write-off: Noncash adjustments, used to write off charges that insurance companies deny and cannot be submitted to patients, are another target for abuse.
• Employees can make payments virtually disappear by moving them off the “balance due” record and marking them as noncash adjustments under the patient’s account. This is a more sophisticated method and is harder to catch.

• High-tech crime: Physicians themselves have sometimes been caught moving charges from one provider to another creating more A/R’s for one and less for another. This can be done using the EMRs and may take a while to track down.

Tips to protect a practice:

• Do background checks on employees that handle money or billing systems.
• Check employee names against the Medicare and Medicaid exclusions list (http://www.oig.hhs.gov/fraud/exclusions/listofexcluded.html) maintained by the Health and Human Services Office of Inspector General.
• Consider a secure credit check on key employees as it could be a clue to how they handle money.
• Bonding employees who handle money
• Separate financial responsibilities by making certain the person who handles accounts receivable is not the same person handling accounts payable.
• Provide receipts for every transaction and implement a protocol for reconciling the receipts.
• Have your staff cross-trained so that multiple people actually share the responsibility of balancing the receipts at the end of the day.
• Physicians should also know how to use the accounting system to periodically check
• Enforce vacation policies as an employee not wanting to take off too many days in a row may be a red flag.
• Guard your statements by having them given to you unopened first and the physician keeps a running total. This would be a nuisance for some offices but is another safeguard.
• Sign your own checks or make it a policy to have two signatures.
• Keep track of monthly numbers on a simple flow sheet or excel spread sheet and look for trends or anomalies.
• Follow the numbers: A simple line graph in Excel or another software program that tracks monthly charge trends can be a lifesaver.
• Establish an office policy on theft and a mechanism for workers to bring concerns directly to the physicians.
• Routinely test the checks and balances you have in place as it sends a message to everyone that things are being watched.
• Check your statements on all credit card machines
• Depending on your office, if you know an employee is struggling financially, offer to help
• Protect your patients from potential identity theft as well. Give access to account information to only those employees with a need to know.
• One of the physician owners should take the time and actually balance the company’s monthly bank statement.

Although these are all suggestions, each practice has to define their limits and come up with a policy that balances risk and benefit.

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Monday, April 23, 2007

Lying to your Doctor

The Tribune had an interesting article printed a while back about the difficulty physicians have when it comes to honesty in patients. The News and Tribune - HEALTH: Don’t try to be ’good patient’ by lying to your doctor

It is well worth the read as it is very prevalent in every medical practice.

I use a similar phrase with my patients when I tell them “you can lie to your spouse, boss, family and friends, but you can’t lie to God and you shouldn’t lie to your doctor.”

We can only make the correct diagnosis and provide the correct treatment plan when we have all of the accurate information. Withholding pertinent details can be deleterious to the patient’s health.

The most common areas I see patients withholding the whole truth concerns, medications, how much they eat, how much they exercise, how much they drink, and their relationship issues. Most patients describe fairly accurately their symptoms if prompted with the right questions.

It seems to be some of the personal information that is commonly concealed.

The take home message is to be honest and do not be offended by what may seem to be a personal question. Many questions that may seem too personal like religion, sexual behaviors, and personal choice behaviors may in many ways affect how you respond to treatment and even if it is the best treatment for you.

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Friday, April 20, 2007

DWD---Are You Guilty??


How many of us are guilty of DWD?

You know these people and you see them every day. They are the beauty queens putting makeup on during the morning rush hour. The hurried mom putting her contacts in while driving. The busy housewife making her grocery list out while sitting at the stop sign and the busy professional talking and making deals on his cell phone while trying to juggle papers in his briefcase in the next seat.

Surely none of us do these things, but according to the results of a survey released by Nationwide Mutual Insurance, "driving while distracted" is prevalent and more dangerous than you might think. Of the 1,200 US drivers surveyed, 59 percent don't consider themselves distracted drivers, yet 80 percent identify themselves as multitaskers.

I guess the definition of distracted was never given to these individuals before the survey.

The most common multitasking events were talking on cell phones, with 73 percent of respondents admitting to chatting and driving. Among the younger crowd, 37 percent confessed to text messaging, while 48 percent said they ate full meals while on the road. Other common themes drivers admit to doing in addition to driving include reading a book, changing seats with a passenger, watching movies, and nursing a baby.

What kind of things have our readers witnessed on the road??

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Thursday, April 19, 2007

Nursing Shortage


In a recent report by the HRSA (Health Resource Services Administration), they report the number of licensed nurses has been on the upswing in the past few years but the shortage continues and nurse to patient ratios remain below the 6:1 national average that is suggested.

This upswing began around 2000 and looks like it is continuing. It may partly be attributed to the average salaries rising as well. It is good news for hospitals looking to fill more openings, but bad because of the salary requirements.

This survey is conducted every four years and included roughly 35,700 RNs in 2004. The current estimate is that the supply of these nurses has risen about 8% from 2000-04.


Wages rose significantly during this time frame with an average 14% increase. This was the largest inflation-adjusted salary increase since 1980.

According to the report, the average age of nurses’ also rose which reflects fewer younger nurses entering the profession. The average age now stands at 46.8 years, up from 45.2 years.

Even though some of the numbers are promising, the shortage is projected to continue and any thought otherwise would be shortsighted.

The wage increase does reflect the importance of these nursing positions and government and private insurers will also need to recognize the additional cost of these professionals when it comes to reimbursement.

The full report can be found at Preliminary Findings 2004 National Sample Survey of Registered Nurses

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Wednesday, April 18, 2007

The Blame Game


It certainly didn’t take long for people to point fingers and attempt to blame the police and university for the tragedy that occurred Monday at Virginia Tech.

The news media has aggravated the situation by the continued barrage of accusations regarding the speed of the response. I find this distasteful and completely irresponsible.

Every crime scene is different and each one is approached with a unique perspective all while keeping historical events of other incidents in mind.

What were the odds of a lone gunman killing two individuals and then 2 hours later going nearly a half mile away and killing 30 more?

How is a university supposed to shut down an open campus of 26,000 acres with a population greater than Floyds Knobs in less time than a full length motion picture?

I believe our society has watched too much CSI, 24, and other programs and believe all these things can happen in an hour.

There is no protocol, no rehearsal, and no anticipation of what possesses someone to commit mass murder or a method to stop it.

A man determined to commit such an act cannot be stopped by shutting down a campus. If he had 2 handguns, several clips and extra ammunition, it could take less than 5 minutes to murder these students and professors.

It is no different than a suicide bomber. Once the commitment is made, there is little anyone can do to stop the carnage.

If any of these reporters actually worked a real crime scene, they would understand what reality is and limit their blaming and second-guessing until the facts are out.

I, for one, feel deep sorrow and empathy for all those involved and believe this blaming mentality only contributes to the hurt and pain. Until all of the information and investigation is complete, I will hold to the belief that the police and university acted appropriately in this tragedy.

Will we learn some things from this tragedy? Absolutely

Should we look to pass blame on the university or police? Absolutely not.

If this killer would have lived, would this have been a “hate crime” or just a very disturbed individual bent on evil and destruction?

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Tuesday, April 17, 2007

Consumerism

The buzz words consumer-directed benefits and managed care are broad terms with important implications for employers.

The recent trend seems to be toward consumerism in an attempt to provide something that has been missing from health benefits for a very long time.

The goal is to reach a point where the patient cares about cost and quality and is actively involved in the financial aspect for their healthcare choices.

The underlying premise is to reach the point where patients will assume a greater role in managing their own healthcare and the associated costs. By providing financial incentives and information to employees, corporations can encourage them to assume this role.

Currently, high-deductible health insurance products like MSA’s, HSA’s are probably the most widely publicized component of this consumerism model. One of the purposes for these products was to help consumers see more clearly the cost of services and allow them to negotiate prices individually. The goal was to help patients make more value-driven healthcare decisions.

Although these plans do serve this purpose, the problem arises because most patients who choose them are not high utilizers to begin with. A high percentage of healthcare dollars are accounted for by a small percentage of high-cost claimants and these are not typically the ones who choose these types of products. Therefore, consumer-directed health plans will not provide the total solution.

Other components of consumerism that need to be implemented are preventive services, wellness and disease management programs, and better communication mechanisms that will provide patients with more information about the quality and cost of the services they are buying.

The common theme among all of these ideas is the patient or direct consumer has to become more involved in the process. We need to eliminate the third party vendors who continually add cost, delay care, reduce quality and confuse the picture.

If patients were required to pay for the service when it is was rendered and then dealt with the reimbursement from the insurance company based on their agreement, this process of healthcare would change in a hurry! Costs and utilization would significantly decline.

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Monday, April 16, 2007

House Bill 1459

The Indiana House of Representatives is considering a bill that would essentially give additional punishment to individuals creating crimes if they were deemed to be targeted at individuals because of the victim's color, creed, disability, national origin, race, religion, sexual orientation, gender identity, or sex needs to hear from you today.

It is essentially a Hate Crime Bill like other states have instituted. With the recent Imus controversy and the crazy stuff that Rosie says on TV, this becomes an important issue.

So the fairness issue is raised because if a man mugs a guy because he is gay or dresses strangely, he may face additional.

Are the aggravating circumstances listed in this bill House Bill 1459 enough to justify additional punishment? I have no problems with the additional punishment for aggravating circumstances as long as it is applied fairly towards everyone.

It seems that judges already have some latitude in adjusting sentences and this may be redundant legal language in an attempt to promote a more liberal agenda or groundwork to get Hate Speech laws passed as in Canada.

Passing laws against certain speech would be detrimental to our society.

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Friday, April 13, 2007

New Brain Mapping


Brain imaging and mapping technologies are becoming more mainstream and many researchers are trying to figure out why we do some of the things we do.

By using these technologies, Duke University researchers discovered that activity in a certain region of the brain can predict altruistic or selfish behaviors as described at the following site: Biological Psychology Links

These researchers used functional magnetic resonance imaging and found the scans revealed that a part of the brain called the posterior superior temporal sulcus was activated to a greater degree when people perceived an action, rather than when they acted themselves. In other words, brain activity was greater when subjects watched the computer play the game rather than playing it themselves.

Researchers believe that this altruistic behavior may originate from how people view the world rather than from how they act in it.

Although we strive to find answers to why some individuals are intrinsically more altruistic, kind, loving, or generous, we still cannot answer this with just knowing what area of the brain is activated.

Scientists can hypothesize, but the question still remains;
Is this area of the brain activated because the individual is more altruistic or is the individual more altruistic because this area of the brain is more active?

It is back to the chicken and egg hypothesis. Depending on your worldview, this can be a difficult question to answer. For others, it is very simple and straightforward.

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Thursday, April 12, 2007

Bush's Budget Cuts

Bush’s budget proposal likely won’t be accepted as it currently stands, but the hospital lobbyists are fearful of the current trend as they would be up for a potential $70 billion cut to Medicare and Medicaid spending over the next five years.

Everyone is waiting for more specifics on where the cuts would actually be made and who really will be affected.

It is anticipated that hospitals may shoulder the brunt of Medicare cuts in the effort to balance the budget by 2012. Hospitals and physicians are far and away the biggest recipients of Medicare dollars and thus likely the easiest areas to cut.

Medicare spending has increased 9.3% to $342 billion in calendar 2005 with hospitals accounting for the largest share—$180.3 billion. The government reportedly financed 40%, or $736.3 billion, of all the nation’s health services and supplies.

The only real way to put the Medicare program on a financially stable and secure path will require a combination of reducing services, increased cost sharing by patients, possibly increasing the age of eligibility, improving efficiencies and somehow bringing in more revenue to the system

The PAC’s are all gearing up for the fight to make sure any cuts for their constituents are the least possible. One example is home oxygen that looks to be cut from 36 month rental ability to 13 months meaning patients would likely have to pay for this after that period of time.

As of now, the Medicare Advantage and the prescription drug program are not slated for cuts. In the Medicare Advantage program, beneficiaries enroll in private plans rather than traditional fee-for-service programs but those plans are paid, on average, about 12% more than what would normally be spent per beneficiary if they were enrolled in a traditional plan.

Sounds as if their lobbyists are working harder for them and these huge insurance companies continue to rake it in.

The budget proposal is not expected to include the so-called “physician fix,” a temporary reprieve on payment cuts that expires at the end of 2007. Once again, physicians will likely be easy targets as our Medical Associations and lobbying groups seem impotent to attain any real change.

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Wednesday, April 11, 2007

Another Drug Off the Market



It’s happened again. Another “wonder” drug is pulled off the market. This time, it is Zelnorm. This was a drug used for the treatment of IBS (Irritable Bowel Syndrome). The above letter is being distributed to all physicians explaining the rationale for why the drug is being pulled.

There are aggressive measures to get all the drugs out of circulation and the company will reimburse patients if they send their drugs back.

This drug is estimated to be around a $500 million dollar drug, but the risk of class action lawsuits has forced the company into pulling it completely even though there has only been 13/11,614 events in patients with underlying heart disease.

This is another example of “science” being relative and not an absolute.

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Tuesday, April 10, 2007

March Board Meeting

We recently had the March Board meeting. It was delayed because of the spring break week. The meeting lasted nearly 6 hours with the dinner starting at around 9:15 pm.

It is noticeably different this year compared to all previous years I have been involved. A strong chairman makes a huge difference in how the meetings are run as well as who dictates the direction of the discussions.

It is very clear to everyone present that our new Chairman is a very strong leader.

We have new CFO candidates interviewing this week and also some new subcommittees looking into the problems related to the financial fiasco created by the current administration. These reports are to be completed in the next few weeks.

The Bond rating continues to be a primary focus for most of the decisions being made related to the finances.

As vice chief of staff, my concerns this year are primarily focused on patient care and how the cuts in staffing will continue to impact these areas. There is a fine line between too many cuts and salvaging the Bond rating.

The financial cuts are also placing further strains on the Medical Staff and their relationship with the administration as some physicians feel care is being compromised.

No easy answers for the Chairman, but it is nice to see some real leadership.

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Monday, April 09, 2007

Indiana uninsured



The ISMA sent out this announcement last week. It has some good news related to attempts at trying to cover more of the Indiana uninsured.

It unfortunately does not attempt to fix the reimbursement schedule that is severely flawed and contributing to the access problems in Indiana.

The ISMA was disappointed as were most physicians about the politics involved in the recent tax proposal on the cigarettes. It was harmful for the healthcare of Indiana and a shameful display of partisan politics.

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Friday, April 06, 2007

And you thought our smoking ban was bad!


Those who complain about our smoking rules, regulations and bans should be very happy we aren’t like those radical progressives in Sweden.

According to a recent article, a Swedish woman has been sued for smoking in her own garden.
United Press International - NewsTrack - Smoker sued for lighting up in her garden

This Swede lawyer is going to test exactly how anti-smoking Europe's courts are willing to be. He has filed a lawsuit against his neighbor for smoking outside in her own garden alleging the in the suit that even though the neighbor lights up in a corner farthest away from his property, the smoke still drifts into his nostrils and through his open windows. He states he cannot even open his windows because of the smoke.

This lawyer wants a court to award him about $2,000 for the prior smoking and an extra $280 for each future offense.

So the question remains; do we have a smoking problem or a lawyer problem? No offense to lawyers as they are some of my best friends as well as family.

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Thursday, April 05, 2007

Minimizing falls

A hospital in Wisconsin has taken the drive-thru craze of fast food, pharmacies, and other industries and begun an innovative way to help minimize the risk of falls at their hospital.

Slips and falls inside and outside of most hospitals are frequent causes preventable injuries and hospitals are always looking for ways to minimize the risks.

Ripon Medical Center started a drive-through blood draw. The hospital utilizes their emergency shelter as the stop for the blood draw. Patients are scheduled for arrival at a certain time and basically get registered and have their blood drawn without ever having to leave their automobiles.

It has increased satisfaction and decreased the risk of falls. The hospital accepted donations as well which assisted them in purchasing a mobile cart.

It has been great for patients with disabilities and older patients who have difficulty walking the usually long distances into and around the hospitals.

Another unique and innovative service provided by employees thinking “outside the box”.

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Wednesday, April 04, 2007

What's the real agenda?

During the New Orleans Hurricane Katrina disaster, a physician and two nurses were charged with euthanizing patients. The three were arrested in July on homicide charges after a 10-month investigation into the allegations.

The medical community appears to largely support them as they believe they were trying to alleviate pain rather than actually terminate their lives.

The grand jury is preparing for the trial and will likely be looking for ways to convince the jury that what they did was more humane. The Television show Boston Legal recently had a similar case and the jury there acquitted the doctor there showing compassion for the situation.

Will this same verdict also occur in real life or should it?

Is there an underlying media agenda supporting euthanasia?

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Tuesday, April 03, 2007

Bloggers suit not thrown out by the Judge

In this article from the Courier, KY_BLOCKED_WEB_SITES we see the judge decided against dropping the case and has referred it to a federal magistrate.

The case deals with the blocking of web sites by the Fletcher administration. The blogger who filed the suit had routinely blogged on public issues and public officials including Fletcher and his administration.

This will certainly test some new waters in the free speech arena and challenge the blocking of selected sites by administrations that do not like criticism.

We’ll anxiously await the decision from the federal magistrate.

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Monday, April 02, 2007

Helpful managing strategies

In many industries including healthcare, managers are given tremendous responsibilities but all too often little direct authority. This type of atmosphere is extremely frustrating and discouraging for most managers.

Since managers often can’t make demands of the boss or even staff, they need to foster a workplace atmosphere of respect in which problems are solved as a team and the open exchange of ideas or debates is encouraged.

Here are some helpful hints from various authorities in the consulting field.

1. Don’t be a yes man (or woman). To earn respect, administrators must bring their own perspective and expertise to the table — even when their opinions run contrary to the direction the organization may wish to take.

2. Keep your boss out of trouble. Sometimes a manager’s most important task is to help the boss help themselves. If the top brass are all wet on a proposal, try to get them to slow down on the implementation. This is not the same as sabotaging a project.

3. Leave your door open. Stay abreast of both morale and sentiment among your staff. Good managers are always checking the pulse of the office.

4. Don’t interfere. Its one thing to be a team player, but stepping in to do another staff member’s job too often sends a message (inadvertent though it may be) that you don’t trust your staff to get it right. Pinch-hitting also confuses customers, patients, and employees, inviting repeat requests for similar “quick favors” down the road. One consultant said “Do it once, and it’s a favor, do it twice, and the job is yours.”

5. Be responsive. When the boss calls you with questions or concerns, respond to them quickly. Even if you don’t know the answer, it’s important to call the boss back and tell them you’re working on it. It’s always appreciated — and often, it relieves any pressure they may have felt.”

6. Invite input. In larger organizations, be sure to involve both everyone the strategic planning process.
Bosses often consider implementing new equipment or procedural changes that could affect other departments without input from some of the end users. If a company is going to grow, it needs everyone to be part of that growth. In any size company, everyone’s opinion matters; each staff member has unique insights into how the company might work better.

7. Don’t rush hiring decisions. When hiring for any position, it’s important to pay attention to any gut-level warning signs you may perceive, despite the pressure you may feel to quickly fill the vacancy. Don’t settle for mediocrity.”

8. Always question strategy. Before undertaking any new project, managers should always ask themselves, “Is the juice worth the squeeze?”

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