Security Reminder

Here is another safety precaution for all the internet users who increasingly use online websites and services.

Passwords are important and if chosen poorly can have significant consequences. More and more identity thefts are being made and phishing is increasing. The above survey shows the most common passwords. If you are using any of these, you need to consider making some changes quickly.

Better and more secure passwords will have both letters and symbols and include upper and lower cases. Avoid using common names or things that would be associated with you personally.

Quality Healthcare

A recent survey completed by The American College of Physician Executives polled 1,155 physician-leaders about patient-safety and quality initiatives at their organizations.

The survey showed that physician-leaders are passionate about improving the care that patients receive but many physician-executives are finding the implementation of safety and quality initiatives to be a major challenge.

Comments from these individuals in the survey were generally ones like “Hospitals are still chasing revenue and are not serious about improving quality and efficiency” and “Society does not allocate sufficient payments to hospitals in areas serving the poor to allow implementation of needed improvements—this is a disgrace to the U.S. healthcare system.”

Most of the respondents reported they have struggled to find an appropriate balance between what they believe is best for patients and what is best for their healthcare organizations when it comes to implementing these initiatives.

A little over one-third of respondents identified a lack of resources (including staffing) as a major barrier to improving patient safety and quality within their institutions and another third felt that the desire to maintain the status quo was a major obstacle.

When compared to most other organizations, healthcare entities have historically had very few people working on quality, comparatively speaking. Hospitals haven’t made a serious investment in this aspect compared with the GE’s, Ford’s etc. but it is improving

Healthcare executives hide behind the excuse that lack of physician engagement makes systematic improvement impossible but according to the survey, physician-leaders are committed to the journey ahead but stymied by obstructions in the road (usually administrations)

Collectively, we as physicians and healthcare leaders need to hold our profession accountable for acquiring the knowledge and skills necessary to effectively lead our medical staff and organizations into the future.

Complacency and proatecting the "sacred cows" cannot continue to be the modus operadum!

What's the Buzz

Floyd Memorial has been on diversion a lot these past few years, but it has never been for the reason that occurred in Arkansas.

The University of Arkansas Medical Sciences’ Medical Center’s emergency room went on diversion for about two hours on April 30. It seems that a swarm of about 7,000 bees congregated outside the ER causing the hospital to divert all ambulances to other facilities while they decided how to get rid of the buzzing bees.

Patients being stung and then possibly having an allergic reaction is not good for public relations or liability.

The hospital was able to solicit help from beekeeper Harvey Johnston to manage the problem. By using a vacuum system, he was able to transfer the insects into a box and then transport them to his home where he raises honeybees.

Evidently, when a beehive becomes too crowded, a new queen bee will leave, attracting a swarm that will follow her to a new site. In this case, the queen landed on the exterior wall near the ambulance bay at UAMS.

Patients entering an emergency room may think twice whether their problem is truly an emergency if they had to walk past 7000 loudly buzzing bees.

Could this be a way to curtail over-utilization of emergency rooms?

Claims Problems

A recent review of the claims processing in healthcare found the system is extremely flawed. This is no surprise to anyone who has actually utilized the system. It is stated that the error-prone claims processing system eats up nearly one out of every three dollars that patients spend on healthcare in this country.

This data was taken from a survey of 200 hospitals and insurance executives and 1,000 consumers and the number would be even higher if they would have included a random survey of physician offices and billing services.

The hospital executives questioned in the survey stated that even without including physician offices, an average of one in five claims is delayed or denied, and 96 percent must be submitted more than once.

Patients who were interviewed also had many problems and 25 percent of consumers say their health plan denied coverage of a legitimate claim. Another one in five ultimately paid the bill out of their own pocket.

Many physicians feel that the insurance companies deny claims regularly and systematically in order to keep money longer or avoid paying altogether. Insurance companies know that many claims will be forgotten or employees and patients will just give up because of the frustrations.

There are ample stories from Floyd of claims related problems, patients sent to collections without ever being billed, denied claims, and the list goes on.

Illustration by John Ceballos

Physician and the Internet reputation

The internet has become a widely used tool for nearly everyone. The magic of search engines like Google allows you to find virtually anything at anytime.

With so much information accessible, it is often hard to decide what is true and what is not. It can be very frustrating.

In addition, it is now considered good business practice to search on potential candidates for jobs, promotions, etc. This comes at a high cost for some and especially the younger generation who feel much more at ease posting very personal things on sites like myspace and facebook.


Physicians are no exception and much information can be placed on the internet without your knowledge. It is wise business practice to do a search engine on some sort of routine basis to see what may or may not be out in cyberspace.

If there are gross errors or things to cause perception problems, it will be an opportunity to fix them or at least give a rebuttal.

Helpful hints for physicians and others include:
1. Monitor your name, your practice name, your partners name and any other key identifier
2. Check search engines, blogs and forums using Google, Yahoo etc.
3. There are paid services that can be subscribed to for monitoring purposes
4. For physicians, no information may be as detrimental as bad information, so check to see what is there.
5. If negativity is found, research the situation to see if the complaint or statement has merit. If not, provide facts and ask for corrections nicely and professionally.
6. If the citation is from a patient and is negative, offer to discuss the situation and then listen closely to help eliminate any misunderstandings and attempt to rectify the problem.


The internet is a tool that can be very helpful or very destructive. Use those search engines and become the Sherlock Holmes of your practice.

A Jumbled Mess

How many parents out there feel as if their kids are speaking a different language with the new abbreviated form of computer language? The television commercial about the mother-daughter and cell phone highlights the problem and frustration.

But before we blame this generation, we should take a hard look at some of our own shortcuts. Our Federal Government is notorious for using abbreviations for everything. This was highlighted recently when a presidential commission made up of top officials from the nation’s healthcare and military complexes, filed a 118-page report. This report required an eight-page index of the 208 acronyms used and what they stand for.

The military has long favored the abbreviated format of discourse and my son who is a Marine constantly uses 3-letter abbreviations for everything related to the service.

Healthcare is not much better. So when you combine the two, expect things like CPRS, or centralized patient record system, as used by the Veterans Affairs Department, P4P meaning pay for performance, and FGLI, for those enrolled in the Family Group Life Insurance program.

In this report, you would learn that HHS (Health and Human Services) has a NCICP—a National Center for Injury Control and Prevention. You would also see that the Department of Housing and Urban Development has SNAPS, or a Special Needs Assistance Program.

One reader who reviewed the report commented it was enough to give us CFS (chronic fatigue syndrome).

So the next time you admonish your children for using the shorthand that’s commonplace on the Web and rampant in text messaging, be aware that Generation Text has nothing on the federal government.

I do admit that the abbreviations used in Government and Medicine usually follow grammatically correct standards whereas this new internet lingo rarely ascribes to the same standards.

Are we “dumbing-down” our youth?

June Meeting

Several people aske me about the Medical Staff meeting on Tuesday and there were some comments from readers about it.

It is true that the CEO gave brief report on the financial situation and did mention the audit was completed and accepted by the Board. He did not elaborate any further until questioned about more specifics.

The CEO didn’t hesitate to mention that the financials for May were improved over the prior few months. This should not come as a surprise with the tremendous slashing of employee hours and other major cutbacks implemented since the $11.5 million dollar mistake.

The issue on the audit was discussed in the April Medical Staff meeting and we were told by the CEO “current results will be available in May." Since the results were completed, and the CEO failed to give us any information, I specifically asked him to give the Medical Staff the results.

When specifically questioned on the “results”, the CEO stated that they were accepted by the Board but not yet approved because they were being sent to the State Board of Accounts and the “Chairman” did not want the results released at this time. (certainly made many of the staff wonder about the results)

A follow-up question was asked about the Bond Rating review that many of us were led to believe was also going to be reevaluated in June for possible revision. Our current rating is an A minus by Standard and Poor. The CEO stated at the meeting that this was not an official review of our rating and he did not expect any revision.

I understand everyone’s confusion because many physicians, staff and Board members were led to believe that one of the main reasons for all the financial cuts and changes was because of the potential for a rating adjustment in June by Standard and Poor.

The Medical Staff received little more information than the Tribune reporter who tried attending the last Board meeting.

Compliance vs. Cost

The cost of medication for patients is often times the barrier between being compliant with physician recommendations. In an Archives of Internal Medicine Journal Sept. 2006, the survey found that 85% of patients are noncompliant with physician recommendations. Sixty seven percent are chronically ill and skip medications to save money and do not inform their physicians. Thirty five percent do not discuss their noncompliance and 32% were middle aged, noncompliant because of cost and noted their health to significantly decline in the past 2 years.

Physicians get on the average 5 phone calls daily from pharmacies about drugs being non-formulary and more than 18 calls daily for drugs that are not preferred. For our office, this means we have 20 calls for non-formulary changes and more than 90 for non-preferred drugs.

This is a huge burden to running an office and trying to treat the patients. Drugs are prescribed based on what we feel is best for the patient and not what is best for the insurance company’s formulary and bottom line.

The current system puts a huge strain on patients and physicians while the drug and insurance companies continue to make it ever more increasingly difficult. Some physicians are refusing to change prescriptions and places the complete burden back on the patient. Others try and compromise, but patients need to understand what their insurance covers and what it does not.

The insurance company doesn’t care about the patient if the required treatment falls outside of their coverage.

New treatment for Emphysema

A new study referred to as the EASE (Exhale Airway Stents for Emphysema) study will examine a new treatment that creates pathways in the lung for trapped air to escape.

It is hoped that this will relieve shortness of breath and other symptoms associated with emphysema. The study is being done at the Univ. of Pennsylvania and as of now, there are very limited treatment options those who struggle with this disease.

This technique is a new, cutting-edge, non-surgical procedure that creates new pathways for airflow. These new small pathways in the lungs are created by using a special kind of needle and then stents are inserted to keep the new air passages open. The stent is shown above in the photo. About 30 patients have been involved in the first phases of the study.

Emphysema is most often caused by smoking and affects more than three million people in the United States and about 60 million people worldwide. It is a chronic, progressive and irreversible lung disease that is characterized by the destruction of lung tissue. Most patients will eventually need home oxygen to survive if they live long enough with the disease.

Heart Hospital gets construction release to begin

The Kentuckiana Medical Center or "the Heart Hospital" as many call it, recently received the design release certificate above.

This gives them the official nod to begin construction and if you have driven by Veterans Parkway you will see it is underway.

The land is now leveled and getting prepared for the foundation. The estimate for construction is 12-15 months.

For all the skeptics and naysayers the competition is getting closer and unless Floyd turns things around and changes the environment, they will have an even tougher time paying the bills and trying to overcome the multimillion dollar "adjustment" created by this administration.

Last couple of hikes

The last couple of hikes were very similar. This 3 mile hike to the lake and waterfall again involved everyone including my granddaughter.

Her hiking skills were nearly gone and she ended up being carried for about 2.5 of the 3 miles on my shoulders. Here she was a little unhappy because the mist from the waterfall was getting her wet. My youngest son thought it was funny and egged her on.

She was much more comfortable sitting on grandma's lap further away from the mist and she found a couple of chipmunks that loved her penutbutter crackers.

This last hike was only for the more agressive hikers. It began on a 40 degree morning after it rained all night. About 1/2 mile into the hike, the path crossing the stream was completely covered in water and not passable. So we hiked up through the woods about 1-200 yards and found a log that we were able to cross with some difficulty. Once over this obstacle, it was just steep, cold and wet until we reached the midpoint overlooking Glacier Lake.

These two pictures are on a rock ledge overlooking Glacier lake. It was a resting point before we continued up the mountain.

As we got further up, it got colder and we hiked partly through snow covered trails.

Once we arrived at the upper lake, the storm clouds were moving in quickly. The mountain peaks cannot even be seen at this point because of the clouds. We didn't stay long up here and headed back down.

This was a beautiful hike, but one that required much more energy. Overall, a great week and a great vacation.

Horseback adventure

One of the highlights of the trip was the two different horseback rides we took. The second was a little over 4 hours and we rode more than 10 miles up into the mountains.

The trails were varied and ranged from flat and grassy, to wooded, rocky and very steep.

At one of the streams, we gave the horses a rest as well as our own saddles. My daughter was the first to attempt walking across the log in the stream. The rest of us followed and luckily no one ended up in the water although there were a couple of close calls.

The horses overall were very well mannered. All the teenagers were able to get them to do most of what they wanted.

The really big excitement came at the last stream when we had to cross in a fairly deep spot with a swift current. Some of the horses were reluctant to cross and the picture above shows me leading my niece's horse across as he was not going voluntarily.

At this point, shoes, boots and pants did get wet. Some horses actually swam more than they walked across the stream.

Ghost Town

This ghost town was another day trip we took up into the mountains. We were the only visitors at the time and spoke with the single park ranger and worker.

The town is being preserved now that it is part of the Historical register. It is extremely interesting to tour because it is so far off the beaten path and miles from anything else.

There was very little crime in this town and anyone convicted was charged, tried and sentenced within a few days. No lengthy trials or expense.

Below is a picture of some of the shoes that were worn. They were very stiff leather with minimal cushioning for the feet. They didn't seem like they would be very warm in the brutal winters.

Most of the buildings are still in pretty good shape.



This town is located more than 6000 ft. up on the remote mountain. The ranger said they followed the stream up to the top when they found gold at the bottom while panning.

This is a view from the overlook at the top of the mountain.

This ghost town was very enjoyable for my wife and kids. Life was much rougher in these days but a whole lot simpler.

Hike number 1

Our first hike was about 3 miles up into the mountains to the lake shown here.

The hike was rated easy to moderate on the trail guide and everyone made it without too many problems.

Most of us carried our fishing gear on the hike and planned to catch lots of fish when we arrived. Unfortunately, the fish had other plans. We were evidently a few weeks too early and all the lakes and streams were higher than normal from the melting mountain snow.

Even though the fishing was poor, the kids and I had a great time in the attempt. The landscape was without question, the most beautiful I have seen.

Montana

I had the wonderful opportunity to spend the past week in Montana visiting the state for my first time. We stayed with family around the Condon area and spent a lot of time in the outdoors. We had a great time enjoying the quality family time.

Prior to my visit, I really had no knowledge of the state other than some generalities. I have come to really appreciate its vastness and its natural beauty that is still untouched in many ways by our progressive society.

Some of Montana statistics include:

**Third largest state by land mass
**Person’s per square mile of only 6.2
**Total population of only 944,632 persons
**Home ownership rate of 69.1 %
**Median household income of $35,574

Where we stayed was nearly an hour’s drive from any city with any major grocery stores, shopping, restaurants etc.

The walk to the mailbox was a little over 1.5 miles and we never walked anywhere away from the vicinity of the house without our bear spray. This is a special OC (capsaicin pepper spray) sold in most stores that is reportedly more effective than guns to prevent bear attacks.

We did a lot of hiking, fishing, 4 wheeling and horseback riding up into the mountains and the trip was extremely refreshing.

There was no cell phone service and a land line was our only phone connection which was used very little. It is relaxing and refreshing to eliminate the cell phone, shopping, and conveniences we seem to expect.

Some needed R & R

I'll be taking a hiatus from both the office and the blog for a few days.

I am quite certain this will not be a disappointment to the CEO as the blog has created a little more stress and a lot more accountability for him.

To all the readers, there may be some intermittant postings related to my time off but otherwise I will be relaxing and enjoying some outdoor activities.