Check out this interesting article in the Economist about how to reduce the level of greenhouse gas emissions caused by hospitals.
It cites a study published in the Journal of the American Medical Association that estimates that 8% of U.S. greenhouse gas emissions come from hospitals. Unfortunately, a solution is not as simple as building more efficient hospitals or reducing the amount energy expended to care for patients. That's because most of the carbon emissions are the result of pharmaceutical and medical equipment waste.
So what can hospitals do? The only truly effective remedy, as proposed in the article, is to simply keep patients out of hospitals...easier said than done, unfortunately. This would require more prevention, consultations over the phone/internet, and perhaps even doctor home-visits.
Much has already been discussed about the benefits of treating chronic diseases at the patients' home instead of in a hospital bed. These benefits would contribute to lower health care spending (an extremely relevant topic), greener practices, and improved safety and quality. In addition to the supposed better health of patients who have engaged in preventive measures, these patients would also eliminate the risk of serious infections that can occur in a hospital. The result: money saved and reduced greenhouse gas emissions.
Saturday, March 13, 2010
Thursday, March 4, 2010
Technology in med schools: iPods and 3D images
I came across these articles related to new technology's integration into medical education programs throughout the country:
Students at Ohio State College of Medicine are "freeing" up their time by listening to reduced lectures on their iPod's. Recorded versions of lectures can be edited to eliminate pauses and other non-essential elements. This allows students more time to view surgeries, shadow docs, and visit with patients. Other mobile functions include watching videos of procedures and reading up on current medical journals.
Meanwhile, students at the University of Aberdeen's med school are piloting a system of using Hollywood 3D technology to view detailed images of MRI's and CAT scans in class. The technology is similar to that used in the record-shattering blockbuster, Avatar. Unfortunately for me, I had a difficult time enjoying that film due to the side-splitting migraine it gave me. I knew medical school would be a headache, but this takes it to an entirely new (literal) level.
Students at Ohio State College of Medicine are "freeing" up their time by listening to reduced lectures on their iPod's. Recorded versions of lectures can be edited to eliminate pauses and other non-essential elements. This allows students more time to view surgeries, shadow docs, and visit with patients. Other mobile functions include watching videos of procedures and reading up on current medical journals.
Meanwhile, students at the University of Aberdeen's med school are piloting a system of using Hollywood 3D technology to view detailed images of MRI's and CAT scans in class. The technology is similar to that used in the record-shattering blockbuster, Avatar. Unfortunately for me, I had a difficult time enjoying that film due to the side-splitting migraine it gave me. I knew medical school would be a headache, but this takes it to an entirely new (literal) level.
Tuesday, March 2, 2010
My Op-Ed on Mass. health policy
So I had to write an Op-Ed for one my classes and, naturally, I chose to address health care. My somewhat long piece (sorry!) is in response to recent legislation proposed by Massachusetts' governor Deval Patrick. We had to assume the position of a leader in the state; therefore, I am the CEO of a community hospital...my dream job. Enjoy!
Community hospitals that treat most of the country’s lower-income and older citizens would be forced to compromise excellent patient care due to Patrick’s legislation. Unlike specialty hospitals and larger academic medical centers, community hospitals serve significantly more government-subsidized patients than those with private health insurance. These patients include low-income individuals who have state and federally funded Medicaid as well as those ages 65 and older with federally subsidized Medicare, in addition to other government-run programs. On average, a community hospital’s patient population includes about 55% to 65% of patients with government-subsidized health insurance; the remaining patients subscribe to private health insurance paid by their employers or out of pocket.
Because the government cannot afford to fully reimburse providers for the amount of costs associated with caring for Medicaid and Medicare patients, community hospitals must recoup losses by charging private insurers higher prices for care. Like any business, hospitals must adhere to basic principles of economics when designing pricing plans. In order to break-even, or generate enough revenue to at least cover costs, hospitals must charge private insurers for the deficit created by the government’s partial reimbursement system. On average, the government only pays community hospitals about 75% to 85% of the costs of caring for Medicaid and Medicare patients. Therefore, providers must impose a 15% to 25% premium on private insurers to simply maintain equilibrium between cost and revenue. This pricing strategy does not allow any room for the hospital to earn a margin, which would provide capital to invest in technology, expansion, and new employees. Further, many private insurance companies leverage their size to negotiate lower prices from providers; this deepens the financial strain on community hospitals.
Governor Patrick’s proposed cap on providers’ prices would force community hospitals to accept a deficit representing billions of dollars in revenue, patient services, and the quality and safety of the organization. Patrick’s bill allows the government to essentially squeeze providers from both ends. While continuing to offer only partial reimbursement for services, the governor’s legislation would prevent community hospitals from breaking-even. The consequences of which are dire for the entire health care industry.
If Patrick’s bill passes, community hospitals will have three basic choices. First, and depending on the financial health of the organization, community hospitals could redesign pricing strategies, eliminate patient services, and continue struggling to generate enough revenue to survive. This is a poor option for consumers, as patients would have to go elsewhere for important services like obstetrics, cardiac surgery, and radiation oncology. These services, among others, would most likely be eliminated first as they represent enormous costs for the organization due to required technology, specialist salaries, and insurance against risky procedures. Unless the financial performances of the organizations dramatically improve, community hospitals could continue cutting services until they exist solely as emergency clinics. The second choice is even bleaker. Community hospitals could decide that they cannot generate enough operational revenue to repay bondholders; this would force the closure of the organizations. Shutting down a community hospital, however, is a major ethical dilemma. Patients within the community would be forced to travel greater distances for care and would face longer wait times for appointments at larger specialty hospitals or academic medical centers.
The third and most likely option involves mergers and acquisitions among community hospitals and larger hospital networks. Massachusetts has already seen a vast number of partnerships develop in the past few years. Currently, most community hospitals in the state no longer exist as freestanding organizations but are affiliated with larger medical centers in Boston. The larger and more advanced centers treat severe cases while referring patients to community clinics for routine procedures. Patrick’s legislation, though, would alter the depth and breadth of hospitals’ affiliation. No longer would the partnership exist to provide patients with better care; rather, the organizations would become financially dependent on the network. Administration would most likely be streamlined to save costs, eventually resulting in only one or a few management teams controlling all the state’s hospitals.
The economic incentive for hospitals to join monopolistic networks would virtually eliminate consumer choice and contribute to decreased patient safety and quality. The basic theory driving hospitals to merge is known as economies of scale. Not unlike major U.S. corporations McDonald's and Wal-Mart, hospital networks would seek to generate revenue by keeping prices low and treating as many patients as possible. While consumers may benefit to some degree by this strategy in the restaurant and retail industries, health care is far too risky to put in the hands of just a few individuals. Further, while McDonald's and Wal-Mart certainly dominate their markets in terms of pricing, consumers still have many choices when searching for quality products. Health care, however, presents a challenge in terms of a patient’s ability to choose. Unlike fast food restaurants and retail stores, it takes a tremendous amount of capital to run a hospital; this means far fewer hospitals can exist than other business outlets. Patients, then, would have to travel extreme distances to reach a hospital run by a different network, not to mention that choice becomes virtually impossible while having a heart attack in the back of an ambulance.
Because the consumer’s choice is limited, there is significantly less incentive for health care managers to continually improve the safety and quality of patient care, particularly when such tasks involve financial investment. The tradeoff for the “dollar menu” at McDonald's and the steep discounts at Wal-Mart is the occasional dirty store, incompetent employee, and poor quality product. Is this something that residents of Massachusetts are ready to compromise for cheaper health care? If so, the true costs of health care may no longer be measured in a dollar amount but in patient dissatisfaction, medical errors, and lives lost.
Rather than proposing legislation that makes providers look like the enemy, the government should focus on managing their own expenses so that they can reimburse community hospitals for the full costs of treating Medicaid and Medicare patients. If that means raising taxes, than Massachusetts’ residents should elect a leader that has the fiscal responsibility and courage to do the right thing and fix health care in this state.
Measuring the True Costs of Health Care
Recently, Governor Deval Patrick proposed a bill that would allow the state insurance commissioner to cap the price of care charged by providers in Massachusetts. The motivation for this bill comes from years of debate as to how the government can curb health spending and relieve employers and individuals from paying increasingly high premiums for private health insurance. However, the governor’s proposals are purely political and would not effectively manage the cost of health care. Rather, providers, particularly community hospitals, would suffer greatly from the impact of such a bill. Further, Patrick’s legislation would contribute to a decline in patient safety and quality for the entire health care industry.Community hospitals that treat most of the country’s lower-income and older citizens would be forced to compromise excellent patient care due to Patrick’s legislation. Unlike specialty hospitals and larger academic medical centers, community hospitals serve significantly more government-subsidized patients than those with private health insurance. These patients include low-income individuals who have state and federally funded Medicaid as well as those ages 65 and older with federally subsidized Medicare, in addition to other government-run programs. On average, a community hospital’s patient population includes about 55% to 65% of patients with government-subsidized health insurance; the remaining patients subscribe to private health insurance paid by their employers or out of pocket.
Because the government cannot afford to fully reimburse providers for the amount of costs associated with caring for Medicaid and Medicare patients, community hospitals must recoup losses by charging private insurers higher prices for care. Like any business, hospitals must adhere to basic principles of economics when designing pricing plans. In order to break-even, or generate enough revenue to at least cover costs, hospitals must charge private insurers for the deficit created by the government’s partial reimbursement system. On average, the government only pays community hospitals about 75% to 85% of the costs of caring for Medicaid and Medicare patients. Therefore, providers must impose a 15% to 25% premium on private insurers to simply maintain equilibrium between cost and revenue. This pricing strategy does not allow any room for the hospital to earn a margin, which would provide capital to invest in technology, expansion, and new employees. Further, many private insurance companies leverage their size to negotiate lower prices from providers; this deepens the financial strain on community hospitals.
Governor Patrick’s proposed cap on providers’ prices would force community hospitals to accept a deficit representing billions of dollars in revenue, patient services, and the quality and safety of the organization. Patrick’s bill allows the government to essentially squeeze providers from both ends. While continuing to offer only partial reimbursement for services, the governor’s legislation would prevent community hospitals from breaking-even. The consequences of which are dire for the entire health care industry.
If Patrick’s bill passes, community hospitals will have three basic choices. First, and depending on the financial health of the organization, community hospitals could redesign pricing strategies, eliminate patient services, and continue struggling to generate enough revenue to survive. This is a poor option for consumers, as patients would have to go elsewhere for important services like obstetrics, cardiac surgery, and radiation oncology. These services, among others, would most likely be eliminated first as they represent enormous costs for the organization due to required technology, specialist salaries, and insurance against risky procedures. Unless the financial performances of the organizations dramatically improve, community hospitals could continue cutting services until they exist solely as emergency clinics. The second choice is even bleaker. Community hospitals could decide that they cannot generate enough operational revenue to repay bondholders; this would force the closure of the organizations. Shutting down a community hospital, however, is a major ethical dilemma. Patients within the community would be forced to travel greater distances for care and would face longer wait times for appointments at larger specialty hospitals or academic medical centers.
The third and most likely option involves mergers and acquisitions among community hospitals and larger hospital networks. Massachusetts has already seen a vast number of partnerships develop in the past few years. Currently, most community hospitals in the state no longer exist as freestanding organizations but are affiliated with larger medical centers in Boston. The larger and more advanced centers treat severe cases while referring patients to community clinics for routine procedures. Patrick’s legislation, though, would alter the depth and breadth of hospitals’ affiliation. No longer would the partnership exist to provide patients with better care; rather, the organizations would become financially dependent on the network. Administration would most likely be streamlined to save costs, eventually resulting in only one or a few management teams controlling all the state’s hospitals.
The economic incentive for hospitals to join monopolistic networks would virtually eliminate consumer choice and contribute to decreased patient safety and quality. The basic theory driving hospitals to merge is known as economies of scale. Not unlike major U.S. corporations McDonald's and Wal-Mart, hospital networks would seek to generate revenue by keeping prices low and treating as many patients as possible. While consumers may benefit to some degree by this strategy in the restaurant and retail industries, health care is far too risky to put in the hands of just a few individuals. Further, while McDonald's and Wal-Mart certainly dominate their markets in terms of pricing, consumers still have many choices when searching for quality products. Health care, however, presents a challenge in terms of a patient’s ability to choose. Unlike fast food restaurants and retail stores, it takes a tremendous amount of capital to run a hospital; this means far fewer hospitals can exist than other business outlets. Patients, then, would have to travel extreme distances to reach a hospital run by a different network, not to mention that choice becomes virtually impossible while having a heart attack in the back of an ambulance.
Because the consumer’s choice is limited, there is significantly less incentive for health care managers to continually improve the safety and quality of patient care, particularly when such tasks involve financial investment. The tradeoff for the “dollar menu” at McDonald's and the steep discounts at Wal-Mart is the occasional dirty store, incompetent employee, and poor quality product. Is this something that residents of Massachusetts are ready to compromise for cheaper health care? If so, the true costs of health care may no longer be measured in a dollar amount but in patient dissatisfaction, medical errors, and lives lost.
Rather than proposing legislation that makes providers look like the enemy, the government should focus on managing their own expenses so that they can reimburse community hospitals for the full costs of treating Medicaid and Medicare patients. If that means raising taxes, than Massachusetts’ residents should elect a leader that has the fiscal responsibility and courage to do the right thing and fix health care in this state.
Monday, March 1, 2010
Starbucks v. NESCAFE, an employee's taste test
This morning, a team of guerrilla marketers pulled up to my school outside the cafe where I was eating breakfast. This is not an uncommon phenomenon as many companies seek the young, easily persuaded market of poor college students who will take samples of just about anything as long as its free.
This time, it was a team from NESCAFE, a company that produces instant coffee. They were handing out free samples of their product and challenging people to compare the taste to that of "expensive coffee stores", eh'em...Starbucks.
The picture on their bags even showed one of these expensive coffees (a white cup with a suspiciously familiar green logo) next to the NESCAFE product. However, if you look closely at this picture I snapped, you can see the team leader sipping not an instant coffee drink, but a Starbucks product...whoops!
I guess he is just confirming his own conviction that Starbucks is highly inferior to the product he is getting paid to represent, right??
This time, it was a team from NESCAFE, a company that produces instant coffee. They were handing out free samples of their product and challenging people to compare the taste to that of "expensive coffee stores", eh'em...Starbucks.
The picture on their bags even showed one of these expensive coffees (a white cup with a suspiciously familiar green logo) next to the NESCAFE product. However, if you look closely at this picture I snapped, you can see the team leader sipping not an instant coffee drink, but a Starbucks product...whoops!
I guess he is just confirming his own conviction that Starbucks is highly inferior to the product he is getting paid to represent, right??
Sunday, February 28, 2010
Modeling leadership in health care
Check out this great interview published yesterday by the NY Times. Found in the weekly "Corner Office" section, the article features Tachi Yamada, M.D., current president of the Bill and Melinda Gates Foundation's Global Health Program. Dr. Yamada discusses his experience managing a variety of organizations including a small lab, a large department of medicine, an even larger R&D firm, and his current team at the Gates Foundation.
A few notable topics include: the importance of delegation, staying in touch with the organization, mentors, giving employees undivided attention, working with "what you have" and bringing out the best in people, the ability to endure change, humor, emotional intelligence, and giving feedback.
He is a true model and a rare example of successful health care leadership.
A few notable topics include: the importance of delegation, staying in touch with the organization, mentors, giving employees undivided attention, working with "what you have" and bringing out the best in people, the ability to endure change, humor, emotional intelligence, and giving feedback.
He is a true model and a rare example of successful health care leadership.
Have six and a half hours to spare?
President Obama's bipartisan Health Summit took place last week. Despite many political talking points clearly directed at the cameras in the room, there were some candid discussions that actually made the group of elected officials appear concerned about the health care debacle in this country.
While it seems that little progress was made in terms of major compromise, there were some promising steps towards inclusion of certain Republican concerns about the health bill. If nothing else, the six and a half hour summit acts as a good summation of the major debates regarding health care that occurred in Washington over this past year.
While it seems that little progress was made in terms of major compromise, there were some promising steps towards inclusion of certain Republican concerns about the health bill. If nothing else, the six and a half hour summit acts as a good summation of the major debates regarding health care that occurred in Washington over this past year.
My dream seminar
The newest "Short White Coat" entry, an interesting blog written by a fourth-year med student at Harvard University through the Boston Globe's website, discusses an extremely important idea: teaching doctors about competition and quality in health care delivery.
Ishani Ganguli, the blog's author, details a seminar she recently attended through Harvard's B-school. Taught by renown business scholar Michael Porter and Elisabeth Teisberg (who co-authored Redefining Health Care: Creating Value Based Competition on Results, an intimidating 430-page book that has sat unopened on my shelf for a year), the seminar brought together health care executives, physicians, and students.
Ganguli gets it right when she says this topic is "critical for all doctors to understand." Further, this was pretty much my dream seminar. I wonder how I can get invited to the next one..?
Ishani Ganguli, the blog's author, details a seminar she recently attended through Harvard's B-school. Taught by renown business scholar Michael Porter and Elisabeth Teisberg (who co-authored Redefining Health Care: Creating Value Based Competition on Results, an intimidating 430-page book that has sat unopened on my shelf for a year), the seminar brought together health care executives, physicians, and students.
Ganguli gets it right when she says this topic is "critical for all doctors to understand." Further, this was pretty much my dream seminar. I wonder how I can get invited to the next one..?
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