Finicky appetite

GVMH’s Food and Nutrition Services Department prepares great tasting food.  We know this to be the case because our patients tell us.  Our patients love our hotel style room service, they appreciate the quality of food, the great variety and the ability to order what they want when they want it.

Here’s a copy of a hand written thank you note from a patient who recently spent a few days in the hospital.

Thank you!  That was delicious!  Words can’t express how very grateful I am for the way you have worked with my finicky appetite.  You have all been so kind and thoughtful!

I feel so blessed!

Blessings!

Room 327

Since we’re talking about our food services.  I would like to compliment our FANS Staff for sharing a few new dishes with us this week as they helped us celebrate Chinese New Year.  The vegetable lo mein and the hot and spicy soup were awesome.  This past Wednesday at Board Meeting they served Beef Roulade….I have no idea how to say or spell it but it was good to eat and very gourmet!

Finally, Congratulations to Sara Church.  Sara graduated from Culinary Academy this week.  I look forward to eating her food!!!

Big Rocks

On September 26 of last year my son’s daycare was closed for staff training (Obviously this blog has sat in the archive for a while). A closed daycare creates a little bit of a problem when both parents work. My wife took off part of the day, my Dad helped for a few hours and I took the afternoon off to be with my son so we made it through the day without a hitch and had fun in the process.

One of the things I appreciate most about GVMH is the importance our organization places on family. The story below reminded me of why GVMH is a great place to work – GVMH knows about the big rocks…

Big Rocks, a matter of perspective

One day, an expert in time management was speaking to a group of business students and, to drive home a point, used an illustration those students will never forget.

As he stood in front of the group of high-powered overachievers, he said, “Okay, time for a quiz.” He then pulled out a one-gallon, wide-mouth mason jar and set it on the table in front of him. Then he produced about a dozen fist-sized rocks and carefully placed them, one by one, into the jar. When the jar was filled to the top and no more rocks would fit inside, he asked, “Is this jar full?”

Everyone in the class said, “Yes.” Then he said, “Really?” He reached under the table and pulled out a bucket of gravel. Then he dumped some gravel in and shook the jar, causing pieces of gravel to work themselves down into the space between the big rocks. Then he asked the group once more. “Is this jar full?”

By this time the class was on to him. “Probably not,” one of them answered.

“Good!” he replied. He reached under the table and brought out bucket of sand. He started dumping the sand in the jar and it went into all the spaces left between the rocks and the gravel. Once more he asked the question. “Is this jar full?”

“No!” the class shouted.

Once again, he said, “Good!”. Then he grabbed a pitcher of water and began to pour it in until the jar was filled to the brim. Then the expert of time-management looked at the class and asked, “What is the point of this illustration?”

One eager Beaver raised his hand and said, “The point is, no matter how full your schedule is, if you try really hard you can always fit some more things in it.”

“No”, the speaker replied, “That’s not the point. The truth this illustration teaches us is this: If you don’t put the big rocks in first, you’ll never get them in at all. What are the big rocks in your life? Your children. Your spouse. Your loved ones. Your friendships. Your education. Your dreams. A worthy cause. Teaching or mentoring others. Doing things that you love. Time for yourself. Your health. Remember to put these BIG ROCKS in first, or you’ll never get them in at all. “If you sweat the little stuff (i.e. gravel, the sand) then you’ll fill your life with little things you will never have the real quality time you need to spend on the big, important stuff (the big rocks). So, tonight, or in the morning, when you are reflecting on this short story, ask yourself this question: What are the “big rocks” in my life? Then put those in your jar first.

A bipartisan Medicare reform proposal – who’d a thunk it?

As this is an election year we are going to hear a lot about how and why Medicare should be reformed and we are going to see even more finger pointing and blame.  In December Representative Paul Ryan (R-Wis.) and Senator Ron Wyden (D-Ore.) announced a bipartisan proposal to fundamentally reform Medicare. 

The proposal would maintain traditional Medicare as an option for all eligible individuals and would require private insurers to offer similar coverage through an exchange.  For those individuals interested in purchasing insurance through private insurers the federal government would provide funding to the individual to purchase the private insurance.  The level of support would be adjusted for beneficiaries depending on their ability to afford coverage.

The proposal is interesting and could be attractive to Medicare beneficiaries who are interested in insurance options that provide better coverage than traditional Medicare and it would also be attractive to beneficiaries who are relatively healthy.   The proposal is a small step in privatizing Medicare which could help limit “overspending” on Medicare services by requiring pre-certs and negotiating rates for services.

I don’t think there’s any way the proposal gains traction but it’s at least something.  There’s no quick or easy fix for Medicare and there’s no denying that Medicare spending must be brough under control.  I’ve commented many times before that Medicare reform has to be more than payment reductions to providers and the only way for that to happen is though a fundamental change to the Medicare program.  Representative Ryan and Senator Wyden will likely never see their proposal come to fruition but they are at least working across party lines and looking for a solution rather than pointing fingers and placing blame which is both refreshing and rare.

Maybe, just maybe, the new year will bring a new commitment to do the right thing in our nation’s capital.

Change

I’ve been reading the book “Mastery” by George Leonard.  The book provides a great explanation as to why we are all resistant to change.  Here’s an excerpt:

Backsliding is a universal experience. Every one of us resists significant change, no matter whether it’s for the worse or for the better. Our body, brain and behavior have a built-in tendency to stay the same within rather narrow limits, and to snap back when changed…Be aware of the way homeostasis works…Expect resistance and backlash. Realize that when the alarm bells start ringing, it doesn’t necessarily mean you’re sick or crazy or lazy or that you’ve made a bad decision in embarking on the journey of mastery. In fact, you might take these signals as an indication that your life is definitely changing–just what you’ve wanted….Be willing to negotiate with your resistance to change. (Mastery, p. 107-115).

I wanted to include another passage from the book that provides more insight to our resistance to change but I’ve got a limited amount of space so let me summarize it for you.  The author explains that our bodies are programmed to keep things the same as much as possible and the most basic example is temperature regulation.  If your body is warm, it sweats.  If your body is cold, it shivers.  Your body regulates itself to keep your body temperature the same regardless of the environment. 

We all know that change is inevitable and in many cases change is good but change is difficult for all of us.  We are creatures of habit and creatures of comfort and what we know and what is routine IS what is comfortable to us. 

The author suggests that to fully reach our potential we must not only be open to change but we must look for change and opportunities to challenge ourselves.  There is no benefit in change for the sake of change but if we are committed to getting better and doing better than we must always be in a state of change because getting better involves us changing ourselves or what we do.

I’m sure most of you, like me, want to do better at work, be a better parent, be a better spouse, learn a new skill or perform better athletically and the only way to do so is to accept and embrace change!

Great People, By Nature

My stint as President of the Greater Clinton Area Chamber of Commerce “officially” begins this week.  The annual awards and installation banquet is Thursday evening.

The below link is a shortened version of a video I’ll be using in my speech.  If you’re familiar with Clinton, you will appreciate the video.

http://www.youtube.com/watch?v=zfEIkAg-oK0

Complaints

Part of my job is to deal with complaints.  It would make sense that dealing with complaints is one of the least favorite aspects of my job and nothing is farther from the truth. 

Don’t get me wrong, I would be happy to never receive a complaint for the rest of my career (a career I’m hoping spans at least another 30 years, by the way).  To think that complaints will go away no matter how great a job we do providing care is unrealistic.  The most important thing I do is deal with complaints and the most satisfying aspect of my job is successfully dealing with a complaint. 

We deal every day with people in highly stressful and emotionally charged situations and we do the most important work on the face of the earth – we save lives.  Complaints are going to happen.  Knowing that complaints will occur becomes incumbent upon us is that we deal with complaints timely and appropriately.

Every complaint is important to the person making the complaint and we need to respect that individual and their complaint and respond in a manner that mirrors their concern.  Nothing is more disappointing than to have the person listening to a complaint not give it the same level of importance as the person does who is making the complaint. 

We must also respond and act timely on every complaint we receive.  We do important work, we hold people’s safety in our hands every complaint provides us the opportunity to evaluate our processes and be sure we are performing to our standards and to the expectation of our patients.

Our work is confusing.  We know what we’re doing but the individual, or the family of the individual, receiving our services often doesn’t understand what we’re doing.  We need to “over” explain things as they’re occurring and many times a complaint can be addressed by helping someone understand why something occurred.  It’s a lot easier to explain things when they’re happening as opposed to explaining why something happened when a person is upset.

We must also be compassionate when dealing with complaints.  Health care is an art and not a science and no matter how great we are, a bad outcome can happen.  We’ve all been in situations that caused us to be upset because we didn’t like or understand why the situation turned out that way it did.  We need to put ourselves in the shoes of the person making the complaint and respond with the same degree of urgency and same level of importance. 

Finally we must also be willing to say “I’m sorry”.  To often in health care we avoid saying “I’m sorry” because we believe doing so is an admission that we’ve done something wrong when in fact we haven’t.  We should say “I’m sorry” and we should be sorry even when we haven’t done anything wrong.  We should be sorry that our patient has a complaint and we should be sorry that we haven’t done everything within our power to set expectations that our patient fully understands and we should be sorry that our patient’s believe they need to spend their time talking to us about their complaint as opposed to sharing with us all the great things we did to help them get better.

Now if you’ll excuse me, I need to take care of a complaint!

Verbal age

Both blog posts this week have been fairly serious and its Friday so let’s be a little more relaxed.

My son turns 3 next Saturday but his birthday will not catch him up to his “verbal age”.  My son’s verbal age has somehow reached the level of a first year postgraduate student.

One day last week I got home from work at around 6:00 pm.  I entered the house through the garage and my son greeted me at the door by saying. “Hi Dad, how was your day?”…

Recently my wife asked my son to pick his toys up off of the kitchen floor.  He stopped, turned to look at her and said “Mom, I’m getting sick of this”.  My wife’s face turned a shade of red that you can’t find in a box of Crayolas, not even the 164 count box.  I had to excuse myself from the room because I immediately went into convulsions due to oxygen deprivation from laughing uncontrollably.  Eventually, the toys got picked up so the two of them must have come to an agreement, I would share what was said but I couldn’t hear anything over my laughing…

The garage door spring broke as my wife and son were pulling into the garage.  The wife, kid and car are all fine but the garage door will not go up or down without a spring.  I manually lifted the door overhead while my wife pulled her car out of the garage so that she would have transportation to work the next morning.  While I’m struggling to hold the door in the air my son says, “Dad, I need to call PaPa (Grandpa)” I said “Why?” and he responded “he can fix anything and the garage door is broken”.  I wanted to say, “really, the garage door is broken”, but I couldn’t get the words out becuase I was straining so hard to hold a BROKEN GARAGE DOOR above my head…

As you learned when you poked your nose out the door yesterday morning, it snowed.  My son woke up at 4:00 a.m. Thursday morning, looked outside and said “Dad, it snowed.  That means Santa Claus is coming!”…

Finally, a Hardee’s commercial on TV showed a picture of a cheeseburger.  My son looked at the cheeseburger and said, “Dad, look at that scrumptious cheese”…

You’re outta here

There’s a proposal in New York that would grant authority to the state health commissioner to replace hospital management and remove board members when self-interest or poor quality of care is an issue.  The authors of the proposal have this to say “The boards of some of these hospitals have failed to satisfy fully their responsibilities to the organization and their communities . . . Instead, they have adopted a strategy that seeks merely to be the last man standing in their communities.”

I guess the authors forget that we live in a free market society and any industry that turns its back on its customers will fail.  If there are hospitals not making decisions in the best interest of their community or their organization, eventually they will fail and everyone associated with the organization will be without a job. 

Fortunately, GVMH is governed by an elected board.  GVMH is a district hospital and our six board members are elected from various geographic portions of the district we serve.  I firmly believe that one of the reasons GVMH has been successful at anticipating and meeting the healthcare needs of our community is because our board represents the community we serve and they help guide us.

There is a situation in health care where a policy to “boot” someone not acting in the best interest of a community could be beneficial.  What if hospital executives and boards could remove public officials who serve only themselves. 

Congress has tried and failed repeatedly to fix the health care system and it has been apparent that they do not always act in the best health care interest of the communities they serve.  It’s not beyond a member of congress to sacrifice public interest to get re-elected and take advantage of perks.  Remember when the health care reform debate was going on and the two sides of the aisle could not come together or reach a compromise.  I did a blog at the time and commented that two pieces necessary for true health care reform weren’t even being discussed.   Those two pieces are tort reform and pharmaceutical costs.

Tort reform would limit the amount a physician can be sued for malpractice thus reducing all of the unnecessary cost associated with defensive medicine.  We all understand the outrageous cost of prescription drugs and the control of drug costs would limit unnecessary health care expenditures as well.  Neither of these topics made it into the health care reform bill that was passed – and do you know why?  Special interest groups were able to exert influence over congress (and money which is influence if you’re in congress) to keep these highly lucrative industries, yet highly costly for the average American, out of any real attempt at reform.

Maybe I’m changing my mind, maybe there should be a policy to “boot” those not acting in the best interest of their communities but I’m not sure hospital executives and boards are the right targets!

Physician pay cuts

How would you like to have your pay reduced 27.4%.  I’m guessing you would not like it at all but physicians who recieve payments from Medicare face a 27.4% pay cut in the next 45 days if Congress doesn’t do something to stop it from happening.

There’s this thing called the sustainable growth rate and it’s used to determine physician payments under Medicare.  The sustainable growth rate first came into use with the Balanced Budget Act of 1997 and from 1998 to 2002 the formula was followed and used to provide payment increases to physicians.  The purpose of the program was to restrain the growth of Medicare spending on physician services.  In 2002 Congress overrode the formula and costs of physician payments exceeded budget and it’s been a mess ever since.

For the past 9 years Congress has extended the sustainable growth rate a year at a time but never created a plan to correct the problem and the formula was set to expire at the end of 2011 but just in the nick of time Congress extended the physician fee schedule for two months. 

Physician’s now face a 27.4 percent reduction in Medicare payments if something isn’t done by March 1, 2012.  By ignoring the problem for the past 9 years, Congress has created a problem that has no good or easy solution.  Instead of addressing the problem head on in the past Congress has elected to “punt” year after year and put a solution off one year at a time.

Because the sustainable growth rate is so far out of balance due to 9 years and two months worth of extensions the formula needs to be scrapped and a new payment formula needs to be created.  Does anyone have faith that Congress can solve even a simple problem in the next two months let alone a complex problem like physician pay…

It appears that Congress may choose to “freeze” physician payments at the current level for the next year and it’s estimated that this will cost around $20 billion.  An important thing to remember in this process is that the Congressional Budget for Medicare spending is set on the original sustainable growth rate formula, not actual spending so the additional $20 billion in cost will need to come from somewhere.

One longer term fix proposal is to replace the sustainable growth rate with the Medicare Economic Index or MEI.  The MEI limits annual physician fee increases to those regarding the costs of producing physician services, such as obtaining medical supplies, and increases in general earnings levels. 

There are two problems with the MEI.  First, it is estimated that it will cost $300 billion to replace the sustainable growth rate.  Health care spending has been slashed and further cuts are ahead as health care reform is implemented over the next few years.  Where will congress find another $300 billion to cut – my guess – it will come at the expense of hospitals.  Second, health care reform increases the number of Medicaid recipients and many physicians will be seeing more Medicaid recipients.  Medicaid pays physicians considerably less than Medicare and substantially less than commercial insurance.  Reducing Medicare payments to physicians and asking them to see more Medicaid patients will materially decrease physician earning potential. 

Physicians have a difficult job and they are some of the brightest and most talented people in our society.  Physicians risk being sued for every decision they make and they have a lifestyle that requires them to devote their time and energy to their occupation at the expense of their personal and family life.  Now don’t get me wrong, I’m not asking you to feel sorry for physicians, we all choose our paths in life and thankfully for all of us compassionate, intelligent people choose to become physicians. 

My fear, and a fear that is real, is that reductions to physician pay may deter the right kind of people from becoming a physician.  Across the health care industry we have seen reductions in talented individuals pursuing health care careers because they have the potential to earn similar or greater salaries and have far fewer headaches in other occupations.

Physicians do great work every day and they have a great deal of influence so I do not believe Congress will make a move to materially decrease physician payments from Medicare.  There are no easy answers when it comes to fixing Medicare and the sustainable growth rate is one more mole hill that’s turned into a mountain because no one in Congress was brave enough to try to slay the dragon.  I’ll keep you updated as the situation unfolds, we’ll know a lot more in the coming months.

Hopitals = Good for Missouri

JEFFERSON CITY, Mo. — According to a new report from the Missouri Hospital Association, the state’s hospitals provided $482 million in charity care in 2010, an increase of 30 percent from 2008. However, charity care is only 22 percent of the total community benefits provided. When added to other financial contributions to the community — such as free clinics, donations, health care professional education, bad debt and unpaid costs of Medicare and Medicaid — hospitals’ total community benefit was more than $2.3 billion.

“It can be hard to imagine what $482 million in charity care looks like, given the size of the outlay,” said Herb B. Kuhn, MHA president and CEO. “To illustrate the value, imagine it this way — $482 million is the equivalent of 1,742 free emergency department visits daily, or 636,000 per year. Alternatively, the sum would cover hospital care for 126 patients daily, or 46,000 days annually, or could be translated as the equivalent of 587 days of in-hospital care every day, or 214,000 days of care annually.”

Hospitals’ total uncompensated care is comprised of both charity care and bad debt. In 2010, the 128 hospitals that participated in this report provided $482 million in charity care and incurred $486 million in bad debt. Combined, the cost of providing this uncompensated care is nearly $1 billion. In addition, Medicare and Medicaid often pay less than the cost of providing care. In 2010, hospitals absorbed more than $1 billion in the unpaid costs of treating Medicare and Medicaid beneficiaries.

Hospitals’ community benefit investments are often driven by defined areas of local need. In 2010, hospitals donated $35 million to causes in their community and $30 million to free or reduced cost medical clinic services. In addition, hospitals contributed $274 million to education of health professionals to build and sustain the health care workforce.

“The report also points to the vital role of hospitals as economic engines in the communities they serve,” Kuhn said. “Hospital jobs and infrastructure investments have continued to add strength to the economy while other sectors were faltering.”

In 2010, Missouri hospitals added 10,000 jobs at a time when the private sector shed 13,400 jobs. The 128 Missouri hospitals participating in the 2010 Community Investment Report provided jobs to 116,527 full-time equivalent employees with salaries and benefits totaling $7.7 billion in 2010. Capital investment in 2010 totaled $1.2 billion. These salaries and capital expenditures support significant economic activity at the local and state level and create jobs and investment in other economic sectors.

“Hospitals provide lifesaving care to the communities they serve 24/7,” Kuhn said, “and they provide economic life and vitality. The 2010 Community Investment Report demonstrates why strong communities need strong hospitals.”