Here is a link to a story by Nancy Snyder, CEO of Commonwealth Corporation. Please watch the two videos (embedded below) about the personal impact of a job training and advancement program we are running with Children's Hospital Boston, New England Baptist Hospital and Bunker Hill Community College. It is made possible by an innovative and thoughtful program funded by Governor Deval Patrick's administration.
This is a great example of a public-private partnership that advances the lives of workers in the health care field.
Congratulations to all the new graduates!
If you can't view the videos, click here.
Friday, June 4, 2010
Thursday, June 3, 2010
Poetry in action
Katherine Swan Ginsburg was a member of the BIDMC community as a house officer in the early 90s. Not long after completing her training she died of cancer at the age of 34. Katherine, whose mastery of medical knowledge and technical competence were outstanding, was also widely admired for her extraordinary compassion and selfless dedication in caring for her patients.
Over the last 18 years, Katherine’s family has kept her spirit alive through the Katherine Swan Ginsburg Humanism in Medicine Endowment Fund, which has played a key role in continuing to promote the importance of patient centered, compassionate care here at the BIDMC, something that has long been critical to our unwritten mission of taking care of patients as we would want members of our own families to be taken care of.
Today's lecture was offered by Rafael Campo, a member of our faculty, whom regular readers may remember. He was a key force in organizing this week's events on humanism in medicine, which overlapped the poetry slam mentioned below. His topic was "Cultural Competence: Poetry and the Importance of Voice in the Illness Experience."
Here are some video excerpts of Rafael's lecture. Beneath his video is a short take of some of the art on exhibit as part of the Medical Humanities Week Celebration. If you can't see the videos, click here.
Over the last 18 years, Katherine’s family has kept her spirit alive through the Katherine Swan Ginsburg Humanism in Medicine Endowment Fund, which has played a key role in continuing to promote the importance of patient centered, compassionate care here at the BIDMC, something that has long been critical to our unwritten mission of taking care of patients as we would want members of our own families to be taken care of.
Today's lecture was offered by Rafael Campo, a member of our faculty, whom regular readers may remember. He was a key force in organizing this week's events on humanism in medicine, which overlapped the poetry slam mentioned below. His topic was "Cultural Competence: Poetry and the Importance of Voice in the Illness Experience."
Here are some video excerpts of Rafael's lecture. Beneath his video is a short take of some of the art on exhibit as part of the Medical Humanities Week Celebration. If you can't see the videos, click here.
Actuarial standards
Rob Weisman in the Boston Globe today reports that MA insurance companies are again proposing increases in small business and individual premiums. A spokesperson for Blue Cross Blue Shield comments that the rates are "actuarially sound."
It is worth reflecting on that comment because it means a lot. The people who go through the extensive process of becoming actuaries are highly trained in statistics and inference, and their qualifications receive independent review. Equally important, they are professionals of the highest order, in terms of ethical standards. See here, for example.
Simply put, actuaries are not permitted to be influenced by political concerns or the hopes of various constituencies. They will only afix their certification to calculations when they are confident that their professional judgments are sound and would pass review by objective observers.
I have received reports in the last few months of actuaries refusing to certify filings that have been demanded by the Division of Insurance, knowing that those certifications would have been actuarially unsound and therefore inconsistent with their Code of Conduct. Notwithstanding that lack of certification, revised rates have been approved by the Division, an agency also charged with the responsibility of insuring proper capitalization of the state's insurance companies.
It is worth reflecting on that comment because it means a lot. The people who go through the extensive process of becoming actuaries are highly trained in statistics and inference, and their qualifications receive independent review. Equally important, they are professionals of the highest order, in terms of ethical standards. See here, for example.
Simply put, actuaries are not permitted to be influenced by political concerns or the hopes of various constituencies. They will only afix their certification to calculations when they are confident that their professional judgments are sound and would pass review by objective observers.
I have received reports in the last few months of actuaries refusing to certify filings that have been demanded by the Division of Insurance, knowing that those certifications would have been actuarially unsound and therefore inconsistent with their Code of Conduct. Notwithstanding that lack of certification, revised rates have been approved by the Division, an agency also charged with the responsibility of insuring proper capitalization of the state's insurance companies.
Wednesday, June 2, 2010
Dave Barry explains all
Dave Barry provides an accurate description of our health care system here. Two excerpts:
The first big breakthrough in medical knowledge was made by the ancient Egyptians, who discovered that the human body contained organs such as the pancreas, and if a person became sick, and you took out one or more of these organs, the person would get better. Or not. But either way you could charge the person, or his heirs, money. This was the beginning of surgery....
The greatest Greek physician of all was Hippocrates, who is often called "the father of modern medicine'' because he invented the concept that remains the foundation of all medical care as we know it today: the receptionist. Prior to this invention, when patients came to see the doctor, the doctor had to actually see them, which, as you can imagine, took up a lot of his valuable time because they were always nattering on and on about being sick. But all of a sudden, thanks to Hippocrates, incoming patients could be intercepted by a receptionist, who would (1) tell them to take a seat, and then (2) avoid making eye contact with them for the rest of the afternoon. This breakthrough meant that a single doctor could schedule as many as 375 appointments per hour, which is the system we still use today.
With thanks to Bob Wachter for the pick-up!
The first big breakthrough in medical knowledge was made by the ancient Egyptians, who discovered that the human body contained organs such as the pancreas, and if a person became sick, and you took out one or more of these organs, the person would get better. Or not. But either way you could charge the person, or his heirs, money. This was the beginning of surgery....
The greatest Greek physician of all was Hippocrates, who is often called "the father of modern medicine'' because he invented the concept that remains the foundation of all medical care as we know it today: the receptionist. Prior to this invention, when patients came to see the doctor, the doctor had to actually see them, which, as you can imagine, took up a lot of his valuable time because they were always nattering on and on about being sick. But all of a sudden, thanks to Hippocrates, incoming patients could be intercepted by a receptionist, who would (1) tell them to take a seat, and then (2) avoid making eye contact with them for the rest of the afternoon. This breakthrough meant that a single doctor could schedule as many as 375 appointments per hour, which is the system we still use today.
With thanks to Bob Wachter for the pick-up!
Tsunami heading here
With the speed of tidal changes in the Bay of Fundy, word is now arriving at hospitals throughout the state that they will be given rate decreases in their current contract renewals.
Think about this. These hospitals face increases in salaries and wages for their nurses and other staff (sometimes as contractual commitments in collective bargaining agreements) and increases in the cost of goods and supplies needed for patient care.
Insurers say, in essence, "That's not our problem."
Well, it is your problem. Insurers do not deliver care. They are financial intermediaries who add little value to the provision of health care*. If they cut the resources needed by hospitals, they will affect communities throughout the state.
By communities, I mean people. Workers at hospitals. Patients and families in the cities and towns.
We need to remember that the proximate cause of this crisis is an Administration that imposed arbitrary price caps on the insurers and then told them to go make up the losses by squeezing the providers.
But not all providers. Not the ones who were found by the Attorney General to have rates that are out of whack.
As disclosed by the Attorney General in explaining the longer term health care cost trend: Disparities in reimbursement rates permitted the highly compensated hospitals and physician groups to expand market share by building facilities and recruiting doctors, compounding the rate advantage they already had.
If we have a $100 million or $200 million short-term problem, let's look in the right place for the solution. Beyond the short-term problem, there is a structural problem that arises out of the state's noble decision to provide greater access to health care and out of the rate-making process that rewards market power.
Insurers who characterize their current approach as being a virtuous resolution to these difficult problems are complicit in the general unwillingness to engage in meaningful change that will set the Commonwealth along a sustainable path.
---
* Admittedly, they have provided actuarial value in the past, but as we move to capitated contracts, that value is diminished.
Think about this. These hospitals face increases in salaries and wages for their nurses and other staff (sometimes as contractual commitments in collective bargaining agreements) and increases in the cost of goods and supplies needed for patient care.
Insurers say, in essence, "That's not our problem."
Well, it is your problem. Insurers do not deliver care. They are financial intermediaries who add little value to the provision of health care*. If they cut the resources needed by hospitals, they will affect communities throughout the state.
By communities, I mean people. Workers at hospitals. Patients and families in the cities and towns.
We need to remember that the proximate cause of this crisis is an Administration that imposed arbitrary price caps on the insurers and then told them to go make up the losses by squeezing the providers.
But not all providers. Not the ones who were found by the Attorney General to have rates that are out of whack.
As disclosed by the Attorney General in explaining the longer term health care cost trend: Disparities in reimbursement rates permitted the highly compensated hospitals and physician groups to expand market share by building facilities and recruiting doctors, compounding the rate advantage they already had.
If we have a $100 million or $200 million short-term problem, let's look in the right place for the solution. Beyond the short-term problem, there is a structural problem that arises out of the state's noble decision to provide greater access to health care and out of the rate-making process that rewards market power.
Insurers who characterize their current approach as being a virtuous resolution to these difficult problems are complicit in the general unwillingness to engage in meaningful change that will set the Commonwealth along a sustainable path.
---
* Admittedly, they have provided actuarial value in the past, but as we move to capitated contracts, that value is diminished.
Tuesday, June 1, 2010
Poetry at the hospital
The hospital's poetry and music slam, held as part of the Schwartz Rounds, is an annual highlight. This is a side of medicine not usually seen by patients, the creative impulses of members of our staff. Some of these are prompted by care-giving experiences, some by family matters, some by other events. With permission of the participants, I offer a small sample in the video below.
The performers are Dr. Mark Gebhardt, playing J.S. Bach's Chromatic Fantasy, BWV 903; nurse Janet Greene reciting "Aged to Stone," a representation of a relative's experience with late-stage Parkinson's Disease; interpreter Domingos Ramos, reading a poem entitled "Ode to Interpreters," written by Shari Gold-Gomez, our Director of Interpreter Services; nurse Marybeth Meservey reciting "Now I know;" case manager Janet Fantasia reading "Respite;" Dr. Catherine Parker reciting "View from a Fourth Row Seat;" and a few stanzas from "Pied Beauty in Primary Care," read by Dr. Leonor Fernandez.
My apologies for the low volume levels, but you can hear these clearly if you turn up your computer's volume. Just in case, though, here is Janet's poem "Respite".
Amidst blue skies and picnickers
he arranges two sun-bleached
chairs side by side,
opens the passenger door
and cradling has wife,
gently raises her tiny form,
pulls her, legs splayed,
delicately hugging the curb
and slides through the grass
lowering her into the seat.
With a click of the radio, he leans
back and loses himself in the ballgame.
If you can't see the video, click here.
The performers are Dr. Mark Gebhardt, playing J.S. Bach's Chromatic Fantasy, BWV 903; nurse Janet Greene reciting "Aged to Stone," a representation of a relative's experience with late-stage Parkinson's Disease; interpreter Domingos Ramos, reading a poem entitled "Ode to Interpreters," written by Shari Gold-Gomez, our Director of Interpreter Services; nurse Marybeth Meservey reciting "Now I know;" case manager Janet Fantasia reading "Respite;" Dr. Catherine Parker reciting "View from a Fourth Row Seat;" and a few stanzas from "Pied Beauty in Primary Care," read by Dr. Leonor Fernandez.
My apologies for the low volume levels, but you can hear these clearly if you turn up your computer's volume. Just in case, though, here is Janet's poem "Respite".
Amidst blue skies and picnickers
he arranges two sun-bleached
chairs side by side,
opens the passenger door
and cradling has wife,
gently raises her tiny form,
pulls her, legs splayed,
delicately hugging the curb
and slides through the grass
lowering her into the seat.
With a click of the radio, he leans
back and loses himself in the ballgame.
If you can't see the video, click here.
Friday, May 28, 2010
Denial
The current political debate in Massachusetts about rising health care costs and insurance company premiums is a striking case of denial. The most thorough evaluation of the underlying causes of inflation was presented by the state's Attorney General this past winter. She found that the long-standing and current disparities in pricing in the Massachusetts market contribute mightily to the growth in health care costs and insurance premiums in the state. As noted in this Boston Globe story, her staff put in thousands of hours studying the issue:
The report, the result of legislation that directed Coakley to investigate why medical costs are rising so rapidly, is based on tens of thousands of contracts and other documents subpoenaed from insurers and providers and depositions from more than 30 key health care executives.
In light of the AG's conclusions, you would think that policymakers would be spending their time to design measures to reduce the disparities in reimbursement rates. But, as noted below, the policies being ordered by the Administration and the actions being taken by the insurers tend to do just the opposite.
In this kind of situation, where does one find the leadership to deal with these problems? The insurers have been willing or forced participants in creating the current situation. Can we expect them to change their stripes and take firm action against dominant providers?
During the hearings on these matters held by the state's Division of Health Care Finance, the witness from Blue Cross Blue Shield said that even his company, the largest in the state, did not have the market power to offset that of the dominant provider group and individual hospitals with special geographical advantages. That such was the case with smaller insurers was demonstrated years ago when Partners Health Care forced Tufts Health Plan to bend, but whether the same would apply to the dominant insurer remains an untested proposition.
We certainly cannot expect those providers who have benefited from higher rates to voluntarily accept cuts that would take them to the statewide average in a timely fashion. For one thing, their cost structures have been built on the expectation of greater revenues.
I believe the leadership has to come from the business community, those firms whose payments of insurance premiums -- or whose self-insurance arrangements -- validate the current reimbursement patterns. Their goal has to be to support market shifts to higher value providers. The business community needs to demand that the state government use its existing authority to expand upon the AG's work and present a clear picture of the current situation.
The "moral outrage" that would support value-driven market shifts will not come until the state chooses to publish actual rates paid to hospitals for commonly used services, and until the state also publishes clinical outcome data in a clear and up-to-date manner. Once these numbers are seen, employers and individual subscribers will discover that they are paying way too much to certain providers for services than can be delivered just as well by lower priced providers.
Once this information is freely available, the market will respond, with employers demanding and offering tiered products that more people would find acceptable. Consumers would then turn to providers who offer greater value, just like they do in other service industries.
For reasons I do not understand, neither the Administration nor the insurers have endorsed this kind of transparency, much less implemented it. Instead of being honest brokers in a transition to a more value-based health care system, they remain in steadfast denial of the AG's well researched and thoughtful conclusions.
Over the coming weeks, we should measure parties' commitment to change by the degree to which they advocate and adopt the kind of transparency that exists in virtually every other segment of the economy. If they do not, we will have to assume that they are motivated instead by self-protection of their owned perceived political and economic interests.
The report, the result of legislation that directed Coakley to investigate why medical costs are rising so rapidly, is based on tens of thousands of contracts and other documents subpoenaed from insurers and providers and depositions from more than 30 key health care executives.
In light of the AG's conclusions, you would think that policymakers would be spending their time to design measures to reduce the disparities in reimbursement rates. But, as noted below, the policies being ordered by the Administration and the actions being taken by the insurers tend to do just the opposite.
In this kind of situation, where does one find the leadership to deal with these problems? The insurers have been willing or forced participants in creating the current situation. Can we expect them to change their stripes and take firm action against dominant providers?
During the hearings on these matters held by the state's Division of Health Care Finance, the witness from Blue Cross Blue Shield said that even his company, the largest in the state, did not have the market power to offset that of the dominant provider group and individual hospitals with special geographical advantages. That such was the case with smaller insurers was demonstrated years ago when Partners Health Care forced Tufts Health Plan to bend, but whether the same would apply to the dominant insurer remains an untested proposition.
We certainly cannot expect those providers who have benefited from higher rates to voluntarily accept cuts that would take them to the statewide average in a timely fashion. For one thing, their cost structures have been built on the expectation of greater revenues.
I believe the leadership has to come from the business community, those firms whose payments of insurance premiums -- or whose self-insurance arrangements -- validate the current reimbursement patterns. Their goal has to be to support market shifts to higher value providers. The business community needs to demand that the state government use its existing authority to expand upon the AG's work and present a clear picture of the current situation.
The "moral outrage" that would support value-driven market shifts will not come until the state chooses to publish actual rates paid to hospitals for commonly used services, and until the state also publishes clinical outcome data in a clear and up-to-date manner. Once these numbers are seen, employers and individual subscribers will discover that they are paying way too much to certain providers for services than can be delivered just as well by lower priced providers.
Once this information is freely available, the market will respond, with employers demanding and offering tiered products that more people would find acceptable. Consumers would then turn to providers who offer greater value, just like they do in other service industries.
For reasons I do not understand, neither the Administration nor the insurers have endorsed this kind of transparency, much less implemented it. Instead of being honest brokers in a transition to a more value-based health care system, they remain in steadfast denial of the AG's well researched and thoughtful conclusions.
Over the coming weeks, we should measure parties' commitment to change by the degree to which they advocate and adopt the kind of transparency that exists in virtually every other segment of the economy. If they do not, we will have to assume that they are motivated instead by self-protection of their owned perceived political and economic interests.
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