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What you should care about in healthcare today, from the editors of Becker's Hospital Review

Hospitals: The new villains in the story of American healthcare? (What Slate has to say)

Online magazine Slate is known for its contrarian and strongly worded headlines.

"Fat People Might be Better Off Staying Fat Than Trying to Lose Weight"
"Thank Aldi for Sending British Supermarkets Into a Death Spiral"
"Update: The Job Market for Academics is Still Terrifying"

If you're like me, a shocking headline doesn't make you blink twice anymore. You're even less tempted to click on it. Yet, when browsing Slate yesterday, one headline made me do a double take:

"Hospitals Are Robbing Us Blind."

Forget Obamacare, read the deck. The real villains in the American health care system are greedy hospitals and the politicians who protect them.

With fewer than 2,000 words, Slate columnist Reihan Salam simply skewers hospitals in this piece. "Whether you're for Obamacare or against it, you can't afford to ignore the fact that America's hospitals have become predatory monopolies," he writes. "We have to break them before they break us."

Mr. Salam touches on many issues, including consolidation, contract disputes with private payers and Medicare's payments to hospitals as they compare to other sites of care. "As for why hospitals charge such high prices, it's fairly simple: They do it because they can," he writes.

When someone or something tries to tame a hospital, lawmakers or local politicians run to the rescue. Politicians see the value in having hospitals on their side, he says. The health sector employs more than a tenth of all U.S. workers, and hospitals hold the key to any meaningful change in the industry. As Mr. Salam writes: "One of the reasons President Clinton's 1993 health reform effort failed is that he never won over the hospital lobby." When it was his turn, President Barack Obama knew better.

Despite all of the arguments he made, what struck me most about Mr. Salam's piece was the word villain. Or crooks. The phrase bleeding us dry. Such terms are not unusual to a magazine like Slate, yet in the broader narrative of American healthcare, these words aren't often used to describe hospitals. The piece is the latest in what has been a series of scrutiny, following Steven Brill's book "America's Bitter Pill" about healthcare and, specifically, hospital prices and profits. It's an expansion of his TIME story, which won the 2014 National Magazine Award for Public Service.

In speeches meant to inspire, I've heard the phrase, "We're rewriting American healthcare." If healthcare is changing, maybe the villains are, too. For so many years, the insurance and pharmaceutical companies were painted as the antagonists in the Great American Healthcare Story. In 2009, then House Speaker Nancy Pelosi said payers were villains and the health insurance industry was "immoral all along." That same year, 13 percent of Americans ranked the biggest problem in healthcare as insurance company greed (3 percent said it was hospital or physician greed). 

In the early 2000s, drugmakers were cast as the bad guys. A Kaiser Family Foundation poll found 70 percent of people thought pharmaceutical companies prioritized profits over the development of new drugs. "Rightly or wrongly, drug companies are now the number one villain in the public's eye when it comes to rising health care costs," KFF President and CEO Drew E. Altman said in 2005.

It's too simplistic to say hospitals were ever heroes in this story, but they held a certain place in our collective conscious. Drugmakers and insurers — distant and faceless — were somewhat easy to paint as villains. But most people know someone who works in a hospital, or they have donated money to one or spent time there as a volunteer. After all, for most of us, life really began the day we were brought home from where? A hospital.

A professor in health policy recently told me, "There are no villains here." He is like the many writers and authors who sit in the camp that there's no such thing as villains at all. Snidely Whiplash was a cartoon for a reason, they say. You don't meet people who rub their hands together, twirl their mustaches and set out to do evil. At their core, villains are no more than flawed people with problems on their hands.

While authors and professors are fortunate to have such a textured appreciation of good and bad, it seems many Americans would really appreciate a healthcare villain right now — especially a new one.



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5 healthcare films we're watching

From the silence surrounding cancer, to the 'quiet revolution' in healthcare practices across America, to the cacophony of the vaccine debate, we've picked a handful of documentaries, films and talks that provide fodder to spark discussions — at any volume — about some of the most salient issues in healthcare.



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Upsets and Cinderella stories: What March Madness and hospital rankings have in common

The first weekend of the NCAA Tournament is complete, and despite my best efforts, it's safe to say my bracket is pretty much busted.

Upsets abounded in the round of 64 and continued in the round of 32 in this year's tournament. No. 1 Villanova couldn't catch up to eighth-seed N.C. State. No. 2 Virginia was ousted by Michigan State, a tough seven seed.

And just as there were surprises, other games went as expected. Namely: Kentucky continued dominating, extending its perfect season.

To be sure, upsets happen every year — each tournament has its own special "Cinderella story." Who could forget Florida Golf Coast University in last year's tournament, when it became the first 15-seed team to win two games in the Big Dance? Some teams are just better conditioned and prepared to play than others come game day.

But some upsets could be telling that the seeding process for the Tournament could use some change. Each year, the NCAA Men's Division I Basketball Committee — made up of 10 members who spend "countless hours evaluating teams during the regular season," according to the NCAA website — chooses teams, then ranks, seeds and divides them into four regions on a bracket. If a team doesn't win its conference tournament, its post-season fate is entirely in the hands of these 10 men and women. Fans are hardly ever completely happy with the committee's choices.

"The committee failed again," Paul Klee, a sports reporter with the Colorado Springs Gazette, wrote after Selection Sunday. "It fails every year."

Complaints range from teams that get snubbed (Mr. Klee was pleading the case of Colorado State) to how a particular team is seeded to how teams are arranged on the bracket, among others.

While all of this uproar over rankings is happening in the college sports world, it is simultaneously occurring in another industry: healthcare. Though it's not a perfect analogy since the stakes are much different, the choosing and ranking of teams by the selection committee is similar to how various rating systems in healthcare select hospitals.



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Friday Feel Good: Tying the knot in the ICU

A dose of feel-good to kick off the weekend.



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What Rahm has shown us: Leadership and 'rubbing people the wrong way'

Leaders are constantly faced with tough decisions, and must consistently negotiate between the need to be an effective leader and a likeable one. But exactly how much does likeability influence efficacy?

Democrat Rahm Emanuel's brash leadership style has helped him drive through the ranks in his career, according to the Wall Street Journal. He has risen from senior White House aide to a congressional leader to chief of staff for President Barack Obama, but now he is fighting for reelection as Chicago's mayor.

Mr. Emanuel's failure to capture the 50 percent plus one vote to win a second term as Chicago's mayor, leading him to an April 7 runoff against Cook County Commissioner Jesus "Chuy" Garcia, may suggest leaders do need to be likeable to be effective — or at least elected.

The mayor's fight for reelection is proving difficult — Mr. Emanuel received 45 percent of the vote, and Mr. Garcia finished the race in second place, garnering 34 percent of the votes, according to the WSJ.

Mr. Emanuel's demeanor is one of his defining characteristics and has become a magnet for media attention. The tale of the politician, in his younger days, sending a dead fish in a box to a pollster who was late delivering results is infamous. He earned the name "Rahmbo" and "Rahmfather." He has a penchant for cussing. He sliced off part of his right middle finger while working at Arby's in his early days. President Obama would later joke the accident "rendered him practically mute."

In the realm of healthcare, too, the manner in which a leader forms and sustains relationships, works with other groups and wages influence are crucial elements that can open doors to new opportunities, or severely damage a leader's potential to get things done.

Mr. Emanuel's tough leadership style has been a point of criticism against him by voters and local politicians, especially those who opposed his decision to close underutilized mental health clinics and schools in a consolidation move, according to the report. Positioned against "nice guy" Mr. Garcia, Mr. Emanuel's brusque leadership style has arrived at the forefront as a potential deciding factor in his reelection bid.

In a recently aired campaign commercial, Mr. Emanuel acknowledges that his style rubs some people the wrong way, but stresses his toughness comes from a love of the city and a genuine desire to make decisive, positive changes.

"They say your greatest strength is also your greatest weakness. I'm living proof of that," said Mr. Emanuel. "I can rub people the wrong way, or talk when I should listen. I know that. But I'm driven to make a difference… I'm not always going to get it right, but when it comes to fighting for Chicago and Chicago's future, no one's going to fight harder."

Scott Becker, JD, CPA, publisher of Becker's Hospital Review and chairman of the healthcare department at McGuireWoods, says Mr. Emanuel's leadership style "issue" is a difficult and complex one.



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Hospital staff helps cancer patients pay co-pays

A dose of feel-good to kick off the weekend.

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A page from McDonald's playbook: Why hospitals need to fix their "patties" first

McDonald's may be on its way to overcoming — or at least to addressing — some of the health issues associated with its fast food. Yesterday, new McDonald's CEO Steve Easterbrook announced that within the next two years, the fast food dynamo will only use chickens "raised without antibiotics important to human medicine," and later in 2015 will begin using milk from cows that are not given rbST, an artificial growth hormone, according to Fortune.

This move focused on quality improvement marks a significant departure from the strategic initiatives of former McDonald's CEO, Don Thompson, who emphasized a "Create Your Taste" strategy aimed to guide customers' attention to the various topping options available instead of what the patties are actually made of.

McDonald's knows it has a perception issue. "The informal eating-out industry, most specifically the quick-service industry, is under a much higher level of scrutiny today than I've seen at my time in McDonald's. People today are questioning the integrity and the quality at the food at a much higher level," Mr. Thompson said in November, according to the report.

The notion of the more informed, savvier consumer with a greater interest in quality is present in healthcare, too.

Mr. Thompson's response to this issue was to implement a series of promotional ads that aimed to change consumers' perceptions that McDonald's serves low quality meat and that, overall, the food is unhealthy.

Mr. Easterbrook's new approach is not to try to change the minds of consumers, but rather to employ the solution the franchise really needs, which is to become better aligned with today's consumers' demands and actually improve the quality of the food.

McDonald's, with its massive scale and brand identity, could become a significant driver of change in the fast food industry and its suppliers. According to Fortune, this move could initiate a new focus on the quality of fast food and even establish new quality standards.

Relating a McDonald's Big Mac to healthcare may seem counterintuitive, but if you look at Mr. Easterbrook's emphasis on quality improvement, McDonald's can serve as a pretty good example for some of healthcare's goals — and Mr. Thompson's attempt at a solution could highlight what healthcare sometimes gets wrong.

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Hillary Clinton's email snafu highlights insider threats to cybersecurity

Washington is having a heyday with the revelation that Hillary Clinton used a personal email account to conduct government business during her four years serving as Secretary of State, but while many of the discussions encircling the revelation are political, the technological implications run just as deep.

On Monday, the New York Times reported Ms. Clinton communicated via a personal email domain when she was Secretary of State. What's more, she used a "homemade" email server located in her New York state home, the Associated Press found.

While other government employees have conducted business from personal emails, the situation with Ms. Clinton raises additional flags given her international stature. The original NYT report said it was unclear what, if any, security measures were implemented with her personal email domain.

"The question is [whether] whatever provider she's using gives her anywhere near the same level of protection for the confidentiality and the authenticity of the communications as she would be getting from her State Department email," said J. Alex Halderman, a cybersecurity expert associated with Ann Arbor-based University of Michigan, in an Al Jazeera America report. "If she's using it from her main work machine to send and receive her mail, then people could be intercepting the mail she's sending and receiving, even changing its content."

What's even more troubling to the Clinton scenario is that her aides warned her and those in her office that using the personal email account was dangerous, especially given the presumably sensitive nature of some of the emails.

"We tried," said a current State department employee in the Al Jazeera America report. "We told people in her office that it wasn't a good idea. They were so uninterested that I doubt the secretary was ever informed."

Whatever your political opinions of Ms. Clinton are, this revelation serves as a reminder for executive leadership that even C-suite level executives don't escape the threat radar or cybersecurity responsibilities of the rest of the organization.

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Patients at Wisconsin hospital are game show contestants

A dose of feel-good to kick off the weekend.

Patients at Wheaton Franciscan Healthcare-All Saints hospital on Spring Street in Racine, Wis., have the opportunity to be game show contestants, right in the privacy of their own room, according to The Journal Times.



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Friday feel good: Physician transforms the hallways of Oregon hospital

A dose of feel-good to kick off the weekend.



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