Here at Becker's Hospital Review, the reporters value the opportunity to open an insightful dialogue with our readers through comments posted at the end of articles. Support, criticism, questions and discussion are all present, and we appreciate our readers for their engagement!
Based on readers' comments, the following 25 articles include some of the most well-received or disputed content, or incited the most interesting conversations. See the list below for the good, the bad and the ugly — and keep commenting.
1. House Republicans sue Obama administration over PPACA: 5 things to know
Ava: What a bunch of fools. Congress wanted President Obama to postpone the employer mandate. This Congress is so ineffective and spends America's money on stupid lawsuits instead of getting the work of the people done....How about if they work on immigration, jobs, infrastructure, or heck, practically anything else instead of wasting our time and hard earned money on ignorant political stunts?
2. Is executive compensation aligned with health system strategy? 10 findings
Dr. No: Anyone who thinks compensation for healthcare execs should be higher must be FIRED. We should go back to the old system of having nuns run hospitals. The privilege of serving patients is the compensation. Overpaid C-suites are the main problem in health care; along with consolidation, acquisition, overbuilding, overtreating, overinvestment in useless technologies - LOOK AT OUTCOMES. Cut the fat right off from the top! What was I just saying about barring men from running anything for 100 years?
3. Union accuses Prime of overbilling Medicare by $93M
Todd: These unions should not be in Healthcare. Hospitals are not sweat shops. This particular union is known for its unscrupulous activities. Our tax dollars are being pilfered by the SEIU.
4. The problem to be solved
Bonnie: As always, David Pate has hit the nail on the head! Whether you call it health maintenance (1990s) or population health (2014), the focus in health 'care' needs to shift from 'sick' care to 'health'. Until we figure this out we're only putting bandages on a very sick system.
Clinicians take accountability: These "buckets" are not new, clinicians have been slow or reluctant to react to the changing conditions of healthcare. The business model has always known that "cost control" was not handled very well by senior leaders. I would disagree with Dr. Pate, it is the healthcare model that needs to adjust to the the business model of healthcare. No one wants to say this out loud, but has been the clinical side of healthcare that has created this out of control spending, not the business side.
Lynn: I agree with all 3 buckets, but the naked emperor wants to know "What is our proposed business model for 'health'"? I've heard this question asked in many forums. Apparently, the answer is "there is none". When we are healthy, healthcare costs drastically reduce/disappear. So how do we motivate the healthcare industry to put themselves out of business?
Dr. David Pate: Bonnie- Thanks for your kind comment. Totally agree. "Clinicians take accountability" - I understand your disagreement (I think), but the "clinical side" is reacting rationally to the business model and incentives that exist. I don't know of any healthcare economist or policy expert that does not agree that ability to pay (including insurance) + unequal decision-making and lack of transparency in favor of the clinician + fees paid for every service rendered drives increased healthcare spending. It is not the sole cause, as my article suggests, but I don't know anyone else that thinks the business model has not contributed to excess healthcare spending.
Dr. David Pate: Hi Lynn: I think that there is a model that will work. In my opinion, a successful model would have to evolve to providers having access to the insurance premium, whether they become the insurer or simply turn the current insurance company-provider relationship on its head. Then, all of our services become cost centers, providers will right-size their operations, providers will be relentless in the pursuit of waste and in reducing cost and in eliminating low value/no value services, the incentive will be on promoting, maintaining, and restoring health, we will engage in more meaningful discussions about end-of-life care, we will shift people into new roles (health coaches, care coordinators, etc.), we will use team-based care to deliver services and thereby relieve the pressure on certain shortages of healthcare professionals, and we will finally be rewarded, instead of penalized, for our investments in health, fitness, wellness, prevention, and early detection. There is so much disease in the pipeline due to childhood obesity, personal health behaviors, and current disease burdens, that there won't be any overnight reduction in the need for acute and chronic healthcare services, and so as we begin to improve health, there will be plenty of time over an extended period of time for the healthcare professional markets to right-size without the need for more drastic measures.
5. 25 healthcare leaders share their best piece of advice
Thron: Understand the interdependency of your ecosystem starting with the impact status quo tactics have on defining the daily environment that either inspires or demoralizes the workforce you depend on to successfully and effectively execute your strategies and meet your system's mission. The leader that is relentless in only tolerating excellence in subordinate leader's to inspire direct reports; excellence in all means of communications; and excellence in all sources of information while fostering an environment of universal accountability is leading and preparing an organization to adapt to any change, and is more likely to be the leader of change.
Ira: Chris Van Gorder, "Leadership is about three things: responsibility, authority and accountability." No hospital medical staff chief of service has true and effective authority, and Dr. Makary's book Unaccountable describes in chilling detail how accountability continues to be dominated by the Code of Silence. Collectively these "pieces of advice" appear to take a very limited (my hospital) perspective while the consensus is "The system is broken!" Perhaps the next question for these HC leaders should be "How do we begin to create a 21st century HC delivery system that works?"
6. Hey bosses: Your employees think they can do a better job than you
Balancing Business: As CEO, I encourage our Operations Manager to encourage new ideas from the section managers he oversees, but can see in our meetings that he uncomfortable at times with candid dialogue. I compliment him for putting together a talented team and give him assurances. Do others encounter this in multilevel meetings?
7. Hospitals on Facebook, Twitter: 8 statistics on healthcare's social media use
Joel: A very useful study would look at how hospitals use their social media platforms - not whether they have them. I think it is a real stretch for the researchers to conclude that they will become a dominant communication channel for healthcare. I think there are some very positive uses of social media being demonstrated by healthcare but these uses have far more to do with finding existing communities built around common interests and then adding value to the discussions going on there. Groups founded by parents around pediatric chronic diseases offer thoughtful children's hospitals the ability to monitor the conversations and interject where a voice of science and medicine might be welcome or where just listening to the concerns and insights of parents can offer tangible benefit to caregivers.
8. Physicians rarely apologize after patient adverse events, survey finds
Will: In a litigious malpractice environment, where admission of guilt can be tantamount to professional suicide, doctors will be slow to discuss their errors or to even imply possible error by discussing poor outcomes. Quality improvement requires the ability to evaluate outcomes in a non-judgmental fashion that allows open discussion without fear of personal harm.
9. CMS releases proposal to improve ACOs: 6 things to know
Thron: The only "shared savings" program CMS should be focused on is identifying and preventing the fraud, waste and abuse of Medicare and Medicaid that approaches 30% of total costs. This can only be achieved by a CMS that has competence in developing IT systems which they have failed to demonstrate with a dead program spending we call the ACA. Even at the present enrollment period, ACA computers are dysfunctional and staff are using paper to enroll members. Once CMS has proven it has a 21st Century information system resulting in Medicare and Medicaid savings that should approach $150 billion annually, then CMS can start "sharing" with providers the monetary gains from solving CMS's past internal failures.
10. The 10 most admired CEOs in healthcare
Tired_of_fighting_hospitals: Wait! The headline says "Most Admired." How is Rommoff admired? He openly flaunts their sham tax free status (just look at how many commercial spin offs and foreign projects they have); his hubris is evidenced by proclaiming the UPMC logo atop of the tallest building in western Pennsylvania; his attack ads against Highmark would make any political campaign look friendly; and he has an appetite to own the entire market. I think they call that a monopoly. Perhaps Pittsburgh's steel barons of old would recognize in him the same avariciousness and admire him for it. But I doubt there is anyone else to join them. Wow. Did you guys get this wrong, wrong, wrong.
Margaret: You left out Russell Meyers. He is the President and CEO at Midland (Texas) Memorial Hospital. He has truly worked miracles through his amazing ability to put the right person in the right job and grow the organization.
11. 130 nonprofit hospital and health system CEOs to know | 2014
Dr. Z: Only 12 out of 130 are women? We note the brags about the SIZE of these orgs and the SIZE of their budgets, staff, campuses, etc illustrate the 'bigger is better' attitude of this testosterone-dominated crowd. It would be interesting - given what's going on at other campuses - to ask whether the financial demands of this crowd are just another kind of 'rape' culture. Interesting but not surprising that the male-dominated-religious ones are playing right along. Just saying.
12. Largest hospital, health system layoffs of 2014
Jim: I would not count outsourcing and elimination of vacant positions as layoffs. These are not direct reductions in healthcare employment.
Keith: Gotta boost that bottom line, if a few folks die, Oh well.
13. Insurers' list of in-network physicians often outdated
Ara: The real problem is that if the insurers are lying to the public about the doctors in their network, then the insurance regulators must have inaccurate data as well from the insurer. For an insurance company to sell insurance plans in a state, they must have "network sufficiency". Network sufficiency means there are enough providers (e.g. hospitals, physicians, therapists, etc.) in each specialty to provide adequate access to care to the members in the insurance plan. You may be buying a plan full of "fluff" that doesn't have the specialist you need when you need them.
14. Grady Memorial ends BCBS contract today
Dr. No: The problem is; 'one of the largest public health systems in the country.' We all have seen that mergers/acquisitions/monopolizations jack up patient costs; FINALLY BCBS - itself part of that evil empire - is putting its foot down. And note it's the Grady executives (can we have a gender-balance tally please?) who are whining. It's always all about them. Maybe it's time to downsize. Less top-down management; divestment; more independent, neighborhood clinics and practices. Cut the fat from the top.
15. Online physician ratings don't correlate with quality of care
Linda: I offered to help my sister find a new family practice physician in her area after unacceptable treatment by her last one. It came down to two physicians that met the criteria that would work best for her that her health plan would accept. As I did my research and attempted to get information I experienced a new and horrifying realization. You cannot get information on physicians unless you know someone who knows someone to get the scoop. I should have recorded the last three conversations I had with the hospital administration, the local Medical Society, the physicians referral line for the health system that gave me a number that is not in service for a physician referral line for the hospital!
I threw a dart to make my selection. It appears that breathing is the only criteria credentialing has to verify. Can someone point me to how to research a physician before choosing them to be your provider that is fair to them and you?
16. Collecting from patients with high deductibles: 5 things to consider
John: One issue that needs addressing is the question of liability if patients defer needed care on the basis of cost and then suffer untoward consequences as a function of their decisions. Does anyone think that there will not be consequences for the physician regardless of how well the patient is informed and discussion documented? We have discussed getting signed "refusal of procedure" forms signed for recommended screening colonoscopies, and for medically indicated procedures recommended as a result of patient consultations - but no guidance from carriers or medical associations as yet. Any input?
17. 17 recent hospital, health system executive moves
Rajat: This list is quite helpful for a quick glance at changes in Leadership.
18. Giving thanks for these 9 medical pioneers
Michel: Thank you all!
Aharrell2000: THANK YOU!! CONGRATULATIONS!
Harley: What about: Ignaz Semmelweis(importance of hand washing), W. S. Haldane (aseptic surgery, minimal blood loss surgery, and use of gloves during surgery), Harvey Cushing (Neurosurgery), Koch (Tuberculosis), Wilder Penfield (Neurosurgery), Jonas Salk (Polio vaccine), and so many others-James Watson, Rosemary Franklin(took THE x-ray crystallograph of DNA, Wilhelm Roentgen (X-rays), etc.????
Ira: Lister used Semmelweis' published findings, and not Pasteur's equally important contributions. Dr. Gawnade should correct his published mistake in his Slow Ideas article in The New Yorker. A 1938 Hollywood short movie (20 min.) That Mothers Might Live (Semmelweis) is at the bottom of the Open Letters page on my findtheblackbox.org web site.
19. Evidence-based strategies for elimination of CLABSIs
Chris: What a great and comprehensive article. This points out the need for basic infection prevention and control practices!
20. Consumers favor Yelp for physician review, survey finds
Alex: In related news, some healthcare marketers are beating Yelp at their own game: http://bit.ly/1FN42O8
21. Patients in the blind spot: How hidden biases affect healthcare
Leslie: Quite interesting findings.
Keith: facing that kind of bias is baffling when you are in the middle of it.
22. St. Francis Hospital to lay off 65, leaves 15 positions unfilled
Anonymous: How about instead of firing the employees you lay-off the incompetent finance and accounting staff starting with the CFO.
NoThanks: Pretty sure they did that.
23. How should hospitals disinfect bedside electronics?
Seal Shield: UV light can be adequate for flat surfaces. However, many electronics (including keyboards) have crevices where light is shadowed and Bioburden thrives. There are waterproof keyboards and other electronics made to withstand hospital disinfectants and even bleach baths.
24. Michigan-based HIE chooses DrFirst platform
Skip: Kind of out of their wheelhouse isn't it?
25. 10 more things to know about HCA
FleetNavalAviator: Definitely the big ''for profit'' camel in the tent.