16 comments from readers: The good, the bad and the ugly

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 16 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.

Note: Comments were lightly edited for length and clarity.

Where in the US do full-time registered nurses earn the most?
MMAN: Earning the most doesn't always translate into more buying power, however. I think doing an article on the best standard of living for RNs would be much more helpful. Comparing the $105,000 that RNs [make on] average in [California and Hawaii] versus the average in the Southeast at $74,000, for example; I wonder which would provide the better standard of living. Talking about salaries while not addressing the cost of living doesn't provide very meaningful information. 

Where healthcare technology is headed in 2016: Five trends
Brain Carroll: Why so pessimistic? While some barriers still lie in the way of greater adoption of telemedicine, positive findings continue to move us forward. For example, a patient leaves the office, where he or she may or MAY NOT follow through on the doctor's suggestions. I think that the main merit of telehealth (even at the current level of implementation) is the fact that patients are able to more effectively self-manage aspects of their long-term care, saving physicians time and money. My granny monitors the medication time by herself using the mobile application ConnectExpert. And it's cool. 

Solving the problematic patient no-show equation
No_Comment: In the clinic, the doctor's time is clearly a scarce and valuable commodity which must be allocated efficiently among many patients. This task is complicated by the fact that each patient requires an unpredictable amount of physician time to diagnose and treat. In addition, it is common for a doctor to allow a number of patients with urgent problems to be added onto an already full schedule, and for patients who do have appointments to simply not show up, without notice. It is rare for these no-shows and added-on appointments to occur with the timing required to cancel out each other's effects.

The underlying reason doctors run late is overbooking, which is the practice of scheduling more patients to be treated than there is time on the schedule for their treatment. The opposite of [being] overbooked time is downtime, when there are no patients for an available physician to treat during office hours, when there are high fixed overhead expenses. Overbooking reduces physician downtime caused by no-shows, but it increases the number of patients waiting to be treated, reducing physician downtime at the cost of increased patient waiting times. 

UnitedHealth may exit ACA exchanges due to losses: 7 things to know
Common Sense: Insurers have been earning record profits for years. It's hard to believe that a company making $8 billion in earnings can't manage to underwrite the additional costs of care for this population. $425 million over two years is a drop in the earnings bucket. I'm quite sure that their premium increases were far higher than this percentage increase in cost, and they inflicted this increase across their entire patient base. 

3 signs you're being too tough as a leader
Thron: These three signs scream your employees do not trust you. Plus, you failed to define "too tough" in a world where everyone has their definition of "too tough." Leaders with self-respect and empathy understand how to deal effectively with each direct report, and [they know] what it takes to grow self-respect and knowledge to be effective professionals and leaders. When a respectful relationship is established by the leader, the employee gains trust and in an open meeting feels empowered by that relationship to verbally participate. And the so-called "toughest" of leaders with self-respect and empathy will delight in their participation because of the respect he has for them.  

11 CNOs, CXOs define the 'biggest win' for patients in 2015
Chloesbrother: Well that tears it. There is no hope. I counted two MDs on this panel of "administrators." We have really come to the point where we are willing to waste all of our resources? All of the training and knowledge, all of those years of education — and turn doctors into "chief experience officers" who count as their achievements such things as getting cell phone chargers in hospital rooms, increasing patient satisfaction surveys (shown to be useless), and installing EPIC — the bane of every doctor and nurse's existence? Really? An MD reduced to the status of chief experience officer? How embarrassing! 

Epic responds to Mother Jones criticism
Note: The following three comments come from a chain in response to this article.

John Trader: Kudos to Epic for standing up to the mostly incorrect assertions in the Mother Jones article. It is vital for patients to know the truth about Epic's capabilities but not in a biased way that uses outdated information to draw conclusions.

I can tell you that in the biometrics industry, we constantly see articles written by third parties that make egregious mistakes in explaining how the technology works. In the absence of anyone stepping up to correct those mistakes, the public assumes the information is correct and makes investment decisions based on it.

Chloesbrother: Are you kidding? Or do you work for Epic? You ARE aware that the number one reason for the government pushing this flawed technology down our throats was for "interoperability" and patient safety, right?? You also know that until it was publicly shamed and forced to reverse itself, Epic specifically impeded interoperability by charging a fee to exchange patient records with ANY provider not using Epic (sickening). Epic exec, Eric Helsher, explains that "We felt the fee was small . . . but it was confusing to our customers and others in understanding how it worked . . . so we decided to end the fee until at least 2020." No one is CONFUSED. Epic was shaking down providers to switch to their product or pay for interoperability.

You also know that Epic puts patient safety at risk every day because it insists on "gag clauses." This means that doctors and hospitals are prohibited from disclosing any of the dangerous malfunctions and/or defects in Epic products. Like when Epic malfunctions caused an entire hospital system to come to a halt. No medication dispensed, no information for doctors, no nothing. If their EHR was a medical device it would be off the market. We need to be honest and call out those who parasite off the system.

Justin M.: At the end of the day, it is not Epic (or any other HIT vendor) that is the problem. Despite what most want to think, hospitals are businesses that compete against one another. In most cases, they have little to no desire to share data with "the competition." I've worked in this space for [more than] 10 years and in many markets that have been dominated by a single vendor. Those places could EASILY share data, but they don't. I've also worked for many organizations that do share data and it has never been a problem. The technology is there, but the organizations have to be willing to work with each other.

18 Michigan hospitals with the cleanest rooms, as reported by patients
DrCyberQuack: I trained in the old University of Michigan Hospital in the 1970s. I remember, quite vividly, when the "unions" went out on strike. The house staff, nurses and nursing assistants (as they were called then) picked up the slack. The comments from our patients (we called them patients back then, not "guests" or whatever some call them today) were amazing and uniform ... they had never seen the place so clean or experienced the quiet. Something to think about. (And no, I am not anti-union...I am just sharing an event.) 

Why are healthcare costs out of control?
David Massello: I wonder what happens when we consider adding just two more ideas to the mix. One is the presumption that saving every life and extending life as long as possible is both economical and sustainable. Innovation for innovation's sake is not the same as a calculated strategic view on where the limited resources we have can be used with the well-being of the community in mind (economic, social, resource management, individuals, greater good for the many versus the few or the one) — not just the one patient or the few like orphan diseases — who might benefit from that innovation. I realize this is a slippery slope and my father lingered for six months on a respirator unable to live on his own at a huge cost, and a close family member's diagnosis of breast cancer — at the early stage it was discovered — was largely attributed to the cutting edge technology that the hospital she visited had available and the talent and skill of the physicians who read the exam. She is alive today.

Two is the idea that the price charged at the provider level of our health system — hospital or physician — is the product in large measure of our economic model. That is the cost of the MRI is driven in large measure by what GE and others invest in developing and innovating and earning a profit, that they charge the health system for that equipment. Yet who decides what innovations should be pursued and how does profit fit into that discussion. Drugs are a similar issue — yes it costs money to develop them — the issue may be that the decision on which drugs to develop is largely in the hands of the economic system and not the health system or the government based on a strategically calculated needs assessment. We often hear that the cost of the healthcare system is built into the cost of everything we make in the U.S. Well that healthcare cost first emanates from the very economic system that then includes that cost into their calculations for profit. A nice vicious circle as our sociology friends might observe.

Has anyone calculated the value of the economic activity that operates below the level of the provider community (hospitals and physicians)? I would think it may be a huge component of the GDP or the valuation of the U.S. economy or even the world economy
Too many people cut their pill in half so they can afford to take at least some of the drug that is helping them live; The issues with Vioxx were driven more out of the economic model than some grand plan for the development of medicine that could benefit the human community. We keep saying we should treat healthcare like it's a business — heck it may already be like every other business, and maybe the biggest business.

The No. 1 thing patients want: 5 steps to improve the physician-patient relationship
Dike Drummond, MD: The number one determinate of the patient experience is the level of burnout in the physicians and staff at the moment of the patient encounter. The system is overloaded with a perfect storm of activities that do not add value and detract from being able to give the patient your undivided attention.

In that setting, if you walk in and ask everyone to "engage" in your patient satisfaction program as just an ADDITIONAL set of activities, your well intentioned program will only add to the burnout of the people providing care.

Address burnout FIRST. Make sure your patient experience program is a ZERO SUM on the workload of the doctors and staff. Know that everyone in the chain of patient flow wants to do a better job and leadership's role is to get rid of activities, requirements and systems that get in our way.

Mykidsheart:This ideal is impossible with the current workload and time now required by EHR, "meaningless use" and all the other "programs" devised by the consultants, bean counters, insurance companies and various leeches sucking the life out of all of us who just want to take care of their patients. If you want this kind of attention you need to fork over the $3,000 to $5,000 a year for concierge care. If not, then hop onto the assembly line and get the most out of the ten minutes you get with your physician. And remember, someone is keeping track of the time you are spending in that exam room!

2014 physician salary by specialty
Concerned OR Nurse: No wonder every fellow and resident has an MBA now… they don't know if they can stay in medicine.

31 Mississippi hospitals at risk of closing
Hospital Man: The largest issue is the reduction in Medicaid payment rates combined with the states hiring managed care teams to deny care payment and making the steps to get approval for inpatient, imaging, and some emergency room care harder to achieve for staff-deprived rural hospitals. The regulations are closing hospitals as much as the economics.

50 things to know about healthcare costs
Haver: [No.] 27. Total health spending related to services from physicians and clinics increased nearly 101.7 percent from 2000 to 2013.

This is ridiculous. How long are they going to try and balance the cost of healthcare on the backs of providers? We are already seeing provider shortages in certain areas. Who wants to go to school for eight years, incur hundreds of thousands of dollars of debt and get paid less than $100,000 a year? Some primary doctors make less than $70,000. While I agree we all need to be smart about our costs everywhere, we still have employees that want raises, rising utilities and internet costs, increased costs in electronic medical records software and occupancy costs — and they did NOT go up by only 1.3 percent during 2000-2013… 



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