The Political Realities of Sequestration
Feb 28, 2013

The Political Realities of Sequestration

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imageNow be honest, before last summer had you ever heard the term, sequestration? Though I’m sure I did, I can’t recall when, and I am quite certain I wouldn’t have known the correct Jeopardy question, “What is the term used to describe the legal confiscation and possession of a defendant’s property in lieu of a judgment or court order?” And that’s not even the popular meaning now embedded into our political lexicon.

I have come to understand that Congress’ use of that term dates back to the 1985 Gramm-Rudman-Hollings Balanced Budget and Emergency Deficit Control Act in which it was used as a means of reforming Congressional voting procedures and intended to raise that body’s consciousness that budgeting should be a process of allocation from funds available – rather than an exercise in arithmetic reflecting the outcome of decentralized appropriations (insert favorite form of sardonic humor here).

The idea was that if the combined totals of appropriation bills passed separately by Congress resulted in spending in excess of the limits agreed to by Congress in the annual Budget Resolution, and then if Congress could not agree on ways to reduce that spending (or did not pass a higher Budget Resolution), then there would be an automatic reduction in spending: the aforementioned sequestration.  For me (and I’m sure many of you), this is a rather easy concept to understand because that’s how sequestration works in our house when our appropriations exceed our funding: we often call it, “cancelling our dinner reservation for Saturday evening.”

Back in fantasyland, however, the automatic reduction was to be sequestered by the Treasury and not disbursed as originally appropriated by Congress. In theory, the application of the sequestration is to be regarded pro rata across all agencies, though Congress has typically exempted certain programs such as Social Security and Defense.  The practical result has been that agencies not exempt would experience a disproportionate share of the spending reductions in order to achieve the total sequestration amount mandated.

As retired Senator, Phil Gramm, noted, “it was never the objective … to trigger the sequester; the objective was to have the threat of the sequester force compromise and action.”  Well, as we’ve seen, there is one thing that simply cannot be forced in Washington right now, and that is compromise. The reason for this is the stark contrast in political realities currently characterizing the two major parties.

The Obama Administration believes it won an electoral mandate to advance the country further in the direction of European style Social Democracy (different than Socialism, but closer than many in this country probably realize). And as Bob Woodward recently found out, they are taking a Machiavellian approach to whatever – and whoever – stands in their way. Woodward has lifted the curtain on the Administration, and he has garnered the attention and concern of a lot of folks, life myself, who have generally been supportive of it. And though I very much doubt it was his intention – or concern – he has created a strategic political opportunity for Republicans.

Unfortunately for their party, however, the Republicans are still wandering aimlessly in the sociopolitical dessert of the late-middle 20th Century, looking for the ghost of Ronald Reagan – or any ideological mantra that could garner greater than 50% support of their tattered leadership. In addition, because of the tremendous expense involved in campaigning in an era of modern media and super PAC’s (even in fending off same-party candidates in primaries), having party power of the House of Representatives is like having a gun with one bullet.  The party in power now gets one shot in a Congressional session to make a political impact.

So what we have is not a game of Chicken, where we wait to see which side blinks first.  We have a legitimate ideological stalemate that is being advanced and dominated by the promotion of minority interests holding sway over the respective parties. I say this because according to opinion polls I’ve seen, a significant majority of this country is in favor of raising taxes in order to pay down debt. What that majority is not in favor of is raising taxes to expand entitlements (there is also significant support for raising taxes and reducing entitlements).

The Administration wants to raise taxes to protect and expand the entitlements that are a critical component of their social agenda, while the Republicans want to reduce entitlements without raising revenue (taxes) so as not to alienate their primary campaign funding sources. The sad irony here is not that elected officials from both parties are acting selfishly in their political self-interests. That we’ve come to expect.  The sad irony is the perceived belief that placating minority interests is in their political self-interests more so than acting in harmony with the majority. Now, why is that?

Cheers,
  Sparky

Filed Under: Editorials & Opinions, Sequestration · Tagged: , , ,
Feb 27, 2013

It’s the Culture, Stupid

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This post’s title is what I reminded myself of when I read the recent interview Megan McArdle did with Delos (“Toby”) Cosgrove, CEO of the Cleveland Clinic.  In that article, Can the Cleveland Clinic Save American Health Care? Dr. Cosgrove shares and explains several of the core elements behind the Clinic’s success. I was able to identify two concepts discussed by Dr. Cosgrove that I believe are more important to redefining healthcare in the United States than anything else: alignment of incentives and change management.  Both of these concepts are, in turn, major pillars of organizational culture.

And both are concepts, which transcend the argument that comparisons to organizations like the Cleveland Clinic, the Mayo Clinic, MD Anderson Cancer Center, Memorial Sloan Kettering, Johns Hopkins, et al) are often misguided and counterproductive because of the unique positioning and market advantages those organizations hold.

As Ms. McArdle writes in her article,

”Great institutional cultures can accomplish great things.  But in some ways, that’s a problem for the rest of us. It’s natural to want to emulate the achievements of [the] Cleveland Clinic in our policies. But you can’t make a culture out of rules. Culture is an organic outgrowth of an organization’s history, it’s people, its successes and failures. It cannot be ordered from the top, or nurtured by simply altering the financial incentives. Cosgrove speaks of maintaining the institution’s culture in much the way that he talks of maintaining their electronic health records system: a constant process of checking in, re-evaluating, and upgrading.”

But Cosgrove also believes the Clinic’s success can be replicated.  In the article he states that, “yes, other people can do it. One of the things that is beginning to drive this is the patient satisfaction scores that is now becoming part of the pay for hospitals ….” but “both the incentives and the culture matter. They’re inexorably tied.”

Creating a culture that instills and motivates behavior, which reflects incentives tied to desired outcomes – whether those are measured in terms of access, cost or quality and safety – is a difficult challenge that really does not get substantially easier or harder in relation to the size of an organization.  This is because – as my friend and colleague, Craig Anderson (National Director of Healthcare at Dixon Hughes Goodman) is fond of saying – “organizations don’t, never have and never will change – people change, one person at a time.”

And individual change is very hard for all of us.  It means being even more uncomfortable in a world of constant uncertainty.  It means not having the level of control you mistakenly thought you had in the first place.  It means letting go of some very deep-seated beliefs on how your environment should be ordered, arranged and understood.

To create the kind of culture that has been successful at the Cleveland Clinic requires an artful infiltration of the organization’s psyche. Careful attention must be given to long-standing relationships and patterns of behavior.  It is quite easy to do more damage than good. But if done right, the payoff can be a remarkable transformation from a healthcare organization inexorably floundering in reaction to its environment – to an organization that is emulated for proactively achieving great success, like the Cleveland Clinic.

Cheers,
  Sparky

Filed Under: Cultural Change Management, Editorials & Opinions · Tagged: , , , ,
Feb 24, 2013

Paging Dr. Watson . . .

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Watson, the IBM supercomputer, generated world interest in 2011 when it competed on Jeopardy against former champions of the famous TV game show and won the first prize reward of $1 million.  With access to 200 million pages of structured and unstructured content consuming four terabytes of disk storage, Watson performed without having access to the Internet.  Ever since IBM’s Big Blue beat Gary Kasparov in 1997 IBM has doubled down on its passion for developing technology that seeks to mirror the capabilities of the human mind.

Now that passion is taking Watson into the hospital and physician office. A February 11, 2013 article in Wired Magazine UK, IBM’s Watson is better at diagnosing cancer than human doctors, describes how IBM is partnering with Memorial Sloan Kettering Cancer Center in New York and Wellpoint to make Watson available (i.e., for a fee) to any hospital or clinic seeking its input on oncology cases, including proposed treatment protocols that seek to minimize cost.

The big advantage Watson has over human doctors is its ability to absorb and analyze enormous quantities of data – and then make that knowledgebase more accessible and more affordable.  As example, according to Sloan-Kettering, only 20% of the knowledge doctors use in diagnosing patients relies on trial-based evidence.  But it would take at least 160 hours of reading a week to keep pace with all of the medical knowledge being published – and that doesn’t include the time it takes to determine how to apply that knowledge in practice. Watson’s successful diagnosis rate for lung cancer is 90 percent, compared to 50 percent for human doctors.

This subject-matter reminds me of Malcolm Gladwell’s book, Blink, in which he tackles the subject of rapid cognition: how the human mind processes environmental stimuli and compares, contrasts and analyzes that stimuli against the billions of elements of data that comprise individual experiences comprising our conscious and unconscious memories.  Watson’s ability to replicate that capability is still a long way off.  But the progress already made is fascinating.

While fascinating, practical application of technological advancements in healthcare are often challenged by skepticism. How much of that challenge is created by the natural human resistance to change, how much results from not understanding the new technology – and how much is based upon previous experiences that demonstrate the risks of adopting technology before it is fully proven – is hard to know.

A lot of faith is being put into technology as the silver bullet to address the healthcare cost crisis. When you read something like what IBM is accomplishing with Watson you want to jump on that bandwagon.  When you spend an afternoon with clinicians that share real life stories of how their ability to deliver care is being impeded by technology that was supposed to make them more efficient and productive – well, not so much.

Cheers,
  Sparky

Filed Under: Clinical Technology, In the News · Tagged: , , ,
WARNING: Rough Waters Ahead
Feb 19, 2013

WARNING: Rough Waters Ahead

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This is a self-promotional blog post, but the connection to healthcare public policy is clear enough.  Just this morning Erskine Bowles and Alan Simpson released a new plan that seeks to find some balance between the polar opposition of the Republican and Democratic parties over fiscal management.

Their approach would cut $600 billion from Medicare and Medicaid and raise $600 billion in new tax revenue from ending or curbing deductions and tax breaks. It would also include $1.2 trillion in cuts to discretionary spending, along with cuts in cost-of-living increases for social security, farm program and civilian and defense retirement programs. 

The Obama Administration has discussed supporting $400 billion in cuts to Medicaid and Medicare, while the House GOP considers any new revenue a nonstarter.  The self-serving political intransigence of the two parties is unlikely to abate any time soon.  But the metaphorical swirls of focus and attention, like water in a sink flowing toward the drain, are clearly zeroing in squarely on further Medicare and Medicaid cost containment.

Healthcare providers are going to have to double down on lowering expenses while concurrently reacting to market and regulatory forces that are driving demands for improved outcomes, higher safety and better quality.  In reaction to this tremendous challenge, Artower Advisory Services has partnered with StrategyDriven Enterprises to create a new product offering that can accelerate the efforts of healthcare providers to meet these challenges.

The Value-Driven Performance Improvement Model© leverages StrategyDriven’s knowledge and expertise developing and implementing performance improvement models in the nuclear power industry to give healthcare providers the tools they need to improve efficiency, enhance production and improve outcomes while lowering costs (i.e., increase patient value).

Please take a moment to read our new White Paper, which describes the V-D PIM in detail (just click on cover page, below).

Cheers,
  Sparky

Performance Measurement Systems Cover

Filed Under: Healthcare Cost Containment, In the News · Tagged: , ,
Gun Control and the ACA
Feb 17, 2013

Gun Control and the ACA

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imageThis is the second occasion I have had in the past four months to correct a news piece that has appeared on the Breitbart web site regarding the Affordable Care Act.  Last November, I shared my disagreement with Dr. Susan Berry’s fallacious interpretation of a Journal of American Medical Association article on knee replacements under the Affordable Care Act.

Interestingly, that post – Death Panels Just Won’t Die – remains the most popular PolicyPub article landed upon.  Visitors come to it by using search engines and wanting to learn more about “Obamacare and knee replacements.” But today I am writing about Awr Hawkins’ piece from January 9, Obamacare Amendment Forbids Gun and Ammo Registration.

A good friend brought this to my attention via  forwarded e-mail. As with many topics of this type, the news gets passed around in emails, blogs and web sites and then reproduced, repurposed and morphed into all varieties of content (just as I am doing here).  As I did in my post on death panels referenced above, however, I will try again to be diligent here in providing to readers original source content, so that you can do your own research – and thinking.  I wish Mr. Hawkins had gone to such effort.  Here is what he wrote:

“Good news — it has become known that hidden deep within the massive 2800-page bill called Obamacare there is a Senate Amendment protecting the right to keep and bear arms.

It seems that in their haste to cram socialized medicine down the throats of the American people, then-Speaker Nancy Pelosi (D-CA) and Barack Obama overlooked Senate amendment 3276, Sec. 2716, part c.

According to reports, that amendment says the government cannot use doctors to collect ‘any information relating to the lawful ownership or possession of a firearm or ammunition.’

CNN is calling it ‘a gift to the nation’s powerful gun lobby.’

And according to Senate Majority Leader Harry Reid (D-NV), that’s exactly right. He says he added the provision in order to keep the NRA from getting involved in the legislative fight over Obamacare, which was so ubiquitous in 2010.”

In his piece, Hawkins references an article produced by HotAir.com, which, in turn, references a video report produced by CNN on the subject that Hawkins’ references in his article (following, so far?).  What the original reporting claims is that Title X, Sec. 2716, Subsection C was a, “little known” piece of the Affordable Care Act that was unwittingly passed in support of the gun ownership lobby by lawmakers whom many would assume are gun control advocates.  In particular, Harry Reid.

As the CNN piece points out, however, up until very recently, Harry Reid has been a rather reliable gun rights advocate.  More importantly, as Ed Morrissey writes on the HotAir site, “this isn’t that much of a bar on Congressional action. What can be done in this manner can be undone in the same manner.”

Even beyond Mr. Morrissey’s interpretation, however, what the above referenced section does is make it explicit the ACA does not empower the Federal government (primarily under the Secretary of the Department of Health and Human Services) with the right to collect, analyze and/or report data and information on gun ownership.  And it was rather widely understood at the time (sorry conspiracy theorists) that in order to achieve some measure of political support of the ACA by the Gun Lobby, this section was intended to provide assurance the ACA was not granting new Federal powers.

That is not the same thing as saying such powers have been henceforth forbidden or cannot be achieved through other means (i.e., through future legislation).  In other words, if Congress were to advance gun control legislation currently under consideration that requires stricter registration, tracking and reporting of gun ownership, there is nothing in the ACA that would conflict with that legislation.

President Obama recently issued 23 executive actions on gun control.  One of these is to, “clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes." This has also been unfortunately interpreted by some media sources as a new Federal requirement that doctors are being required to act as deputies in ferreting out individuals at risk of committing gun violence.

In any event, while speaking on gun control during last week’s State of the Union, the President noted that, “each of these [gun control] proposals deserves a vote in Congress.  If you want to vote no, that’s your choice. But these proposals deserve a vote. Because in the two months since Newtown, more than a thousand birthdays, graduations and anniversaries have been stolen from our lives by a bullet from a gun."

What I believe this to mean is the President does not have the votes in Congress to pass any meaningful gun control legislation at this time.  But he is seeking to gain some measure of political capital by getting those opposed on record.

This is a very difficult ball of public policy yarn: wrapped in together you have healthcare delivery policy, mental health policy and gun ownership/gun control policy.  It requires serious efforts in research, understanding and debate.  It requires, wherever possible, a clear articulation of the known facts.  Although my readership is paltry compared to what Breitbart controls, I hope my efforts here will combat this latest demonstration of reporting laziness, manifested in unhelpful misinformation.

Cheers,
  Sparky

Blog post picture courtesy of www.sodahead.com

Filed Under: Editorials & Opinions, Gun Control · Tagged: , , ,
Feb 15, 2013

Update: Hospital Readmissions

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Hospital Readmissions continues to be a driving topic of concern, debate and contention in the healthcare industry.  It also continues to be an area of great interest for potential partnerships between acute and post-acute care organizations.  Whether that interest is warranted based upon expected improvement in outcomes and cost reductions remains to be seen.

JAMA Study: Assessing Program Risk
On Tuesday of this week the Journal of the American Medical Association published a study, which looked at the relationship between risk-adjusted mortality and 30-day hospital readmissions.  The reasons for testing this relationship are because of concern that artificial incentives will drive behaviors with unintended consequences.

First, the concern is that hospitals may invest resources to lower readmissions for targeted conditions at the expense of quality care for other conditions.  Second, there is concern that patients may not cared for in an environment that is determined by clinical needs and requirements, but instead by financial considerations.  For those who believe these concern are overstated the results of this research will serve to reinforce their perception. 

Data was analyzed for Medicare beneficiaries admitted to hospitals between July 2005 and June 2008 with a heart attack, heart failure and pneumonia. These are the three conditions hospitals are now being penalized for 30-day readmissions under the Medicare Hospital Readmissions Reduction Program.  According to the study, “risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure.”

RWJ Foundation: Revolving Door
Another report released this week, by the Robert Wood Johnson Foundation, found that hospitals and their partner relationships made little progress from 2008 to 2010 at reducing hospital readmissions for elderly patients.  Using new Medicare data from the Dartmouth Atlas Project, researchers found , “one in eight Medicare patients were readmitted to the hospital within 30 days of being released after surgery in 2010, while one in six patients returned to the hospital within a month of leaving the hospital after receiving medical care. Patients were not significantly less likely to be readmitted in 2010 than in 2008.”

The report also shares findings from interviews with patients and providers that sought to better understand the root causes of patient readmissions.  While some portion of those readmissions were either anticipated or necessary, there were also a significant number of readmissions that could primarily be attributed to non-clinical considerations, such as discharge planning, the individual’s support system, care coordination and the availability of primary care post-discharge.

So what to make of this? Research is continuing to support the hypothesis that cost savings are achievable by creating better alignment of care requirements and care settings without sacrificing quality.  The ways in which providers achieve such savings, however, are no clearer today than they were several years ago.  Also up for debate is whether the Hospital Readmissions Reduction Program is providing a meaningful incentive to drive innovation – or whether providers are reacting to market realities (likely some combination thereof).

What does not seem to be up for debate is the reality that proactive healthcare providers are pushing integrated delivery models that seek to facilitate better resource alignment.  Are you one of those organizations?

Cheers,
  Sparky

Filed Under: Hospital Readmissions, In the News · Tagged: , ,
Pick a Price, Any Price
Feb 11, 2013

Pick a Price, Any Price

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imageIn today’s edition of the Journal of the American Medical Association: Internal Medicine is a new research article that spotlights the challenges the average consumer faces in navigating the healthcare system.  Researches  Jaime Rosenthal, Xin Lu and Dr. Peter Cram share the results of their research on, Availability of Consumer Prices From US Hospitals for a Common Surgical Procedure.

They selected 20 of the nation’s top-ranked orthopedic hospitals, according to US News and World Report rankings, and using a secret shopper script (one of the author’s 62-year-old grandmother who did not have insurance but had considerable means to pay privately), requested from each the lowest complete bundled price (i.e., including hospital costs and physician fee) for an elective total hip arthroplasty (THA, or hip replacement).    They also contacted 102 non-top-ranked hospitals to request the same information.  What they found was considerable variability in the hospitals’ ability to respond to the request – and the range of prices quoted where responses were received. Each hospital was contacted up to 5 times.

The tables below (taken directly from the article) show the research results.  Table 1 indicates the number and percentage of hospitals unable to provide a single, bundled cost for a THA (55% of the top-ranked hospitals and 90% of the non-top-ranked hospitals).  Table 3 illustrates the significant in pricing. The range of prices for those top-ranked hospitals able to respond with a payment bundle was between $12,500 and $105,000.

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This research is hardly going to come as a surprise to those familiar with the economic realities of the US healthcare delivery system. It would have been more surprising if the results were reversed.  Healthcare cost accounting has for decades now been driven by incentives that seek to allocate costs for the purpose of maximizing third-party reimbursement and not for the purpose of understanding production costs per unit of service/care similar to what you would find in any manufacturing sector.

In September 2011 Robert Kaplan (of the Balanced Scorecard fame) and Michael Porter (Redefining Healthcare) wrote an article for Harvard Business Review, How to Solve the Cost Crisis in Healthcare.  While I challenge both the immediate practicality and scalability of their approach, it was a strong effort to advance the cost allocation discussion from the bottom up, instead of the top down as we are used to doing.

But here’s the key takeaway: Consumer-Driven Healthcare must play a critical role in the future of the US healthcare delivery system.  Debate surrounds what policies best encourage and promote CDH and to what extent consumers can truly be their own advocates in a system where even prices are hard to understand (or believe).

Regardless of policy, however, healthcare providers – and hospitals in particular – are realizing quickly how important it is in an era of hyper-competitiveness, higher costs and shrinking reimbursement to understand costs the way a Lean manufacturing concern understands costs.  We’re heading in the right direction.

Cheers,
  Sparky

Filed Under: Consumer-Driven Healthcare, Editorials & Opinions · Tagged: ,
Leadership Opportunity for Hospice
Feb 6, 2013

Leadership Opportunity for Hospice

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imageIn an article that has received a good amount of advanced press, today’s Journal of the American Medical Association publishes research findings on end of life care, or more particularly, utilization of hospice care.  The article, entitled, Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009, shares the findings of research seeking to determine changes in site of death, place of care and care transitions for Medicare decedents between 2000, 2005, and 2009.

Research results indicated that while more individuals aged 65 and older are dying at home, their utilization of intensive care services (i.e., hospital ICU) during the last month of life increased (29.2% of decedents utilized ICU in 2009).  In addition, 11.5% of decedents in 2009 had three or greater hospitalizations during the last 90 days of their lives.  And while hospice use increased, upwards of 28% used hospice services for three days or less in 2009.

A key finding of the research is that increased use of hospice may not lead to a reduction in resource utilization.  The authors believe their findings could, “raise concerns that hospice is an ‘add-on’ to a growing pattern of more utilization of intensive services at the end of life.” Hospice providers hoping to avoid the sequestration axe take note: while your inherent value proposition of improving the quality of life, while easing the individual pain and family burden associated with end of life care is invaluable, getting paid for your efforts in this environment also requires demonstrable cost savings.

As I have written here before, the Death Panels moniker given to us courtesy of Sarah Palin has been a tremendous disservice to encouraging open and candid discussion on the personal, social and economic challenges of dealing with end of life care.  But I see a huge opportunity here for hospice providers – and the trade associations that represent them – to seize this important initiative back from politicians and elected officials.

They should use this opportunity to take a leadership role in creating a national framework for encouraging candid dialogue, open sharing of concerns, fears and ideas – and for advancing policy initiatives that encourage knowledge and education regarding the alternatives available to individuals and their families facing end of life decisions.

Oscar Wilde wrote that, “life is too important to be taken seriously.”  Well, I posit that death is too scary to run in fear from.

Cheers,
  Sparky

Filed Under: Editorials & Opinions, Hospice Care · Tagged: , , ,
“The Doctor Will Skype You Now . . .”
Feb 5, 2013

“The Doctor Will Skype You Now . . .”

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healthcare-marketing2-300x199In this month’s edition of the McKinsey Quarterly is an insightful article: Six social-media skills every leader needs.  If you are either currently – or aspiring to be – in a position of managerial leadership at any level of your organization and plan to work for more than a few more years, this is an article you need to read.

And if you are working in healthcare, I think you will find the personal and organizational ramifications of the Six Dimensions of Social-Media-Literate Leadership model presented in the article to be particularly exciting – and troubling.  Because of the inherent nature of the industry’s product (i.e., human health), the potential benefits and threats presented by social media are accordingly heightened.  When messaging distribution spins out of control and goes viral at a manufacturing concern someone could lose face.  When messaging gets convoluted in a hospital someone could lose their life.

The opportunities for creating organizational value through social media are vast and still largely untapped.  For example, the ability to engage and capture a broad spectrum of individual thinking; the ability to facilitate collaboration and engagement across social and cultural barriers; the ability to build brand loyalty through direct communication; the ability to accelerate innovation.

The other side of the social media sword is just a sharp – and even more so in healthcare.  Risks of individual privacy are at the forefront.  But there are also tremendous risks associated with distribution of disinformation, as well as the misuse and/or misunderstanding of credible information.

As the article points out, “the leader’s task is to marry vertical accountability with networked horizontal collaboration in a way that is not mutually destructive.”  How is this done? I have highlighted below the key points I took out of the article.

Accept Reality
Whether appreciated or not, social-media is a transformative disruption that is changing the way organizations operate (their structure, their strategic positioning, their business models).  The article describes McKinsey’s work with General Electric’s leadership in their social-media-transformation.  It is not a fad of the entertainment-minded pre-Baby Boomer generations.  Ignore its implications on the future at your own peril.

Learn to Let Go
The days of being able to carefully plan, construct and deliver your message via traditional forms of media (i.e., whether through print, e-mail or video) are quickly waning.  Today’s distribution network has been turned upside down: the message often starts with social communication and then gets crafted, molded and morphed into new meaning as it cascades upward through organizational hierarchies.  Recognize sooner rather than later what this means for your ability to control messaging.

Embrace – and Learn – Media Technology
In social-media risk mitigation, the best offense is a good defense.  The sheer volume of information bits from e-mail distribution, networking and news aggregation is overwhelming for most of us.  Being able to use tools that help navigate and focus your attention on highest priorities is essential.  Also being able to understand when, how and in what context your messaging will be received should help guide your communication style.  There are some wonderful software applications to increase your abilities in this area.

Stay Tuned In
Part of GE’s Leadership Explorations program includes reverse mentoring, where senior leadership is able to engage with media-savvy millennials to accelerate their knowledge and understanding of emerging social-media technology and applications.  Staying on top of the social-media evolution takes precious time that has to be diverted from more meaningful endeavors.  In other words, time has to be made to stay on top of it.

Be Cognizant and Be Careful
If you are familiar with the old adage, Some things are better left unsaid, then internalize that phrase and broaden its application to any potential means of sharing a thought via social media.  I have been personally mindful of the line from Kipling’s poem, If: “If you can bear to hear the truth you’ve spoken twisted by knaves to make a trap for fools . . .”  Unfortunately, that is an inherent risk that comes with raw and transparent communication. 

Healthcare organizations – and their leadership teams – that “get” the socially and culturally transformative implications of social-media will note in the model presented by McKinsey aspects that reflect their own evolution.  They will be able to recognize and identify with the opportunities and challenges presented because they have already begun to experience both firsthand.

For those who don’t get social-media, well as was written in a Western Union internal memo in 1876, “this ‘telephone’ has too many shortcomings to be seriously considered as a means of communication.  The device is inherently of no value to us.”

Cheers,
  Sparky

Filed Under: Good to Know, Social Media in Healthcare · Tagged: , , ,
Jan 31, 2013

Chaos Theory & Doc Shortage

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A major concern of policy analysts regarding the Affordable Care Act is whether and how the country will be able to produce a sufficient supply of primary care physicians (PCPs) to meet the projected demand arising from extending healthcare coverage.  But to what extent future demand for PCP services will be owing to demographics versus expansion in coverage requires the use of some rather subjective assumptions.  While it is plausible to assume that removal of cost as an obstacle to healthcare utilization would increase demand among that portion of the population unable to afford coverage, such thinking can also be counterintuitive.

According to a 2012 article published in the Annals of Family Medicine, Projecting US Primary Care Physician Workforce Needs: 2010-2025, “with nearly 209,000 PCPs in 2010, the United States will require almost 52,000 additional PCPs by 2025—about 33,000 to meet population growth, about 10,000 to meet population aging, and about 8,000 to meet insurance expansion.”  There are numerous similar studies using different methodologies and approaches and different (hypothetical) assumptions, but most all I have seen support the challenging reality that demand for PCP services is going to substantially outpace supply given the historical rate at which new physicians enter the workforce.

In reaction to this concerning challenge, the journal Health Affairs recently published a paper that argues the projected PCP shortage can be largely addressed by using teams, better information technology and sharing of data, and non-physician professionals (i.e., physician extenders, such as Registered Nurses, Physician Assistants and/or Nurse Practitioners).  I fear again, this may be a situation where the reliance on subjective assumptions produces desirable findings from sound research practices that won’t bear out over time.

I think it also illustrates – and this is really the larger point I wanted to make with this post – where very often healthcare policy research methodologies inherently rely upon linear dynamics to study problems that really require a nonlinear dynamics approach.  And understandably so.  If you want to produce a movie using a still frame camera, you had either be extremely fast or quite imaginative.  You work with the tools at your disposal.

As advances continue in information technology computing power and capacity (i.e., Big Data), the ability to model nonlinear relationships will increase.  But the nature of unpredictability in human reactions to environment and circumstances will still be a difficult challenge.  There is quite a body of interesting literature suggesting ways in which nonlinear dynamics (e.g., Chaos Theory) can be adapted in social policy research, which is well beyond my purpose here.  But to be sure, the observations I offer on the subject are neither unique or original.

As a more practical matter, however, I think the ideas presented in the Health Affairs paper are viable and will probably result from being as much a function of necessity as requiring support of public policy.  But the nature of how these clinician-patient relationships form and whether or not they will be sufficient to meet the projected demand for PCP services really cannot be predicted because of the modeling constraints of linear dynamics.

Unfortunately, there are usually significant limitations to what healthcare policy research can offer in terms of predicting the future benefit of what appear to be good ideas.  On the other hand, fortunately, the lack of a projected empirical benefit has not been an obstacle to the pursuit of good ideas throughout the history of mankind.  The historical resolution of these two realities has always been the economic reward for the risk taken in pursuit of an idea that lacks a demonstrable benefit.  The challenge we face today is our inability to accept the consequences when that pursuit does not bear fruit.

We love being rewarded.  Paying the Piper – not so much.

Cheers,
  Sparky

Filed Under: Editorials & Opinions, Healthcare Policy Formation · Tagged: , , ,
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