Monday, January 31, 2011
Values, outcomes and you
12:30 PM | Posted by
Matthew
As you can imagine, the future is top of mind for the rural hospital CEOs and trustees gathered here in Phoenix. To be more specific, the future in an accountable, value-based, bundled, integrated and coordinated world.
Clinton MacKinney, M.D., talked this morning about how rurals can find their way. MacKinney, an assistant professor at the University of Iowa, told attendees that they need to realize that the payment equation is changing. "Value" is becoming the driver. He spent a fair amount of time talking about how rurals may participate in accountable care organizations once the Medicare regulations are issued later this year. He cautioned the ACO concept seems to be built around an urban model of integration and hospitals owning physician practices. That's not necessarily how rural hospitals are set up. Also, rurals need to think about how referral patterns may change as ACOs are formed, or if new affiliations will be needed.
Ultimately, MacKinney said, rurals need to think about the new world order in terms of improving patient care. Providers need to be more proactive in managing patient health. He wondered why it is that his vet sends him notes a couple of times a year that it is time for his dogs to get their shots, but primary care physicians very rarely notify patients that it is time for their immunizations.
Oh, and a word of warning from Ronnie Musgrove, former governor of Mississippi and current chair of the National Advisory Committee on Rural Health and Human Services: don't get sidetracked by the political chatter going on in Washington or your statehouse. Changes are upon us and providers need to work toward system reform.
Clinton MacKinney, M.D., talked this morning about how rurals can find their way. MacKinney, an assistant professor at the University of Iowa, told attendees that they need to realize that the payment equation is changing. "Value" is becoming the driver. He spent a fair amount of time talking about how rurals may participate in accountable care organizations once the Medicare regulations are issued later this year. He cautioned the ACO concept seems to be built around an urban model of integration and hospitals owning physician practices. That's not necessarily how rural hospitals are set up. Also, rurals need to think about how referral patterns may change as ACOs are formed, or if new affiliations will be needed.
Ultimately, MacKinney said, rurals need to think about the new world order in terms of improving patient care. Providers need to be more proactive in managing patient health. He wondered why it is that his vet sends him notes a couple of times a year that it is time for his dogs to get their shots, but primary care physicians very rarely notify patients that it is time for their immunizations.
Oh, and a word of warning from Ronnie Musgrove, former governor of Mississippi and current chair of the National Advisory Committee on Rural Health and Human Services: don't get sidetracked by the political chatter going on in Washington or your statehouse. Changes are upon us and providers need to work toward system reform.
‘There were miracles everywhere’
12:28 PM | Posted by
Matthew
Seeing graphic images of patients injured during last year's earthquake in Haiti isn’t exactly what I'm used to after eating breakfast, but, wow, Paul Auerbach, M.D., delivered one heck of an opening keynote at the 24th Annual Health Forum and American Hospital Association Rural Health Care Leadership Conference.
Auerbach is a professor of surgery at Stanford University School of Medicine. He flew with a team of fellow clinicians immediately after the quake last January to provide much needed medical care at University Hospital in Port-au-Prince. I can't do justice to their story in this blog. We've all read about and seen videos of the devastation and the heroic efforts to medical professionals from around the world. But hearing Auerbach retell his experiences was a real eye opener given the debates we are currently having over health care in this country.
He talked about seeing between 500 – 1,000 new patients a day and often the very best care they could provide was to amputate a limb (he noted that he could work in the Stanford ED for weeks at a time and not hear a patient say, "Thanks," but every patient he saw in Haiti said it). Many of those procedures were done without pain medicine, which Auerbach said they ran out of in the first six hours of his deployment. There were no CT scans or X-rays; all diagnosis were made by seeing and touching. "It was some of the best medicine I ever got to practice," he said. The clinicians went on instinct. There was no place to put waste or trash; it piled up outside.
Eventually, though, things began to take shape: Five ORs were established, there was a TB ward, a 24-hour pharmacy, a lab for point of care testing, dialysis, a maternity ward, a 30-bed ICU. Keep in mind that nearly all of these "departments" were in tents or destroyed parts of the hospital. But the point is Auerbach, his team from Stanford and all of the other serving at University Hospital refused to let adversity slow them down. One of the biggest leadership lessons he learned, in fact, was to "stay in motion and seek out problems," because if wait for the problem to find you, it'll be too big by then.
More than one person remarked during a break how Auerbach reminded them of why they got involved in health care to begin with: to make a difference. And this: leaders lead. They don't sit on the sidelines or run from trouble. Auerbach is now working to establish an effective emergency medical system in Haiti.
Auerbach is a professor of surgery at Stanford University School of Medicine. He flew with a team of fellow clinicians immediately after the quake last January to provide much needed medical care at University Hospital in Port-au-Prince. I can't do justice to their story in this blog. We've all read about and seen videos of the devastation and the heroic efforts to medical professionals from around the world. But hearing Auerbach retell his experiences was a real eye opener given the debates we are currently having over health care in this country.
He talked about seeing between 500 – 1,000 new patients a day and often the very best care they could provide was to amputate a limb (he noted that he could work in the Stanford ED for weeks at a time and not hear a patient say, "Thanks," but every patient he saw in Haiti said it). Many of those procedures were done without pain medicine, which Auerbach said they ran out of in the first six hours of his deployment. There were no CT scans or X-rays; all diagnosis were made by seeing and touching. "It was some of the best medicine I ever got to practice," he said. The clinicians went on instinct. There was no place to put waste or trash; it piled up outside.
Eventually, though, things began to take shape: Five ORs were established, there was a TB ward, a 24-hour pharmacy, a lab for point of care testing, dialysis, a maternity ward, a 30-bed ICU. Keep in mind that nearly all of these "departments" were in tents or destroyed parts of the hospital. But the point is Auerbach, his team from Stanford and all of the other serving at University Hospital refused to let adversity slow them down. One of the biggest leadership lessons he learned, in fact, was to "stay in motion and seek out problems," because if wait for the problem to find you, it'll be too big by then.
More than one person remarked during a break how Auerbach reminded them of why they got involved in health care to begin with: to make a difference. And this: leaders lead. They don't sit on the sidelines or run from trouble. Auerbach is now working to establish an effective emergency medical system in Haiti.
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