Monthly Archives: June 2017

Healthcare Reform

Background:

Even with a bill passed in both houses of Congress, Healthcare reform and the issue of a universal or national healthcare system continues to dominate discussions on the hill. There is talk of repealing the bill and potentially leaving millions more Americans vulnerable and uninsured. Some argue that repeal is for the best because the current bill gives the government too much power and circumvents our individual rights and freedoms. Still others argue that the bill does not go far enough to grant every single American the right to healthcare services. These views are polarizing both the Representatives on Capitol Hill and their constituents who live on main-street.

Nurses and physicians work in the field taking care of the insured, the under-insured, and the uninsured. These healthcare professionals see first-hand how the ability to pay for healthcare services shape people’s perception of illness and their willingness to seek medical assistance in a timely manner. Given how highly charged the issue is, it is important to know what these nurses and doctors think of all the hoopla that still surrounds the issue of healthcare.

Healthcare Workers’ Viewpoint:

The opinions in this article are those expressed by the nurses and physicians at a Dallas hospital. For confidentiality reasons the names of said nurses and physicians, as well as, the name of the Dallas area hospital where they work will not be used. Based on their experience in the system, these healthcare workers pointed out their frustrations with the current system, reform, and universal healthcare. The issue is healthcare reform and universal healthcare. How do nurses and doctors view this?

CONs:
On the other hand, there are some nurses and physicians who vehemently oppose the idea of universal healthcare and reform that have been passed. These healthcare workers state the following:

  1. Healthcare is not a right. It is the responsibility of each individual to work hard and pay for the care they require. Many people do not think their hard earned money should be syphoned to take care of individuals who are not pulling their own weight. A system that provides healthcare for all rewards people who are not contributing members of society. Even more, those who oppose healthcare reform and universal healthcare insist that it is not their place to take care of individuals who are lagging in their duties to self and society. These people become a drag on the system. Universal healthcare encourages the weaker members of society to stay weak and non-productive. If people had to pay for the services they receive, they are motivated to find work and everyone wins.
  2. Paying for such a system will require an increase in taxation. This means more money taken from hard working Americans; money they can use to take care of their families, co-pays and deductions, as well as anything they think necessary. Increased taxation also limits funds available during retirement.
  3. Some physicians and nurses believe that Medicare is a blithe on the healthcare system. In a free market society, insurance companies should be allowed to compete freely without a government run system that undermines the free market. Ideally, a free market will take care of pricing and completion will reduce the overall cost of healthcare. Hospitals and insurance companies that meet the demands of society will prevail. People who work hard will have access to healthcare services.
  4. It is common knowledge that physicians in the United States earn more than physicians in other industrial nations. Extensive training and hard work is rewarded by respectable pay checks. Many worry that their living standards will drop if a national healthcare system is passed. Moreover, current reform advocates preventative care which may live certain specialties out of the loop. After years of training to be of service to society, these specialties may become obsolete.
  5. Many people like to know that if they are insured, the care they need will be available to them when it is needed. It is perceived that extending healthcare benefits to all will lead to long waiting lines and if this were the case, many individuals are rightfully afraid of the cost to their lives and quality of living.

PROs:

  1. Patients are more likely to get preventive care if they are insured. Healthcare services cost a lot of money. Many people have been bankrupted as a direct result of their inability to pay medical bills, which include hospital stay, physician and auxiliary care visits (home health nurses & therapists), as well as, pharmaceutical aids and medical supplies. This means that the health and financial well-being of patients are affected by any laws that offer improved access to healthcare services.
  2. Preventative care saves hospitals and tax-payers money. Although not a primary concern for nurses, they were quick to point out that the under-insured and uninsured patients who make it to the hospital only arrive when they are so sick that they may never be completely healed from a disease that could have been prevented with the right out-patient care. Due to the advanced progression of their illness upon admission, these patients stay longer in hospitals and respond less to conventional therapies. The result is a very high cost for the care provided. Since these individuals cannot pay, in many instances, the hospitals are stuck with the bills. In order to pay off debts accrued the hospitals increase the cost of care for those who can pay. It is a logical solution that now affects law abiding tax payers which could have been prevented.
  3. People that are chronically ill cannot work and pay for healthcare. Some end up homeless and become society’s problem relying on assistance from private parties or city government. If everyone was insured, many people who require frequent medical care will be taken care of, thus reducing the number of homeless people in society.
  4. The U.S. is the only industrial nation that does not offer healthcare coverage to all its people.
  5. In a system that relies solely on profit motivated insurance companies to provide compensation, access to certain needed therapies become limited if they are not approved by the patient’s insurance company. These used to be most prevalent with the introduction of HMOs and have since improved. Still it is a stain many organizations prefer not to discuss. As people whose sole reason for being is the care of patients it is no wonder that many will like a system where compensation did not play such an indelible role.

Conclusion:

Overall, during the interview process that led to this article, it became apparent that most healthcare workers opinions on access to healthcare were greatly influenced by the role they played in the care of their patients. It was quite apparent that the nurse’s role as patient advocate greatly influenced their view on healthcare reform and a universal healthcare system. An overwhelming number of nurses were in support of a system that offered coverage to every patient that walked through the hospital doors. Physicians, who were more likely to voice concerns over structure, efficacy, and compensation, were less likely to provide support of a system that will drastically change the existing landscape.

Healthcare Schools Online

As demand for healthcare services continues to increase, it takes a specially trained person to run the oft-overlooked position that some people don’t think much about – that of a healthcare manager. That’s where healthcare schools online come in: they offer courses that train a person to be management material when the time comes for a promotion or a new job. Healthcare managers are the brains behind the operation and they ensure that things run smoothly. Healthcare schools online are a great resource for a person that needs the training, but may not have the convenient hours that other less demanding jobs can afford.

Those in healthcare management keep the day-to-day operations of any type of patient facility running efficiently. They make decisions on patient healthcare and treatment. They also work in conjunction with nurses and other administrative workers to ensure that the quality of healthcare is up to regulations and medical records and reports are accurately kept or given. These men and women must always be ready for new healthcare implementations – anything from new technology to new methods of patient care. They are typically very busy and may be called upon at all hours for advice and/or assistance in a problem. They also travel to attend healthcare conferences, or to meet with the government or private affiliates and owners of a company.

Healthcare managers work in all sorts of environments. Anywhere there is a facility that treats patients, no matter old or young, in-patient or out-patient, there is a manager that makes sure everything is carried out in a respected and efficient manner. Managers can work in hospitals, for example, but there is probably one that works in every ward who also answers to the manager in charge of the entire hospital. In a nursing home, there is one main manager, and a few managerial assistant managers to help keep the workload manageable. This type of management system is seen in all aspects of healthcare.

On a day-to-day basis, the variety of people whom a healthcare manager works with is vast. They work with nurses and nurse’s aides, medical recorders and information analysts. Every day brings a whole pack of problems to solve, but also an equal amount of reward. A great hospital with satisfied patients and workers is a sign of a great healthcare manager, who at the end of the day, is a people-person that aims to make everyone happy while keeping care effective and up to standards. Healthcare managers also have to answer to their own bosses. They must attend conferences that inform and advise them on new and effective ways of managing and on the developments that constantly happen in the healthcare industry.

Getting into this oft forgotten administrative job usually requires a master’s degree at minimum. It can be in healthcare administration, but there is also a combination of other degrees that could put the candidate in the right spot for a promotion. This could be an MBA with combined experience in the nursing field, for example. Another good example is experience and an advanced degree in a specialized field, combined with a graduate certificate in healthcare administration.

This combination of degrees and experiences places a candidate in a good position. Another common route is earning the Masters in Healthcare Administration (MHA) through an accredited college. Nowadays, more people than ever are turning to the benefits of healthcare schools online to gain this degree. With the work load and schedule of a normal healthcare employee often times unusual and demanding, many, if not all, healthcare employees would not be able to attend a traditional ground school without having to cut hours (something they may not want to do for financial reasons). Healthcare schools online offer healthcare management degrees at the graduate level for these ambitious, but time-pressed, individuals.

A Must Have For Today’s Healthcare Industry

IT solutions have found its root in each and every field and healthcare sector is not an exception to the rule. Till date, the healthcare industry was going very slow in the implementation of healthcare it solutions for the very reason that the industry depends more on individual knowledge and judgment. It is true that information technology can not be a substitute for human brains; however, it can prove to be a very useful tool or aid in performing various tasks.

Healthcare it solutions can prove to be of great help all across the entire healthcare industry:

Healthcare Diagnostics – Proper and timely diagnosis plays a very important role in the treatment and recovery of the patient. If a diagnostic tool is available to the healthcare professional that is equipped with advanced healthcare software, the task of diagnosing a disease would become much easier. Healthcare it solutions are playing a very crucial role in the field of healthcare diagnostics, the trend is catching up and there is lot to come.

Healthcare Treatment – Once the disease is diagnosed it has to be treated in the right manner. Availability of advanced new age tools can make the task of treating a patient much easier. Advanced radiation, surgical and other medical equipments that are equipped with cutting-edge software is providing a new route to the over all treatment process. Use of healthcare it solutions has made possible the treatment of a no. of diseases till date that was not available to the mankind.

Healthcare Billing – Healthcare it solutions not only plays a crucial role in the diagnosis and treatment of the patient. However, it also plays an important role in the healthcare billing sector. Once the services are provided the patient needs to be billed by the healthcare professional / hospital. The process may seem to be very easy, however, in real practice it involves a step ladder process to be followed including providing codes and various formalities. The task is tedious and time consuming, the manual process often results into a no. errors, here comes the role of healthcare it solutions in the billing process.

A fully-functional billing system especially designed for the healthcare industry, taking into consideration the industry requirements, can prove to be of great help and support to the medical professionals as well as hospital setups. The billing system makes the overall process of entering data as per the guidelines, data processing and bill generation an easily manageable task.

Healthcare Claims Processing – Healthcare costs are rising and so is the need for health insurance. Entering data, forwarding claims and getting them processed is a time consuming process… it is believed that healthcare professionals spend maximum time on this issue, which otherwise could be utilized for providing quality service to the patients. Healthcare it solutions like an advanced claims processing system could come handy in this situation. It ensures to speed up the over all process and helps to make it an easily manageable task.

Healthcare Record Maintenance – Once the healthcare services are delivered including billing and claims processing, it is not an end to the road. The most important task starts from here – patient record maintenance is a very important activity that every healthcare professional has to take care of. Patient records are maintained for future use by healthcare professionals. In case of any ailment in the future, the patient records are referred by doctors that help them to diagnose the disease. In case patient records are not maintained in the right manner or they can not be accessed under circumstances of emergency; it could be a life threatening condition for the patient.

Healthcare it solutions by way of an advanced emr system is making life easy for both healthcare professionals as well as patients. The system helps to store the patient data in a systematic manner, which can be accessed at any point of time by any registered healthcare professional. The availability of detailed patient data at the right time ensures better diagnosis and timely treatment.

It wouldn’t be wrong to say that the specialized field of healthcare it solutions is all set to transform the healthcare industry and has become a must have!

The Evolution of Healthcare

Patients answer patient satisfaction survey questions based on their perception, and yet there is limited context for the healthcare provider. It leaves one asking the questions – who were they interacting with, what was said, when did it happen, and how capable and reliable was the patient to make those interpretations? So instead of convening a committee to explore the reasons for poor scores, healthcare mystery shopping provides healthcare clients with the research intelligence needed to make real-time improvements.

In an era of value based purchasing with a focus on inpatient stays, I have estimated that over 80% of the lives touched by health systems in this country are not patients at all, but rather family members, visitors, outpatients, and consumers of everything from equipment to Starbucks. By all means make the patient room environment as clean and silent as possible, communicate effectively with the patient, and ensure that they are fully prepared to be discharged, but the emphasis must still be on the patient’s perception. Observations, opinions, and ultimately consumer decisions derive from that source.

The elevated importance of patient satisfaction data means that as the data is digested, more and more questions will arise. For instance, a survey will tell you there is a concern with the friendliness of the radiology staff. Instead of creating a broad-brush customer service program for the Radiology Department, the logical next step is to determine how the department is being perceived by end-users, what the department’s behavioral weaknesses are, and who on the staff is exhibiting those behaviors.

Together patient satisfaction data and healthcare mystery shopping can begin to focus on meaningful solutions that cause providers to say, “We know from patient satisfaction there is a problem and from mystery shopping we know what that problem is and who is primarily responsible.”

While it is recommended that managers look for coaching opportunities by observing their employees in action, expecting them to alter the service culture is less likely since – for the most part – they created the culture. Because this type of research is strictly consumer perception, it provides an unbiased view of a department or organization’s culture. This gives managers a third party perspective that increases coaching opportunities.

Types of Healthcare Mystery Shopping

From those early days of healthcare mystery shopping, healthcare provider requests have gotten more creative, more targeted, and more sophisticated. For example, a client may request something as all encompassing as a 24-hour inpatient stay in which the shopper is admitted for a 24-hour period to evaluate the patient experience from registration to discharge. Or shoppers may be asked to call physician offices to make appointments with the intent of determining how long it will be before they can be seen tying the research to more efficient use of resources.

In 2008, healthcare mystery shopping received significant national press when the American Medical Association attempted to take up a position on the practice. What was not as readily reported was the fact that the issue was tabled indefinitely. In fact, it was already the custom of one of the leading providers (prior to the accusation that healthcare mystery shopping was unnecessarily taking up physician time) to utilize what they call process observations. This form of mystery shopping, which is most effective in Emergency Departments, avoids taking up valuable patient time by having a shopper join a patient as a friend as they go through the patient experience.

Two of the most beneficial types of perception research are: 1) shopping the competition, and 2) evaluating individual employees. Call it spying, many do, but it is important to know your competition’s culture. For example, what do they believe in and how is it transferred to the patient, and can the anecdotal stories you’ve heard be verified?

A great deal of value can be derived from conducting evaluations of individual employees. For a number of reasons – cost certainly being a factor – this works best in a departmental environment and gives managers an apples-to-apples comparison of each employee as it pertains to specific standards, i.e., is Cindy more likely than Jeff to greet patients immediately (setting up a coaching opportunity for Jeff)? Or, does Jeff do a great job of cross-selling services and should be commended?

Healthcare mystery shopping also gives managers concrete examples of the specific behavior that “turns patients on.” This sets up the perfect opportunity to present to staff the behaviors the organization would like emulated while giving kudos to the employee who displays them.

Quantitative and Qualitative Appeal

Healthcare mystery shopping appeals to managers and administrators whether they are left brained (numbers focused) or right brained (narrative focused). On the one hand, mystery shopping is about story telling. Fred Lee wrote in If Disney Ran Your Hospital, “What seems to be a major component of both loyalty and dissatisfaction are stories. A satisfied person has no story to tell.” Stories are important in articulating the who, what, when, where, and how of the patient or consumer experience. The right brain approach to mystery shopping allows clients to clearly discern the difference between a completely satisfactory experience and all the various facets that went into it, and those elements of an experience that triggered displeasure or frustration. At the same time, healthcare mystery shopping is an effective compliance tool. Standards that are specific to the healthcare industry, and therefore can be benchmarked, are mixed with organizationally specific standards to create a quantitative amalgam that can be data spliced in any way necessary. Healthcare mystery shopping primarily answers the following question – How well does your organization perform on the behaviors and processes you told your people are important? In addition, it lets organizations measure those standards against perception-based goals.

The Flexibility of Healthcare Mystery Shopping

Patient satisfaction surveys are, for the most part, static. They are unchanging for a reason. Conversely, healthcare mystery shopping is much more flexible. It can be designed as a program that measures the same standards or processes over time, or studies can be developed to determine exactly what behaviors or processes are being performed.

Healthcare mystery shopping can also be redirected ‘on the fly’ if the desired objectives are not being met. For example, to their surprise, a physician practice that was asking shoppers to make appointments found out they weren’t accepting new patients. Another practice that was evaluating the customer service of their registrars discovered that none of the calls were being answered by a ‘live’ person. In both instances, the practice put on the brakes until they could fix the issue. One hospital was having shoppers go to their website to look for specific information and then having them request a response. What this uncovered was that the requests were accumulating on a PC that was not being used. This finding allowed the hospital to avoid upsetting hundreds of consumers who felt they were being rudely ignored.

How does one know if a service initiative is really working? Healthcare mystery shopping is an excellent complement to any service initiative. It can be directed in such a way that it provides real time verification that the initiative is being effective. Anything from a discharge process to valet service can be shopped at various times to ensure that the initiative’s message was received and implemented.

Flexibility does not, however, extend to internal programs. Sometimes in the name of saving money, healthcare providers will launch a do-it-yourself program. They attempt to get employees or volunteers to perform the same function that professional healthcare mystery shopping firms do. This rarely if ever works for any duration for obvious reasons. Insiders have internal biases and, despite their best intentions, are no longer able to be objective. The other reason this is not effective is that employees (and even volunteers) can think of a million things they should be doing or would rather be doing. And the lack of staying power for a do-it-yourself program puts a tremendous burden on the manager assigned to administer the task.

What Clients are Looking For

Hospitals, health systems and physician practices seek out healthcare mystery shopping vendors for a number of reasons. In some cases, they want to validate “good news.” For example, one health system client entered into a long-term relationship with the primary goal of proving that their services were superior to the competition that was also shopped. A recent wayfinding study of over 300 ‘shops’ conducted for a large hospital on the east coast concluded that less than 76% of their employees received a top box score of five for greeting consumers with a smile. This finding was indicative of a culture that was not treating consumers in ‘a personal and memorable way.’ However, healthcare mystery shopping afforded them the advantage of validating their original concern, isolating where this concern is most prevalent, and using the shopper’s language to convey to staff why greeting people was critically important to overall perception. Much like satisfaction surveys, healthcare mystery shopping is able to monitor improvement over time, but with the added benefit of story telling to pinpoint issues. It can also be instrumental in determining the specific nature of the concern and identifying where weaknesses exist.

A healthcare mystery shopping executive, who is undergoing therapy for breast cancer, wrote in a blog recently, “What matters to healthcare organizations are things like how many steps it takes to check a patient in, scripted greetings for frontline employees, record keeping for correct billing, and clinical training for new safety measures. However, as a patient, I notice if the person checking me in for chemo is smiling and greets me because she cares, not if she delivers a scripted sentence. Next, I notice if the nurses in the chemo area are working as a team and greet me personally (they should know me after two months). But what is most important to me is whether or not the clinical staff is aligned with my recovery goals.”

While this executive may be more attuned to her surroundings than most patients and able to articulate what it means to her, the goal for any healthcare mystery-shopping program is to use the shopper’s heightened sense of awareness and their ability to effectively communicate their experiences in a way that is clear and concise.

Healthcare Executive Recruiting

Experience breeds intuition when it comes to healthcare executive recruiting. Does it work for horse racing too? I will not attempt to prove whether experience improves your outcome at the track. However, healthcare venture capitalists often use horse racing analogies when discussing ideal investments. These venture capitalists prefer to bet on the jockey versus the horse. Their logic, it’s the people that drive the business.

A healthcare venture capital firm’s success is dependent on their ability to recruit and retain a high-performing Jockey, a.k.a. “the CEO.” If it was only so easy to win The Kentucky Derby or deliver a ten-bagger return. My healthcare executive recruiting experience working with healthcare venture capital firms provides intuition in defining the firm’s CEO need. Once understood, identifying and recruiting the CEO and building a solid support team for the CEO requires experience, extensive networks, new and real-time research and a thorough process. The intent of this article is to offer outcome-driven insights for the healthcare venture capital firm that chooses to search internally for a portfolio CEO versus retaining a healthcare executive recruiting firm.

Recent quarters show an increased level of new capital investment from healthcare venture capital firms. The Health Care M&A Monthly reported in March 2008 that healthcare services deal volume in February 2008 totaled thirty completed deals. Looking back to 2007, total funding for healthcare venture capital deals was more than $9 billion across more than 480 deals. Healthcare venture capital investment increases the demand for these firms to conduct a thorough and accurate executive search process in order to identify, recruit and retain the CEO. While a healthcare venture capital firm often retains a healthcare executive recruiting firm to assist in CEO recruiting efforts, healthcare venture capital firms can mimic the search process of the top healthcare executive recruiting firms.

Insights from healthcare executive recruiting firm processes will lead to an improved exit:

1. Healthcare venture capital firms are committed to recruiting a proven CEO for the portfolio business and may occasionally be inclined to conduct an in-house CEO search process. The approach is to put a CEO in place that is known by the healthcare venture capital firm from previous experiences and business dealings. However, many times these healthcare venture capital firms will admit they “don’t know what they don’t know” about the business, the segment, or the pool of available CEO talent. However, if there was any doubt at the onset, it quickly becomes clear they need to bet on the jockey to run an unfamiliar race. It is at this point the firm should consider duplicating the search methodology that healthcare executive recruiting firms utilize for CEO assignments.

Healthcare executive recruiting firms are engaged to identify and recruit leading CEOs for high-growth, venture backed businesses. To reduce the risk of making a hiring mistake, a healthcare venture capital firm’s internal search process should assess those executives the firm knows and trusts in parallel with proven executives who are newly introduced to the healthcare venture capital firm. Ultimately the CEO may be selected from the firm’s personal rolodex. However, the value of benchmarking known CEOs against a broader CEO talent-pool will prove valuable.

2. CEO contingency and succession planning belongs early in the healthcare venture capital firm’s investment. Recruiting strategies to recruit key CEOs, senior leaders and board members are at the foundation for a portfolio company’s success. Common practice is for the healthcare venture capital firm to identify and recruit a seasoned and industry-experienced board member, one capable of leading the business if the current CEO cannot finish the race. The immediate need is fiduciary but both succession and contingency planning should be considered too. While some individuals believe that succession planning should be below the CEO, healthcare venture capital firms are interested in developing concepts and financial carry more so than developing future leadership talent. Therefore, succession and contingency planning belong in the board room for two reasons: one, if the CEO in place is successful the new board member can maintain his or her fiduciary duties. However, if the CEO loses control of the business or the market, this board member is engaged and able to step in immediately. This hedge strategy can be effective to dramatically reduce downside risk.

If the CEO loses control of the business or the market and the healthcare venture capital firm did not plan appropriately, there will be many sleepless nights. It’s during those sleepless nights when the unprepared healthcare venture capital firm will incorrectly pursue one of these three options:

o Retain a healthcare executive recruiting firm. However, the search is often initiated on quick sand as the healthcare venture capital firm needs to recruit a savior. Conversely, the venture capitalist may decide to avoid retaining a healthcare executive recruiting firm as it is perceived to be too cumbersome of a process during this time of panic. Neither scenario leads to a high-multiple exit.

o Turn to someone the healthcare venture capital firm knows from previous dealings. This option is not focused on growth but rather on building a floor to minimize investment loss.

o The healthcare venture capitalist will take over the business and act as CEO. My experiences say that poor planning and a subsequent reactionary jerk will not deliver a positive cash outcome.

The success of a risk-taking healthcare venture capital firm is based on hiring and recruiting the right Jockey for the business. While healthcare executive recruiting firms are often critical resources to venture firms, there are occasions when a healthcare venture capital firm chooses to conduct their CEO search internally. In those occasions, healthcare venture capital firms should mimic the proven search process of the top healthcare executive recruiting firms. Healthcare venture capital firms will benefit by conducting an unbiased and thorough executive search process tied to board level contingency and succession plans. This will develop strong businesses and deliver solid returns.