Category Archives: Healthcare

Funding Your Own Healthcare

Introduction

More folks including both individual adults and families are on their own to provide funding for healthcare. There is a growing trend of being your own freelance business owner, being a contract employee or being employed by a business that does not offer a health insurance benefit. Many people make the mistake of buying price instead of value in a healthcare funding plan. This article provides an overview of options for funding healthcare with both advantages and disadvantages of each strategy.

How Much does Healthcare Cost?

Understanding what healthcare costs is important to deciding the best strategy for funding your own healthcare needs. Buying based only on price and not value (price vs. benefits) is a common and very grave mistake. Some examples of what healthcare can cost will help illuminate the importance of value and risk transfer (insurance) in funding your own healthcare.

Routine Care: Having an ongoing relationship with a medical doctor is important value and can help you avoid much more costly illness and improve your overall health outcome. I am an example of the benefits of routine medical care with the goals of avoiding cardiovascular disease, diabetes and managing my sinus allergies. My recent doctor visit including blood test = $248 Well Baby Check (price from local pediatrician) = $160 Annual Physical = $500? Cost depends on how elaborate a physical you get.

Rx Drug: Prescription drugs are approximately 10% of total healthcare spending [1]. Prescription drugs can be a large component of treating a major or chronic illness. These are drugs that I take with the list prices from my local drug store. OTC Claratin (equivalent house brand) = $10 / month Crestor = $137.99 / month Astelin = $115.99 / month An example of a more expensive medicine that my wife takes regularly for her chronic migraines: Topamax (generic equivalent) = $566.99 / month

Diagnostic Tests: Diagnostic tests are an important part of most disease identification, management and treatment and are a large component of healthcare costs. My recent blood test (three panels) = $152 X-Rays = $100+ Mammogram = $150+ MRI = $1000+; a complex MRI can cost several thousand dollars

Emergency Care: ER Visit = $1000+; this is based on my experience – I have never had an ER visit that was less than a $1000 in billed costs

Hospital Admission About 30% of healthcare costs are for in-patient hospitalization. The average length of a hospital stay is five days [2] with costs highly dependent on treatment. Heart Arrhythmia (irregular heartbeat) – Example from one of my clients = $45,000 including an ER admission and then three days in the hospital

Major Illness: Cancer (Lymphoma) – My brother over two years of treatment = $500,000+; It is hard to tell the actual total but when I called to see if my brother was close to exceeding his $1 million lifetime limit the expectation was at least $500,000 in paid benefits to complete his cancer treatment.

Chronic Illness: A chronic illness is defined by a medical condition lasting a year or more that requires ongoing treatment. Examples are Diabetes, Asthma, hypertension and Depression. Approximately half of all Americans have some kind of chronic aliment [2]. Type 2 Diabetes – Average Annual Cost = $5949 [3] Asthma – Average Annual Cost = $3192 [4]

Put all of this in a gigantic pile and the average cost of healthcare in Texas according to the Texas Department of Insurance in 2006 was $7110 per person. That is $593 per month per person. Admittedly that includes a lot of unhealthy and high healthcare uses but it provides some perspective on what healthcare costs. If you have not had a close relative, family or friend with a serious illness or injury, it is hard to imagine the high cost of healthcare. Value in funding healthcare is more than helping with the cost of routine care. Value to me means grappling with the risk of a major illness or injury.

Choices for Funding Healthcare

Cash – Just buy it when you need it and pay what it costs out-of-pocket. The big disadvantage of the “Cash” or what I call the “If we are Lucky Plan…” is that you have no protection of the risk for a major illness or injury. We have over 24% of Texans uninsured for healthcare with a fourth of the uninsured on the “Cash” plan by choice — about 6% of the entire population.

Advantages:

  1. No Monthly Premium / Fees
  2. Ask for Cash discount from healthcare providers
  3. Available to all

Disadvantages:

  1. No financial protection from the risk of a major illness or injury
  2. Difficulty in accessing cares without insurance; some healthcare providers may require advance payment
  3. You pay the whole bill for medical treatment

Discount Health Card – Buy it when you need it and pay less with an “Affordable Healthcare” discount card. Essentially, you access contracted network rates without a Health Insurance policy for an annual or monthly fee. I look at this plan as a variation of the “Cash” plan since you have no protection of the risk for a major illness or injury. “The FTC and many states have found that although some medical discount plans provide legitimate discounts that benefit their members, many take consumers’ money and offer very little in return.” – Federal Trade Commission

Advantages:

  1. Low Monthly Fee
  2. Discounted care from some healthcare providers
  3. Normally available to all applicants

Disadvantages:

  1. No financial protection from the risk of a major illness or injury
  2. Difficulty in accessing care without insurance; Some healthcare providers may require advance payment
  3. After any offered discount, you still pay the whole bill for medical treatment

Limited Benefit Plan – Pay a monthly premium for a defined-benefit insurance policy. Also often marketed as “Affordable Healthcare,” these mini-med health insurance plans typically offer a set payment amount for a specific healthcare treatment and a maximum benefit limit under $100,000. These plans don’t meet the “my brother test” – would this type of plan coped with the healthcare costs of my brother’s lymphoma? – No, so I won’t sell them. The healthcare discount cards and limited benefit plans are aggressively marketed on the internet. Just Google “affordable healthcare” or “low-cost health insurance” and you will see bunches. There just is no free lunch in health insurance. If the plan is cheap, then the benefits are limited.

Advantages:

  1. Less expensive monthly premium
  2. Discounted care from some healthcare providers
  3. Limited insured benefit payments for medical procedures
  4. Improves access to care
  5. Few enrollment restrictions

Disadvantages:

  1. Incomplete financial protection from the risk of a major illness or injury
  2. Due to benefit limitations, some healthcare providers may require advance payment
  3. After any offered discount and benefit payment, you pay the remaining balance of the bill for medical treatment

Major Medical Policy – This is your “Traditional Medical Insurance” policy for individuals and families. You pay a monthly premium for an insurance policy covering a wide range of healthcare risks with a substantial benefit limit, often $1 million or more. Most Major Medical Insurance policies now sold use a network concept called a “PPO” or Preferred Provider Option. Most plans feature co-pays for doctor visits and prescription drug purchases which reduce the out-of-pocket cost of these routine healthcare expenses.

Advantages:

  1. Protection from the financial risks of a major illness or injury
  2. Provider discounts if “in network”
  3. Improves access to healthcare providers and treatments
  4. Encourages preventive health treatments
  5. Reduced out-of-pocket costs for routine healthcare

Disadvantages:

  1. High monthly premium costs
  2. Applicants must qualify based on health screenings
  3. Generally, no maternity coverage
  4. Must use “in network” providers for lowest out-of-pocket costs

High Deductible Health Plan (with optional Health Savings Account) – This is a “Major Medical Policy” to grapple with a major illness but only after an annual deductible is exceeded. An optional tax-advantage savings account (H.S.A., “Health Saving Account”) is available to set money aside for healthcare costs prior to reaching the deductible. A family insurance plan that qualifies as a prerequisite for a Health Savings Account in 2009 can have a deductible of no less than $2400 and no more than $11,900.

Advantages:

  1. Protection from the financial risks of a major illness or injury
  2. Provider discounts if “in network”
  3. Improves access to healthcare providers and treatments
  4. Access to optional Health Savings Account to save toward future medical bills with a tax advantage

Disadvantages:

  1. Monthly premium costs (lower than Major Medical Plans but still substantial)
  2. Applicants must qualify based on health screenings
  3. Generally, no maternity coverage
  4. Requires making more choices on healthcare
  5. Larger deductible and no expensive reducing co-pays

Additional Advantage of Optional Health Savings Account:

  1. Reduced taxable income by amount saved in H.S.A. account
  2. Use it or keep it — any funds not used are retained for future medical expenses
  3. Funds saved are available for broad range of healthcare expenses while retaining the tax advantage

David W. Crump, Ross Gray Insurance Agency

I specialize in Business, Health and Personal Insurance sales and service.

IAQ in Healthcare Environments

As the economy heads further down the slippery slope of what promises to be a deep recession, and our healthcare infrastructure continues to grow and age, it is a natural progression to see more and more IAQ professionals turn to what some believe is a recession resistant market. From ambulatory facilities to long term care, the buildings that make up our healthcare infrastructure are constantly in need of renovations and repair. This new and promising opportunity for IAQ pros offers many long term rewards but is not without new and complex challenges that must be addressed.

Every IEP realizes the importance of appropriate use of antimicrobials, containment barriers and personal protection. Though often times IEPs find the regulations and guidelines they encounter in healthcare facilities to be daunting to say the least. In traditional remediation environments the focus is to ultimately provide an environment free of dangerous pathogens or contaminants. While attention is give to the methodology, often times the end results dwarf the means of acquiring those results. With a host of accepted methods to address indoor air quality in businesses, homes and public spaces the contractor finds themselves able to select from a variety of methods to deal with each issue. In the end it is the air clearance that counts, not so much which method was used to obtain it.

While the end results are just as, if not more important in healthcare environments; far more attention must be paid to the processes used. As many occupants of a healthcare facility cannot be moved and are highly susceptible to infection, there are very specific guidelines in place that govern all maintenance, repair and renovation work in a healthcare facility. Organizations like CDC, APIC and JCAHO have placed standards that apply to all activities that may have an impact on a healthcare environment. This is done with good reason considering the number HAIs (Hospital Acquired Infections) reported annually due to airborne pathogens like Aspergillus, which is disturbed during common daily maintenance. Nosocomial infections caused from routine maintenance reach into the hundreds of thousands each year. These guidelines and regulations are enforced in a facility by ICPs or infection control professionals.

Hospitals continually adapt to new, more stringent CMS guidelines limiting what medical treatments are reimbursable through Medicare or Medicaid, this has caused hospital administration to look more closely at every aspect of infection control in their facility. Beginning in October of 2008, Medicare and Medicaid began limiting payments made to facilities for the treatment of preventable nosocomial infections or conditions. These new CMS guidelines are driven by Section 5001(c) of the Deficit Reduction Act, which could mean that as deficits climb the list of non-reimbursable conditions are likely to grow. Infections like Aspergillosis, which is caused by airborne A.Fumigatus, are common in healthcare facilities. Aspergillus is one airborne pathogen that is commonly disturbed and distributed throughout a facility after maintenance work or renovations. The argument could be made that Aspergillosis is a preventable condition by ensuring appropriate containment and disinfection of disturbed areas.

Infection control professionals in healthcare environments have become increasingly diligent in monitoring the actions of contractors that work in their facilities. It is ICP’s responsibility to ensure all components of the infection control risk assessment are adhered to. While these key people can complicate the lives of the contractors working in healthcare facilities they are also actively saving lives by doing so. ICP’s will monitor and log details about each project to ensure that all compliance issues are being addressed. Two primary issues that impact infection control and prevention in healthcare settings are disinfection of contaminated surfaces with broad spectrum EPA registered disinfectants and appropriate containment of airborne particulate and pathogens.

Choosing the best disinfectant is one way to ensure the best possible level of microbial control during any abatement project in a facility. Healthcare facilities present the IEP with a unique set of challenges in regards to pathogens beyond the standard fungal and bacterial flora. Many of these pathogens can be highly infectious as well as drug resistant making them far more dangerous to the many immunocompromised patients housed in a healthcare facility. When selecting a hospital grade disinfecting it is imperative to keep several things in mind.

Does your disinfectant have sufficient kill claims to address the microbes you might encounter?
While no disinfectant can list every possible organism, it is important to find a disinfectant with the most possible EPA registered kill claims. Look for efficacy data. Disinfectants that do not show efficacy & testing data often have few or irrelevant kill claims and are not sufficient for the challenges found in healthcare facilities. It is also a positive if your disinfectant has EPA approved efficacy in the presence of 98% soil load as opposed to 5% which is required by the EPA. This higher soil load represents real world conditions. Beyond fungicidal kill claims, other claims that you might require involve infectious pathogens like MRSA, E-coli, HIV, Salmonella and Avian Influenza. You may also want to look for a product that can be used on both porous and non-porous surfaces and has disinfectant and sanitizing claims.

Understand what the active ingredients are in your disinfectant
It is essential to know what type of disinfectant is appropriate. Most common disinfectants are formulated using Alcohol, Phenol, Chlorine or a Quaternary Amine Base. There are arguments for each type of disinfectant and it is important to know the facts about the products you are working with. Each has advantages, but some have dramatic disadvantages that might make you think twice about using them.

Quaternary Ammonium Chloride (Quats) –
Examples Shockwave Disinfectant/Sanitizer, IAQ 2000/2500
Quats are often considered easier to use and safer than other disinfectant bases because they are less corrosive, non-carcinogenic and maintain efficacy for extended periods of time. Not all quat based disinfectants are equal though. There are a variety of products with EPA registered kill claims ranging from just a few all the way to over 130. In a healthcare environment it is important to seek out the latter, as the spectrum of microbes likely encountered in a hospital will be much broader than in common remediation situations. Unlike many other disinfectants quats based disinfectants are excellent cleaners making them ideal for surfaces with a large amount of biomaterial like fungi, blood or human waste. As many MDROs like C-DIFF, MRSA and VRE are transmitted by contaminated bodily fluids and waste this is an important factor in the equation to finding the ideal disinfectant for healthcare environments. Quats are highly stable and maintain efficacy even in the presences of high soil load. This makes them ideal for mold remediation as well as blood or bodily fluid spills.

Many IEPs as well as ICPs prefer the use of a quats because they not only offer a broad spectrum of kill claims, but are easy to work with and more cost effective than other options. In addition most quats do not have the drawbacks associated with chlorine, alcohol or phenol based products on the market.

Alcohol
While not as user friendly as quats, alcohol based disinfectants are considered by many to be easier to use than chlorine or phenol based products. High concentration alcohol based disinfectants can however be dangerous in a healthcare environment because of its tendency to open pores and dry skin. This can create openings for microbes to enter the body if not properly protected.

Though high concentration alcohol based disinfectants are generally highly effective against lipophilic viruses they are less active against non-lipid viruses and ineffective against bacterial spores. Generally alcohol disinfectants are not used for equipment immersion due to diminishing efficacy as the alcohol volatilizes. Alcohol disinfectants cannot be used as cleaners thus making them less effective for practical use on many surfaces. Even though some Alcohol based disinfectants can offer a broad spectrum of kill claims, it can be difficult to maintain appropriate wet contact time due to the rapid evaporation rate.

Chlorine
These corrosive oxidizers are known for cidal action against a wide variety of gram-negative and gram-positive bacteria as well as many viruses. Difficult to work with, these disinfectants are rapidly neutralized in the presence of organic matter making them less than ideal for healthcare and remediation environments.

While chlorine disinfectants are currently used in many facilities, future use of halogens is expected to decline as options like quats and alcohols become more abundant with appropriate kill claims. Sodium hypochlorite is known for causing significant corrosion to metals and other common materials. Chlorine disinfectants are considered toxic, and in 1994 the Clinton Administration called for the ban of all chlorine and chlorine based products.

Phenol
Phenol is one of the oldest known disinfectants still in use today and is both commercially manufactured and naturally occurring. Phenols are often effective for use on vegetative bacterial, lipid containing viruses and Mycobacterium tuberculosis but have limited or no efficacy for use against spores or non-lipid viruses. While these disinfectants are effective over a relatively large PH range, their limited solubility makes product residue difficult to clean. These disinfectants cannot be used on food contact surfaces and often require additional PPE like goggles, face shields gloves and protective clothing for application. Phenols cannot be used in many parts of a healthcare facility like neonatal, pediatric ICU or any infant contact surface due to toxic residue. Reports of eye irritation, contact dermatitis/utricaria, and depigmentation of the skin have been tied to phenol and phenol residue contact.

Phenols are commonly found in a host of consumer products and are not dangerous in very low concentrations. Disinfectant strength phenols however are considered a health risk by EPA and NIOSH. OSHA recommendations state that employee exposure to phenol in the work place should be controlled to less than 20 mg/cu m in air determined as a time-weighted average (TWA) concentration for up to a 10 hour work day or 40 hour work week. The NIOSH guidelines also limit exposure to phenols to 60 mg phenol/cu m of air as a ceiling concentration for any 15 minute period. Phenols generally enter the blood stream via ingestion, respiration or skin contact. NIOSH recommendations are just one indicator of the need for PPE when using Phenolic disinfectants. Disinfectants with a concentration of 1% phenol or greater are considered an extreme skin and inhalation hazard and are moderately combustible.

Containment plays a key roll in infection prevention.
While disinfection of surfaces, equipment and touch points plays one of the most critical roles for infection control in a health care facility; another primary responsibility of the IEP working in a healthcare facility is containment. The containment of harmful pathogens and particulate during work in a healthcare facility is essential, especially when working in areas near immunocompromised patients.

Regulations set by CDC & Joint Commission are clear in dictating specific criteria for the elimination of airborne Aspergillus, asbestos and dust. A term that IEPs will hear all to frequently as they make their transition into a healthcare environment is ICRA or infection control risk assessment. These operating guidelines are critical to any maintenance work done in a healthcare facility. APIC has developed guidelines assisting healthcare facilities in developing their ICRA to specifically mandate that dust and airborne particulate must be contained under negative pressure in Kontrol Kube like containment or by using other solid barrier methods.
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For many years hospitals were forced to either temporarily close an entire wing or build temporary solid barriers during mold remediation or asbestos abatement jobs to prevent airborne particulate from escaping the work area. In recent years a new method of mobile containment has been made available making daily remediation, repair and renovation faster and far more cost effective. Kontrol Kube type containment essentially revolutionized the way hospital maintenance was being done by allowing an IEP to quickly roll tools, ladders, chemicals and other equipment into a location and then isolate that area for the duration of the work.

Infection control professionals prefer contractors to use methods like portable containment when possible for several reasons. Mobile containment units are easy to set up and inspect, this not only makes use of the unit easier for the IEP but also makes the inspection process much faster and efficient for the ICP. Knowing that all materials are fire rated and meet NFPA 701 is also important with any sort of temporary barrier material you use. Fire codes and standards are extremely critical in healthcare situations and are a focal point during Joint Commission inspections.

When selecting a mobile containment unit be sure to consider if the unit is made of durable components that will hold up under rigorous daily use. It is also important to know that the unit is easily cleaned and is capable of providing all the functionality needed. Will the unit accommodate an eight foot ladder effectively? Does the unit have a solid yet mobile working platform? Is it highly adjustable, durable and lightweight?

Disinfectants and Kontrol Kube type containment are used in almost every type of daily work an IEP might encounter in a healthcare facility; both are key components to any comprehensive infection control plan. For the individual contractor working in a healthcare facility, understanding what is expected of you could make all the difference between winning a bid and being passed over. The knowledge and expertise shown while in the facility can also ensure future jobs in that facility.

As IEPs progress into the healthcare arena to reap the benefits of this relatively protected market they are not only assuming the role of IAQ professional; they are also assuming the role of infection control professional helping to maintain safe, clean and infection free environments. While the challenges they face are unique and in some cases daunting, the benefits exceed a simple increase in business. When we stop to consider the impact of the work they do in the facilities that care for our sick, our elderly and our very young we can see how each of us does our part to win the battle against infection and disease. With proper education and training, IEPs can make the leap from the private or public sector into the highly lucrative and relatively stable market of healthcare remediation, abatement and repair with ease. Knowing the facts about not only the rules and regulations in healthcare facilities, but also the tools available can help ensure a successful transition into IAQ in healthcare environments.

Healthcare Administration Degree

A career in healthcare has long been associated with doctors and nurses in their crisp white uniforms delivering care to patients. But there is an entire workforce that functions tirelessly, away from the glaring lights, to support these primary care givers and ensure the smooth delivery of healthcare.

Among these men and women are the healthcare administrators or managers on whose shoulders rests the responsibility of managing and running a healthcare organization.

The Department of Labor describes the day to day function of a healthcare administrator as planning, directing, coordinating, and supervising the delivery of healthcare. In other words, they are the ones who take care of the administrative and business aspects of running an organization, so the healthcare providers can do just that – provide care to the patients.

Why Healthcare?

If you are the crossroads of choosing a career, then this is as exciting a time as any to get a healthcare administration degree and enter this profession. Pages after pages have already been written about how an aging population has led to a sharp increase in the demand for healthcare professionals.

According to the Department of Labor, 10 of the 20 fastest growing occupations are related to healthcare. Now, that is a staggering figure by any measure of standards.* Healthcare administration itself is projected to grow at a faster than average pace and the employment of healthcare administrators and managers is expected to grow 16 percent by 2018.**

But excellent job opportunities and attractive compensation are not the only reasons to pursue a healthcare administration degree. The industry is also going through an exciting phase as innovate technology gets integrated with the healthcare delivery system and regulatory environment becomes more complex. The job of a healthcare administrator has become more challenging in the recent years.

Education & Training

If you thought that you need to put in six to seven years of college education to become a healthcare administrator, think again. The good news is that interested candidates can enter the profession with a bachelor’s degree in healthcare administration.

Since healthcare managers need to be familiar with management principles and practices, a bachelor in healthcare degree is designed to teach students the clinical and business aspects of managing a healthcare facility by training them in management principles, strategic planning, resource management, leadership skills, and other office procedures and medical terminology.

Graduates with a bachelor’s healthcare administration degree begin their careers as administrative assistants or assistant department heads in larger hospitals. Small hospitals or nursing facilities may hire them as department heads.

Employment Opportunities

With so many healthcare facilities springing up to provide care to an aging population, healthcare administrators may find employment in a wide range of settings. These include hospitals, clinics, office of physicians, nursing care facilities, residential care facilities, home healthcare facilities, federal healthcare facilities, community care facilities, rehabilitation centers, etc.

The Department of Labor has classified healthcare administrators as either specialists or generalists. Specialists are in charge of a specific clinical department and are called clinical managers. They are trained or experienced in the specific clinical area that they manage.

Generalists, on the other hand, manage an entire facility or a system within a facility. In large facilities, they work as assistant administrators aiding the top administrator in the running of various healthcare departments.

In smaller facilities like nursing homes or doctors’ offices, healthcare administrators are usually responsible for carrying out the day to day operations like managing personnel, handling finances, recruitment, etc.

As far as remuneration is concerned, it depends on a variety of factors such as level of responsibility and the type and size of healthcare facility. According to the Labor Department, the average annual income of a healthcare manager was $80,240 in May 2008.**

So, if you think your shoulders are strong enough to take on the responsibility of running a healthcare organization, then a career full of opportunities and personal gratification is waiting for you!

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.

The New Approach to Healthcare

Introduction –

The lack of a healthcare specific, compliant, cost-effective approach to Enterprise Information Management (aka EIM) is the #1 reason integration, data quality, reporting and performance management initiatives fail in healthcare organizations. How can you build a house without plumbing? Conversely, the organizations that successfully deploy the same initiatives point to full Healthcare centric EIM as the Top reason they were successful (February, 2009 – AHA). The cost of EIM can be staggering – preventing many healthcare organizations from leveraging enterprise information when strategically planning for the entire system. If this is prohibitive for large and medium organizations, how are smaller organizations going to be able to leverage technology that can access vital information inside of their own company if cost prevents consideration?

The Basics –

What is Enterprise Information Management?

Enterprise Information Management means the organization has access to 100% of its data, the data can be exchanged between groups/applications/databases, information is verified and cleansed, and a master data management method is applied. Outliers to EIM are data warehouses, such as an EHR data warehouse, Business Intelligence and Performance Management. Here is a roadmap, in layman terminology, that healthcare organizations follow to determine their EIM requirements.

Fact #1: Every healthcare entity, agency, campus or non-profit knows what software it utilizes for its business operations. The applications may be in silos, not accessible by other groups or departments, sometimes within the team that is responsible for it. If information were needed from groups across the enterprise, it has to be requested, in business terminology, of the host group, who would then go to the source of information (the aforementioned software and/or database), retrieve what is needed and submit it to the requestor – hopefully, in a format the requestor can work with (i.e., excel for further analysis as opposed to a document or PDF).

Fact #2: Because business terminology can be different WITHIN an organization, there will be further “translating” required when incorporating information that is gathered from the different software packages. This can be a nightmare. The gathering of information, converting it into a different format, translating it into common business terminology and then preparing it for consumption is a lengthy, expensive process – which takes us to Fact #3.

Fact #3: Consumers of the gathered information (management, analysts, etc) have to change the type of information required – one-off report requests that are continuously revised so they can change their dimensional view (like rotating the rows of a Rubik’s cube to only get one color grouped, then deciding instead of lining up red, they would really like green to be grouped first). In many cases, this will start the gathering process all over again because the original set of information is missing needed data. It also requires the attention of those that understand this information – typically a highly valued Subject Matter Expert from each silo – time-consuming and costly distractions that impact the requestor as well as the information owner’s group.

Fact#4: While large organizations can cope with this costly method in order to gather enough information to make effective and strategic business decisions, the amount of time and money is a barrier for smaller or cash strapped institutions, freezing needed data in its silo.

Fact #5: If information were accessible (with security and access controls, preventing unauthorized and inappropriate access), time frames for analysis improve, results are timely, strategic planning is effective and costs in time and money are significantly reduced.

Integration (with cleansing the data, aka Data Quality) should not be a foreign concept to the mid and smaller organizations. Price has been the overriding factor that prevents these tiers from leveraging enterprise information. A “glass ceiling”, solely based on being limited from technology because of price tag, bars the consideration of EIM. This is the fault of technology vendors. Business Intelligence, Performance Management and Data Integration providers have unknowingly created class warfare between the Large and SMB healthcare organizations. Data Integration is the biggest culprit in this situation. The cost of integration in the typical BI deployment is usually four times the cost of the BI portion. It is easy for the BI providers to tantalize their prospects with functionality and reasonable cost. But, when integration comes into play, reluctance on price introduces itself into the scenario. No action has become the norm at this point.

What are the Financial Implications for a Healthcare Organization by maintaining the status quo?

Fraud detection is the focal point for CMS in their EHR requirements of healthcare organizations, Let’s take a deeper, more meaningful look at the impact of EHR. Integration, a prominent component of Enterprise Information Management in the New Approach, brings data from all silos of the organization, allowing a Data Quality component to verify and cleanse it. The next step would be to either send it back to its originating source in an accurate state and/or put it into a repository where it will be accessible to auditing (think CMS Sanctions Auditors), Business Intelligence solutions, and Electronic Health Records applications. With instantly accessible EHRs, hospitals and their outlying practices can verify patients with payors, retrieve medical histories for diagnosis and treatment decisions, and update/add patient related information. What impact to treatment does a review of a new patient’s history have for both patient and practice? Here are some elements to consider:

1. Diagnosis and treatments that are based on previous patient dispositions – reducing recovery time, eliminating Medicare/Medicaid/Payor denials (based on their interpretation as to fault of the practitioner in original treatment or error incurring additional treatment).

2. Instant fraud detection of patients seeking treatment for the same malady across the practices within the organization. Prescription abuse and Medicare fraud saves money not only for the payors, but the healthcare organization as well.

3. The Association of Fraud Examiners states that 9% of a Hospital’s revenue each year is actually lost to fraud.

One overlooked but common impact is in the cost of managing patient records. Thousands of file folders in storage with new instances being added each time a new patient enters into the system. Millions of pieces of paper capturing patient information, payer data, charts, billing statements, and various items such as photo copies of patient IDs, are all stored in those folders. The folders are then stored in vast filing cabinets – constantly being accessed by filing clerks, nurses, practitioners and assorted staff. Contents of the files being misplaced or filed incorrectly. Hundreds, if not thousands, of square feet being consumed for storage. The AHA projects that an enterprise leveraging Electronic Health Records will recover no less than 15,000 square feet of usable space. That space can be used for additional services, opening up new channels of revenue. The justification is easy: how much would it cost the hospital to build out 15,000 square feet for a new service? The average cost to build space utilized for Health Services is $65 per square foot, or $975,000 total. An EIM solution through the New Approach would be less than 20% of that. Not only has the EIM solution reduced dollars lost to fraud, lowered the days for payor encounters to be paid, increased cash on hand, but it will also open up new services for the patient community and revenue back to the healthcare organization.

Electronic data is costly in its own way. Bad aka “Dirty” data has enormous impact. Data can be corrupted by error in data entry, systems maintenance, database platform changes or upgrades, feeds or exchanges of data in an incompatible format, changes in front end applications and fraud, such as identity theft. The impact of bad data has a cause and effect relationship that is pervasive in the financial landscape:

1. Bad data can result in payor denials. Mismatched member identification, missing DRG codes, empty fields where data is expected are examples of immediate denials of claims. The delay lowers the amount of Cash on Hand as well as extends the cycle of submitted claim to remittance by at least 30 days.

2. Bad data masks fraud. A reversal of digits in a social security number, a claim filed as one person for the treatment of another family member, medical histories that do not reflect all diagnosis and treatments because the patient could not be identified. Fraud has the greatest impact on cost of delivering healthcare in the United States. Ultimately, the health system has to absorb this cost – reducing profitability and limiting growth.

3. Bad data results in non-compliance. CMS has already begun the architecture and deployment of Sanctions Data Exchanges. These exchanges are a network of data repositories that are used to connect to health healthcare system, retrieve CMS related data, and store it for auditing. The retrieval will only be limited to the patient encounters that show a potential for denial or fraud, so the repository will not be a store of all Medicare and Medicaid patient encounters. But, the exchange has to be able to read the data in its provider data source in order for CMS to apply certain conditions against the information it is reading. What happens when the information is incomplete or wrong? The healthcare system is held accountable for the encounters it cannot read. That means automatic and unrecoverable denials of claims PRIOR to an audit, regardless of claim legitimacy.

The Price Fix by Big Box Healthcare Technology Firms

Are the major healthcare software and technology vendors (Big Box) price gouging? Probably not. They are a victim of their own solution strategies. Through acquired and some organic growth (McKesson, Eclipsys, Cerner, etc), they find their EIM solutions lose their agnostic approach. This is bad…very bad for health systems of all sizes. With very few exceptions, the vast majority of healthcare organizations DO NOT BUY all applications and modules from a single stack player. How could they? Healthcare systems grow similarly – some organic, some through acquisition. When a hospital organization finds over the course of time, an application that is reliable, such as a billing system, there is tremendous reluctance to remove a proven solution that everyone knows how to use. Because the major technology providers in the healthcare space act as a “One Stop Shop”, they spend most of their time working on integrating in their own product suite with little to no regard to other applications. Subsequently, they find themselves trapped: they have to position all products/modules to maintain the accessibility and integrity of their data. This is problematic for the hospital that is trying to solve one problem but then must purchase additional solutions to apply to areas that are not broken, just to be able to integrate information. That is like going to the hardware store for a screwdriver and coming back with a 112 piece tool set with a rolling, 4 foot cart built for NASCAR. You will probably never use 90+% of those tools and will no longer be able to park in your own garage because the new tool box takes up too much space!

IT resources – including people – must be utilized. In today’s economy, leveraging internal IT staff to administer a solution post-deployment is a given. If those IT resources do not feel comfortable in supporting the integration plan, then status quo will be justified. This is the “anti” approach to providing solutions in the healthcare industry: the sales leaders from Big Box technology firms want their sales people in front of the business side of the organization and to stop selling to IT. While this is a common sense approach, the economy in 2010 mandates that IT has to at least validate their ability to administer new technology solutions. The prospect of long-term professional consulting engagements to follow post installation has been shrinking at the same rate as healthcare organizations profit margins.

Empowering the healthcare organization to utilize its existing IT staff to administer and develop with the new products is not part of the business plan when Big Box players market to the industry. It is the exact opposite – recurring revenue from lengthy, and sometimes permanent, professional services consulting engagements is part of the overall target. The initial price quote for a Big Box solution is scary enough, but the fact remains that it is still not representative of what the ongoing cost to maintain through consulting arrangements. This is a variable cost, which is difficult to predict, and drives finance managers and executives crazy.

Solving the Dilemma – A Better Solution through a New Approach at a Fraction of the Cost

When Healthcare Business Experts combine talents with Technology Architects, EIM Solutions cost drop dramatically. This is the New Approach to Healthcare EIM, providing the way health organizations will be able to provide successful solutions at significantly reduced costs – opening the door for health systems of all sizes.

The EIM Firm (using the New Approach) versus Big Box Healthcare Technology Providers:

Smaller, more agile firms bring many benefits to Healthcare Organizations of any size. The benefits:

1. They are focused on specific verticals – just like the Big Box Health Technology providers. Subject Matter Experts (SME) in the smaller firms typically are industry veterans with years of experience and success in their approach who see their resume as a service offering better utilized when they are able to apply their methods for successful strategy planning as opposed to learning the methods of a Big Box player. Their income is better since their revenue is applied into a smaller operating cost, extending lower pricing for solutions that are MORE EFFECTIVE and offering stronger client/vendor relationships as the SME limits themselves to a certain number of clients.

2. Solutions built on proven approaches and strategies. Again, the firm’s SMEs are able to define a methodology that can be re-used or re-configured in each client instance. This saves time and money for the client as delivery is accelerated and the cost of architecting is eliminated.

3. The firms themselves develop solutions and methodologies agnostically. Their understanding of the diversity of systems that exist in the technology of a healthcare organization allows them to not only develop adaptable solutions but also add a Business Process Management Plan (BPM). The BPM will define for the organization EXACTLY how information is received, processed, cleansed, stored, shared and accessed. It also will define an action plan for training IT for administration and support as well as end users at all levels on how they will leverage it going forward. BPM planning in a healthcare organization is a low six figure investment with an outside consulting group. The EIM firms will include it in the cost of the solution. Basically, it is the difference in being told what is wrong and here are the recommendations to fix it versus here is what is wrong and this is how it will be fixed with the new solution.

What is a typical EIM Firm solution?

1. Solution Assessment, noting the current systems, data sources and methods of sharing information as well as business processes, key personnel identification that are gate keepers if information, timeliness of providing information and overall effectiveness in leveraging enterprise information for strategic business planning. See figures 1 for an example of the information process flow visual component of an actual assessment.

2. EIM solution that contains an integration engine that accesses all data sources – reading and writing back to the database or application, providing data quality services and maintaining HIPAA as well as HL7 requirements. See Figure 2 for a diagram.

3. EHR Data Warehouse. A repository to build Electronic Health Records through the integrated data flow.

4. EHR Portal for patient entry (when additional information needs to be added) via a browser.

5. Business Intelligence Dashboards for metrics, AD Hoc analysis and Performance Management Scorecards on organizational goals and objectives.

6. Onsite implementation and integration of the EIM solution.

7. Onsite training during installation for IT and end users. Ongoing training provided via webinars, documentation and technical support staff.

8. Relationships maintained by the Subject Matter Experts for the life of the solution.

9. Stimulus “HITECH” Act pays $44,000 per physician for an EHR solution implemented. The SME creates the grant request to be submitted so the healthcare organization receives Stimulus funds to pay for the total EIM solution

Key Element of the Solution

Onsite Delivery and full time support are key. But, the most important element is training. Why? As noted earlier, it is paramount that existing IT investments, namely personnel, be able to not only administer but also conduct development as the need arises. In Healthcare, CMS managed Medicare/Medicaid is already margins that are in the negative. As private payers follow suit, the number of uncollectable encounters will increase, impacting current profitability models and increasing future cost for treatment. By mitigating IT costs, the Total Cost of Ownership (TCO) qualifier should actually evolve to a Return on Investment (ROI). ROI is immediate for this solution approach, but it is sustained year over year by leveraging internal IT to support and develop. Now, the Healthcare Organization has eliminated costly professional service consulting engagements and re-investments into new feature licensing. This takes a variable cost every year and makes it a fixed, yet smaller amount – a sensible financial approach to accomplish a proven strategy.

Summary –

Why EIM? Whether it is Omnibus, “Obama”-care or an edit (not overhaul) of the Healthcare industry, Healthcare Organizations know these truths:

1. Electronic Health Records are necessary for the Fraud detection unit of CMS. Each organization must comply with accessibility, HIPAA and format. Fraud reduces overall revenues for a hospital by 9% (ACFE)

2. EHR/EHR have proven to be highly effective in eliminating internal waste, patient fraud, practice fraud and paper overhead. Vast amount of space within the facilities that had been used to store patient records in hard copy can now be utilized to provide additional services and open new revenue streams.

3. Bad or “dirty” data in electronic or hard copy format is costly. According to the AHA (September, 2008), the average cost of a patient record with good or accurate information is $343 annually. The annual cost of a patient record with bad information is $2,054 annually. On average, 18% of patient information within a healthcare organization is bad.

4. Strategies developed by healthcare organizations without 100% of the information they own that is also timely and relevant are ineffective. Objectives cannot be defined, successful processes cannot be identified and improvement plans have little to no metrics in which to determine success.

5. Stimulus/HITECH Act pays $44,000 per physician when EHR is part of the EIM solution. With the smaller EIM firms, Stimulus pays for the entire solution.

Why a New Approach EIM Firm?

1. Subject Matter Expertise from consultants that have proven methodologies.

2. Agility to adapt to the client need instead of the Big Box approach of the client adapting to their product limitations.

3. A Better Solution at a Fraction of the Cost. Their solutions are based on needs and not features.

4. Relationships with the vendor, resulting in improved services, maximum values from vendor solutions and a focused approach to the client needs and goals.

5. A Return on Investment as opposed to a Total Cost of Ownership. Clients need to see solutions that immediately pay for itself and then recover lost revenue while offering channels to new profit centers.

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.

The Evolution of Healthcare Mystery

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.

Evolving Healthcare Trends

The model trends in the healthcare system have been changing over the period of time. The old trend gave importance to the individual patients and the emphasis was on treating illness. The goal of the hospitals was to do inpatient admissions, fill up the beds and more emphasis was given to acute inpatient care. The role of managers in the old paradigm was to run the organization and coordinate services. In the old system, all providers were essentially the same. The hospitals, physicians and health plans were separate and not integrated.

The newer trends that evolved gave importance to the population as a whole. It not only treated illness, but emphasized on promoting the wellness of the people. The goals of the healthcare system after being transformed over the years is to provide care at all levels which is continued. The role of managers in the new paradigm is more broad. They see the market and help in quality and continued improvement. They not only run the organization, but also go beyond the organizational boundaries. In the evolving system, the providers are differentiated according to their ability. The hospitals, physicians and health plans have formed an integrated delivery system.

One of the current trend in the healthcare delivery model is that continued care is emphasized. The key professionals are not only treating patients for their illness, but they are promoting and managing quality of health. For example, a patient with high cholesterol visits a doctor. He is not only given one-on-one medical treatment, but he is also offered to attend a group session where information is provided on how lifestyle and behavioral change can help. The patients learn from the clinicians and also from each other. Another current trend is to take care of the health of the defined population and not only individual patients. All the health needs of the population as a whole are identified and served. It is emphasized that the community uses the health and social services provided. Healthcare has become more population-based. Another trend that has evolved is that the hospitals, physicians and health plans have got connected and have formed an integrated delivery system. More investments are being made with a goal of providing services to the customers and retaining them.

There is a beneficial impact in the transformation of healthcare towards emphasizing continued health. The way healthcare has been viewed in the past has been changing. The shifting of care from treating acute illnesses to providing continued care is resulting in enhancement of the health of the people. The only appropriate and feasible model is to provide a continuum of care with the emphasis firmly on the family and community. The health of the population and community is considered as a whole. This is advantageous as it creates value in the healthcare delivery system. The healthcare providers work with the community as a whole and consider to improve the health of the general population. Even though this requires new kinds of ways of organizing and managing healthcare services, it helps in understanding the health needs of the target population. By studying their needs, the right health and social services could be provided to them. Examples of promoting wellness of the whole community are organizing health campaigns and providing preventive education to the people in general. Another example is providing awareness about flu vaccines and encouraging people to get the vaccination.

Integrating the healthcare delivery system has led to certain advantages to the patients. For example, they can be offered alternative sites of care depending on their convenience. It helps in meeting the needs of the customers and their preferences which is taken into account. The number of providers are expanded and the patients get to have a choice. The relationship between providers and health plans are organized in the current trend and this ensures that the right care is provided in a convenient way to the customers.

There are defined budgets and expenditure targets for the populations which implies that there is a need to be efficient and productive. The formation of strategic alliances, networks, systems and physician groups can also add value. There are capitated payments and budgets allotted to the healthcare organizations. These are used to provide care to the defined population. The organization might like to improve on the payments and budgets as the expenditures of the companies increase. This results in the management to make decisions like forming strategic alliances with other organizations and increase the total resources. The growth of such networks will help in providing better care to the customers. Financial resources greatly influence the efficiency and productivity of the organization.

The aging population is influencing the healthcare delivery. There is increased demand for primary care of people over 65 years and for chronic care of people over 75. The ethnic and cultural diversity is also influencing the healthcare delivery. This provides a challenge in meeting patient expectations on one hand and diverse workforce on the other. Biological and clinical sciences have met with technological advances and have led to new treatment modalities. This has led to open new treatment sites and manage across the organization. External forces change the supply of certain areas of health professionals like physical therapy and some areas of nursing. The management needs to compensate for such shortages and they need to develop different teams of caregivers at different work sites. Changes in education of health professionals implies that the management be more creative in offering healthcare services. With an increase in diseases like AIDS and morbidity from drugs and violence, there is more and more need to work with community agencies, form social support systems and there is a need for more chronic care management. Advances in information technology is another area where there is a need to train the healthcare employees in new advances. They also need to manage issues of confidentiality and rapid information transfer. Increasing expansion of world economy has led to more competitive management of strategic alliances, care of patients across the nations and of different cultures.

Current environmental trends impact the healthcare delivery model. Organization’s success depends on its external and internal environment. The complex environments made up of uncertainties and heterogeneity of components leads to different organizational designs. The current environmental trends influence managerial and organizational decision making. The unique challenges facing the healthcare delivery organizations should be analyzed in order to develop and implement new and effective operational processes and strategies. As an impact of current environmental trends, the healthcare delivery system needs to improve individual, team, and organizational accountability and performance. The impact of advances in medical knowledge and information technology on the process of healthcare delivery should also be examined, and it should be leveraged to improve quality of care, process and cost controls, and revenue. New strategies would need to be identified and implemented for learning and performance improvement to create a culture that supports accountability, safety, and high-quality care. Innovative models in healthcare delivery would also be required in order to develop and implement strategies that promote organizational success and competitiveness.

Due to the current environmental trends, more emphasis is given to the customers and there is more of a patient-focused care. The healthcare delivery model has been shifting to the community based care. There has been an increased modification in care processes. The traditional ways are being challenged and more experiments are being performed to fulfill the demands to improve the quality of care. Due to the shift in the environmental trends in the healthcare delivery model, more emphasis is given to quality improvement. This will help improve the performance levels of key processes in the organization. The performance levels are being measured, the defects are eliminated and new features are being added to meet the customer’s need efficiently.

There is a new emerging contemporary trend in the U.S. healthcare system. Presently, the management research and assessment have been offered increased recognition. The emerging trend seen is that this is slowly forming an integral part of managerial and organizational effectiveness. With the emerging efforts in information management, it is leading towards clinical and financial networking. The trend seen among the physicians and nurses is that they are being increasingly involved in managerial activities. The managerial trends are also changing with respect to role performance and changing values. The managers role is getting more and more recognized in managing finance and human resources. Management training, lifelong and distance learning is being offered in preparing future managers.

The healthcare executives and managers will be faced with the major responsibility and challenge in the years ahead. They will be working with other healthcare providers and will be creating a competitive future for their organizations. They will not only be managing organizations but also a network of markets, services and joint ventures. Formation of more and more strategic alliances and partnerships will lead the management to manage across boundaries. The management will change from managing a department to managing the continuum of care. The management will be following a community-based approach. Trend in management is also shifting from just coordinating services to providing improvements in quality.

As the demands in healthcare are increasing, the management is responsible for forming performance standards. The management is also challenged to maximize the productivity and quality to serve the health needs of the community. The management is looking after the demands of the external environment as well as attending to the performance of the internal environment. The management is responsible for the performance of the organization.

Healthcare organization leadership will be responding to new trends and competitive forces. It will respond to continuum of care, overall health status of the population and more complex organizational structures. These emerging trends in the healthcare system will effect the organization’s leadership. The future managers would need leadership skills and vision to integrate the organizations and help in providing the best care. The managers will have to be committed to leadership and work on giving their organizations the best place and help their organizations adapt to the changing circumstances. More value will be given to leaders who will be able to lead the change process. As changes are inevitable for the betterment of the organization, the leaders should be able to identify how the change is to be received and how it is to be communicated at all levels of the organization without damaging the implementation process. The leaders might have to deal with increased pressures due to organizational complexity.

The leader in the organization provides strategic direction to the organization, manages diverse stakeholders, becomes mentors for management, is willing to take risks, helps the organization interact with the external environment and attends to the internal needs as well. Where required the leader will involve physicians in governance process and align physician and organizational interests. There will be a need for formation of learning organizations. Transformational leadership will create the required vision for the organization. Leaders will have a greater role complexity and they themselves will have to adjust rapidly to new situations. The healthcare organization leadership will have to live up to the values of the organization and will help in fulfilling the mission of the organization.

Individuals and groups within the healthcare organizations require more and more competencies. An enhanced lifelong learning is required due to the fast, changing environment. The individuals and groups within the healthcare organizations will be benefitted as there will be rapidly developing medical technologies which will result in increased services. More sophisticated health services will be provided to the consumers. The range and quality of services provided will be regulated for the benefit of people requiring home care, long term care and ambulatory care. The anticipated future development will also result in the increased competition among the health services organization. The individuals and groups will be involved more and more with the community for issues like drug abuse, teenage pregnancy and violence.

Individuals and groups will be faced with increased strategic planning and management in the healthcare organizations as there will be ever increasing involvement by the trustees and physicians. As the future environment in the organizations will be more complex, the individuals and groups in the healthcare organizations might feel more pressurized. They will need to serve the changing demands of the community as the population of elderly patients will increase. These individuals will require more professional training, increased levels of education and should be taking part in continuing education programs.

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.

How Can a Healthcare Professional

Social Media: Opportunities and Dangers

With social media, healthcare providers have many tools at their disposal to help build their businesses. Social network sites can be a powerful tool in the hands of persons who know how to leverage it to its full potential. When social media is misunderstood or misapplied, it can turn into a time sink where many hours that could have been spent more productively in other ways to build your business. Since social media is easily misunderstood, it will help to clarify some of those areas.

One of the things that makes it confusing is that social media uses terms that people often assume they understand, like ‘networking’, yet in the realm of social media, it has very different meanings.

Social Media and Meetings

With 128 million people using the internet in the US, the way of reaching people and being relevant to their needs has changed. This means that the way of doing business has changed as well. The public now consults their phone for the best buys on products and services. They are also using their phones to purchase items. The changes in the way business is conducted also impacts healthcare.

Social Media offers many tools that you as a healthcare professional can use to build your business. With the use of social (interactive) media, the nature of business building has changed. Social network sites provide an interactive way of dealing with potential clients. In previous generations, the relationship between a healthcare provider and potential clients was limited to one way interactions dominated by the healthcare professional. Today, the patients talk back to you using Facebook, email, twitter or some other service, asking questions and want you as a healthcare professional to be responsive. If you provide good service, they can tell others, if your service is lacking, your reputation suffers much faster when they use social media.

In previous generations, any kind of marketing consisted of ads telling about the services provided and contact information. If the healthcare professional had social skills, they may even engage in networking as a way to develop their business. In previous generations, networking consisted of joining local business promotion groups in the local community. A healthcare professional typically joined the Chamber of Commerce, local professional group of their specialization, a business group like the lions or rotary or if they are really adventurous, toastmasters.

With social media, the groups that an aspiring healthcare professional joins have changed. Sure, there are still some of the old groups used in previous generations, which can be used. Social media provides more options. There are physician only sites like Sermo.com, which are a social media site devoted to only physicians.

In other healthcare areas, professional groups like the American Psychological Association and the American Association of Marriage and Family Therapy have developed their media presence. This allows the old professional groups to have a new place to meet on the internet.

In addition to those groups, there are groups on social media sites, themselves. LinkedIn has many professional groups on its site, as does Facebook. These groups vary by specialty. There are groups on oncology, depression, healthcare professional support, etc. Such groups often provide forums where you can discuss issues of concern to yourself as the healthcare provider. I recall a recent lively discussion on the existence on Sexual Addictions on LinkedIn, where healthcare professionals addressed the issue from many different perspectives. These provide a place to find out the latest information and to stay in touch with colleagues.
These groups provide a forum where healthcare professional meet and connect with others sharing similar interests. This is a new application of old style social networking. The networking that occurred at monthly or annual meetings is now available on a daily basis. Meetings and relationship continue remaining an important essential for a healthcare professional to develop in building their business.

The New Networking and New Challenges

Social media is changing the application of the term ‘networking’ in new ways. With social media, the healthcare professional is faced with the new dimension when you have to deal with interactive media. In previous generations, building a practice involved the use of static media. With social media, the relationship between the healthcare provider and client becomes interactive. It is no longer one way with the healthcare provider telling the public that they are the expert and the patient has to accept that. Now the public talks back to you, wanting evidence of your expertise, caring and empathy. In the past, you could get away with just ‘being the healthcare professional’. In the age of social media, they want to know something about Dr. Jane, or Jack the therapist.

With the new application of ‘networking’ including the interaction with the client, healthcare professionals are in new game. The clients now ask questions and interact with them in an environment where the healthcare provider is not the one in control. The healthcare professional and the potential clients now share control. Potential clients now ask questions and engage in social interactions that did not exist ten years ago. With social media, the potential client is empowered.They know more and want more than they did ten years ago.

With social media, today’s patients often self-diagnose before seeing the healthcare professional. In one study 81% of respondents indicated that they expect to find help on the internet, including medical help. This means that the public is going to the internet, and its social media for their healthcare help including self-diagnosis. In one recent study 47% of those seeking medical information also made self-diagnoses. This practice is becoming so prevalent, there is a tendency to refer to Dr. Google. One of the big challenges related to this information is is that the public is not always verifying the veracity of information they obtain.

Not only are the public going to the internet looking for help, they are often diagnosing themselves with the information they have access to. Dr. Bryan Varabedian said “Information is the new third party in the exam room”. (Dr. Varabedian maintains a blog addressing the convergence of social media and medicine.) Healthcare providers building their business now have to deal with patients having and using more information.Some of the information is good, while some is not from proven sources. Another challenge is when patients have the right information but are using it in an unorthodox manner.

With patients knowing more, they have begun to self-diagnose their presenting issues or problems.The whole idea of patients daring to self-diagnose is seen as threatening by some healthcare professionals. In Texas, a physician’s group has sued the Chiropractors, podiatrists and family therapists because they dared to diagnose clients. This is a far cry from Pennsylvania, where all 277 of University of Pittsburgh Medical Center (UPMC) sent out e-mails, offering digital house calls. In that state, some patients receive a diagnosis without seeing a doctor (or any healthcare professional) in person or even speaking to one on the phone. It remains to be seen how those healthcare professionals will respond to patients diagnosing themselves. Today’s social media savvy patients also present with more information and ask more informed questions than previous generations. Healthcare professionals now have to be prepared to deal with this challenge of patients having a knowledgeable voice in their healthcare decisions. The patients of today do not always go along with healthcare choices, just based on your word. They may also compare your information with what they find on the internet. This means the healthcare professional needs to provide good information and be on top of the latest trends and developments in their field.

The input of patients in healthcare decisions has great potential in improving the quality of healthcare. By using social media, the patients are not only making informed choices, they are speaking out. With patients having a voice, the healthcare providers who listen to their voices and respond will be seen as the expert. This means that healthcare will have to become more responsive to patients overall if they want their business to thrive.

Potential patients also want to know about their healthcare providers. When patients are often limited as to who the patient can see, when the patients do have some choice, they often have questions and want to interact with the provider. Social media provides a way for them to “get to know” their healthcare provider. Providers that learn how to use social media in dealing with patients will be ahead of their competition. Those providers will also need to develop written “social media policies” in dealing with those patients. Healthcare providers using social media will need to be clear concerning the boundaries between themselves and clients, specifying what information they will share about themselves and their accessibility.

In using the new social media, the public is now going to Facebook or Google to find help before they go to the yellow pages. This means that healthcare providers who do not have a social media presence will be passed over. They will not even by considered by potential patients that are seeking out healthcare.

The Importance of Social Media

When millions of people are using social networks, those healthcare providers who choose not to be a part of it by exercising ‘social media abstinence’ are missing out on the changing way that people interact. Healthcare professionals who choose to avoid social sites altogether are crippling themselves. The public now use them extensively. Whether in the use of their computers or phones, or both, it is a reality. Social media has changed the way people interact in the marketplace.

Dr. Ross Speck, who researched social networks back in the 1970’s saw the changes coming. He stated, “If the psychotherapist is to maintain a healing relationship with human beings in this predicament [social change]-if he is to be of value in relieving distress-he has to innovate”. Although Dr. Speck’s comments were directed at psychotherapists, it has application to any healthcare professional in practice today. It is becoming important for healthcare providers to know how to use social media, or hire someone for them who does.

Dr. Ken Cohn MD, has observed the importance of the new media and medical practice. He often addresses this subject. He sees the time for healthcare providers to act on social media is now, “…because physician leaders over the next 2 years will influence patterns of care delivery for the next 25 years”.
Social media is also a way for an aspiring healthcare professional to compete with much larger competition, whether it be from other people in healthcare, publishing or speaking. Using social media removes the size advantage that some exploit in providing healthcare.

Dr. Ken Cohn who has pioneered collaborative work between physicians, hospitals and patients has used the new media to present the message of his work to others. In promoting his book, “I see social media as a great equalizer.” He has seen social media improve the quality of care for hospitals. He has also seen how he, with his book could compete with larger publishers using social media.

Social media also allows the little person just starting out to make a name for themselves. A highly responsive healthcare professional can establish a name for themselves with the public rather than always having to be dependent on the power brokers of established practices.

Social sites are is changing healthcare, including how healthcare providers build their practice. It changes how clients find them, interact with them, and services are delivered. It also changes the way that healthcare providers will find potential patients. Knowing how to use and master social media is critical for any healthcare professional wanting to build their business in today’s social media saturated culture.

Social Media Tools

Once you as a healthcare provider has a social media policy, you need to use the tools available. Below are some of the social media tools and ways they can be used by a healthcare professional in building their business.

Facebook: Facebook is the largest social community. With increasing frequency, people search Facebook for their needs. You can have business page to establish awareness of your business. Given the size of Facebook, it is critical that the healthcare provider have a page in order to remain relevant.

LinkedIn: This social site allows healthcare professionals to network with other professionals. 80% of small business owners in one 2011 survey report using LinkedIn. Having a profile will let others know that you are in business and lead to important business leads. Building a business often involves joint ventures. LinkedIn is a way to find potential partners for joint ventures.

Twitter: This site provides a platform to keep people informed of “what is going on”. The public often likes to know about what is new. Keeping them informed as to events and new items coming out. In the US, 13% of the population online use twitter.

Digg: This news site can be used to develop a following for healthcare providers.

Google: Although not often seen as a social media, it has many functions that involve social interactions. This is where people look for services. Having a good Google ranking can make a difference in your business visibility.

Once a healthcare provider has visibility, they will need to use social media in interacting with their potential clients.

The healthcare provider can use these tools for announcements, patient education, answering frequently asked questions, dealing with common healthcare issues, and healthcare topics that would be of interest to them.

Summary of how to use social media

To sum up how a healthcare professional can use social sites to build their business the following steps can be taken:

1. Network with other professionals and people in the local community.

2. Provide good patient information. Become a resource. For example, if you are a chiropractor, you could write a series of articles, blog posts, etc. on exercise, health eating, how to lift heavy loads, etc. With each article, it would enhance your expertise in the eyes of potential clients.

3. Have a written social media policy, then use social media to promote your business.

4. Interact on social sites regarding questions and concerns. Be willing to answer questions and make yourself accessible on such sites. You can use them to post interesting articles, videos, etc.

5. Know how to use social sites to their full potential. Social media has many opportunities. You can set up a blogtalk radio show, have regular episodes on your own YouTube channel, have book club on LibraryThing. You are limited only by your own imagination in reaching out to clients and provide good quality patient care.