Impact of the Vatican's Universal Translation of Faith, Catholic Owned Health Care Facilities and State Legislation on Health Care for Women
The triad of the new stricter Vatican rules for interpretation of Catholic protocols, the trend toward Catholic organizations purchasing non-Catholic hospitals, and the furor over the proposed women's health standards for the 2014 health insurance exchanges have made this a topic which must be revisited. In order of appearance here are the players:the Vatican, Swedish Health Services, and the State of Mississippi.
Vatican Rules on a Universal Translation for Catholics
Beginning November 27, 2011, the Vatican has issued another edict which attempts to tighten the interpretation of the Catholic faith, by mandating a single universal translation of the faith. The church hopes to reign in the more liberal interpretation which is prevalent in the United States and other western countries. Though one might think this only affects Catholics, not-so-fast, it affects all Catholic Church owned enterprises, including hospitals and schools, which serve an interfaith community and that brings us to our next player.
Swedish Health Services Acquiescence to the Catholic Entity Providence Health
Counter-intuitive to the trend of Catholic hospitals purchasing non-Catholic facilities throughout the United States, the secular hospital group, Swedish Health Services has acquired Providence Health Services hospital and clinics. However, what is most interesting about this transaction is the Pope still got his way, as the deal is subject to his approval, and he has mandated a line-item-veto on the secular facility’s ability to provide abortions. One could understand a Catholic hospital which did not wish to provide abortions, but Swedish is a secular institution and it is acquiring Providence. Though Swedish has indicated this wouldn’t have a huge impact on the service for women in the Puget Sound area of Washington State, they did not have any public hearings about this reduction in service. Clinically, there are cases where women may require a hospital facility for an abortion, but that doesn’t seem to matter here. At least in the Seattle area there are other secular facilities which will provide the service. It is important to note that the Vatican has specifically addressed the elective abortions, which can include victims of rape or incest. I am sure these women consider their legal health concerns to be paramount and hardly “elective.” Apparently there is no due process required if it concerns female reproductive rights, even in the highly secular community of Seattle, where Swedish is based. The fact that we have allowed our health care practice to be determined by a celibate male from another country offends not only me, but also the majority of residents.
According to a 2005 report by Catholics for a Free Choice , there are 60 Catholic health care systems located in all 50 states in the United States. One of the concerns about Catholic hospitals is do they restrict health services? This question applies not only for reproductive rights, but also for advanced medical directives for patients who wish to die without certain medical interventions. According to a 2006 survey by Pew Research Council, 70% of Americans felt that patients should sometimes be allowed to die, 70% also indicated they would rather die at home, than in a prolonged artificially extended manner in the hospital. Only 22% of those polled said that life should be prolonged using extraordinary measures. The majority of Americans shun the loss of dignity while being kept alive mechanically, but would a Catholic hospital respect their wishes? The nonprofit group Catholics for a Free Choice, states that Catholic hospitals do restrict health care services based on the edicts of the Vatican via the Ethical and Religious Directives for Catholic Health Care. It should be obvious that non Catholic patients as well as Catholics may disagree with these practices, so it behooves the patient to verify any service restrictions in policy and in practice in advance of treatment in a Catholic facility. Unfortunately, for many people in America this is not an option, as the only hospital in their area may be a Catholic institution, which has an impact on end-stage-of-life-care and other health services decisions.
Mississippi is Close to Defining Life as at the Point of Conception
Previously I have written about my 50-state analysis of the 2010 health care mandates for the regional insurance purchasing cooperatives, including the incendiary furor over women’s reproductive autonomy. Not to be outdone in its leap to the dark ages, the State of Mississippi is close to passing a law which defines human life as beginning at the moment of conception. Needless to say, this will be a sticky wicket when it comes to actually, catching-someone-in-the-act. The personhood law, if it passes will make it a crime for a woman to obtain an abortion at all, as the life of the fetus will supersede that of the woman who is already alive and kicking. Additionally, this “chastity belt” would also outlaw the use of certain birth control devices, including IUD’s which are intrauterine devices that allow fertilization but prevent embryo attachment to the uterine wall. Of course, the morning after pill would not be allowed either. Going a step further than just the birth canal, the destruction of any in vitro fertilized eggs would also be a crime.
The proposed law certainly cuts a wide swath across those who are fertile and those who may have fertility challenges. This state could potentially institutionalize pregnant women to enforce delivery and likewise for rape victims or incest victims. More to the point, for those fertile lasses who have already had several children while using various birth control measures, and decide they cannot afford more children, they would become criminals. It will be interesting to see how this one winds its way through the courts, if it passes the legislature.
Lest you want to write off Mississippi as an rogue state, Colorado attempted to pass similar legislation in 2008, which thankfully failed. In fact, Personhood USA is based in Colorado and is the backer for the Mississippi bill. Additional states who are considering personhood laws to circumvent the 1973 Roe versus Wade ruling that confirmed constitutionality for a woman to have an abortion prior to the fetus’s ability to live outside the womb include; Arkansas, Montana, Nevada, and Oklahoma.
From this vantage point there is no end-in-sight for the pitch back to the dark ages for women in the United States. I can almost see the black hole from here.
On a more personal note, I expect my book, Unraveling U.S. Health Care to be available within the first quarter of 2012 and yes, it is OK to say FINALLY. Anyway, thanks for reading and I hope you continue to review and comment on my musings.
Monday, October 31, 2011
Monday, September 19, 2011
Reducing Health Care Costs By Improving Primary Health Care
How Primary Care Reduces Health Care Costs in the Long Run
Now that the teeth gnashing over health care reforms has been ongoing for two years, before the lifelines are cut on financing health care for the forty-nine million uninsured population, let’s examine the health care continuum for the impact of a failure-to-fund the health insurance subsidies. One of the things that is missing from many discussions and assertions about the 2010 U.S. health care reforms are which systems need to be changed in order to reduce the long term cost of American health care. And when I say reduce, I mean reduce the cost increases in providing health care to an aging population. It is essential the U.S.A. get the per-capita cost of its health care in-line with other nations, as it gobbles funds that could be used for education, capital investments for industry, and other economy building activities. The country will need to make substantial investments in k-12 education as well as building a more energy efficient infrastructure to have a chance at competing with global leaders for competitive contracts, as Germany and other countries have done. This article addresses the components of American health care that are impacted by the 2010 mandates and what it means for managing patient care over a lifetime.
Perspective
Rather than thinking of health care as a commodity that deserving people get, for those who have worked where it is provided by an employer or who qualify for Medicare by virtue of accumulating enough quarters of eligible earnings, or military personnel, please consider it a part of the national infrastructure for a moment. A healthy population is necessary to obtain optimal output from workers, students, and for the care of our families. The provision of health care may be considered a utility. Utilities are measured by their output, the efficiency of their output, and the cost of producing the service. Measuring quality across the United States health care system, which is disparate and complex, is a major challenge in building higher efficiency into American health care.
Measuring Health
From the moment we are born until we die, we are introduced to various aspects of health care in the U.S. system. Even from birth, we do not provide the same level of care to all pregnant women, nor do all babies have the same chance of surviving their first year in America. In my book, Unraveling U.S. Health Care, I researched all fifty states for health metrics, including infant mortality statistics and in one area of the country, infant mortality was as poor as it is in developing countries (12.6 deaths per 100,000 babies for the District of Columbia) Only in a hand full of states was the infant mortality rate equal to European standards, of 5 or fewer deaths per 100,000 infants. Health care workers do understand and are alarmed about this dramatic difference in a basic health care outcome in the country; however, it seems much of the population is uninformed. A basic measurement for health is infant care and reducing the chance of infant death.
Another health care measure is degree of healthy living, as measured by the DALE or Disability Adjusted Life Expectancy, which measures the number of years an American can expect to live healthily, able to move around, and do their activities of daily living. In other words, how many years you can expect to be reasonably free of impairment from chronic disease. The World Health Organization, developer of this index ranked Japan as the number one country for living longest in good health to an average age of 74.5 in the year 2,000. Though the earthquake and tsunami disaster may have some impact on this in the future, the Japanese have a national health care system designed to provide primary care for their population. The United States ranked below all other developed nations in these criteria, with a Dale index of 70 years. Women are expected to be healthy to age 72.6 (true in my Mom’s case), and American men are only healthy to age 67.5. Wake-up call for boomers born in 1957 or later, you are not eligible for full Social Security benefits (under current standards) until age 67, so guys, just about the time you are expected to lose your quality of life.
The ability to live free of chronic disease is an indication of the effectiveness of a health care system and how it identifies population needs and deploys successful interventions. The U.S. health care system has been less focused on primary care, largely because clinician reimbursements and the high cost of medical school have driven more practitioners into specialty care, which treats disease, but is not geared for prevention of chronic disease. One of the provisions of the 2010 health care reforms is the Medical Home provision in Medicare, which attempts to correct the primary care problem by paying clinicians more to be the primary care provider. This concept is a start in the right direction, but as a nation we need to have more health care incentives for primary care, which prevents chronic diseases from birth through life expectancy. Only through this process can we hope to reduce the incidence and associated costs, both social and economic of chronic disease like Type II Diabetes, hyper tension, and heart disease.
Cost of Delaying Treatment
As cited above, the United States had the poorest score for healthy life expectancy of any industrialized country, literally at the bottom, yet we spend 25% more than any other country in the world. The only way we are going to be able to change this result is to build efficiency into health care delivery and improve basic preventive and primary care.
Arguments about a person’s right to health care miss the Titanic-size glacier that pummels U.S. hospital systems, which is EMTALA, the Emergency Medical Treatment Act which requires all hospitals to treat patients, regardless of their ability to pay for services. States with huge uninsured populations, like Texas, with over 25% lacking any insurance , and half of those people are working for employers who do not provide any medical insurance . Not only do those people lack access to primary care, they appear at the hospital emergency department in advanced stages of chronic disease, which must be treated. This is not an effective way to deliver health care as a nation. Hospitals are designed to treat the acutely ill, not to provide primary care. Much discussion has occurred around the health care safety net for the nation, which directly addresses the ability of these hospital systems to continue to provide free care and pass those un-reimbursed charges on to full paying customers, enrolled in private sector health care plans.
Pass-Through Costs in the Health Care System
To those who complain about providing health insurance for the uninsured, a significant portion of the insurance premium these individuals already pay is based on reimbursing hospitals for under payment serving the uninsured and to a lesser extent, Medicare and Medicaid patients. By deferring treatment in the form of primary care, the nation has elected to force these folks to develop worse chronic disease conditions, which are more expensive to treat, and result in premature death from preventable conditions. In health care, treating a patient earlier in the care continuum is best clinically and economically and this is the direction the nation needs to go. For all of the caterwauling about health insurance rate increases, if there is any hope of stabilizing these impacts, it must be driven by increasing patient access to early and consistent primary care. Further, to those who object to paying a portion of their taxes for the provisions of health care, you are already doing so, by paying more than any other country for your health insurance and the administration of your health care. A better question would be how can we reduce the cost of health care overall? Should be continue to have employers contributing to health care financing or go the European route of having the individual be responsible? And finally, health insurance is a financing tool and not a delivery system for health care. We need to improve how we provide basic health care, including disease surveillance, continuity of care for those with chronic disease, and assurance of quality care throughout the country, not just for the lucky few who live close to centers of excellence.
Moving Forward
The 2010 health care mandates attempt to address these concerns in a number of ways, including improving access to primary care by subsidizing health insurance purchasing for small businesses and individuals and thus increasing the number of people who have health insurance and thereby the ability to obtain care. The Medical Home provisions are a start to addressing the access problem that seniors have with Medicare, which pays so little to doctors providing the care. And the Accountable Care Organization standards will pay health care systems more money for high quality patient outcomes in targeted areas for Medicare. FYI, changes in Medicare become a part of the private sector as well, so health care reporting of patient outcomes for Medicare, will also be reflected in the rest of the nonmilitary (Veterans Administration has its own health care system)population. None of these components of the 2010 reforms will go away, but further wrangling will continue on standardization of care for the health insurance purchasing cooperatives and the insurance purchasing subsidies. In a worst case scenario congress may choose not to fund the subsidies to help people buy medical insurance, which would of course result in tax penalties on all of the private sector who decide they cannot afford to buy the insurance. But then again the United States is famous for its unfair tax policies which tax the poor and middle-class much more than the wealthy. Just remember any deferment of health care access and treatment now will result in more serious chronic diseases later, which we will pay for, by increased hospital charges apportioned across the private sector insurance payers and higher costs for government health care programs.
This article was written by Roberta E. Winter, MHA, MPA an independent health care consultant and journalist and may be reprinted with her permission.
Now that the teeth gnashing over health care reforms has been ongoing for two years, before the lifelines are cut on financing health care for the forty-nine million uninsured population, let’s examine the health care continuum for the impact of a failure-to-fund the health insurance subsidies. One of the things that is missing from many discussions and assertions about the 2010 U.S. health care reforms are which systems need to be changed in order to reduce the long term cost of American health care. And when I say reduce, I mean reduce the cost increases in providing health care to an aging population. It is essential the U.S.A. get the per-capita cost of its health care in-line with other nations, as it gobbles funds that could be used for education, capital investments for industry, and other economy building activities. The country will need to make substantial investments in k-12 education as well as building a more energy efficient infrastructure to have a chance at competing with global leaders for competitive contracts, as Germany and other countries have done. This article addresses the components of American health care that are impacted by the 2010 mandates and what it means for managing patient care over a lifetime.
Perspective
Rather than thinking of health care as a commodity that deserving people get, for those who have worked where it is provided by an employer or who qualify for Medicare by virtue of accumulating enough quarters of eligible earnings, or military personnel, please consider it a part of the national infrastructure for a moment. A healthy population is necessary to obtain optimal output from workers, students, and for the care of our families. The provision of health care may be considered a utility. Utilities are measured by their output, the efficiency of their output, and the cost of producing the service. Measuring quality across the United States health care system, which is disparate and complex, is a major challenge in building higher efficiency into American health care.
Measuring Health
From the moment we are born until we die, we are introduced to various aspects of health care in the U.S. system. Even from birth, we do not provide the same level of care to all pregnant women, nor do all babies have the same chance of surviving their first year in America. In my book, Unraveling U.S. Health Care, I researched all fifty states for health metrics, including infant mortality statistics and in one area of the country, infant mortality was as poor as it is in developing countries (12.6 deaths per 100,000 babies for the District of Columbia) Only in a hand full of states was the infant mortality rate equal to European standards, of 5 or fewer deaths per 100,000 infants. Health care workers do understand and are alarmed about this dramatic difference in a basic health care outcome in the country; however, it seems much of the population is uninformed. A basic measurement for health is infant care and reducing the chance of infant death.
Another health care measure is degree of healthy living, as measured by the DALE or Disability Adjusted Life Expectancy, which measures the number of years an American can expect to live healthily, able to move around, and do their activities of daily living. In other words, how many years you can expect to be reasonably free of impairment from chronic disease. The World Health Organization, developer of this index ranked Japan as the number one country for living longest in good health to an average age of 74.5 in the year 2,000. Though the earthquake and tsunami disaster may have some impact on this in the future, the Japanese have a national health care system designed to provide primary care for their population. The United States ranked below all other developed nations in these criteria, with a Dale index of 70 years. Women are expected to be healthy to age 72.6 (true in my Mom’s case), and American men are only healthy to age 67.5. Wake-up call for boomers born in 1957 or later, you are not eligible for full Social Security benefits (under current standards) until age 67, so guys, just about the time you are expected to lose your quality of life.
The ability to live free of chronic disease is an indication of the effectiveness of a health care system and how it identifies population needs and deploys successful interventions. The U.S. health care system has been less focused on primary care, largely because clinician reimbursements and the high cost of medical school have driven more practitioners into specialty care, which treats disease, but is not geared for prevention of chronic disease. One of the provisions of the 2010 health care reforms is the Medical Home provision in Medicare, which attempts to correct the primary care problem by paying clinicians more to be the primary care provider. This concept is a start in the right direction, but as a nation we need to have more health care incentives for primary care, which prevents chronic diseases from birth through life expectancy. Only through this process can we hope to reduce the incidence and associated costs, both social and economic of chronic disease like Type II Diabetes, hyper tension, and heart disease.
Cost of Delaying Treatment
As cited above, the United States had the poorest score for healthy life expectancy of any industrialized country, literally at the bottom, yet we spend 25% more than any other country in the world. The only way we are going to be able to change this result is to build efficiency into health care delivery and improve basic preventive and primary care.
Arguments about a person’s right to health care miss the Titanic-size glacier that pummels U.S. hospital systems, which is EMTALA, the Emergency Medical Treatment Act which requires all hospitals to treat patients, regardless of their ability to pay for services. States with huge uninsured populations, like Texas, with over 25% lacking any insurance , and half of those people are working for employers who do not provide any medical insurance . Not only do those people lack access to primary care, they appear at the hospital emergency department in advanced stages of chronic disease, which must be treated. This is not an effective way to deliver health care as a nation. Hospitals are designed to treat the acutely ill, not to provide primary care. Much discussion has occurred around the health care safety net for the nation, which directly addresses the ability of these hospital systems to continue to provide free care and pass those un-reimbursed charges on to full paying customers, enrolled in private sector health care plans.
Pass-Through Costs in the Health Care System
To those who complain about providing health insurance for the uninsured, a significant portion of the insurance premium these individuals already pay is based on reimbursing hospitals for under payment serving the uninsured and to a lesser extent, Medicare and Medicaid patients. By deferring treatment in the form of primary care, the nation has elected to force these folks to develop worse chronic disease conditions, which are more expensive to treat, and result in premature death from preventable conditions. In health care, treating a patient earlier in the care continuum is best clinically and economically and this is the direction the nation needs to go. For all of the caterwauling about health insurance rate increases, if there is any hope of stabilizing these impacts, it must be driven by increasing patient access to early and consistent primary care. Further, to those who object to paying a portion of their taxes for the provisions of health care, you are already doing so, by paying more than any other country for your health insurance and the administration of your health care. A better question would be how can we reduce the cost of health care overall? Should be continue to have employers contributing to health care financing or go the European route of having the individual be responsible? And finally, health insurance is a financing tool and not a delivery system for health care. We need to improve how we provide basic health care, including disease surveillance, continuity of care for those with chronic disease, and assurance of quality care throughout the country, not just for the lucky few who live close to centers of excellence.
Moving Forward
The 2010 health care mandates attempt to address these concerns in a number of ways, including improving access to primary care by subsidizing health insurance purchasing for small businesses and individuals and thus increasing the number of people who have health insurance and thereby the ability to obtain care. The Medical Home provisions are a start to addressing the access problem that seniors have with Medicare, which pays so little to doctors providing the care. And the Accountable Care Organization standards will pay health care systems more money for high quality patient outcomes in targeted areas for Medicare. FYI, changes in Medicare become a part of the private sector as well, so health care reporting of patient outcomes for Medicare, will also be reflected in the rest of the nonmilitary (Veterans Administration has its own health care system)population. None of these components of the 2010 reforms will go away, but further wrangling will continue on standardization of care for the health insurance purchasing cooperatives and the insurance purchasing subsidies. In a worst case scenario congress may choose not to fund the subsidies to help people buy medical insurance, which would of course result in tax penalties on all of the private sector who decide they cannot afford to buy the insurance. But then again the United States is famous for its unfair tax policies which tax the poor and middle-class much more than the wealthy. Just remember any deferment of health care access and treatment now will result in more serious chronic diseases later, which we will pay for, by increased hospital charges apportioned across the private sector insurance payers and higher costs for government health care programs.
This article was written by Roberta E. Winter, MHA, MPA an independent health care consultant and journalist and may be reprinted with her permission.
Monday, August 22, 2011
When the judge yourself, if you include the type of the sharpest critics and evil? The attitude of self-critic can be beneficial but also detrimental impact. You need to be overcome.
When co-workers congratulated on promotion that you just received, you actually even say that the actual work done is far from enough. Or, the most simple, when you are far more attentive to reflect the lack of visible and ignore the extra. For example, a dull hair, puffy eyes, acne are many.
If your mind is often boarded by a negative view of yourself, then no wonder if the plans and the desire to end the extent of discourse. The reason is not other people or external reasons, but your own thoughts. Other people may just give advice. However, you argue, criticize yourself if want to get ahead.
Actually, self-critic would be beneficial if you also appreciate the successes ever achieved."Self-critic will be bad and makes us judge ourselves negatively if done excessively. It is best to be fair to yourself," explains psychologist, Ida Diantini Viatrie, MSI from the University of Malang, East Java.
A person tends to focus on the ugliness or weakness, because they do not want to be judged ugly by others. Therefore, he will always try to find it before anyone else knew.
"The problem is, whether our efforts to overcome it realistic or even redundant? If realistic, we can certainly accept ugliness as part of the self and trying to match their best. The excessive weakness is that if we reject it vigorously, so that even looks ridiculous," he continued.
How to cope
"Believe in yourself. Thank shortcomings are, and discover the advantages and our greatness. It would be better than furiously reject ugliness or weakness," advises Diantini.
Accepting yourself as it is also included to receive the achievements, not necessarily even modestly to humble yourself. It is reasonable attitude is actually not hard to do. So, there's no point in sabotaging yourself by being a critic is too sharp and wicked against themselves.
Prevention Indonesia / Irene J. Meiske)
SUNBER: COMPASS
When co-workers congratulated on promotion that you just received, you actually even say that the actual work done is far from enough. Or, the most simple, when you are far more attentive to reflect the lack of visible and ignore the extra. For example, a dull hair, puffy eyes, acne are many.
If your mind is often boarded by a negative view of yourself, then no wonder if the plans and the desire to end the extent of discourse. The reason is not other people or external reasons, but your own thoughts. Other people may just give advice. However, you argue, criticize yourself if want to get ahead.
Actually, self-critic would be beneficial if you also appreciate the successes ever achieved."Self-critic will be bad and makes us judge ourselves negatively if done excessively. It is best to be fair to yourself," explains psychologist, Ida Diantini Viatrie, MSI from the University of Malang, East Java.
A person tends to focus on the ugliness or weakness, because they do not want to be judged ugly by others. Therefore, he will always try to find it before anyone else knew.
"The problem is, whether our efforts to overcome it realistic or even redundant? If realistic, we can certainly accept ugliness as part of the self and trying to match their best. The excessive weakness is that if we reject it vigorously, so that even looks ridiculous," he continued.
How to cope
"Believe in yourself. Thank shortcomings are, and discover the advantages and our greatness. It would be better than furiously reject ugliness or weakness," advises Diantini.
Accepting yourself as it is also included to receive the achievements, not necessarily even modestly to humble yourself. It is reasonable attitude is actually not hard to do. So, there's no point in sabotaging yourself by being a critic is too sharp and wicked against themselves.
Prevention Indonesia / Irene J. Meiske)
SUNBER: COMPASS
Saturday, August 6, 2011
Improving Health Care at Hospitals
Methods for Improving Health Care in the Hospital
The Centers for Medicare and Medicaid have required hospitals to start reporting on quality criteria for reimbursement consideration as early as 2012, based on 2010 health care reforms. Major changes that clinicians and hospitals must conform to include:
Value-based Purchasing-This provides greater reimbursement with an emphasis on better clinical outcomes, starting in 2013.
Risk-Adjusted Reimbursement-This accounts for higher risk patients with multiple conditions and gives the doctor a higher fee to manage their care than previously, effective in 2014.
Reduced Payments for Hospitals with Excessive Re-admission Rates-This is a penalty for poorer performance and is effective in 2013 for hospitals who do not perform within certain guidelines for specific diagnoses.
This article reviews a report commissioned by The Commonwealth Fund to analyze some of the things the top performing hospitals, who submitted to quality surveys by the independent quality watch dog nonprofit, Leapfrog Group, are doing to improve clinical care and efficiency at their facilities.
Case Study Criteria
This information was drawn from case study analysis of 4 hospitals out of the top 13 hospitals in Leapfrog's Highest Value Hospital criteria using their 2008 survey data. Standards reviewed included short lengths of stay and low readmission rates for the following cardiac procedures; CABG, PCI, and AMI, in addition to pneunomia. The case study review was conducted by Jennifer Edwards, Sharon Silow-Carroll, and Aimee Lashbrook in a report entitled, Achieving Efficiency: Lessons from Four Top Performing Hospitals and was published as a Synthesis Report for the Commonwealth Fund in July 2011.Hospitals included in the report are Fairview Southdale Hospital in Edina, Minnesota,Park-Nicollet Methodist Hospital in Minneapolis, Minnesota, North Mississippi Medical center in Tupelo, Mississippi, and Providence St. Vincent's Medical center in Portland, Oregon. These hospitals scored high in at least three of the four criteria and were recognized as high value hospitals. The Commonwealth Fund commissioned the study in order to assess what hospitals were doing to create high quality outcomes with low resource investments, in other words, producing good results for less money. Here are the top factors influencing high patient quality outcomes at hospitals, listed in order of precedence:
Full-time Quality Assessment Departments
All four hospitals have full-time quality development, measurement, and compliance departments, but the difference between the best scoring facilities and the medium hospitals was how they trained their staff to solve quality problems as a part of their job. This includes clinical and nonclinical staff that assess performance improvement processes. At Fairview Southdale, every department director is required to sponsor at least two initiatives to improve clinical quality and produce a minimum of $60,000 in savings yearly.
Matrix Management Models Enhance Fluid Organizational Changes
In the top hospitals, executives with more fluid organizational roles rather than hierarchical, were able to make systemic adjustments more readily. Matrix operational models support management changes based on organizational links impacting outcomes rather than chain-of-command methods.
Increased Use of Hospitalists as Patient Care Coordinators
All four of these hospitals used hospitalists to coordinate inpatient care rather than "on-call" physicians. These full-time clinicians make patient assessments and provide greater continuity of patient care, making it easier to measure and track patient health. It is easier to implement standards of practice changes with full-time employees than independent contractors. Notably, the Accountable Care Organization criteria looks at reduced hospital re-admissions when rewarding hospitals with higher payments.
Engaging Staff: Quality Improvement is the Responsibility of Everyone
North Mississippi Medical Center, a recipient of the Malcolm Baldridge Award for Quality, solicits all its employees for ideas on process improvement and in 2008, 37% of those were implemented. This process is reinforced through recognition and incentives. Staff empowerment is also one of the measures for the Baldridge Award. St, Vincent's Hospital in Portland, Oregon created a new model to increase staff engagement, called self-governance or one-team-many-hands approach, which gives all staffers representation in hospital decision making.
Information Systems Supporting Patient Care
St. Vincent's and Fairview Southdale are part of integrated systems where patients can request medications on-line, facilitate non emergency health assessments, and schedule appointments. It is much harder for nonintegrated health systems to offer these tools, but here are some of the creative things these facilities have done with technology to improve patient care:
1. An electronic bed board for optimizing facility space and accommodating patients.
2. Patient discharge systems for streamlining patient processes when leaving the facility.
3. An internal alert process when a unit is close to capacity so other departments can handle the back fill.
4. Fairview Southdale uses wireless technology to allow ambulances to send electrocardiograms to the hospital when a patient is enroute, which reduces patient care time by twenty minutes.
Standardization and Simplification
All four hospitals had processes to eliminate unnecessary redundancies, reduce patient slow downs, and stop errors. Something as simple as a defined protocol for assigning a bed for a patient eliminated slowdowns. And in health care, minimizing delays means patients obtain care quicker and financially the facility is able to optimize its resources for all patients. St. Vincent's uses a staggered staffing system to avoid shift change down time.
Centers for Medicare and Medicaid Demonstration Projects
Here is a brief list of health care demonstration projects through CMS:
Global Capitation Payments-This is a project which is in five states and attempts to address the hospital safety net, which is the extent hospitals serve the poor and uninsured, and it runs from 2010 to 2012.
Medicare Shared Savings-
Medicaid Children's Health Insurance Shared Savings Program-Like the adult shared savings program.
Bundled Medicaid Demonstration Projects-This reviews episodes of care in a hospital and other settings, is deployed in eight states, and runs from 2012 to 2016.
Bundled Medicare Payments-This is a method of enhancing primary or Medical Home provisions to increase clinician reimbursement for patient care.
In closing, all of the selected hospitals were part of health systems, where benchmarking and resourcing services are readily available, which could be problematic for community hospitals lacking these resources. Still, these four stellar hospitals provide creative solutions for managing patient care on a budget, in urban and suburban settings.
It was excruciating to sequester myself to write this article when it is the peak of the Pacific Northwest nirvana weather, so I thank those of you who are going to read it tomorrow morning when it posts. My service to you is reducing the 25 page report down to less than 2 pages. This is the healthpolicymaven signing off in 78 degree air with 56% humidity.
The Centers for Medicare and Medicaid have required hospitals to start reporting on quality criteria for reimbursement consideration as early as 2012, based on 2010 health care reforms. Major changes that clinicians and hospitals must conform to include:
Value-based Purchasing-This provides greater reimbursement with an emphasis on better clinical outcomes, starting in 2013.
Risk-Adjusted Reimbursement-This accounts for higher risk patients with multiple conditions and gives the doctor a higher fee to manage their care than previously, effective in 2014.
Reduced Payments for Hospitals with Excessive Re-admission Rates-This is a penalty for poorer performance and is effective in 2013 for hospitals who do not perform within certain guidelines for specific diagnoses.
This article reviews a report commissioned by The Commonwealth Fund to analyze some of the things the top performing hospitals, who submitted to quality surveys by the independent quality watch dog nonprofit, Leapfrog Group, are doing to improve clinical care and efficiency at their facilities.
Case Study Criteria
This information was drawn from case study analysis of 4 hospitals out of the top 13 hospitals in Leapfrog's Highest Value Hospital criteria using their 2008 survey data. Standards reviewed included short lengths of stay and low readmission rates for the following cardiac procedures; CABG, PCI, and AMI, in addition to pneunomia. The case study review was conducted by Jennifer Edwards, Sharon Silow-Carroll, and Aimee Lashbrook in a report entitled, Achieving Efficiency: Lessons from Four Top Performing Hospitals and was published as a Synthesis Report for the Commonwealth Fund in July 2011.Hospitals included in the report are Fairview Southdale Hospital in Edina, Minnesota,Park-Nicollet Methodist Hospital in Minneapolis, Minnesota, North Mississippi Medical center in Tupelo, Mississippi, and Providence St. Vincent's Medical center in Portland, Oregon. These hospitals scored high in at least three of the four criteria and were recognized as high value hospitals. The Commonwealth Fund commissioned the study in order to assess what hospitals were doing to create high quality outcomes with low resource investments, in other words, producing good results for less money. Here are the top factors influencing high patient quality outcomes at hospitals, listed in order of precedence:
Full-time Quality Assessment Departments
All four hospitals have full-time quality development, measurement, and compliance departments, but the difference between the best scoring facilities and the medium hospitals was how they trained their staff to solve quality problems as a part of their job. This includes clinical and nonclinical staff that assess performance improvement processes. At Fairview Southdale, every department director is required to sponsor at least two initiatives to improve clinical quality and produce a minimum of $60,000 in savings yearly.
Matrix Management Models Enhance Fluid Organizational Changes
In the top hospitals, executives with more fluid organizational roles rather than hierarchical, were able to make systemic adjustments more readily. Matrix operational models support management changes based on organizational links impacting outcomes rather than chain-of-command methods.
Increased Use of Hospitalists as Patient Care Coordinators
All four of these hospitals used hospitalists to coordinate inpatient care rather than "on-call" physicians. These full-time clinicians make patient assessments and provide greater continuity of patient care, making it easier to measure and track patient health. It is easier to implement standards of practice changes with full-time employees than independent contractors. Notably, the Accountable Care Organization criteria looks at reduced hospital re-admissions when rewarding hospitals with higher payments.
Engaging Staff: Quality Improvement is the Responsibility of Everyone
North Mississippi Medical Center, a recipient of the Malcolm Baldridge Award for Quality, solicits all its employees for ideas on process improvement and in 2008, 37% of those were implemented. This process is reinforced through recognition and incentives. Staff empowerment is also one of the measures for the Baldridge Award. St, Vincent's Hospital in Portland, Oregon created a new model to increase staff engagement, called self-governance or one-team-many-hands approach, which gives all staffers representation in hospital decision making.
Information Systems Supporting Patient Care
St. Vincent's and Fairview Southdale are part of integrated systems where patients can request medications on-line, facilitate non emergency health assessments, and schedule appointments. It is much harder for nonintegrated health systems to offer these tools, but here are some of the creative things these facilities have done with technology to improve patient care:
1. An electronic bed board for optimizing facility space and accommodating patients.
2. Patient discharge systems for streamlining patient processes when leaving the facility.
3. An internal alert process when a unit is close to capacity so other departments can handle the back fill.
4. Fairview Southdale uses wireless technology to allow ambulances to send electrocardiograms to the hospital when a patient is enroute, which reduces patient care time by twenty minutes.
Standardization and Simplification
All four hospitals had processes to eliminate unnecessary redundancies, reduce patient slow downs, and stop errors. Something as simple as a defined protocol for assigning a bed for a patient eliminated slowdowns. And in health care, minimizing delays means patients obtain care quicker and financially the facility is able to optimize its resources for all patients. St. Vincent's uses a staggered staffing system to avoid shift change down time.
Centers for Medicare and Medicaid Demonstration Projects
Here is a brief list of health care demonstration projects through CMS:
Global Capitation Payments-This is a project which is in five states and attempts to address the hospital safety net, which is the extent hospitals serve the poor and uninsured, and it runs from 2010 to 2012.
Medicare Shared Savings-
Medicaid Children's Health Insurance Shared Savings Program-Like the adult shared savings program.
Bundled Medicaid Demonstration Projects-This reviews episodes of care in a hospital and other settings, is deployed in eight states, and runs from 2012 to 2016.
Bundled Medicare Payments-This is a method of enhancing primary or Medical Home provisions to increase clinician reimbursement for patient care.
In closing, all of the selected hospitals were part of health systems, where benchmarking and resourcing services are readily available, which could be problematic for community hospitals lacking these resources. Still, these four stellar hospitals provide creative solutions for managing patient care on a budget, in urban and suburban settings.
It was excruciating to sequester myself to write this article when it is the peak of the Pacific Northwest nirvana weather, so I thank those of you who are going to read it tomorrow morning when it posts. My service to you is reducing the 25 page report down to less than 2 pages. This is the healthpolicymaven signing off in 78 degree air with 56% humidity.
Saturday, July 2, 2011
Consumer Tips for Surgery
One of the chapters in my book, Unraveling U.S. Health Care, which is a guide to the health care system, addresses surgery and tips on how to vet your surgeon and find the optimal facility.
Finding a Surgeon
The best web site for researching surgical specialties is the American College of Surgeons, which allows consumers to look up surgeons by specialty and location. The web site for this is: www.facs.org.
Hospital Safety Rankings
Secondarily, it is worth your while to review hospital patient safety ratings before deciding on the facility. Methods to discern patient safety ratings of hospitals include reviewing the published information on www.leapfroggroup.org, by going to the 2010 hospital survey and looking up your state and the targeted hospital. Another method is to go to the federal Health & Human Services Agency web site for comparing hospital performance. It allows you to look at multiple hospitals at once. The web address for this is http://www.hospitalcompare.hhs.gov. and the site was recently updated to make it easier for consumers to use.
Reporting of Hospital Medical Errors
Another important aspect of doing your due diligence before undergoing surgery is reviewing patient medical errors and whether or not your state shares this information with the general public. Let me save you the time on this one, as I have reviewed all fifty states and the District of Columbia and the only states which required public reporting of hospital medical errors impacting patient safety were: Minnesota,Connecticut, and Indiana, The following states collect the data but do not necessarily make it readily available to the public or the data is not facility specific: Colorado, Illinois, Maryland, Massachusetts, Michigan, Missouri, New Jersey, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington, and Wyoming. I will also mention California, but they have been criticized for not complying with a state law on the reporting of hospital patient safety data. Scarier still is the 2005 Montana Law that has been dubbed the "I'm Sorry Law" giving health care providers additional protections for adverse patient safety events. Though Montana is rural and retention of some clinicians may be an issue, it is still of concern when in 2003, they repealed the requirement for a statewide health database and now clinicians are given more protections than patients.
In terms of preparing for any surgical procedure, it is most important to select the surgeon and the facility, but also to verify the accuracy of the diagnosis, so getting second opinions are a good method if you have any doubt. However, given today's digital imaging, it is much easier to see clear images of tumors and other issues than in 1993 when I had my first big surgical event. So verification of the diagnosis is key.
Once the diagnosis is determined,the treatment plan needs to be discussed and planned. Adverse events, post surgical recovery, and rehabilitation need to be considered in any plan. I suggest using a healthy level of detachment and planning your surgery like a project.
Presently an agent is reviewing my consumer opus: Unraveling U.S. Health Care: A Guidebook to the Complex and Confounding U.S. Health System. I hope to have the publishing path decided soon and of course, I will keep you posted.
Ending with my usual penache the healthpolicymaven suggests that having surgery done at a local facility, one where it is easier for friends to visit, or with a clinician you like are not enough evidence to support a decision potentially involving your health and well being. Take the time to look up the data, as reviewed by independent third party nonprofit organizations or a government agency under the Health & Human Services arm.
And finally, to the douchebag patients who criticize surgeons for not giving them a back rub and serving as their psychologist, that is not his or her job. They are skilled at cutting you up and putting you back together quickly and with low margin for error, so forgive them if they took the cram course in bedside manner. For oncologists, whose relationship with patients is typically long-term the consultative manner of the M.D. is more important. Having had a few surgeries myself, I do not go into the operating theater thinking I am special, but I realize I am one of many in the sea of humanity and many whiny consumers would do well to consider this perspective. It doesn't mean you take less care in your research, preparation, or recovery from your surgery, it just means, have a little consideration for the brilliant hard working medical staff, especially the surgeons.
For an advanced peek at my guide to the health care system, you can read part of it on:http://www.authonomy.com/books/24823/unraveling-u-s-health-care-everything-you-always-wanted-to-know-about-health-care-but-were-afraid-to-ask/
And this is your healthpolicymaven signing off.
Finding a Surgeon
The best web site for researching surgical specialties is the American College of Surgeons, which allows consumers to look up surgeons by specialty and location. The web site for this is: www.facs.org.
Hospital Safety Rankings
Secondarily, it is worth your while to review hospital patient safety ratings before deciding on the facility. Methods to discern patient safety ratings of hospitals include reviewing the published information on www.leapfroggroup.org, by going to the 2010 hospital survey and looking up your state and the targeted hospital. Another method is to go to the federal Health & Human Services Agency web site for comparing hospital performance. It allows you to look at multiple hospitals at once. The web address for this is http://www.hospitalcompare.hhs.gov. and the site was recently updated to make it easier for consumers to use.
Reporting of Hospital Medical Errors
Another important aspect of doing your due diligence before undergoing surgery is reviewing patient medical errors and whether or not your state shares this information with the general public. Let me save you the time on this one, as I have reviewed all fifty states and the District of Columbia and the only states which required public reporting of hospital medical errors impacting patient safety were: Minnesota,Connecticut, and Indiana, The following states collect the data but do not necessarily make it readily available to the public or the data is not facility specific: Colorado, Illinois, Maryland, Massachusetts, Michigan, Missouri, New Jersey, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington, and Wyoming. I will also mention California, but they have been criticized for not complying with a state law on the reporting of hospital patient safety data. Scarier still is the 2005 Montana Law that has been dubbed the "I'm Sorry Law" giving health care providers additional protections for adverse patient safety events. Though Montana is rural and retention of some clinicians may be an issue, it is still of concern when in 2003, they repealed the requirement for a statewide health database and now clinicians are given more protections than patients.
In terms of preparing for any surgical procedure, it is most important to select the surgeon and the facility, but also to verify the accuracy of the diagnosis, so getting second opinions are a good method if you have any doubt. However, given today's digital imaging, it is much easier to see clear images of tumors and other issues than in 1993 when I had my first big surgical event. So verification of the diagnosis is key.
Once the diagnosis is determined,the treatment plan needs to be discussed and planned. Adverse events, post surgical recovery, and rehabilitation need to be considered in any plan. I suggest using a healthy level of detachment and planning your surgery like a project.
Presently an agent is reviewing my consumer opus: Unraveling U.S. Health Care: A Guidebook to the Complex and Confounding U.S. Health System. I hope to have the publishing path decided soon and of course, I will keep you posted.
Ending with my usual penache the healthpolicymaven suggests that having surgery done at a local facility, one where it is easier for friends to visit, or with a clinician you like are not enough evidence to support a decision potentially involving your health and well being. Take the time to look up the data, as reviewed by independent third party nonprofit organizations or a government agency under the Health & Human Services arm.
And finally, to the douchebag patients who criticize surgeons for not giving them a back rub and serving as their psychologist, that is not his or her job. They are skilled at cutting you up and putting you back together quickly and with low margin for error, so forgive them if they took the cram course in bedside manner. For oncologists, whose relationship with patients is typically long-term the consultative manner of the M.D. is more important. Having had a few surgeries myself, I do not go into the operating theater thinking I am special, but I realize I am one of many in the sea of humanity and many whiny consumers would do well to consider this perspective. It doesn't mean you take less care in your research, preparation, or recovery from your surgery, it just means, have a little consideration for the brilliant hard working medical staff, especially the surgeons.
For an advanced peek at my guide to the health care system, you can read part of it on:http://www.authonomy.com/books/24823/unraveling-u-s-health-care-everything-you-always-wanted-to-know-about-health-care-but-were-afraid-to-ask/
And this is your healthpolicymaven signing off.
Saturday, June 11, 2011
Health Insurance Premiums and Government Oversight: Consumer Implications from the Affordable Care Act Implications
Government Oversight of Private Insurance: What it Means for the Cost of Your Health Insurance
The plethora of health care laws passed in 2010 under the Affordable Care Act,include provisions for “rate setting” and monitoring of private sector insurance plans on a federal level. The ruling applies to all insurance plans which participate in any government funded health care program, including Medicare, Medicaid, and the soon-to-be-deployed regional insurance exchanges. This article explains how this differs from present rate monitoring and premium-setting and the ultimate impact on the consumer.
The Rules
Health & Human Services is charged with establishing a health insurance rate oversight committee, to assess the reasonableness of proposed health insurance rate increases starting in 2014. Since health insurance premiums have continued to grow at a rate in excess of inflation and increased 41% between 2003 and 2009, according to a Commonwealth Fund study , affordability is a concern. The federal PPACA law mandates health insurance as a means to providing national health care, so the viability of the national health care program depends on manageable health insurance premiums for the private sector.
Current State
Insurance premiums are determined based on each state’s rate authorization standards with the Insurance Commissioner, who is an elected official. Some states have a “use and file” policy which means the insurance company can decide to make plan changes, adjust the rates, and start implementing before the state approves them. Other states have a “file and preapproval” policy, which means you have to get the state office to approve of your math, the reasons for your plan increase first. The insurance company then has the opportunity to comment and either accept the commissioners regulations or withdraw the product. In the case of Principal Financial Group, when a previous Washington State Insurance Commissioner mandated that all individual medical plans provide maternity coverage and other provisions, they pulled their product from the state. In economic terms this is referred to as an unintended consequent of a regulatory action. The federal government does not have the authority to control state insurance premiums for the private sector. Medicare and Medicaid plans are of course, a different story as they are government plans.
Altered State
Through the process of gathering data, analyzing cost impacts, discerning patterns, and revealing information to health care purchasers, both individual and corporate, Health and Human Services, which oversees the Centers for Medicare and Medicaid, is charged with creating a more transparent process for what you actually end up paying for medical insurance. The intent is good, but there is no regulatory authority to enforce rate fairness by state and a regulation without enforcement can be problematic. Finally, the cost of the regulation will be borne by the private sector rate payers, which will add a nominal cost to individual premiums, spread over the entire population.
Economic Impact
I spoke briefly of unintended consequences above, but let me restate, if an additional regulation means more insurance companies will cease to offer insurance plans to the small group and individual markets, this may not be a good thing for consumers. Of course, the insurance industry is already seeing a reduction in the number of companies offering medical insurance and this trend has been going on since I was in the benefits business in the 80’s and 90’s. In short, private sector companies, both for-profit and not-for-profit will make market decisions based on where their strengths lie and act accordingly. And one could argue that as long as the companies which remain are of quality and offer good consumer products and services, this change is not untenable. The Netherlands and Switzerland both have private sector insurance programs financing their public health plans and only a hand full of companies provide the coverage, which seems to work fine. Also, they pay much less per-capita for health care than the United States does, but the healthpolicymaven has told you that before.
What it Means to the Health Insurance Premium Payer
OK, here is the “skinny” on this one, since the federal government Does Not have rate setting authority for insurance, which is controlled by each state’s elected insurance commissioner and those state administrators, this change will not have a direct impact on the rates you pay for medical insurance. What is more, since it is highly unlikely the government will be able to overturn ERISA or the McCarran Ferguson Act; don’t expect to see any rate relief. ERISA is the Employee Retirement Income Security Act which created the exemption for self-funded or self-insured plans, which most major employers have used to exempt themselves from many state and federal mandates. I do not see the government succeeding in overturning this act either. The McCarran Ferguson Act is a federal law which gives states the authority to regulate insurance. It should also be noted that insurance premiums taxes are a major source of funding for the states and they will never give up that revenue. Indirectly the fact the government is requiring the disclosure of the rate factors and will publish the information is a good thing for consumers. You will no longer have to be an insider in the insurance business, which you know I was for a couple of decades, to understand this process. In conclusion, will this make your insurance cheaper, no, because that depends on many complex factors that have to do with underfunding of government programs which the private sector has to support with cost transfers, market supply factors, and the degree to which primary health care is deployed in this country. Finally, people will still have to care enough to read about the provisions and many people don’t. The healthpolicymaven’s book, Unraveling U.S. Health Care should come out later this year and it is a guidebook to our health system, in lay person’s terms, which I am hoping will facilitate more outreach in this area.
The plethora of health care laws passed in 2010 under the Affordable Care Act,include provisions for “rate setting” and monitoring of private sector insurance plans on a federal level. The ruling applies to all insurance plans which participate in any government funded health care program, including Medicare, Medicaid, and the soon-to-be-deployed regional insurance exchanges. This article explains how this differs from present rate monitoring and premium-setting and the ultimate impact on the consumer.
The Rules
Health & Human Services is charged with establishing a health insurance rate oversight committee, to assess the reasonableness of proposed health insurance rate increases starting in 2014. Since health insurance premiums have continued to grow at a rate in excess of inflation and increased 41% between 2003 and 2009, according to a Commonwealth Fund study , affordability is a concern. The federal PPACA law mandates health insurance as a means to providing national health care, so the viability of the national health care program depends on manageable health insurance premiums for the private sector.
Current State
Insurance premiums are determined based on each state’s rate authorization standards with the Insurance Commissioner, who is an elected official. Some states have a “use and file” policy which means the insurance company can decide to make plan changes, adjust the rates, and start implementing before the state approves them. Other states have a “file and preapproval” policy, which means you have to get the state office to approve of your math, the reasons for your plan increase first. The insurance company then has the opportunity to comment and either accept the commissioners regulations or withdraw the product. In the case of Principal Financial Group, when a previous Washington State Insurance Commissioner mandated that all individual medical plans provide maternity coverage and other provisions, they pulled their product from the state. In economic terms this is referred to as an unintended consequent of a regulatory action. The federal government does not have the authority to control state insurance premiums for the private sector. Medicare and Medicaid plans are of course, a different story as they are government plans.
Altered State
Through the process of gathering data, analyzing cost impacts, discerning patterns, and revealing information to health care purchasers, both individual and corporate, Health and Human Services, which oversees the Centers for Medicare and Medicaid, is charged with creating a more transparent process for what you actually end up paying for medical insurance. The intent is good, but there is no regulatory authority to enforce rate fairness by state and a regulation without enforcement can be problematic. Finally, the cost of the regulation will be borne by the private sector rate payers, which will add a nominal cost to individual premiums, spread over the entire population.
Economic Impact
I spoke briefly of unintended consequences above, but let me restate, if an additional regulation means more insurance companies will cease to offer insurance plans to the small group and individual markets, this may not be a good thing for consumers. Of course, the insurance industry is already seeing a reduction in the number of companies offering medical insurance and this trend has been going on since I was in the benefits business in the 80’s and 90’s. In short, private sector companies, both for-profit and not-for-profit will make market decisions based on where their strengths lie and act accordingly. And one could argue that as long as the companies which remain are of quality and offer good consumer products and services, this change is not untenable. The Netherlands and Switzerland both have private sector insurance programs financing their public health plans and only a hand full of companies provide the coverage, which seems to work fine. Also, they pay much less per-capita for health care than the United States does, but the healthpolicymaven has told you that before.
What it Means to the Health Insurance Premium Payer
OK, here is the “skinny” on this one, since the federal government Does Not have rate setting authority for insurance, which is controlled by each state’s elected insurance commissioner and those state administrators, this change will not have a direct impact on the rates you pay for medical insurance. What is more, since it is highly unlikely the government will be able to overturn ERISA or the McCarran Ferguson Act; don’t expect to see any rate relief. ERISA is the Employee Retirement Income Security Act which created the exemption for self-funded or self-insured plans, which most major employers have used to exempt themselves from many state and federal mandates. I do not see the government succeeding in overturning this act either. The McCarran Ferguson Act is a federal law which gives states the authority to regulate insurance. It should also be noted that insurance premiums taxes are a major source of funding for the states and they will never give up that revenue. Indirectly the fact the government is requiring the disclosure of the rate factors and will publish the information is a good thing for consumers. You will no longer have to be an insider in the insurance business, which you know I was for a couple of decades, to understand this process. In conclusion, will this make your insurance cheaper, no, because that depends on many complex factors that have to do with underfunding of government programs which the private sector has to support with cost transfers, market supply factors, and the degree to which primary health care is deployed in this country. Finally, people will still have to care enough to read about the provisions and many people don’t. The healthpolicymaven’s book, Unraveling U.S. Health Care should come out later this year and it is a guidebook to our health system, in lay person’s terms, which I am hoping will facilitate more outreach in this area.
Tuesday, May 10, 2011
Indicate "Attitude" When Finding a Job
KOMPAS.com - Attitude had a large portion of the valuation department of human resources (HR) when selecting employees. Although technical skills are important, but without the attitude that good companies will think twice to accept the prospective employee.
"If at Holcim, which we see attitude, because it is more important than technical skill that everyone can," said Rully Safari, HR Director of PT Holcim Indonesia Tbk, while talk show at Compass Career Fair (KKF) 2011, held at the Balai Kartini, Jakarta, Friday (04/29/2011) then.
HR sees attitude based on experience Rully divided into three terms. The first is dynamic.Are you a dynamic, and exudes the spirit? According Rully, this can be captured from his eyes. "From the eyes visible enthusiasm for work," said Rully.
A further factor is the preparation. If you are applying for a job, you should gather information about the company as much as possible. Why do you want to apply in this company, and what your target. Finally, large companies usually ask for the desired salary.
If you are classified as new graduates, Rully advised not to ask for higher salaries. Should do research first how the range of salaries with similar positions in other companies.Salary scale which you requested should still among the range of salaries in other companies. This is also true for those who have experienced. Although experienced in other companies, not necessarily someone will be suitable to work in new places.Therefore should follow the first salary range of the company.
"If you've proven to work fine, you can propose a reasonable salary increase," said Rully.
At the end of the interview, applicants will normally be given the opportunity to ask something to the interviewer. Unfortunately, many applicants who squander this opportunity. "In the interview, if the interviewer asks if you have any questions, you should ask it. Gali more information about the company," said Rully.
Rully added, in work, relationships between employees and firms have to happen both ways. Therefore, during the interview, job seekers should start with a two-way relationship is asked when are welcome.
After the work achieved, do not forget to keep your attitude. According to experience Rully, usually during the period of one month to three months, new employees are still being respectful, keep the image, but after it started its own wishes. In fact, the attitude should still be retained as your selling points in a company that has entrusted you a job.
Fleas
The phenomenon of "fleas" are not recommended by Rully, because sometimes make a person become less good attitude. Fleas Rully is the term given to employees who work just so he does not idle. He did not really want to work at the company. These fleas usually move from one job to another every three to six months.
"Although fleas, you must keep the attitude to create a good reputation to get the job you want," added Rully. Reputation is important to keep your good name in any company. You may not realize when the companies that you singgahi is still the same group.
If you have been getting the job you want, attitude is important to make others comfortable working with you, so you can work with a longer period of time. The fighting spirit that you show during the interview, should be retained. Thus, when getting fed up with work, you can challenge yourself to continue to innovate and continue to be creative.
"If at Holcim, which we see attitude, because it is more important than technical skill that everyone can," said Rully Safari, HR Director of PT Holcim Indonesia Tbk, while talk show at Compass Career Fair (KKF) 2011, held at the Balai Kartini, Jakarta, Friday (04/29/2011) then.
HR sees attitude based on experience Rully divided into three terms. The first is dynamic.Are you a dynamic, and exudes the spirit? According Rully, this can be captured from his eyes. "From the eyes visible enthusiasm for work," said Rully.
A further factor is the preparation. If you are applying for a job, you should gather information about the company as much as possible. Why do you want to apply in this company, and what your target. Finally, large companies usually ask for the desired salary.
If you are classified as new graduates, Rully advised not to ask for higher salaries. Should do research first how the range of salaries with similar positions in other companies.Salary scale which you requested should still among the range of salaries in other companies. This is also true for those who have experienced. Although experienced in other companies, not necessarily someone will be suitable to work in new places.Therefore should follow the first salary range of the company.
"If you've proven to work fine, you can propose a reasonable salary increase," said Rully.
At the end of the interview, applicants will normally be given the opportunity to ask something to the interviewer. Unfortunately, many applicants who squander this opportunity. "In the interview, if the interviewer asks if you have any questions, you should ask it. Gali more information about the company," said Rully.
Rully added, in work, relationships between employees and firms have to happen both ways. Therefore, during the interview, job seekers should start with a two-way relationship is asked when are welcome.
After the work achieved, do not forget to keep your attitude. According to experience Rully, usually during the period of one month to three months, new employees are still being respectful, keep the image, but after it started its own wishes. In fact, the attitude should still be retained as your selling points in a company that has entrusted you a job.
Fleas
The phenomenon of "fleas" are not recommended by Rully, because sometimes make a person become less good attitude. Fleas Rully is the term given to employees who work just so he does not idle. He did not really want to work at the company. These fleas usually move from one job to another every three to six months.
"Although fleas, you must keep the attitude to create a good reputation to get the job you want," added Rully. Reputation is important to keep your good name in any company. You may not realize when the companies that you singgahi is still the same group.
If you have been getting the job you want, attitude is important to make others comfortable working with you, so you can work with a longer period of time. The fighting spirit that you show during the interview, should be retained. Thus, when getting fed up with work, you can challenge yourself to continue to innovate and continue to be creative.
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