The Affordable Care Act & Henry Ford

What does the U.S. Supreme Court’s ruling on the Affordable Care Act mean to Henry Ford Hospital and Henry Ford Health System, and our patients?

The law has been in effect for two years and Henry Ford has been meeting the necessary steps to comply with the provisions of the law affecting us and our patients.

Doc in the “DIV.” The end of this post includes links to my local news interviews about ACA.

The ruling on Thusday supported the constitutionality of the ACA.

Some of the most controversial aspects of the law are scheduled to be implemented in 2014. Two of these components, mandated insurance and extension of Medicaid, were major subjects of the Court’s ruling.

Mandated insurance was supported as part of the tax provision, that is, failure to adhere to obtaining or providing insurance will be subject to tax penalties.

Without the insurance mandate, the insurance exchanges or pools would likely have fewer healthier enrollees, meaning insurance rates for policies purchased through the exchange would need to be much higher to support costs.

Expansion of Medicaid was left to states wtihout Federal threat of withholding all Medicaid dollars for not extending.

The ruling has brought some “certainty” to the constituionality of the law. This is a certainty that must be looked at through the lens of continued political polarization, the fall elections, threats of repeal of the law in the 2013 Congress, business and personal reaction, and implementation at the state and delivery system level.

But, importantly, this ruling allows Henry Ford to continue to make positive reforms to the country’s health care system, through our efforts to integrate care, reduce costs, increase access and make advances in medical technology, treatment and hospital care.

The ACA means the possibility of extending Medicaid to the nearly 500,000 uninsured people in Michigan, as well as extending additional benefits to lower income familes through insurance exchanges.

The implementation in 2014 also strikes denial of insurance to those patients with pre-exisiting illness. Families will continue to cover their adult children on family policies up to the age of 26.

By expanded coverage for uninsured and low-income patients, the act may help to provide economic relief to Henry Ford’s growing burden of uncompensated care.  In the past eight years uncompensated care at Henry Ford has doubled, from $111 million in 2003 to $210 million in 2011. Continue reading

Share Doc in the D:

Planning a “Good” Death

Dr. Ken Murray, a retired clinical assistant professor of family medicine at the University of California, wrote a thought-provoking article earlier this year in the Wall Street Journal entitled, “Why Doctors Die Differently.”

The essential point of the paper was captured in the sub-headline, noting that doctors’ experiences throughout their careers teach the limits of treatment and reinforces the importance of the need to plan for the end.

In essence, physicians – and I would add other clinical care providers to that list – know all-too-well that medicine cannot fix all, especially at the end of life.

Murray quotes nursing professor Karen Kehl, who in the article called “Moving Toward Peace:  An Analysis of the Concept of a Good Death,” noted features of a graceful death, such as:

  • Being comfortable
  • Being in control
  • Having a sense of closure
  • Making the most of relationships, and
  • Having family involved in their care.

Unfortunately, in today’s world, many patients experience a death without these attributes. Physicians have seen this so frequently that it influences how they think about the end if their lives too.

Why the disconnect? 

To avoid what may be considered undo influence, physicians try not to impose their own views on the situation.

Providing hard clinical data to enable a patient to make a decision is generally believed to be the extent of the information a physician or care provider should offer.

When asked directly what they would do for themselves, physicians often deflect the question to ensure patients are not overly influenced by their answer:

“It is what you would want to do, not what I would do.” 

This is adherence to the medical ethical principle of autonomy, making sure that patients or their decision-makers make decisions for themselves and without coercion.

But perhaps we have lost something by the answer we provide.  Continue reading

Share Doc in the D:

It’s the Little Things (and the Routine Things) That Count

Every day I hear a patient care story at Henry Ford Hospital that absolutely inspires me and fills me with pride. 

Henry Ford Hospital teams work to bring water into the hospital during the August 2003 power outage.

These are often heroic efforts of clinical expertise and team work, with many of our people working against all odds to perform care that saves a patient from what appears to be an impossible situation. These “miracles on the Boulevard” seem almost routine.

Times of crisis also seem to bring out the best in Henry Ford. 

I noticed this years ago when we lost electricity on Campus on two occasions. 

You could not have had a group of people working together more incredibly to overcome not only the obstacles of minimum electrical power, but the even greater challenges of inadequate water so needed for thirst and cleanliness.

I sit back in awe of our people at these times.

Where do we falter?

What is remarkable is that when we fail, it is in the little things or the routine things that we need to perform on a daily basis. The concentrated efforts and energy during a crisis do not always translate as well to our daily tasks.

Not that it is easy to have these bursts of focus at all times. 

As a physician once told me, you can sprint for periods, but you can’t run a marathon by sprinting. It takes a different approach and mindset.

Much of health care is a marathon. Repetitive, frequent, routine, if you will. 

No fan fare in our employee newsletter and no flurry of congratulatory emails on a remarkable effort.

Our true business challenge is to relentlessly focus on day-to-day patient care and to do it as well as it can be done.  It is the most important element to ensure our success as a hospital.

Yet these daily acts – the ones that we must do – count just as much as all of our photo-op moments.  Continue reading

Share Doc in the D:

Tour de Ford 2011

I had the pleasure of participating along with 300 other cyclists in the second annual Tour de Ford bike ride.

Cyclists of all experience levels had the opportunity to tour our city while benefiting the Tom Groth Patient Medical Needs Fund, which provides health care, medication, equipment medical supplies and social services to underinsured patients at Henry Ford.


Participants had the opportunity to ride in their choice of a 70-mile, 35-mile or 10-mile route. You can view a photo slideshow of the event here.

Now no one would confuse me for Lance Armstrong or Greg Lemond, but I did take the training wheels off to make it the 35 miles on an absolutely glorious late summer Michigan day. (I am sure Tom Groth negotiates the weather for us for each of our events.)


Each route started and ended at Henry Ford Hospital, and traveled to a number of our sites throughout Henry Ford Health System — Henry Ford West Bloomfield Hospital,  Henry Ford Medical Center–Cottage and Henry Ford Medical Center-Fairlane. Riders also got to see a number of Detroit’s landmarks along their routes, such as Eastern Market, The Dequindre Cut and The Heidelberg Project.

As I rode through the Detroit Lions’ tailgaters at Eastern Market and along the River Walk, I felt proud of our organization, our city and all that this event was able to accomplish.

Continue reading

Share Doc in the D:

One Year

Share Doc in the D:

Preparation is Key to Joint Commission Review

Over the last week, Henry Ford Hospital and the clinics of the Henry Ford Medical Group underwent a rigorous review by its external regulatory agency, the Joint Commission.

Like a lot of things that are good for you – eating spinach or undergoing preventive health screenings like the one that each of us at age 50 looks forward to with trepidation – preparation for the visit was the most important action taken.

The reviewers were rigorous, incredibly insightful and offered exactly what is needed by all of our organizations: A second set of eyes to validate (or not) the usual work of the hospital and clinics.

The assessment includes review of all policies and procedures, facility safety, processes of care, and the medication management. Almost every process related to care of patients is scrutinized.

The method used is generally to start with a real-time patient, say someone entering the emergency department, and review the care of the patient and the rules of management followed by the hospital or clinic.

If issues are found, for example something related to medications, the reviewers go to the pharmacy area and analyze its activities.

Eventually almost all parts of the hospital are looked into with this so-called “tracer” process.

All tolled, the visit included 30 surveyor days, a review of 300 standards, and an examination of 1,300 elements of performance.

Continue reading

Share Doc in the D:

Day 3: The Complete Top 10 Health Care Issues in 2011 List

Here are the final three items on my list of the top things I expect to see in health care over the next year. 

I will stop at 10.

Which are on your mind? (Please post your comments, or your top 10 list below.)

 Top 10 List, Day 3:

1. Fight Over Health Care Reform
2. Transparency. Moving Toward Reporting Performance & Outcomes in Health Care
3. Organized Physician Practices (Can You Say Accountable Care Organizations?)
4. Health Care Amenities
5. Recruitment, Retention and Engagement
6. Declining Revenues
7. Reduction in Cost per Unit Service

8. Looking for Solutions Outside of Our Industry
. Health care has been slow to adopt business practice changes that other industries have used to be internationally competitive. 

Industrial re-engineering, relentless process improvement and management transformation will increasingly be used in hospitals beyond the usual inventory and production functions.

Benchmarking of performance will become more focused on best in class, not best in industry. (Think of the service expectations set by an excellent hotel versus a traditional hospital).

Continue reading

Share Doc in the D:

Reducing Door to Balloon Times

I recently attended a celebration for door-to-balloon time at Henry Ford Hospital.

It is a quality measure in the treatment of heart attacks, specifically an ST segment elevation myocardial infarction.

This particular form of heart attack has a high probability of destroying heart muscle, and leads to some of the direst of acute and chronic heart conditions.

Henry Ford Hospital Door to Balloon Team

The time interval measure starts when the patient arrives in the emergency department and ends when a cardiac catheterization wire, placed from the patient’s artery, crosses the blockage in the coronary artery.

This all sounds very technical, but it is easy to understand.

You are having a heart attack. The treatment is to quickly open the artery that is blocked. The technique used is by a heart catheter.

The longer it takes to open the artery, the more heart damage (“time is muscle”). And the more heart damage, the worse the patient does (“muscle is function”).

This measure is adopted as a core quality measure of how good a hospital performs in caring for heart patients.

Continue reading

Share Doc in the D:

Tragedies and Miracles In Medicine

Years ago, our head of trauma surgery developed explosive hepatitis. As a result, he developed failure of his liver and required a liver transplant. 

This was before we had a liver transplantation program at Henry Ford Hospital. 

One of the surgeon’s best friends ran one of the most successful transplantation programs in the country at a large Midwestern university. He was accepted there for urgent consideration of liver transplantation. 

We stabilized him in our medical intensive care unit and prepped him to be flown by aircraft to the center. 

As he was wheeled out of the ICU, I stopped the gurney and took his hand in mine.  I said, “I’ll see you when you get back.” 

Even with jaundiced eyes, his gaze pierced through me. “We’ll see,” he said. 

He died within a few days. No organs were available.

Flash forward a few years.  Continue reading

Share Doc in the D:

The Tribes of Medicine

Two doctors are rushing to get on an elevator. To stop the doors from closing, the first doctor sticks in his right hand; the other sticks in his head.  Which one is the internist and which one is the surgeon?

There are so many jokes circulating about the differences in the specialties of medicine.

It’s been described as the sibling rivalries of the specialties, and has spawned a slang language to describe almost all of the tribes: “Fleas,” “blades,” “midnight cowboys,” “cath jockeys,” “caveman,” “doc in a box,”  “gas passers,” “shadow gazer,” “neuron,” “orthopod,” “pediatron,” “trick cyclist,” “witch doctors,” and about five or six terms for proctologists and urologists that should not be placed in print. 

(My apologies if I missed your specialty. This was not meant to be a comprehensive listing.)

Some of these slang terms are insults that are meant to be humorous; some are meant to be serious.  All have a tendency to underscore the differences in specialties and have a tendency, humor not withstanding, to reinforce the tribes.

But patients do not care about tribes, slang terms, or the humor developing from the seriousness of the business of medicine.

Continue reading

Share Doc in the D: