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

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The Power of Habit

How’s that New Year’s resolution going so far? Still carrying those extra 10, 15 or 20 pounds?

Certainly, if we resolve to do something and put all of our effort behind it, we should be able to do it, right? This type of “free will” is a great part of our traditional view of how we change or conduct our lives and business.

Unfortunately, it is not as simple as that.

I recently read an opinion piece by David Brooks in the New York Times that highlighted a book written by Charles Duhigg called “The Power of Habit.” In the book, Duhigg, who’s also a reporter at the Times, explores research about how our habits determine our actions.

As much as we think free will overcomes all, much of our actions and behaviors are driven by unconscious habits. Duhigg notes that researchers at Duke University calculated that 40% of our actions are governed by habit, not by conscious decisions.

So much for free will!

According to Brooks’ article, researchers have also come to know the structure of habits. Cue, routine, reward is how habits become ingrained.

Duhigg highlights several examples of how people have learned to replace bad habits with good ones, or create new habits.

From the routine use of toothpaste to football coaches creating practice drills to Starbucks baristas, creation of habits will dictate how one responds to a situation even more quickly and routinely.

Changing your neural network not merely based on forming routine or common triggers. These are instead fortified by emotions and strong desires, like the commitment to a higher purpose or gaining admiration.

What does this have to do with Henry Ford Hospital? 

We are going through a world class service training exercise called by the mnemonic, AIDET (Acknowledge, Introduce, Duration, Explanation, Thanks).

The habit that we wish to create is a common greeting and dialogue that forms the basis of our service culture.

I have heard from many that say they already do this in their patient interactions. Me too, except sometimes I do A, I and E, or I, D and T, but not the habit of routinely doing all the elements. I have a hunch you are no different. Continue reading

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Doc in the DC

 

Congratulations to the employees of Henry Ford. This award was won by each and every one of you…

Nancy Schlichting and Bob Riney receive the Malcolm Baldrige National Quality Award in Washington, DC.

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On the Journey from Good to Great: The Baldrige Award

I cannot tell you how proud I am of everyone at Henry Ford Health System for winning the 2011 Malcolm Baldrige National Quality Award.

Let me make that clear:  YOU WON THE BALDRIGE AWARD.

Nancy set the goal, Bob and the Executive Team set the framework, Bill Conway drove the quality agenda, and Sue Hawkins, Edie Eisenmann and their teams created the work plans and applications.

But they could not win the Baldrige Award even with all of their aspirations and actions. Only you could.

Nancy and I spoke about this after the site visit. I cannot tell you how we were in awe of the way in which every employee surveyed, individually or in groups, expressed our mission and vision, as well as identified how their work fit into the greater whole of what we do each and every day in restoring patients and communities to health and wellness.

You know that something different is happening when medical and nursing students, who are not yet Henry Ford employees, can express what we do, how we do it, and what it means in their evolution as the next generation health workers.

After winning, my deep reaction to the award is we must get better, as an organization and as individuals making up that organization.

Justin Verlander knew he won the MVP. He already is thinking about how he can be better. We should too.

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Care Rounds

As you may have read this week in a Detroit News article, my leadership team and I have recently incorporated care rounding with patients at Henry Ford Hospital into our weekly activities.

You might ask, “What’s new about a physician and an administrative team rounding on patients in a hospital?”

My response? “Quite a bit.”

At Henry Ford Hospital, care rounds concentrate specifically on the general care and services a patient receives.

Although not fully divorced from clinical issues, these rounds bring out issues related to environment, food, communication, ease of use, and general comfort. Quite simply, it is the service aspect of our profession and business.

At the hospital, all of us go about our activities with a specific purpose. As a physician caring for patients, my concentration and intention is primarily on the diagnosis and treatment of the patient. Patients’ needs are generally first viewed from the perspective of their clinical care.

Much is discovered when the lens is focused intently.

I was struck by the application of purposeful activities when studying LEAN-inspired management methods, where so called “waste rounds” had managers stepping out of their usual role (which includes waste reduction in processes) to concentrate fully on eliminating unnecessary steps or use of supplies.

On care rounds, after asking if I can come into the room and talk, I introduce myself and acknowledge the patient formally before asking one simple question: “How has your care been at the hospital?”

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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).

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Day 2: Top 10 List for 2011

The other day, I began my list for the Top 10 issues in health care that I expect to see in 2011.

Today, I’ve added four more items to my list, as well as included links to the items discussed on yesterday’s blog. Again, join in the discussion if you wish to add, delete or create a more specific list of your own.

Top 10 List, Day 2:

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. Hospitals and health care facilities are going to increase amenities and improve the service aspects of care. Henry Ford West Bloomfield Hospital is a great example of providing high-touch, healing surroundings with an emphasis on hiring employees who provide service anticipating patient and family needs.

Most of these amenities are not costly, but require a commitment to assure patient experience is every bit as good as the quality and safe of care provided.

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Day 1: Top 10 Health Care Issues in 2011

Frequently I am asked to name some of the top things I expect to see in health care over the next year. 

I thought it might be a good starting point for me to start the list and see what you think. 

I have to say that my list will be biased related to the immediate issues that The Henry Ford Hospital faces, and I view the list as broadly related to health care. 

I’m going to begin posting my Top 10 for 2011 list today, and continue adding other items to the list throughout the rest of the week.

Join in if you wish to add, delete or create a more specific list of your own, such as the top discoveries or the top trends that you see.

Top 10 List: Day 1

1.     Fight Over Health Care Reform. The politics and positioning may be as interesting to watch as the Super Bowl, but the stakes for all are much higher. Increasing challenges will come from all arenas, including judicial challenges, leading to a possible Supreme Court ruling on the constitutionality of health reform.

The dominant issue looming is the continued high costs of health care and the national deficit concern. The outcome of health care reform will more likely be predicated on finances and health care expense, competing priorities with other social programs, and state budgets and entitlements.

Best advice on how to individually deal with health care reform: Commit to staying as healthy as possible. If you are a health care worker, commit to being a solution to the high cost of health care.

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