Early this week, I met with two representatives from IBM who asked to hear my thoughts for their 2010 Global CEO study entitled, “Leading in the New Economic Environment.” IBM publishes a CEO report every two years, and interviews 1,200 CEOs across the world regarding how they will lead into the future. This is useful for IBM, as it also provides them with a chance to survey their audience about the directions they will be headed, since IBM has evolved over time from a technology-driven business to a focus on business process and “helping businesses solve the big problems of the day.”
One of the first questions they asked was, “What are the three most important external forces that will impact your organization over the next three years?” I was able to choose from a list they provided, and identified:
1. Regulatory concerns. The change brought to our industry by health care reform will be revolutionary. I still think this is a great time to be in health care, though. I often say that the “good old days” really weren’t that good. We’re able to treat so many more diseases because of advances in medicine and technology than when I was a med student. Granted, these days may not be easier, but they are much more rewarding, and require that we truly must figure out how to be the high quality, low-cost providers in our communities. Ten years ago, you could sleep in your office and make money because Medicare reimbursement was so high. Today, though, only the high quality/low cost providers will be able to prove their value to consumers and survive.
2. Technological factors. CHRISTUS has a commitment to incorporate small technologies (technology that is owned by most people) into every day care. We know that it is possible for diabetics to take a blood sugar reading by feeding a blood sample into their cell phone, which can read it and then send the results to their physician. We also know that tools are being developed for and in use at our Senior campuses like toilet seats that send messages to remote caregivers if the toilet has not been sat on or shoes that send similar messages if they have not been put on. These signs let us know that a Senior in our care has not gotten out of bed, and may need help. All of these tools help us as we move from “health care” to “health.”
3. Globalization. Because of the regulatory environment in Mexico, we operate there as a for-profit and reinvest our profits in our clinics for the poor in rural areas of Mexico. We are now the second largest for-profit health system in Mexico, and are exploring opportunities to expand into Panama and Peru. I really do believe that 10 to 15 percent of the health care solution in the U.S. will be provided by medical travel to Mexico. And we expect the current number of 1 million American expats in Mexico to grow because of our recent recession that undoubtedly affected many retirement funds.
We have worked hard over our history to manage change, which has positioned us well to meet the challenges and opportunities of the future. We have expanded into Mexico; systematized many key functions like our supply chain and home care activities; made future planning a key focus of our organization and are currently reorganizing our portfolio from an emphasis on acute care to 1/3 acute care, 1/3 non-acute care and 1/3 international facilities.
Innovation is a key part of our future planning strategy. This is why we have created and sponsored two Futures Task Forces in our 10-year history as CHRISTUS, and why we founded the CHRISTUS Innovations Institute. We have partnered to systematize our supply chain, extend care to the poor in Mexico and provide psychiatric services at Our Daily Bread in Galveston, Texas, which provides support services to homeless men, women and children.
The folks from IBM who visited with me this week had many more questions about CHRISTUS and our future--too many to fit into one blog post. Therefore, I plan to revisit some of their additional questions in next week’s post as well.
Wednesday, October 28, 2009
Wednesday, October 21, 2009
The Cost of Care, Part 5 of 5
The fifth and final section of the Dallas Morning News’ series called “The Cost of Care” featured the approach of Scott & White Healthcare (sometimes called “The Mayo of Texas”) to collaboration instead of competition, examined why primary care physicians may be choosing to move to other models of care delivery and what the U.S. can learn from other countries’ health systems. You can access the series here.
The first article in the final section of the series reports on Dr. Bill Walton’s final day in his 31-year-old popular family practice in Dallas. Walton is moving to Temple, Texas to join Scott & White as a salaried physician because of the pressures and costs of running his solo practice, also known as the “business of medicine.”
The Newsexamines why primary care doctors are “becoming an endangered species.” I have addressed this problem on my blog numerous times. If you are interested in some of my thoughts, you can hear them here. It is clear that the trials and tribulations of primary care doctors must be addressed if we are to provide adequate care to Americans, and especially if larger numbers of them will have insurance coverage in the near future.
The second article provides an in-depth look at the strengths and weaknesses of Scott & White, which is an accountable care organization (ACO) that uses salaried doctors and a team approach to deliver high quality care at a low cost. The company controls costs by managing all aspects of medical care, including health insurance, outpatient clinics and hospice centers. ACOs received quite a bit of attention this summer, as some health care reform proponents suggested them as a way to reward physicians for the quality of care they provide, instead of the amount of procedures they perform. We supported including a Super MEDPAC or Super IMAC if the organization had the power to evaluate ACO and cost-saving projects and suggest them on a large scale instead of having only the power to cut Medicare reimbursement rates.
Jim Landers, a columnist for The Dallas Morning News, also wrote a short column to round out this series that examined the health care systems of other developed countries around the world. None of them are perfect, he concludes, but many have found ways to spend less for equal or better care than that provided in the U.S. I have spent some time comparing our system to that of Great Britain and Canada as well. Like the U.S. health system, each has its own strengths and weaknesses.
My thanks to The Dallas Morning News for its in-depth and informative coverage of the health care industry in Dallas. Surely there was much more to discuss, but their staff did a wonderful job getting straight to the heart of the matter.
The first article in the final section of the series reports on Dr. Bill Walton’s final day in his 31-year-old popular family practice in Dallas. Walton is moving to Temple, Texas to join Scott & White as a salaried physician because of the pressures and costs of running his solo practice, also known as the “business of medicine.”
The Newsexamines why primary care doctors are “becoming an endangered species.” I have addressed this problem on my blog numerous times. If you are interested in some of my thoughts, you can hear them here. It is clear that the trials and tribulations of primary care doctors must be addressed if we are to provide adequate care to Americans, and especially if larger numbers of them will have insurance coverage in the near future.
The second article provides an in-depth look at the strengths and weaknesses of Scott & White, which is an accountable care organization (ACO) that uses salaried doctors and a team approach to deliver high quality care at a low cost. The company controls costs by managing all aspects of medical care, including health insurance, outpatient clinics and hospice centers. ACOs received quite a bit of attention this summer, as some health care reform proponents suggested them as a way to reward physicians for the quality of care they provide, instead of the amount of procedures they perform. We supported including a Super MEDPAC or Super IMAC if the organization had the power to evaluate ACO and cost-saving projects and suggest them on a large scale instead of having only the power to cut Medicare reimbursement rates.
Jim Landers, a columnist for The Dallas Morning News, also wrote a short column to round out this series that examined the health care systems of other developed countries around the world. None of them are perfect, he concludes, but many have found ways to spend less for equal or better care than that provided in the U.S. I have spent some time comparing our system to that of Great Britain and Canada as well. Like the U.S. health system, each has its own strengths and weaknesses.
My thanks to The Dallas Morning News for its in-depth and informative coverage of the health care industry in Dallas. Surely there was much more to discuss, but their staff did a wonderful job getting straight to the heart of the matter.
Wednesday, October 14, 2009
The Cost of Care, Part 4
The fourth part of the Dallas Morning News’ five part series called “The Cost of Care” covered home health agencies in Texas and the soaring amount of spending on home health care in the state. You can access the series here.
The article once again aims to examine the fine line between the need for home health agencies and the great services they provide and the abuses of the system and its patients, which can account for a part of the huge increase in costs. It also points to decreases in Medicaid reimbursement rates that some have suggested as a solution to these abuses.
It seems unwise to cut reimbursement across the board for a very necessary service that does much good for patients in order to end some abuses to the system, especially because home care can, in many instances, decrease the cost of care since patients can be treated outside the hospital. Perhaps Texas should re-examine instituting a certificate of need statute as one possible part of the solution.
CHRISTUS HomeCare services are available in Texas, Louisiana and Utah, and we are continuing to invest in those necessary programs. I have blogged before about how we have been realigning our portfolio from its heavy focus on acute care to include one-third non-acute care and one-third international operations because of the trends we’re seeing in our industry and the culture worldwide.
In fact, we continue to believe that advances in technology like remote monitoring devices may make home care services less costly and more effective in the future. They are already assisting us in provide high quality home care today.
Yes, home health care is an important part of the CHRISTUS ministry, and therefore we believe it should remain an important part of the health care fabric in our country.
The article once again aims to examine the fine line between the need for home health agencies and the great services they provide and the abuses of the system and its patients, which can account for a part of the huge increase in costs. It also points to decreases in Medicaid reimbursement rates that some have suggested as a solution to these abuses.
It seems unwise to cut reimbursement across the board for a very necessary service that does much good for patients in order to end some abuses to the system, especially because home care can, in many instances, decrease the cost of care since patients can be treated outside the hospital. Perhaps Texas should re-examine instituting a certificate of need statute as one possible part of the solution.
CHRISTUS HomeCare services are available in Texas, Louisiana and Utah, and we are continuing to invest in those necessary programs. I have blogged before about how we have been realigning our portfolio from its heavy focus on acute care to include one-third non-acute care and one-third international operations because of the trends we’re seeing in our industry and the culture worldwide.
In fact, we continue to believe that advances in technology like remote monitoring devices may make home care services less costly and more effective in the future. They are already assisting us in provide high quality home care today.
Yes, home health care is an important part of the CHRISTUS ministry, and therefore we believe it should remain an important part of the health care fabric in our country.
Tuesday, October 6, 2009
The Cost of Care, Part 3
The third part of the Dallas Morning News’ five part series called “The Cost of Care” covered the medical imaging industry, which is quickly growing in size and scope. However, some worry that unnecessary scans are driving up expenses. You can access the series here.
The article examines why business is so good for those in medical imaging, which generates $100 billion a year nationally. As The News points out, “More imaging machines has meant significant increases in use, and rising costs for American consumers and taxpayers.”
I have said before that CT scans and MRIs are over-utilized for many reasons, including the fact that patients may demand them because of marketing done by vendors, clinicians may find it easier and faster to do a study rather than spending the time to do an extensive and complete history and physical and because these studies are—at least currently—significantly reimbursed.
The News also quotes a McKinsey Global Institute study, which found that “extra U.S. capacity results in about $26.4 billion in additional costs annually for CT and MRI scans.” The author points to other potential reasons for physician overuse of these technologies, including self-protection from potential malpractice claims, or financial reasons--referring patients for scans to be done on machines they own.
Technologies that have been developed for diagnosis can be extremely beneficial, but can also quickly decrease in overall value because their ease of deliverance and their high financial reimbursement may cause them to become over-utilized. As this technological equipment becomes more affordable, their availability exceeds need and only accentuates the potential for their overuse.
Reform in the U.S. may address some of these issues. (The Texas Legislature has thus far been unsuccessful.) Until then, we will continue to carefully monitor the development and introduction of new technologies, ensure that we’re acquiring and locating appropriate numbers of these technologies in our various regions and business units, utilizing appropriate guidelines to minimize overuse.
The article examines why business is so good for those in medical imaging, which generates $100 billion a year nationally. As The News points out, “More imaging machines has meant significant increases in use, and rising costs for American consumers and taxpayers.”
I have said before that CT scans and MRIs are over-utilized for many reasons, including the fact that patients may demand them because of marketing done by vendors, clinicians may find it easier and faster to do a study rather than spending the time to do an extensive and complete history and physical and because these studies are—at least currently—significantly reimbursed.
The News also quotes a McKinsey Global Institute study, which found that “extra U.S. capacity results in about $26.4 billion in additional costs annually for CT and MRI scans.” The author points to other potential reasons for physician overuse of these technologies, including self-protection from potential malpractice claims, or financial reasons--referring patients for scans to be done on machines they own.
Technologies that have been developed for diagnosis can be extremely beneficial, but can also quickly decrease in overall value because their ease of deliverance and their high financial reimbursement may cause them to become over-utilized. As this technological equipment becomes more affordable, their availability exceeds need and only accentuates the potential for their overuse.
Reform in the U.S. may address some of these issues. (The Texas Legislature has thus far been unsuccessful.) Until then, we will continue to carefully monitor the development and introduction of new technologies, ensure that we’re acquiring and locating appropriate numbers of these technologies in our various regions and business units, utilizing appropriate guidelines to minimize overuse.
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