If Columbus had an advisory committee he would probably still be at the dock. (A)

“Effective meetings don’t happen by accident, the happen by design.” (author unknown)

In 1975 I was appointed Administrator of Mount Sinai Services at City Hospital at Elmhurst, a public hospital where Mount Sinai School of Medicine contractually provided professional services. We had a quarterly Dean’s Committee meeting with the Dean of the Medical School. After our first Dean’s Committee meeting I was proud of my contributions only to be chastised by our Clinical Director of Medicine who said: “Dr. Metsch, this is our meeting with the Dean not yours, you can meet with the Dean (your boss) whenever necessary, we only get to talk to him four times a year. It’s our agenda, not yours!”
A painful but important Lesson Learned which led me to constantly monitor committee work for the rest of my career.

Here are some more Committee Lessons Learned.
When I was an SVP (Office of the President) at Mount Sinai I had to remember that my role was different at every meeting. Meeting with the same people on different topics my role might range from full participant to minute taker.
Parenthetically I once had a staff member who always thought he was as important as the most important person in the room and spoke up accordingly. If he was in a meeting with the President of our organization, he acted presidential too.

I remember a meeting with a Board member who was a senior state legislator. I introduced several important issues and asked his assistance on them. He said: “Jonathan, there are ten people outside waiting to see me after our meeting. They all have important issues. So which one issue do you want me to help you with, and after we finish that please come back and raise the next most important one then.”
Parenthetically I once asked another Board member, also a senior state legislator why he had signed on to a bill that was not good for our hospital. He said: “Jonathan, I am part of the Leadership. Sometimes I can vote how I want but there are other times the Senate President directs the caucus on an issue. At the end of the day you should want me to be in the leadership group more than you are upset about one bill.”
Lesson Learned: when you are asking an influential to step in on an issue, make sure you understand the “demands” on that person and request support accordingly. Otherwise you may wind up with no gain.

If you raise ten great ideas at a meeting, no one will remember any of them. Be prepared by doing your homework and raise one sensational idea at a meeting, and everyone will remember.

I have served on numerous industry and community Boards. It is always easy to go to a few Committee meetings and quickly identify some “best practices” that would make a committee more effective. Share those ideas privately with the chairperson; never embarrass the chairperson publicly.
Parenthetically, when I was the CEO I once made a colossal mistake at a SVP/ VP staff meeting. One SVP caught it but he walked out of the meeting with the others at the end of the meeting, then circled back, explained my mistake which I quickly corrected.

Every project management committee meeting should end with scheduling the next meeting and clarifying individual assignments. Meeting notes should be produced quickly. And anyone with an assignment for the next meeting should send out reading material at least two days before the next meeting.
Parenthetically, always volunteer to write to write the Meeting Notes if the opportunity is there. This gives you a strategic role and earns you appreciation from the chairperson (particularly if the chairperson is higher up in the organization).

Never hijack someone else’s meeting because you would do things differently.

When someone makes a point that adds value never say “I was going to say that” when you didn’t speak up first.

When you chair a committee your job is to facilitate not dominate.

And at any meeting you learn more by listening than by talking. So pick your spots strategically.

“When in doubt, don’t call a meeting.” (source unknown)

“Meetings without an agenda are like a restaurant without a menu.” (Susan B. Wilson)

(A) Arthur Goldberg

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The Mystery of the Hospital CLAUSTROPHOBIA CLUSTER

Recently a friend was told by his doctor he needed an MRI and said that he could get it at the hospital on the campus where the doctor’s office was located, or at a private imaging center two blocks away.

This reminded me of the mystery of the Claustrophobia Cluster about twenty years ago, in a community hospital that (CH) was part of the system where I was then CEO.

Our Teaching Hospital (TH) had just acquired a new state-of-the-art MRI, CH was only a little over a mile away, there was an MRI transfer protocol in place, and we ran a robust county-wide EMS transport system.

But almost every insured patient at CH who needed an MRI was referred to a “private” free-standing Imaging Center due to CLAUSTROPHOBIA. Somehow, also mysteriously, Medicaid patients and the uninsured made it to TH.

The problem was compounded by the fact that we were under a DRG reimbursement system where we got reimbursed an all-inclusive rate for every diagnosis, and had to pay for “outside” MRIs out of that bundled payment. These very expensive outside MRIs often meant that CH and the system lost money on many of these patients.

Since 1989 Federal Law “Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation),…

The following items or services are DHS: Clinical laboratory services; Physical therapy services; Occupational therapy services; Outpatient speech-language pathology services; Radiology and certain other imaging services; Radiation therapy services and supplies; Durable medical equipment and supplies; Parenteral and enteral nutrients, equipment, and supplies; Prosthetics, orthotics, and prosthetic devices and supplies; Home health services; Outpatient prescription drugs; Inpatient and outpatient hospital services. (A)

Whichever entity provides the service tacks on a Facilities Fee to the professional fee charged, for example, by a radiologist.

This raises the question of whether self-referral is a purely clinical recommendation or might “ownership” and the Facilities Fee be an influence.

We never solved the CLAUSTROPHOBIA CLUSTER mystery but we all can help make sure that a diagnostic or treatment referral is clinical and not financial:
– Ask the referring physician if he or she has a financial interest in any of the facilities on the list of sites. Make sure you have not signed away that right when registering.
– Make sure your insurance will cover the charges before you go to a diagnostic facility.
– If uncertain, get a second opinion from another physician who is not in a referral relationship with the first physician.

(A) https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/index.html?redirect=/physicianselfreferral/

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Trump told a GOP senator she could only ride on Air Force One if she voted for the healthcare bill. *

“At no point during the campaign or since the inauguration has Trump articulated any kind of clear vision for how to improve health care. There is no unifying theme around his pronouncements, such as the promotion of a market-driven system. Instead, he makes vague statements about how the ACA is a disaster, without specifying with facts what he means with his criticisms, and then promises that he will deliver a better plan without describing in any way exactly how he will do it….
Instead of pushing McConnell to pass whatever can get 50 Republican votes in the Senate, Trump and his aides should regroup and do the hard work that should have been done months and even years ago to come up with a more plausible approach to health reform. The goal should be to develop a plan built more on market principles than on government control and regulation, and which can garner support from most Republicans, and some Democrats too. Such a plan would necessarily be more incremental than a plan written just by GOP members, and it would roll back less of the ACA than many Republicans would like to see occur. But it would also be far less controversial than the various versions of repeal and replace that have been assembled so far this year, and thus also more likely to survive when political control inevitably shifts again…. (A)

“Don’t tell President Trump, but cutting off extra Obamacare subsidies to insurers could actually improve – not ignite – the very insurance marketplaces he wants to undermine.
Weirdly enough, slightly more people – not fewer — could receive health insurance by 2020 were the president to terminate the controversial cost-sharing payments, otherwise known as CSRs, which compensate insurers for discounts they must offer their lowest-income customers.
That’s the rather unconventional conclusion the Congressional Budget Office came to last week after analyzing the effect on the Obamacare marketplaces should the president eliminate the monthly subsidy payments, as he’s repeatedly threatened to do over the past few weeks (to the chagrin of some Republicans in Congress). And perhaps this is one CBO report that the Trump administration could like. (B)

“When Senator Robert Menendez of New Jersey goes on trial on federal corruption charges in less than three weeks, far more than his own fate hinges on the outcome.
If Mr. Menendez, a Democrat, is convicted and then expelled from the United States Senate by early January, his replacement would be picked by Gov. Chris Christie, the Republican governor of New Jersey and an ally of President Trump.
That scenario — where Mr. Menendez’s interim replacement would more than likely be a Republican — would have immediate and far-reaching implications: The Republicans would be gifted a crucial extra vote just as the party remains a single vote shy in the Senate of advancing its bill to dismantle President Obama’s signature health care law. Those potential consequences only heighten the drama around the first federal bribery charges leveled against a sitting senator in a generation. (C)

“Unlike the double-digit percentage rate hikes individuals purchasing coverage under the Affordable Care Act will see next year, those with coverage at large employers will face single-digit increases, a new national survey of large employers shows….
Large employers face 5% health care cost increases for 2018, according to the National Business Group on Health annual Health Care Strategy and Plan Design Survey.
Though employer and worker premiums are still rising two to three times the rate of general inflation, the percentage increase won’t come close to the premium increases Americans are expected to face should they seek ACA-compliant coverage this fall for 2018. ACA-compliant Obamacare plans are submitting rate hikes of 25% or higher thanks in part to the Donald Trump White House’s inability to commit to signing off on cost-sharing reductions for low-income purchasers of subsidized Obamacare policies.
Employers say they are thankfully immune from the issues plaguing the ACA’s unstable individual market and its risk pools of sick patients whose costs far outweigh the number of healthy Americans signing up. To pay sick patient claims, premiums are jumping dramatically in the individual market.
But the employer market has remained stable.” (D)

“…Before I go into details, here are some bullet points of my findings.
For a broad spectrum of middle-aged persons in the middle class, premiums for even the cheapest bronze policy today are, in a majority of rating areas examined, so expensive that people are formally exempt from the individual mandate.
For people age 60 and earning about 450% of the federal poverty level, premiums today for the second lowest silver plan are unaffordable in a majority of rating areas studied. This is true using both metrics employed here to determine affordability.
In 2018, assuming premiums rise 20% as is frequently forecast, the situation becomes much worse for the middled-aged, middle class. Among persons age 50 and earning 500% of the federal poverty level, for example, people will be exempt from the individual mandate in 73% of rating areas studied. This is so because even the cheapest bronze policy will cost more than 8% of their income. And in about 30% of the rating areas, prices for the second lowest silver plan will be so high, that persons of this age and income will have to pay more than 1.5 times the amount they would have been required to pay for the same policy if they received even the smallest subsidy from the federal government. (E)

“Most enrollees in the marketplaces (84%) receive a tax credit to lower their premium and these enrollees will be protected from premium increases, though they may need to switch plans in order to take full advantage of the tax credit. The premium tax credit caps how much a person or family must spend on the benchmark plan in their area at a certain percentage of their income. For this reason, in 2017, a single adult making $30,000 per year would pay about $207 per month for the second-lowest-silver plan, regardless of the sticker price (unless their unsubsidized premium was less than $207 per month). If this person enrolls in the second lowest-cost silver plan is in 2018 as well, he or she will pay slightly less (the after-tax credit payment for a similar person in 2018 will be $201 per month, or a decrease of 2.9%). Enrollees can use their tax credits in any marketplace plan. So, because tax credits rise with the increase in benchmark premiums, enrollees are cushioned from the effect of premium hikes. (F)

“Senate Majority Leader Mitch McConnell (R-Ky.) acknowledged Monday that Congress’s next steps on healthcare are unclear after Republicans failed to repeal ObamaCare….
McConnell added that lawmakers were “going to see” what negotiations between Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the top two members of the Senate’s healthcare committee, aimed at stabilizing the individual health insurance market could produce.
“We have … collapsing individual insurance markets around the country. Requests to continue to subsidize the insurance companies. It’s a pretty controversial subject to subsidize insurance companies without any reforms,” the GOP senator said.
He added that Democrats “have been pretty uninterested in any reforms,” but the two parties will need to try to negotiate when they get back to Washington next month.
“So when we get back after Labor Day we’ll have to sit down and talk to them and see … what the way forward might be,” he said.” (G)

“The Senate health committee will hold two hearings early next month on how the nation’s individual health insurance marketplaces can be stabilized, as party leaders grasp for a fresh path following the collapse of the Republican effort to repeal and replace much of former President Barack Obama’s health care law.
GOP and Democratic leaders are exploring whether they can craft a bipartisan but limited bill aimed at curbing rising premiums for people who buy their own insurance. In many markets, consumers are seeing steeply rising premiums and fewer insurers willing to sell policies.” (H)

“Democrats are ready to go on the health care offensive. And Sen. Brian Schatz (D-HI) may have a new plan for them to do it.
In an interview with Vox, Schatz revealed that he’s preparing a new bill that could grant more Americans the opportunity to enroll in Medicaid by giving states the option to offer a “buy-in” to the government program on Obamacare’s exchanges.
His proposal would expand the public health insurance program from one that covers only low-income Americans to one open to anyone seeking coverage, depending on what each state does. The idea is similar to the government-run “public option” that some Democrats advocated for during the battle over the Affordable Care Act’s passage.” (I)

The new (Republican) concept, sponsored by Senators Bill Cassidy and Lindsey Graham, would redirect current Obamacare spending to the states, giving each state legislature significant flexibility in how the dollars are spent, so long as it’s on healthcare.
The bill is an amendment to the Senate’s initial repeal bill, the Better Care Reconciliation Act, and it would also repeal the employer and individual mandates, but keep the rule requiring insurers to cover pre-existing conditions. It would cut subsidies and Medicaid expansion and direct the money to the states to use as they see fit.
Cassidy, a physician, says the plan returns power to the states. But the amendment wouldn’t necessarily benefit each state equally. Funding equations would be based on poverty, density and income, and as with any healthcare policy, some consumers would likely benefit from the Cassidy/Graham plan, and others would be worse off. (J)

“The relationship between President Trump and Senator Mitch McConnell, the majority leader, has disintegrated to the point that they have not spoken to each other in weeks, and Mr. McConnell has privately expressed uncertainty that Mr. Trump will be able to salvage his administration after a series of summer crises.” (K)

* http://www.businessinsider.com/trump-tried-to-trade-a-gop-healthcare-vote-for-a-ride-on-air-force-one-2017-8

(A) Trump deserves much of the blame on health care, by James C. Capretta, http://www.aei.org/publication/trump-deserves-much-of-the-blame-on-health-care/
(B) The Health 202: Trump’s plan to harm Obamacare would actually help it, by Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/08/22/the-health-202-trump-s-plan-to-harm-obamacare-would-actually-help-it/599b077f30fb0435b8208f43/?utm_term=.ad1c6e43d3c6
(C) At Senator Menendez’s Trial, Stakes Are High for Democrats, by By SHANE GOLDMACHER, https://www.nytimes.com/2017/08/17/nyregion/senator-robert-menendez-trial.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0
(D) Employers Will Escape Obamacare-Sized Rate Hikes In 2018, by Bruce Japsen , https://www.forbes.com/sites/brucejapsen/2017/08/08/employers-will-escape-obamacare-sized-rate-hikes-in-2018/#107a0e8f30c5
(E) New Research Shows Many In Middle-Aged, Middle Class Can’t Afford ACA Policies in 2018, by Seth Chandler Seth Chandler, https://www.forbes.com/sites/theapothecary/2017/08/17/new-research-shows-many-in-middle-aged-middle-class-cant-afford-aca-policies-in-2018/#1c4cbc0c461f
(F) An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges, by Rabah Kamal, Cynthia Cox, Care Shoaibi, Brian Kaplun, Ashley Semanskee, and Larry Levitt, http://www.kff.org/health-reform/issue-brief/an-early-look-at-2018-premium-changes-and-insurer-participation-on-aca-exchanges/
(G) McConnell: Path on healthcare ‘murky’, by JORDAIN CARNEY, http://thehill.com/blogs/floor-action/senate/347373-mcconnell-path-on-healthcare-murky
(H) Senate panel plans 2 hearings on girding health insurance, by ALAN FRAM, http://abcnews.go.com/Health/wireStory/senate-panel-plans-hearings-girding-health-insurance-49356269
(I) Exclusive: Sen. Schatz’s new health care idea could be the Democratic Party’s future, updated by Sarah Kliff and Jeff Stein, https://www.vox.com/policy-and-politics/2017/8/22/16171160/schatz-health-care-medicaid
(J) New Obamacare Repeal Bill Returns Power to States, But Will It Pass?, by Alex Tolbert, http://www.huffingtonpost.com/entry/new-obamacare-repeal-bill-returns-power-to-states-but_us_599c269ce4b0ac90f2cba9bc
(K) McConnell, in Private, Doubts if Trump Can Save Presidency, by ALEXANDER BURNS and JONATHAN MARTIN, https://www.nytimes.com/2017/08/22/us/politics/mitch-mcconnell-trump.html?ribbon-ad-idx=4&rref=world&smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0&module=ArrowsNav&contentCollection=Politics&action=swipe&region=FixedRight&pgtype=article

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It’s okay and important to ask your doctor “DID YOU WASH YOUR HANDS?”

Recently after a doctor’s appointment I went to a nearby lab to have blood drawn for routine tests. I asked the phlebotomist to wash her hands to which she replied she already had. She had washed her hands in another room after the last patient, done some other work, come into the room, put gloves on, then went and used a shared computer*, before finally drawing blood. When I asked, she refused to wash her hands in front of me. So I refused to let her proceed. The same with the second tech. Finally the third washed her hands correctly in front of me.

“Most patients wouldn’t dare to ask their doctor to wash his or her hands..” It’s a simple enough request, but for patients and families who feel vulnerable, scared or uncomfortable in a hospital room, the subject can be too intimidating to even bring up with a doctor or nurse…” (A)

Some hospitals post signs in each examination room encouraging patients to be vigilant about doctor hand-washing; one even gives patients a card stating “Your care provider should clean their hands: 1) Before contact with you; 2) Before a procedure; 3) After a procedure; and 4) After contact with you.” (B)


Some background on Hospital Acquired Infections:

Hospital infections affect almost two million people in the United States every year, 100,000 of whom die. Up to 70 percent of these infections could be prevented if health care workers follow recommended protocols, which include hand hygiene. (C)

“…this sobering truth. When bacteria lurking on, for instance, a medical device, a bed rail, a bandage or a caregiver’s hands find their way into a patient’s body via a surgical wound, a catheter, a ventilator, or some invasive procedure, the disturbingly frequent result is a serious, sometimes devastating, infection.” (D)

“Hospital-acquired infections (HAI) cost $9.8 billion per year, with surgical site infections alone accounting for one-third of those costs, followed closely by ventilator-associated pneumonia at 31.6 percent….” (E)

“Hands are the most common vehicle for transmission of organisms and “hand hygiene” is the single most effective means of preventing the horizontal transmission of infections among hospital patients and health care personnel. “ (F) (G)


Protect yourself! Start by asking your doctor, nurse, phlebotomist, physical therapist and others –



* “It turns out that your computer keyboard could put a host of potentially harmful bacteria — including E. coli and staph — quite literally at your fingertips.” (H) “A study… suggests that dangerous bacteria may be spread by health care workers’ clothing.” (I)



(A)    Why Hospitals Want Patients to Ask Doctors, ‘Have You Washed Your Hands?’ by Laura Landro  http://online.wsj.com/news/articles/SB10001424052702303918804579107202360565642?KEYWORDS=hospital&mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303918804579107202360565642.html%3FKEYWORDS%3Dhospital

(B)   It’s okay to ask your doctor: “Did you wash your hands?”, by Paul Taylor, http://healthydebate.ca/personal-health-navigator/okay-ask-doctor-wash-hands

(C)   Hand Washing Stops Infections, So Why Do Health Care Workers Skip It? ,  by Sanjay Saint, http://labblog.uofmhealth.org/industry-dx/hand-washing-stops-infections-so-why-do-health-care-workers-skip-it

(D)   What Zero Looks Like: Eliminating Hospital-Acquired Infections, http://www.ihi.org/resources/Pages/ImprovementStories/WhatZeroLooksLikeEliminatingHospitalAcquiredInfections.aspx

(E)    Hospital-acquired infections rack up $9.8B a year, by Julie Bird, http://www.fiercehealthcare.com/healthcare/hospital-acquired-infections-rack-up-9-8b-a-year

(F)    Guidelines for prevention of hospital acquired infections, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963198/

(G)  Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene, http://www.jstor.org/stable/10.1086/677145

(H)   How dirty is your Qwerty? by Dan Childs   http://abcnews.go.com/Health/Germs/story?id=4774746&page=1

(I)     Do white coats, scrubs, stethoscopes, cell phones and computer keyboards collect dangerous hospital germs?, by Joe Graedon, https://www.peoplespharmacy.com/2016/11/03/are-doctors-and-nurses-transporting-deadly-hospital-germs/

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I just got an urgent cold call from a Financial Advisor recommending I buy warrants  in UBER since it is about to announce the opening of  a system of  “gig” urgi-care, UBER HEALTH.

You will be able to get a doctor to make a house call within ten minutes using a new UBER HEALTH APP. . If the doctor prescribes an MRI an imaging van will be sent to your house within one hour. Read by a radiologist somewhere in the ethernet.

There will be surge pricing and competition from LYFTparamedic.

Further research disclosed:

IBM WATSON DX will enable you to self-diagnose your health problems and treatment plans through secret proprietary algorithms, while the doctor is on the way.

APPLE MEDICAL SCHOOL will have virtual clinical rotations in medicine, pediatrics, surgery and obs/gyn, where students will deliver virtual babies.

WALMART HOSPITALS will become the anchor hospitals in many communities, right across from Walmart stores.

BLACKROCKdoc will employ 75% of physicians, with practice purchases funded by creating clinical derivatives.

AMAZONrx will dominate the mail order prescription medicine market.

MICROSOFTcare will capture 50% of the health insurance market driving Aetna, United and the Blue Cross plans out of business.

YAHOOlitigator will be do malpractice trolling akin to reverse mortgages.

To quote President Trump “nobody knew that healthcare could be so complicated”…

So I am going to sell all these stocks short.







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With recurring infection should Congressman Scalise have been transferred to another hospital rather than to the ICU where he is hospitalized?

About twenty years ago as President of LibertyHealth each of our hospitals (a medical school affiliated teaching hospital and two community hospitals) had an ICU. I was always concerned that sometimes patient acuity in one of the community hospital ICUs might have exceeded its capability and pushed for clear clinical threshholds for patient transfer to the teaching hospital ICU.
Which brings me to Congressman Scalise…
“A lone gunman who was said to be distraught over President Trump’s election opened fire on members of the Republican congressional baseball team at a practice field in this Washington suburb on Wednesday, using a rifle to shower the field with bullets that struck four people, including Steve Scalise, the majority whip of the House of Representatives.”
“His injuries are extensive, and he was in critical condition Wednesday night, MedStar Washington Hospital Center said in a statement. As the bullet traveled across his body, it broke bones, tore up internal organs and caused major internal bleeding.
Doctors operated immediately, but additional surgery is required, the hospital said.” (A)

Mr. Scalise underwent several surgeries last month, and his condition improved from critical to fair. However, hospital officials on Wednesday said he was moved back to the ICU. Mr. Scalise had another surgery Thursday to manage infection and is now in serious condition, according to the report.
Soon after his rehospitalization, attention shifted toward Washington Hospital Center’s publicly available grades for patient safety and care quality. The Leapfrog Group gave Washington Hospital Center a D in hospital safety ratings for 2016, and CMS’ Hospital Compare website shows the hospital earned 2 out of 5 stars in the most recent update.
“[I]nfections [at the hospital] are a pattern and a serious one,” Leapfrog Group CEO Leah Binder told USA Today. “They are significantly below the national average in four out of five areas that we have data, which suggests an inability to prevent infections.” (B)

a little old (2014)
“Staff at the region’s largest private hospital — MedStar Washington Hospital Center — have given it consistently low marks in key areas of patient safety over the past four years, according to results released Friday.
Although doctors’, nurses’ and administrators’ perception of patient safety has improved during that time — in some cases significantly — the hospital scores below the national average in seven out of 12 patient safety measures in key areas, including the overall perception of safety at the hospital and the ability of staff to report mistakes without fear of punishment.”

June, 2017
“Like many other hospitals across the country, MedStar Washington Hospital Center has been experiencing the financial impact of numerous changes in health care,” the statement from MedStar said. That has included the nationwide nursing shortage that forced the health system to use agency nurses to fill critical positions, as well as “inflationary pressures” that have driven up costs of pharmaceuticals and medical supplies.
MedStar officials also pointed to investments in the last year that have required additional staff, such as the creation of a Sepsis Response Team and the Behavioral Emergency Response Team, that have impacted the budget. The health system saw positive effects from those investments, such as reductions in hospital-acquired infections, and it intends to leave those teams intact, officials said. (C)


So I would be digging deeper…..but understand this can be quite frustrating
The U.S. News analysis of hospitals includes data from nearly 5,000 centers across multiple clinical specialties, procedures and conditions. Scores are based on a variety of patient outcome and care-related factors, such as patient safety and nurse staffing. Hospitals are ranked nationally in specialties and regionally in states and major metro areas. U.S. News assigns a rating to hospitals in a handful of common procedures and conditions, including hip replacement and COPD. This hospital achieved the highest rating possible in 5 procedures or conditions.
To see the U.S. News rankings of MWHC highlight and click on http://health.usnews.com/best-hospitals/area/dc/medstar-washington-hospital-center-6330120

The information on Hospital Compare:
Helps you make decisions about where you get your health care
Encourages hospitals to improve the quality of care they provide
In an emergency, you should go to the nearest hospital. When you can plan ahead, discuss the information you find here with your health care provider to decide which hospital will best meet your health care needs.
To see Hospital Compare’s ratings of MWHC highlight and click on https://www.medicare.gov/hospitalcompare/profile.html#profTab=0&ID=090011&loc=WASHINGTON%2C%20DC&lat=38.8951118&lng=-77.0363658&name=MEDSTAR%20WASHINGTON%20HOSPITAL%20CENTER&Distn=3.3

Completed by more than 1,800 hospitals annually, the flagship Leapfrog Hospital Survey collects safety, quality, and resource use information you can’t find anywhere else. We report on the issues that matter to patients and purchasers—from maternity care and surgical outcomes, to handwashing policies and nursing standards.
To see Leapfrog’s report on MWHC highlight and click on

An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
To see JCAHO’s most recent accreditation report for MWMC highlight and click on

whew! That’s hard work

Maybe we need to designate levels of ICUs just as we do for trauma centers and perinatal centers.
Here’s one example:

LEVEL 1: should be capable of providing immediate resuscitation and short-term cardiorespiratory support for critically ill patients; will also have a major role in monitoring and prevention of complications in “at risk” medical and surgical patients; must be capable of providing mechanical ventilation and simple invasive cardiovascular monitoring for a period of at least several hours
LEVEL II: should be capable of providing a high standard of general intensive care, including complex multi-system life support, which supports the hospital’s delineated responsibilities; minimum of 6 beds
LEVEL III: a tertiary referral unit for intensive care patients should be capable of providing comprehensive critical care including complex multi-system life support for an indefinite period; should have a demonstrated commitment to academic education and research; All patients admitted to the unit must be referred for management to the attending intensive care specialist; all consultants are FCICMs; may have over 50 beds, should include pods of 8-15 beds
PICU: as for a Level III unit, but dedicated to the care of pateints under the age of 16 years

(A) Steve Scalise Among 4 Shot at Baseball Field; Suspect Is Dead, by Michael D. Shear et al, https://www.nytimes.com/2017/06/14/us/steve-scalise-congress-shot-alexandria-virginia.html
(B) Medstar hospital’s poor safety ratings get limelight as it treats Rep. Steve Scalise, by Mackenzie Bean, http://www.beckershospitalreview.com/quality/medstar-hospital-s-poor-safety-ratings-get-limelight-as-it-treats-rep-steve-scalise.html
(C) MedStar Washington Hospital Center gets low marks from staff on key safety issues, by Lena H. Sun, https://www.washingtonpost.com/local/medstar-washington-hospital-center-gets-low-marks-from-staff-on-key-safety-issues/2014/07/18/94f3643e-0e95-11e4-b8e5-d0de80767fc2_story.html?utm_term=.d762fccecd67
(D) ICU Design and Staffing, https://lifeinthefastlane.com/ccc/icu-design-and-staffing/


Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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For 17 years I was President and CEO of a safety net hospital. TrumpCare will “disinsure” twenty million+ people and devastate the hospitals we all depend on.

A little background….

I was appointed President and CEO of Jersey City Medical Center (JCMC) in 1989, one year after JCMC had been converted to not-for-profit governance after a long and colorful history as a public hospital (including bankruptcy protection from 1982 to 1985). JCMC was and still is Hudson County’s (500,000+ residents) regional referral center “safety-net” hospital.

“As defined by the Institute of Medicine, the health care safety net comprises hospitals and other providers that organize and deliver a significant level of health care and other health-related services to patients with no insurance or with Medicaid. Often referred to as providers of last resort, safety-net hospitals (SNHs) have historically assumed a major role in the provision of comprehensive services to medically and socially vulnerable populations.” (A)

When I started New Jersey Hospitals were reimbursed through an all-payor state rate-setting system for Medicare, Medicaid, and commercial insurance, which assured hospital financial stability if managed effectively.
This was coupled with a robust Certificate of Need (CN) process which rationed approval of certain tertiary care services to assure access to them throughout the state, rather than based on a hospital’s fiscal situation, since approved CNs garnered additional reimbursement in reimbursement rates.

Already the sole designated paramedic provider for the County, together rate-setting and CN allowed JCMC: to apply for and be designated as a Regional Perinatal Center (1992), Level Two Trauma Center ((1994), and Medical Coordination Center for Emergency Preparedness (2003); and build a total replacement hospital on a new site (CN approved in 1986, hospital opened in 2004) where an Open Heart Surgery CN (approved in 1999) was started. JCMC became a state approved Children’s Hospital in 2000. Along the way JCMC became LibertyHealth adding two community hospitals, Greenville and Meadowlands (which in 1996 opened a CN designated inpatient rehabilitation unit). In 1997 JCMC became a major teaching affiliate of Mount Sinai School of Medicine (now Icahn School of Medicine at Mount Sinai).

All as a safety-net hospital.

Why am I writing all this?

“Hospitals that primarily serve low-income patients could collectively lose $40 billion in funding over the next decade if the Affordable Care Act is repealed and not replaced by something comparable, according to a new analysis by America’s Essential Hospitals.
That amount represents lost coverage and cuts to Medicaid and Medicare disproportionate share hospital (DSH) funding from 2018 through 2026. The ACA called for those cuts because hospitals would have theoretically needed that funding less as more people gained coverage on the marketplaces and through Medicaid expansion.” (B)

“People with health insurance tend to think of safety-net hospitals the way airline travelers think of the bus: as a cheaper service they would use only if they had to. But without these essential hospitals — which specialize in the care of our country’s most medically and financially vulnerable, particularly the uninsured — our entire health care system would be in danger.” …
For uninsured patients, lifesaving surgeries and treatments, along with a limited recovery period, are often covered through Emergency Medicaid funds. But patients who don’t fit neatly into our medical system for reasons of health or finances or their social situation — the “medical misfits” that any one of us can become under the wrong circumstances — need far more long-term support. This is often where safety-net hospitals step in. “(C)

“Despite promises to the contrary, it will leave millions of people without health coverage, and others with only bare bones plans that will be insufficient to properly address their needs. As the nation’s medical schools and teaching hospitals see every day, people without sufficient coverage often delay getting the care they need. This can turn a manageable condition into a life-threatening and expensive emergency.” (D)

“In short, Democrats are focused on trying to maximize the number of people who have decent health insurance, and are willing to accept whatever tax increases and arrangements with health insurers and other private interests are needed to make that happen. They seek the broadest possible availability of health care, whatever the cost and political trade-offs it takes to achieve it.
Republicans are focused on trying to minimize taxes, especially on investment income, and keeping federal subsidies for health care to a minimum. They are willing to accept the wrenching consequences that attaining those goals might have for Americans’ insurance coverage, betting that lower taxes and smaller government will fuel a more vibrant economy.” (E)


(A) https://www.hcup-us.ahrq.gov/reports/statbriefs/sb213-Safety-Net-Hospitals-2014.pdf
(B) http://www.modernhealthcare.com/article/20170209/NEWS/170209902
(C) https://www.nytimes.com/2017/05/26/opinion/sunday/safety-net-hospitals-health-care.html
(D) http://www.beckershospitalreview.com/hospital-management-administration/9-organizations-react-to-senate-gop-healthcare-bill.html
(E) https://www.nytimes.com/2017/06/23/upshot/the-health-debate-shows-what-both-parties-care-about-most.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

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