HEALTH CARE CASE STUDIES

CORONAVIRUS TRACKING UPDATES CAN ALWAYS BE FOUND AT

https://doctordidyouwashyourhands.com/

Doctor, Did You Wash Your Hands?®

Jonathan M. Metsch, Dr.P.H.

[email protected]

HEALTH CARE CASE STUDIES

1.CASE STUDIES – GETTING STARTED

A.Case Study Teaching

B.Curated Contemporaneous Case Study Methodology

C.Project Management. The hardest part of getting started….is getting started

D. The new health care Gold Standard” GawandeCare”.

2.QUICK CASES

A.Hospital Web Site Archeology

B.Four years ago, while on vacation, my wife punctured her hand with a BBQ skewer. So she went to the nearest ER.

C.EMERGENCY ROOMS are not all created equal!

https://doctordidyouwashyourhands.com/2016/04/emergency-rooms-are-not-all-created-equal/
D.Stop the name games. University hospitals and regional medical centers should live up to their billing

E..Is community hospital cancer center an oxymoron? Do cancer hospitals have better outcomes?

F.“Two-thirds of beneficiary communication is more complex to read than Moby Dick…” Let’s start with EOBs!

3.CONTINUING CASE

Coronavirus Tracking (parts 1-15, more to follow)

4.SHORT CASES

A1.President signs “Right to Try Act” – “Despite good intentions – right to try legislation grants no rights.”

A2.“Right-to-try should not be right-to-die-poorer”

B1.SEPTEMBER 11, 2001. PART 1. Military helicopters and jets were overhead, as President Bush was getting ready to leave NYC. PART 2. LESSONS LEARNED memorandum by hospital CEO Jonathan Metsch goes “viral”…

B2.“The soldier, above all other people, prays for peace, for he must suffer and bear the deepest wounds and scars of war.” Douglas MacArthur

5.LONG CASES

A.PARTs 1-5. What are the Lessons Learned (or not!) from the Johns Hopkins All Children’s Hospital and North Carolina Children’s Hospital pediatric cardiac surgery program failures?

B1.UBER HEALTH Inc., WALMART HOSPITALS NFP, AMAZONrx (Ireland), MicrosoftCare LLC.

B2. Apple, Amazon, Google and Microsoft trajectories for healthcare

B3. “Walmart’s (health care) strategy is based on price competition. Patients know what services will cost before they walk into the physician’s office. Prices are rock-bottom.”

B4. “…what would it look like if Amazon CEO Jeff Bezos took the helm of a major integrated (health care) delivery system?”

6.SURPRISE MEDICAL BILLS

A.1PARTS 1- 3. SURPRISE MEDICAL BILLS. “I was never in a position to preselect who (would) perform my heart transplant,” (and if the physicians and surgeons were in network)….because I did not know when a new heart would become available.

A2.PARTS 1- 4. San Francisco General, a public hospital with San Francisco’s only trauma center, all commercial insurance WAS “out-of-network.”

A3.PART 2. May 20, 2019. OUT-OF-NETWORK BILLS. Private Equity is a Driving Force Behind Devious Surprise Billings

A4.we met the surgeon as I was being..taken into the operating room… the surgeon’s bill $17,000.. I called the insurance company..”Sorry, he’s not one of ours. No contract with us.”

A5.Nothing is certain but death and taxes, and “preexisting conditions”!

A6.write in AS LONG AS THE PROVIDERS ARE IN MY NETWORK…before you sign any hospital admission documents accepting financial responsibility for your care

7.LESSONS LEARNED – (FROM OBAMA CARE TO TRUMPCARE)

A.TrumpRyanCare Obits

B. PARTS 1-57. From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare)

C. “President Donald Trump declared that the GOP will now be the “party of health care…”

D. 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.

E. MEDICARE FOR ALL. “Midway through July’s interminable Democratic debate, Senator Elizabeth Warren asked a simple question. “I don’t understand why anybody goes to all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for,”..“I don’t get it.”

F.Slow down Bernie…….Lessons Learned from a local government buying a failing not-for-profit hospital

8.SEPSIS

A..“…of the 1.5 million Americans who develop sepsis each year, nearly 260,000 die from it.” (A)

B.. Renaissance Master Caravaggio Didn’t Die of Syphilis, but of Sepsis,

C..“President Garfield didn’t die from an assassin’s bullet, but rather from a doctor’s dirty hands.”

D.. Iatrogenic disorders. Never events. Incidentalomas

9.HANDWASHING

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

B.There’s a growing movement in the United States to install video cameras in operating rooms…

C. PARTS 1 & 2. “Massachusetts Surgeons will have to document each time they enter and leave the operating room, and who took over in their absence… amid controversies over doctors who perform more than one surgery at a time…

D.Doctor, Did You Wash Your Hands?® There is a sign in my primary care provider’s examination room:

10.TECHNOLOGY

A.I am still a family medicine physician and still see my own patients each day. My nurse and I review all messages for the day and all phone calls are returned before we leave. (A)

B.I went on my morning walk committed to losing the weight I gained over the summer

C.….the evidence today does not support the idea of the annual physical exam

D.Concierge medicine is the all the rage but rather should we be enraged about it?

11.MEDICAL CARE TRANSFORMATION

A.Have you met your interventional pathologist or interventional neurologist or interventional oncologist?

B.Most surgical meniscus repairs are unnecessary. How do you learn about other possibly unnecessary procedures? What is CHOOSING WISELY?

C.Should physicians be afforded Mulligans for non-reimbursable Medicare readmissions?

D.It’s like the Wild, Wild West, the (physician specialty) turf wars….

E.Do you want to be treated by a stranger when you are admitted to the hospital? Every practicing physician should have hospital privileges.

F.Medicare Conundrum: Observation status – Readmission penalties – Hospitalist handoff to primary care physician.

G.Unlike Joan Rivers who died in a surgi-center during a routine procedure, I would only be given general anesthesia on a hospital campus.

12. PARTS 1-12. RAPID RESPONSE. Hurricanes

13. PARTS 1- 17. July 1, 2019. A federal judge has ordered a mediator to move swiftly to improve health and sanitation (FOR MIGRANT CHILDREN) at Border Patrol facilities in Texas

14.CONFLICT OF INTEREST

A.PARTs 1 & 2. Conflict of Interest. MSK continued & top executives at the University of Maryland Medical System have resigned amid investigations into accusations of self-dealing among the hospital network’s board members

B.You are a new member of the Board of University Medical Center and have been appointed chairperson of the Board’s Compliance Committee.

C.HOW ACADEMIC MEDICAL CENTERS ADDRESS CONFLICTS-OF-INTEREST

D.The Mayo Clinic is discriminating against Medicare Patients. Unbelievable! Outrageous!

15.PUBLIC POLICY

A.A public health approach will enable the United States to address culture, firearm safety, and reasonable regulation

B.American College of Physicians Says Hate Crimes are Public Health Issue

C.“…SEXUAL HARASSMENT IN HEALTHCARE CAN ADVERSELY AFFECT EMPLOYEE HEALTH AND, BY EXTENTION, PATIENT SAFETY…”

16.SO YOU WANT TO BE THE CEO?

A.PARTS 1-12.   “When you come to a fork in the road, take it.”

B.When I was appointed President and CEO of LibertyHealth/ Jersey City Medical Center in 1989 one of our goals was to become a top tier New Jersey teaching hospital.

C.The Mystery of the Hospital CLAUSTROPHOBIA CLUSTER

17.CHIEF FOURTH OF JULY OFFICER 

A.PART 3. (Chief Fourth of July Officer)…the term “CEO” is not long for the world… we should do the business world a huge favor and decide, ahead of time, what term should replace “CEO”

B.Is Chief Innovation Officer an oxymoron? Innovation is cultural not structural.

March 26, 2020