Yellow Flags: U.S. Hospitals Face a Shortage of This Most Basic Necessity – Bloomberg Businessweek

In our race to the bottom as a global leader, we are now becoming unable to ensure that our supply chain of critical medical supplies is secure and able to produce the volumes needed for our hospitals. I was under the impression that capitalism did not allow this to happen as a need is always filled by ready competitors waiting to step in and compete. It would be interesting to know whether JCH CEO Mike Glen has been aware of this, and what his thoughts are on it. Bloomberg Businessweek, a great newsource, had this recent article.

A long-standing problem, the situation worsened when Hurricane Maria slammed into Puerto Rico, knocking out power at factories that make the small bags for Baxter International Inc., the product’s biggest supplier. Another large maker of the bags, B. Braun Medical Inc., is having problems of its own—the U.S. Food and Drug Administration is looking into reports of leaky and moldy intravenous bags. And a third, ICU Medical Inc., hasn’t been able to keep up with the increased demand. The industry has also been swept up in a U.S. Department of Justice criminal probe of possible collusion and price-fixing.

Support real news. Support Bloomberg Businessweek.

https://www.bloomberg.com/news/articles/2017-11-14/this-simple-lifesaving-liquid-is-suddenly-in-short-supply

 

We must house homeless to cure health inequities – Seattle Times

This article is a good overview of the issue of homelessness and it’s affects on healthcare. It’s worth a read given the disgraceful behavior of our current Jefferson County Hospital Commissioners Jill Buhler and Tony Deleo in determining that it was not in the interest of our community health,  to even take a stand on Prop  1 after hospital staff worked so hard on identifying it as part of the Community Health Improvement Plan (CHIP).

While Prop 1 failed, it would have been nice to have had the support of the people supposedly supporting healthcare in our county.  It will be interesting to see if Mr. McComas, who is currently leading in the returns, has anything more than the nice words behind his campaign promises of understanding the needs of the less fortunate. We obviously can’t count on our medical society members to give a damn. They demonstrated their ability to buy into misinformation and help spread the fear campaign against Ms. Van Hoover.  Nor expect any criticism of the status quo from the Leader, which derives significant ad revenue from the endless ads that the hospital places every week. It’s all about power and money. As usual. It’s worth noting that marketing costs are outpacing charity care this year at our hospital.

We need a health-care system that recognizes homelessness first and foremost as a medical issue…We need a health-care system that recognizes homelessness first and foremost as a medical issue. People experiencing homelessness are hospitalized at rates four times that of the general population. Yet, the medical community has often sat on the sideline, with homelessness siloed as an issue for the housing authority to address. It is time for the housing crisis to be treated as a public-health crisis and for our health-care dollars to be invested in housing.

https://www.seattletimes.com/opinion/we-must-house-homeless-to-cure-health-inequities/

 

Public Options – Produced by HumanKind

This radio show was on KUOW last night. It’s the best overview of the Canadian healthcare system I’ve heard. This debunks the myths, mainly American,about how they created it, what’s right and what’s wrong with the system. But it’s clear, we have a long way to go to give the same care as Canadians get. Their system was highly controversial when it went in, but is a given now. Unfortunately, the show is not free, but you can download it for $4.50 at this web site. If you are involved in wanting to see universal health care become a reality in America, you should listen to this and share it.

One takeaway is that the system was created as a provencial system, which was then adopted nationally. This holds out hope that perhaps we can create a regional, say west coast system, that could allow us to show what can be done in a best case scenario.

Most nations with advanced economies provide health care for all through a government-financed system. Even the United States offers a basic single-payer plan for seniors: Medicare. But for the rest of the population, health care is a mind-numbingly complex patchwork quilt – as well as a giant money maker for the health care industry. Hence the continuing, high-stakes battles over how to care for people’s medical needs. In this program we hear from two very knowledgeable experts:

Danielle Martin, a family physician and strong advocate of single-payer in Canada and author of Better Now. We listen to a short history of the early battles in Canada to launch this system – including a doctors’ strike – fascinating for Americans to hear.

Jacob Hacker, author of American Amnesia and Yale professor of political science who devised the Public Option, by which people with employer-provided insurance can keep their coverage, but others may opt-in to a new system that would be based on Medicare, which remains highly popular, yet has managed to restrain the medical costs.

http://www.humanmedia.org/catalog/program.php?products_id=407&PHPSESSID=68dc7764aa33ecd5aedb830ae1883d0c

The IT Transformation Health Care Needs – Harvard Business Review

A really good look at what needs to change in Electronic Medical Records (EMRs also known as Electronic Health Records). As I have said in other posts,  we are in the worse possible moment for EMRs. They have automated data collection by imposing huge data entry burdens on healthcare providers. That has been done for the benefit of the incredibly wasteful insurance industry. EMRs are not helping physicians or ERs to do a better job and they are not being used to their potential. Want proof?

Yet such systems have had little impact on quality improvement and cost reduction to date. Indeed, clinicians routinely criticize them, lamenting that they waste their time, are rigid and not user-friendly, and interfere with their patient interactions. Many health care organizations are suffering more pain than gain as they struggle to integrate new IT systems into their operations. For example, in January 2017, MD Anderson Cancer Center announced that it would lay off 900 employees, or about 5% of its workforce, largely because of financial losses attributable to a new EHR system.

Here’s a long, thoughtful article about what needs to change.

https://hbr.org/2017/11/the-it-transformation-health-care-needs

Living poor without health care in Mississippi – Harper’s Magazine

A searing view into life at the bottom in a state that keeps healthcare from the poor. Even the working poor. This is what the Republicans are bringing to the rest of American with their cuts last week in Medicaid and Medicare. We already have neighbors suffering like this. It’s going to get worse. Read it and weep.

In this country and this state, access to health care depends on access to health insurance. This, in large part, depends on race and class. My family members have had access to health insurance on and off in their adult lives. What does it mean to live as an adult without health insurance in Mississippi? For much of my twenties, I was that adult. It meant praying that I wouldn’t get into a catastrophic accident that would saddle me with exorbitant emergency-room bills. It meant that when I swam through the floods of Hurricane Katrina and developed a staph infection from whatever toxic sludge floated in the storm surge, I suffered with it for weeks until I was able to visit a free clinic. It meant living with failing vision, displaced dental fillings, abscessed teeth, and strep throat. It meant living with migraines so crippling that I could not stand…Migraines that could be averted only with an Imitrex shot. Imitrex shots, with insurance, cost a hundred bucks, came two to a pack, and should have been used once a month. When I was uninsured, I couldn’t see a doctor to get a prescription and couldn’t afford the medicine even with one. Living without health insurance meant suffering depression so deep after my brother died that my mind was unspeakable. For years.

https://harpers.org/archive/2017/10/delisle-mississippi/

 

We shouldn’t play politics with our kids’ health – Editorial by Frank Chopp

Crosscut ran this editorial today.

Ten years ago, the idea of providing health care for all Washington state children regardless of ability to pay was just a dream. However, thanks to passage of the Apple Health for All Kids program in 2007, 840,000 children now have comprehensive coverage, including medical, dental, vision and mental health. The program is an unqualified and historic success, but it is now at risk.

Read the rest at the link below.

http://crosscut.com/2017/10/childrens-health-insurance-program-chip-renewal-washington-state-apple-health/

Jefferson County Medical Society endorses McComas based on inaccurate information

“Physician, Heal Thyself” is a biblical quote, from Luke, who was a physician. The saying meant that during the rejection of Christ, that Christ would be told to fix his own faults before criticizing those of others. It could be applied last week to Dr. Steve Erickson, the head of the Jefferson Medical Society as he led a campaign to get the society to back Bruce McComas over Cheri Van Hoover for Hospital District Commissioner.

Minutes of the meeting were leaked to me and they tell an interesting story. First, the society apparently has never endorsed a political candidate in recent memory. Not even the threat of Donald Trump, a foe of Obamacare, (which has been responsible for helping the hospital stay in the black) was seen as enough of a threat to take a stand.

Now, apparently the threat of a skilled midwife, RN and ARNP,  carrying two degrees and one certification has . A woman with a background as a counselor in a community-based mental health crisis intervention and the  chair of national committees for the American College of Nurse-Midwives, chair of Ethics Task Force for Northern California Kaiser Nurse-Midwives Peer Group and Educator & Health Policy professor and nationally recognized for instructing medical, nursing, and midwifery students seems to have spooked the doctors of our town just before Halloween.  If these aren’t qualification enough to get medical professionals to endorse her, just what is? They can’t criticize her credentials so they go after her motives. They say that we ‘need’ a business person in the role, yet where were they when they elected commissioner after commissioner over 40 years with virtually no specific business acumen?  With that background the argument could just as easily be made that the hospital has done wonderfully without a businessperson on the commissioners.

The minutes stated that,”

Steve Erickson express the majority view of the meeting, which is that the two newest commissioners have been pushing for financially risky endeavors such as a subsidized dental clinic and a takeover of the county mental health services.  As far as anyone can tell, candidate Van Hoover is sympathetic to those views and candidate McComas is more concerned with maintaining the financial health of the county hospital system.

That statement puzzled me. I could not understand why Dr. Erickson was attacking the investigation that Mr. Glenn is leading into the dental clinic and mental health clinic.

The ‘risky financial endeavors’ that Dr. Erickson mentioned were originally raised as part of a multi-year community effort to prioritize county health needs. Called the “Community Health Improvement Plan” nearly 100 members of the community participated, including Mike Glenn, many hospital staff, (not Dr. Erickson apparently), Public Health, and others. The entire CHIP document can be found at :

CHIP Document

with a summary chart here:

CHIP Summary

I have attended or listened to all the Commissioner meetings since last fall, have interviewed both Mr. McComas and Ms. Van Hoover, attended 3 different candidate forums,  and never had come to the same conclusion as Dr. Erickson. I contacted Commissioner Kees Kolff and asked him about this allegation. Here’s what he told me (emphasis added):

Dental Health has been a concern of board members even before I was elected, in particular Tony Deleo. During the first year of my term I worked to get an outside agency, namely SeaMar, to come to the county since they had been so successful elsewhere. At that time Mike Glenn had already stated to the board that he would start in the fall of 2016 to explore options for JHC to provide dental services. With unanimous support from the board, he (Mr. Glenn) has spearheaded getting:

  1. the State to authorize the same reimbursement for Rural Clinics as for FQHCs (like Sea Mar) making it potentially sustainable, b. our legislators included $1 million into the hopefully soon to be approved state capital budget, for a 6 dental chair facility, and c. there is interest on the part of the Wash Dental Foundation to perhaps provide an additional $500,000.
  2. Behavioral Health service integration with medical services will be mandated shortly in our state, and is considered “best practice”. That has been the goal for several years, supported unanimously by the board. We jointly hired a Psychiatrist to spend half her time with JHC and half with Discovery Behavioral Health. Then it became evident that more integration would be best for both entities, especially the clients. Some in the community hoped that it would be a purchase of DBH and others that it would be a merger, when in fact we learned along the way that the only way to continue to get the kind of reimbursement that would make it pencil out, was to do a unique affiliation. Mike Glenn and his team, including Dr. Mattern and others on the medical staff and leadership team, spearheaded the effort, with unanimous board support.

Meanwhile, just a reminder that when the inpatient psych unit did not pencil out financially in spite of a grant for over $1 million, the board unanimously turned down the grant.

Finally, the CHIP effort also included the County and the City. A director for the program will hopefully materialize, since both the County and JHC committed money to hire one.

Although the CHIP has many ideas and priorities, they will be implemented by the different entities in the community only if they are affordable.

Hope that helps.

Cheers, Kees Kolff, MD, MPH

 

Dr. Katie Ottaway, also in attendance at the meeting brought this issue up, as the minutes state:

“Ottaway objected that community access committees have argued in favor of the dental and mental health services and that the hospital district should take those concerns seriously.”

Dr. Erickson and the others were unconvinced.  UPDATE: The minutes stated:

Prior to the meeting, the officers had met, discussed the issue of the board of commissioners dysfunction and effect of that on the financial stability of the hospital, and determined that candidate Bruce McComas was best qualified to serve on the board.

Which means that a small group of people (the officers) made the decision that this information that Dr. Erickson provided was accurate, then presented it to the members as fact. In fact, the Commissioners have never stated that they were dysfunctional. Commissioner Tony DeLeo stated this, and it is not agreed by the entire Board. It was his opinion. In fact,  the Commissioners routinely vote unanimously on many issues. Commissioner DeLeo has been manipulating this election since day one. Once he declined to run, Ms. Van Hoover stepped in. Apparently Commissioner DeLeo didn’t like that and argued publicly in the Port Townsend Leader that others should come forward to run against her. That’s when Mr. McComas stepped in. Mr. Deleo and two of the other commissioners routinely chastise Commissioners Kolff and Ready for their work to expand the Board into more than simply a narrowly defined oversight on Mr. Glenn, into a board that would take on greater work to help gain greater healthcare access to all citizens, not just the wealthiest. If anyone could be called dysfunctional, it would be outgoing Commissioner DeLeo. His disdain for anyone challenging his point of view is on display at almost every meeting. It is certainly the hope of this publication that whoever prevails in the election, that they bring a more open and mature way of approaching board disputes.

However, the vote, while claiming to be representing the “majority” of the physicians in the organization, which, according to Dr. Erickson has 25 members, had only five were present at the meeting. Dr. Erickson claimed that at the meeting they decided that they would endorse if 75% of the members who chose to express an opinion. Those who didn’t attend the meeting or responded via email were not counted as part of the threshold, so in essence, the decision was made by a minority. Dr. Erickson told me that not a single member endorsed Ms. Van Hoover, but Dr. Ottaway told me she was the lone dissenter present at the meeting. Dr. Erickson did say that the total number of votes present or not, made up a majority of the total membership.

This election for a minor county position, usually draws little to no attention. It has taken an ugly turn as some supporters of Mr. McComas have taken to a smear campaign of Ms. Van Hoover, fueled by stories like this one that Dr. Erickson used to convince the medical association of the supposed danger to the hospital by supporting Ms. Van Hoover.  I’ve also heard the stories myself directly from Bruce’s supporters that Dr. Kolff recruited Ms. Van Hoover. That is wrong. Commissioner Kate Dean was responsible for urging Ms. Van Hoover to run . Additionally, Facebook posts have lent more fuel to the misinformation campaign being waged by those same people. At this stage, I have no idea who will win. Mr. McComas has a huge amount of signs but a long time political campaign manager in town told me that “signs don’t matter, knocking on doors does.” Ms. Van Hoover has worn out her shoes doing just that.

At a recent hospital district commissioner meeting, a special consultant was hired (at a not to exceed non competitive bid of $20,000) to help mend the fences between the feuding factions. On one side are Matt Ready and Kees Kolff. They represent a belief that the Commissioners role should be more expansive than simply managing the CEO and rubber stamping all that he does. They would like to see the Board of Commissioners act more as a champion for getting health care to *all* the people in the county. There are issues at the hospital worth addressing from a policy point of view. While the hospital is doing well it has it’s share of issues, just as all bureaucratic organizations do. The faction of Marie Dressler, Jill Buhler and Tony Deleo are on the side of saying that the job is narrowly defined. They don’t want to ‘color outside the lines’ and accuse Mr. Kolff and Mr. Ready as interfering in the day to day operations. I can’t agree with that assessment, and it seems like more stories to tell Bruce’s supporters.

I listened to the opening hour of the meeting, and you could cut the tension coming from Mr. DeLeo and Ms. Buhler with a knife. You can listen to the whole recording here. The first hour is probably all you need to review.

Given the level that even the distinguished members of the Medical Society has sunk to, by not holding off making a decision until they clearly understood the facts behind the allegations, (which was requested of them),does not bode well for this election or next year’s election. Regardless of who wins the sour taste of accusations made against qualified candidates will linger. The Democrats have been warring between themselves as the Bernie faction challenges the traditional party people who brought us to a near domination of the political landscape with their hard work. The  Republicans seem willing to say and do anything to try and regain their positions in the county.

It also shows the depths that the medical society will go to in order to protect the status quo. There are plenty of positive things going on at Jefferson Healthcare. Mike Glenn and his staff have done an outstanding job of building reserves and expanding services. However, issues such as physician recruitment and retention, costs of services, and a lack of transparent pricing are just a few issues that continue to drive possible patients, such as myself, to take my healthcare elsewhere. That, in the end, will do more to harm Jefferson Healthcare than a well qualified woman who has spent a career in healthcare and health policy, which is the primary focus of the Hospital Commissioners.

If you are on the fence, or a supporter of Bruce because of these allegations, I urge you to at least research the facts before voting.