Thursday, November 27, 2008

Community's Thanksgiving Quilt

This week Community General’s Thanksgiving Quilt shows the appreciation felt by members of the hospital family.

The words on the quilt are simple and direct. They express a personal sense of gratitude for one’s family and specific family members; for one’s co-workers and one’s friends; for life and health and recovery; for work and for the ability to help others.

The Thanksgiving Quilt is in poster-size display cases at Community’s main entrance (across from the first floor information desk) and outside the cafeteria (basement floor). It is also on the splash screen of the hospital's intranet.

Click on the two quilts shown here for easy readability.

I appreciate all who submitted their thoughts to the Thanksgiving Quilt project. My own Thanksgiving thoughts are posted below.

Happy Thanksgiving!

I am thankful for:

• All who make our patients feel welcome, safe, and respected.

• All who who pay attention to the details of their work, who wash their hands consistently, and who follow the “red rules” of patient safety to assure safe practices.

• All who welcome new employees, who teach proper procedure, and who encourage employees to feel a part of the hospital family.

• All who celebrate birthdays, take up collections, offer congratulations at coworkers' weddings and graduations, and who help when there is an accident, an illness, or a death in someone's family.

• All who volunteer their time, who donate their money, who share their stories, and who make time for others.

• All who have a ready smile, who are courteous, and who our patients first.

• All who respect our doctors by showing professionalism, responsiveness, and teamwork.

• All who forego gossip and comments that are hurtful, unkind, or thoughtless.

• All the patients who entrust to us their safety and well being.

• All the physicians who rely on us for the care of their patients.

• All who see another's awkwardness or worry or pain and who make an effort to help.

• All our Board members and advisers who offer their time, their expertise, and their funds to make Community General a better place.

Wednesday, November 26, 2008

Good Manners & Good Medicine

Congratulations to Dr. Myron Luthringer, the latest recipient of the STAR award, presented to members of the Community General Hospital medical staff who demonstrate sensitivity, thoughtfulness, appreciation, and respect (“STAR”).

I have written before about our STAR doctors and how good medicine includes good manners:

Being kind and respectful is not merely good citizenship. These are the attributes of individuals who build positive relationships with other members of the caring team. This can aid communications at all levels. Better communications help reduce risks for patients – and reduced risks mean better patient safety.
According to his nomination, Dr. Luthringer of Advanced OB-GYN “always takes the extra step to make sure that his patients are comforted in the OR. He does this by staying in the room by the patient’s side with his hand resting on theirs until they are under anesthesia. He is also…willing to pitch in & help the OR staff & treats everyone in the OR with respect.”

That’s Dr. Luthringer in the photo above (at right) with Dr. Fred Goldberg, Vice President & Chief Medical Officer at Community General Hospital. For more about Dr. Luthringer, see the video in which he speaks about his experience with the daVinci surgical robot.

Dr. Luthringer joins other recent STAR doctors: Dr. Richard Zogby, a spine surgeon with Syracuse Orthopedic Specialists (below, left), and Dr. David Simon, an internist with FamilyCare Medical Group, PC (below, right with Dr. Goldberg).

An earlier posting discussed STAR doctors Joseph T. Barry, MD, an internist and geriatrician with Preservative Medicine Associates, PLLC; Daniel Dombroski, MD, a general surgeon, who practices in Physicians Office Building – North; and James Watts, MD, a pulmonologist with FamilyCare Medical Group, PC.

If you would like to recognize a STAR doctor at Community General Hospital, nomination forms are available in the Medical Affairs office (first floor, west wing) and on Community’s intranet.

Sunday, November 23, 2008

Action on pensions?

Earlier this month I wrote about the crisis in pension funding resulting from the intersection of the Pension Protection Act (PPA) of 2006 and the extraordinary market collapse of 2008.

I expressed a hope that, once the national elections were behind us, federal officials would consider legislation to “make it possible for companies to adequately fund their pension plans over longer periods of time” than are required by the PPA.

Last week the New York Times reported several senators have proposed such legislation. The report speculated that, if the bill was not addressed in the Congressional lame duck session, it would be considered in “a pension relief bill in January.”

Saturday, November 22, 2008

A sad & bitter time...November 22, 1963

Forty-five years ago in my high school classroom, I was shocked to hear an announcement on the address system that President Kennedy had been shot while traveling in Dallas, Texas. Only minutes later, it seemed, the school principal returned to the address system, reporting sadly that the President was dead.

My memory holds such images from November 1963: the horse-drawn caisson in the streets of Washington, DC; the dark, riderless horse with boots backwards in stirrups; President Kennedy's young son, saluting as he stands with his mother and sister; President Johnson, his hand on a Bible, taking the oath of office on Air Force One with Mrs. Kennedy beside him, her husband's blood stains visible on her skirt; the assassination of Lee Oswald by Jack Ruby, broadcast live on television.

Some 37 years later, John Fey, MD, a surgeon, and I set out on foot to find Dealey Plaza from our hotel in Dallas, where we were attending a conference on patient safety. What an experience to visit the place where the President's murder took place – to see the confined space of the sixth floor in the school book depository, now a museum, and to walk the surprisingly small area bordered by North Houston and Elm Streets, where the book depository was located. Dr. Fey and I were touched to be at Dealey Plaza, to view the artifacts of the assassination, and to refresh our memories and our emotions of that time.

What a sad, bitter, and angry time it was.

Congratulations, Doctors!

Congratulations to the physicians listed in last month’s CNY Magazine as “best doctors.” I want to acknowledge and congratulate all who practice at Community General Hospital, starting with our Medical Staff President, David Halleran, MD (photo, at left) of Colon Rectal Surgeons of Central New York, along with his partner John Nicholson, MD.

Others from the list include our intensivists Russell Acevedo, MD and Daniel Polacek, both of Critical Care Associates; John McCabe, MD, leader of the emergency medical group that provides services at Community General; James Tifft, MD, of Associated Gastroenterologists of Central New York; and John Gullo, MD, and Anthony Scalzo, MD, both of Hematology Oncology Associates of Central New York, which operates a cancer care and hematology center on the campus of Community General.

Congratulations, as well, to Francisco Gomez, MD, (photo, at right) of CNY Neurology; Leonard Levy, MD, Chair of the Department of Pediatrics; Robert Weber, MD, Medical Director of our Physical Medicine and Rehabilitation Service; Mark Levinsohn and David Thompson, MD, of the radiology group that provides services at Community General; as well as surgeon Robert Schwartz, MD, of Vascular Care.

It is a tribute, indeed, to be recognized by your peers!

Sunday, November 9, 2008

Why hospitals seek 'herd immunity'

"Herd immunity” occurs when a sufficiently large part of a population is immune to a disease. A large number of immune individuals effectively interrupts the chain of contagion from person to person. This can prevent an epidemic, and it can confer indirect protection against the disease for members of the population who are without individual immunity.

Herd immunity is why hospitals, consistent with advice of the CDC and the Joint Commission, work hard to get flu shots for their physicians, employees, and volunteers. A high level of flu vaccination within the "hospital herd” helps protect vulnerable patients – those who are older, those with multiple conditions, and those with weakened immune systems.

Richard Daines, MD, the New York State Commissioner of Health, says flu shots for physicians and hospital workers are a matter of patient safety:

[T]he failure to adequately immunize HCP (health care personnel) is a patient safety issue….Low vaccination rates among HCP are associated with an increased number of outbreaks, poor patient outcomes, and increased employee absenteeism. Despite this, HCP vaccination rates remain low…
According to the National Foundation for Infectious Diseases, the percentage of health care workers getting flu shots was 42% in 2006. Dr. Daines has set a goal of 60% flu vaccinations for health care workers by 2010.

I’m pleased to observe that 74% of the employees at Community General Hospital received the flu vaccine last year. We're working for an even greater percentage this flu season.

The flu season is upon us, and the Department of Health tracks the flu, county by county. See the state map (above), which is updated weekly. Influenza was confirmed in six New York counties the week of November 1.

In recent weeks the infection control staff has given flu shots all over Community, including on weekends and evenings. Yesterday, nurse leaders conducted a flu clinic for employees and members of their families. My thanks to Employee Health and to Infection Control and Nursing Services for their special efforts to assure herd immunity at Community General this flu season.

Sunday, November 2, 2008

The coming crisis in pension funding

In a discussion last month with candidates for national office, I voiced a concern about the impact of the current economic crisis on pension plan funding. I spoke about the federal requirement that would make companies, including hospitals, pay significant amounts of cash to make up in one year the significant losses suffered by their defined pension pension plans in this year’s stock market.

The economic crisis is quite extraordinary. Stocks have tumbled 30% below their value last year at this time. It is unrealistic to expect companies to make up the shortfalls in their pension funds in a short amount of time.

Most pension plans have at least 50% of their funds invested in the stock market. On October 30 the Wall Street Journal reported that, of 361 defined benefit pension plans operated by companies on the Standard & Poors 500 list, stocks typically account for 50-70% of their investments. “Pension plan shortfalls,” the Journal reported, “will likely result next year in hits to earnings… and possibly [hits to] cash at a number of companies.” This could happen not only at the big, publicly traded corporations. It could happen at modest-sized, not-for-profit hospitals, as well.

The Pension Protection Action of 2006 (PPA) requires companies to achieve 94% of their target pension funding next year. The target level has been creeping up year-by-year and will reach 100% in a few years. Assuming the 30% decline in stock values continues through year-end, getting to the PPA’s target funding will require millions of dollars in cash from companies that are already strapped. This is the prospect unless there is a miracle stock market recovery equivalent in size to the disastrous performance seen since September.

I recently spoke about this looming problem to a member of the House Ways and Means Committee. I don't think he was being facetious when he told me Congress really shouldn’t pass laws about things it poorly understands, such as actuarial requirements and accounting rules. However, that is exactly what Congress does. It passes such laws, just as it did in 2006 when the PPA was enacted.

One candidate for office with whom I spoke speculated that a solution to pension underfunding might be to extend the pension plan coverage provided by the Pension Benefit Guarantee Corporation (PBGC). But that won’t work for a couple reasons.

First, the PBGC is itself under funded. In testimony last month before the House Committee on Education and Labor, Charles Millard, PBGC Director, acknowledged that “PBGC has been in a deficit position for most of its existence.” He said, "the single-employer program lacks the resources to fully satisfy its benefit obligations" See Mr. Millard's graph, below. As of 2007 the PBGC had an accumulated deficit of $14.1 billion.

Here's a second reason extending PBGC coverage won't work: to do so, the PBGC would have to increase its premiums to the companies whose plans are covered. That would mean additional out-of-pocket cash from the strapped companies.

The solution isn’t to prepare for more PBGC bailouts. The solution is to change the PPA rules for the extraordinary circumstance in which we find ourselves. Congress should make it possible for companies to adequately fund their pension plans over longer periods of time. Companies have to be able to meet their funding targets in a reasonable way – or they won’t meet them at all.

The American Benefits Council has started to talk about this, proposing last week to the Ways & Means Committee a ten-point plan to deal with “the [pension] funding requirements that were unanticipated just weeks ago.” The Council called upon Congress to enact changes that would avoid the huge cash calls that are now possible for organizations across the county as PPA requirements collide with the stock market's extraordinary losses.

With the national elections nearly behind us, dealing with the coming crisis in pension funding is an important (and apparently as yet unrecognized) responsibility of our elected leaders.