Thursday, December 30, 2010

Our new website with Upstate

Community General Hospital and Upstate Medical University have started a combined website, a joint project to help keep everyone informed as we plan to combine the two hospitals in 2011.

Happy new year!

Tuesday, December 28, 2010

Medicine's limits, and patient needs

There was a small, important article in Bloomberg News last week by David Klein, the CEO of Excellus, the large BlueCross BlueShield insurer in Upstate New York.

Mr. Klein discusses lessons learned during his wife's battle with cancer. He speaks plainly about what must be a very confounding and very emotional period in their life together. He notes that sometimes "clear answers don't exist" in medicine, despite the best research and despite the care of able practitioners.

David Klein's article emphasizes both the human and the humane: respect for the art of medicine, not just its scientific content, and the importance of emotional and spiritual support in patient care.

These are important reminders for professionals and lay people alike.

Friday, December 24, 2010

Today's poinsettias

The poinsettia plants being delivered to patients today remind me of the generosity of Morris Berman, one of the founders of Community General Hospital.

When he was alive, Morey Berman, a prominent Syracuse attorney, would call Community General Hospital each December and request that poinsettias be given to any patient who was otherwise without flowers over the holiday season.

"Send the bill to me," Morey would say, but he never wanted credit for the gift. "Just enclose a card saying, 'Happy holidays from the Board of Directors.'"

That's how I first met Morey. I was usually the guy receiving his call, and I would work with nurses to identify patients and make arrangements for the flowers.

As a young lawyer, Morey Berman chaired the 1957 study that resulted in a new Community Hospital of Greater Syracuse opening on Onondaga Hill in 1963. I wrote about this history a few years ago.

Morey's brother, Dr. Leon Berman, was President of Community's Medical Staff (1965-1967), and Morey served as Chairman of the Board of Directors (1970-1973). What a remarkable family that produced these siblings!

This morning, when I saw the poinsettia plants filling a conference room at the Community General Foundation, I remembered Morey Berman and his thoughtfulness for hospital patients. In the years since his death, an anonymous donor has continued the poinsettia tradition at Community in Morey Berman's memory.

Sunday, December 19, 2010

Holiday tea

My thanks to all who made the annual Holiday Tea so enjoyable last week, especially the Food Service and Human Resource Departments. Those departments work each year so that the rest of the Community General Hospital family can enjoy the season and one another's company.

Saturday, December 18, 2010

ACOs as "inside baseball"

Local hospitals and physician groups are talking about accountable care organizations (ACOs), the somewhat mythical structures that are envisioned in the Protection and Affordable Care Act (PPACA), also known as "health care reform."

I say "somewhat mythical" because ACOs do not actually exist. . . at least, not yet.

PPACA encourages providers to form ACOs so they can benefit by sharing a percentage of savings they generate for Medicare. An ACO, according to PPACA, is “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in Medicare’s traditional fee-for-service program.”

The Centers for Medicare and Medicaid (CMS) says that ACOs may be started by physicians, by medical group practices, or by medical practice networks. They may be partnerships or joint ventures involving hospitals and physicians, or it may involve hospitals employing physicians.

I recently posted comments about hospitals that have bought medical practices to "align physician and hospital performance" for health care reform. Purchasing medical practices is a likely step toward the formation of ACOs in Central New York.

CMS says it will establish the ACO program one year from now -- on January 1, 2012. Right now ACO polices and standards are in the developmental stage. CMS has asked for public comments about ACO characteristics and functions. At a workshop in October, CMS (with the FTC and the OIG) promised to develop safe harbors for ACO structures. “Safe harbors” are legal structures that have automatic clearance from government anti-trust laws.

One of the confusing things about ACOs, as I understand them, is their invisibility to beneficiaries and patients. The providers who join an ACO would not apparently have to tell their patients about it. Nor would any patient be obligated to seek care only from the ACO providers.

ACOs are expected to save money by better care coordination, such as preventive care, early treatment, avoiding duplicate tests, etc. But Medicare beneficiaries would not know that their care is being coordinated within an ACO network. As CMS explains, “[a]ssignment [of the individual to an ACO] will be invisible to the beneficiary, and will not affect their guaranteed benefits or choice of doctor. A beneficiary may continue to seek services from the physicians and other providers of their choice, whether or not the physician or provider is a part of an ACO.”

Although not “enrolled” in an ACO, beneficiaries would somehow be “assigned” to one. Exactly how assignment might work is the subject to public comment – see the recent Federal Register (November 17, 2010).

It may seem that managed care plans, which have been around for decades, offer models for ACOs. But is that the case? Beneficiaries who are enrolled in managed care plans know it. They have "gatekeepers" who actively or passively coordinate their care, determining whether care is covered and which providers are eligible to provide the care. Managed care also presumably confers a vale for individual beneficiaries through lower premiums or co-pays.

If I understand the ACO concept correctly, providers will be responsible for the cost of all the care beneficiaries receive

- even if those beneficiaries don't know their care is being coordinated within an ACO network;

- even if beneficiaries are not obligated to get their care from the ACO's providers; and

- even if beneficiaries experience no personal advantage by being assigned to an ACO.

A recent white paper about the 30-year experience of managed care in California suggests that “efforts to apply care coordination techniques to the open choice . . . environment have not been successful.”

The author James Robinson, Director of the Center for Health Technology, recently told Modern Health care magazine that beneficiary choice poses a major obstacle to care coordination. He called it "the biggest challenge to ACOs. . .”

Discussing ACOs may seem a bit like talking inside baseball. This is an active topic within the health care industry. Decisions about player changes shape next year's baseball season. Watching CMS decision-making will help us understand the impact of ACOs on Medicare services and costs.


Saturday, December 11, 2010

Remembering Bastogne

December 13. That is the date that begins the story told by Dr. John Prior about his experiences in Bastogne, Belgium in 1944.

A few years ago I posted Dr. Prior's
memoir about the Battle of the Bulge. This is a fitting time of year to recall his story.

I recently heard about this episode in history from
Martin King, a British author who is finishing a book about Bastogne, based on the experience of Augusta Chiwy.

Ms. Chiwy is one of the nurses who worked with Dr. Prior when their aid station in Bastogne took a direct hit from a German fighter-bomber on Christmas eve, 1944. Thirty American soldiers died in the aid station, along with one of the nurses, Renee Lemarie.

Augusta Chiwy survived the blast and is still living.

Dr. Prior passed away in Syracuse, NY at age 90 in 2007.

That's a young Captain John Prior, pictured at right, when he served with the Medical Battalion of the 10th Armored Division. At left is Dr. Prior in the 1980's as Chairman of Pathology at Community General Hospital. He also served as President of the Onondaga County Medical Society at the time.

Episode 6 of the HBO television series Band of Brothers includes scenes in the aid station in Bastogne, and both Augusta Chiwy and Renee Lemarie are portrayed briefly in the dramatization (but not Dr. Prior).

Mr. King wrote me that Dr. Prior features prominently in his book about Augusta Chiwy. "The lives of Dr. Prior, Augusta and Renee Lemaire will always be inextricably linked due to the sequence of events that occurred in Bastogne during WWII," Mr. King said.

"I can't emphasize enough the major role that Dr.Prior played with the 10th Armored division . . . . His bravery and tenacity saved literally hundreds of US lives. Augusta remembers him with great affection."

That's a photo of Augusta Chiwy, at right, as a young woman. Below is a brief video about her that was made recently by Mr. King. I look forward to reading his book when it is published.

Monday, December 6, 2010

Dr. Joe Smith, 1946-2010

Dr. Joe Smith died Saturday.

Joe suffered much these past two years, a consequence of the accident that left him paralyzed in 2008. He was in and out of the hospital frequently, and it was easy to get discouraged. He acknowledges being discouraged -- and also being extremely grateful -- in his last, inspiring message. It was posted yesterday on the website of Syracuse Orthopedic Surgeons (SOS).

Joe was supported by a great family, especially his wife Carol, and his children. Carol cared unselfishly for Joe though all the difficulties. Joe was also supported by his friends, a loyal and steady tribe, many of whom have known him from childhood. They stayed in touch, visiting him, offering words of encouragement, helping the family.

When he retired as an orthopedic surgeon in 2005, Dr. Smith was a larger-than-life figure, having succeeded Dr. Bob Lockwood as Chair of Orthopedics. He was honored with an award from the Community General Foundation, and he served on the Community General Board of Directors.

After retirement, Joe loved to work in his garden. It was an avocation he shared with his father-in-law, about whom Joe always spoke with much affection and respect. Joe often brought a box of fresh vegetables when we met for lunch at Luigi’s Restaurant on Valley Drive. Luigi's was one of his favorite haunts.

Last January at the dedication of Community’s new Center for Orthopedics, speaker after speaker paid tribute to Joe, whose leadership helped shape orthopedic excellence at the hospital. Later that day, I gave a DVD copy of the dedication ceremony to State Senator John DeFrancisco, Joe’s high school classmate and lifelong friend. He took the disc with him when he visited Joe the following day. It was great that Joe was able to hear the words spoken in his honor and to see the new Center, “but it was very bittersweet to sit and watch it with him,” the Senator later told me.

“If you are reading or listening to this,” Joe writes in his final message, “I am no longer present in this world but hopefully moved on to a better spiritual place. I’d like to thank you, I’d like to thank everyone for their help and consideration and especially their love.”

Our thoughts are with you, Joe, and with Carol, your family and your friends.