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BLOGZOT 2.0 on MacZOT.com is a promotion whereby software is exchanged for publicity. Today's incarnation is for SubEthaEdit from CodingMonkeys, a very highly regarded text editor and collaboration tool.
The price for SubEthaEdit is normally $35, but today the price drops 5 cents for each blog post about the promotion. As I write this, it's down to $19; two hours ago it was $20. If the promotion manages to get the cost down to $0.00, MacZOT and TheCodingMonkeys will award $105,000 in Mac software.
The deal lasts and the price drops until midnight Pacific or until 3,000 bloggers have posted, so if you want SubEthaEdit for less than retail, start blogging.
the health care future of Metropolis
(Reminder: To read the article referenced by this post or any post, click the headline.)
Oh, goody – there are now hospitals that could be mistaken for four-star hotels. With beds in the rooms for family, and quilted bathrobes, and gourmet food, and carpet, and flat-screen TVs.I didn't know flat-screen TVs were essential to post-operative cardiac care. Apparently I was wrong. I'll be sure to mention that to AACN for inclusion in the next CCRN exam.
"Specialty hospitals" are opening up all across the country – facilities that concentrate on profitable procedures for profit-minded surgeons. Profitable procedures like CABGs, total knees, lap cholecystectomies (gall bladder removal through 4 or 5 tiny incisions) – you know, the stuff that makes the money for a hospital, instead of the uninsured motorcyclist with half his brain on the pavement and the other half spilling out into the ED's nice tiled floor.
After all, these poor surgeons are just living out their dreams:
It wasn't money that fueled the dreams of a lot of Fresno's surgeons. What they wanted — and built — were hospitals they could call their own. They created the concrete embodiment of their every professional fantasy, places where they could work unencumbered by department bureaucracies and where their patients' care and comfort would be the top priority.
This sounds good to everybody on the surface, but it's not.
These 'heart hospitals' and 'surgery centers' are taking the money away from hospitals that have ICUs and emergency departments and trauma staff. Running a hospital is in many ways like running an NCAA athletic program – the things that bring in the dough pay for a lot of the things that don't. At OU, football pays for basketball, fencing, gymnastics, and everything else. In a hospital, surgery pays for the care of diabetics, cancer patients, and people who come to the emergency department after they've had motor vehicle accidents, strokes, or the flu.
There's very little money in being a trauma center, because much of the trauma care is for uninsured or underinsured patients requiring massive resources, and those resources have to be available 24/7. There's even less money to be made from medical units, like floors that take patients with emphysema and chronic bronchitis or diabetes. Intensive care units don't bring in the dough because they're so unpredictable and so dependent on expensive technology. 'Non-profit' when used with the word 'hospital' doesn't really mean no profits – it means no stockholders. The money has to come from somewhere to pay for the emergency care you expect.
As if that wasn't enough, a huge majority of the patients in these specialty hospitals are otherwise healthy, with no underlying or contributing health conditions, and they have few or no complications. That's good for those patients but bad for everybody else – if the non-profit hospitals only get the sickest of the sick and the worst surgical candidates, they're obviously going to have patients with longer stays that cost more money. The specialty hospitals get the cream of the crop while non-profits pick up the leftovers and have to care for everyone who walks (or rolls) in the door.
The for-profit facilities described in this article sound great for a fussy patient, and they might be very good employers, maybe even as good as the writer seems to believe. But I've got my doubts:
In their dream-come-true hospitals, administrators don't scramble to hire nurses. They have the cream of the crop pounding on their doors. Doctors are in charge of scheduling the operating rooms, and when they walk in, they get handed patient files, updates on their conditions — all in an uncluttered work area.
"You walk into a regular hospital, and you have to find your charts. Nurses and technicians have purses and backpacks spread all over, and there's no place to sit. Then you have to try to find your patient, find out who your nurse is," says Chambers.
"Suddenly, you say, 'By God, I'm going to do it my way.' ""There was a sense that we were being disenfranchised. It was hard to get our patients in, hard to get the hospital to work with us," says Dr. Robert Chambers, a cardiac surgeon in Fresno who with colleagues opened the Fresno Heart Hospital. "We wanted more nurses, more involvement, more [operating room] time."
I've never seen a disenfranchised surgeon, but that's not the part that bothers me. He insinuates that it's the nurses' fault that life isn't peaches and cream at a non-profit hospital.
Yes, of course, hospitals should make the doctors happy – all the doctors, including the endocrinologists who have diabetic patients, the gastroenterologists who care for IBD patients like me, and the oncologists whose cancer patients need hope instead of wall-to-wall carpeting. The surgeons go through something during their residency that makes them feel entitled, and I don't know what that is. It's worse in some than in others, but there are dozens of other physicians practicing at a given hospital that don't act as if they have been anointed or something. They are all working together to provide a service to a community, not to themselves alone.
And that's why I've called this post 'the health care future of Metropolis.' We're each living in our own Metropolis, be it on the east coast or the Great Lakes or the southwest. Every Metropolis has a finite amount of health care resources; some people are happy with the emergency departments at Metropolis's hospitals and some tell horror stories of waiting 8 hours for stitches and antibiotics. It's the same story all across the country, with slightly different players. You only think your particular town is better or worse than the rest. Let's play a little game – you live in one particular Metropolis, and I say what happens to you. :-)
You are at your family doctor's office one day because you can't stand the pain in your knee anymore, and your doctor told you last time that replacement was the only option. You're here to be referred to an orthopedic surgeon. While waiting, you look over a brochure for Metropolis Surgery Center (MSC), which opened about 18 months ago. You see the high-end furnishings and the promises of attentive staff and plasma TVs, and you think to yourself that it might feel good to tell your friends, "I'm going to have my operation at MSC, because they have oak cabinets, and beautiful curtains, and it's all carpeted. And there's even a sofa for my husband to sleep on all night." So based on brochures and news articles, when you need your knee replaced you choose a surgeon who practices only at MSC over another excellent orthopedic surgeon who only operates at University Hospital of Metropolis (UHM). UHM is a teaching hospital and a Level I trauma center, meaning that UHM has met a very stringent qualification procedure outlined by the American College of Surgeons and is one of the best trauma facilities in the country. (Level I trauma centers don't grow on trees – Oklahoma has only one, the OU Medical Center, and that is a big reason why Oklahoma's trauma system has been so poor. But back to the game.)
Your surgery goes well, and you're thrilled with the level of attention you receive at MSC: You got a thick, new bathrobe with matching slippers to wear, you had your own personal nurse with no one to care for but you, and for dessert at your last evening meal you had crème brûlée. The other patients you saw as you made your walks were all surgical patients that seemed to be a lot like you – you didn't see any of those "sick people" usually found in a hospital. Your insurance paid for everything and your knee works just fine. MSC definitely provided top-notch care and you're a satisfied customer. You tell all your friends, especially the friends with bum hips and knees and heart disease.
Six months after your surgery at MSC, your 26-year-old son crashes his car late at night trying to avoid an animal that ran out onto the highway in front of him. He is taken by ambulance to UHM, the teaching hospital, where the emergency physician tells you he has a broken pelvis and a shattered right femur (thighbone), among other serious injuries. The doctor goes on to tell you that if your son had had this accident two months ago, he would have had the best care in the region from a terrific orthopedic surgeon, but now they can't give him the procedure he needs – the surgeon left UHM and MSC lost its Level I trauma status. Why did UHM lose it? Because they couldn't afford it anymore – MSC and other facilities like it had taken more than 70% of the elective and non-emergent surgeries away from them, and they had to cut their budget and staff. UHM's beds are now full of COPD patients, diabetics, cancer patients, and patients in kidney failure; they're losing money so fast that they may have to shutter entire units. Your son probably will be permanently crippled from this accident because MSC doesn't take emergent cases and the nearest Level I trauma center is 300 miles from your Metropolis.
Who is to blame?
All of us. We're all to blame for valuing the almighty dollar over what's best for our communities and neighborhoods. We're all to blame for expecting champagne health care on a tap water budget. We're all to blame for thinking the problems of hospitals and clinics are somebody else's problem, instead of our own problem. We're all to blame because we cannot continue to cut Medicare reimbursements and insurance payments to hospitals while lining the pockets of the wealthiest 1% of Americans and the CEOs of managed-care companies.
If you have a choice for a surgical procedure between the teaching hospital and the Metropolis Surgery Center, think about the real choice you're making, which is actually the future of health care in this country: the choice between what's good for some surgeons and what's good for Metropolis. Remember, too, that you're not just mulling it over in your head while reading this blog – you do it with every choice you make, every day.
Yes, it is that easy to change the health care system – for better or worse.
the health care future of Metropolis
(Reminder: To read the article referenced by this post or any post, click the headline.)
Oh, goody – there are now hospitals that could be mistaken for four-star hotels. With beds in the rooms for family, and quilted bathrobes, and gourmet food, and carpet, and flat-screen TVs.I didn't know flat-screen TVs were essential to post-operative cardiac care. Apparently I was wrong. I'll be sure to mention that to AACN for inclusion in the next CCRN exam.
"Specialty hospitals" are opening up all across the country – facilities that concentrate on profitable procedures for profit-minded surgeons. Profitable procedures like CABGs, total knees, lap cholecystectomies (gall bladder removal through 4 or 5 tiny incisions) – you know, the stuff that makes the money for a hospital, instead of the uninsured motorcyclist with half his brain on the pavement and the other half spilling out into the ED's nice tiled floor.
After all, these poor surgeons are just living out their dreams:
It wasn't money that fueled the dreams of a lot of Fresno's surgeons. What they wanted — and built — were hospitals they could call their own. They created the concrete embodiment of their every professional fantasy, places where they could work unencumbered by department bureaucracies and where their patients' care and comfort would be the top priority.
This sounds good to everybody on the surface, but it's not.
These 'heart hospitals' and 'surgery centers' are taking the money away from hospitals that have ICUs and emergency departments and trauma staff. Running a hospital is in many ways like running an NCAA athletic program – the things that bring in the dough pay for a lot of the things that don't. At OU, football pays for basketball, fencing, gymnastics, and everything else. In a hospital, surgery pays for the care of diabetics, cancer patients, and people who come to the emergency department after they've had motor vehicle accidents, strokes, or the flu.
There's very little money in being a trauma center, because much of the trauma care is for uninsured or underinsured patients requiring massive resources, and those resources have to be available 24/7. There's even less money to be made from medical units, like floors that take patients with emphysema and chronic bronchitis or diabetes. Intensive care units don't bring in the dough because they're so unpredictable and so dependent on expensive technology. 'Non-profit' when used with the word 'hospital' doesn't really mean no profits – it means no stockholders. The money has to come from somewhere to pay for the emergency care you expect.
As if that wasn't enough, a huge majority of the patients in these specialty hospitals are otherwise healthy, with no underlying or contributing health conditions, and they have few or no complications. That's good for those patients but bad for everybody else – if the non-profit hospitals only get the sickest of the sick and the worst surgical candidates, they're obviously going to have patients with longer stays that cost more money. The specialty hospitals get the cream of the crop while non-profits pick up the leftovers and have to care for everyone who walks (or rolls) in the door.
The for-profit facilities described in this article sound great for a fussy patient, and they might be very good employers, maybe even as good as the writer seems to believe. But I've got my doubts:
In their dream-come-true hospitals, administrators don't scramble to hire nurses. They have the cream of the crop pounding on their doors. Doctors are in charge of scheduling the operating rooms, and when they walk in, they get handed patient files, updates on their conditions — all in an uncluttered work area.
"You walk into a regular hospital, and you have to find your charts. Nurses and technicians have purses and backpacks spread all over, and there's no place to sit. Then you have to try to find your patient, find out who your nurse is," says Chambers.
"Suddenly, you say, 'By God, I'm going to do it my way.' ""There was a sense that we were being disenfranchised. It was hard to get our patients in, hard to get the hospital to work with us," says Dr. Robert Chambers, a cardiac surgeon in Fresno who with colleagues opened the Fresno Heart Hospital. "We wanted more nurses, more involvement, more [operating room] time."
I've never seen a disenfranchised surgeon, but that's not the part that bothers me. He insinuates that it's the nurses' fault that life isn't peaches and cream at a non-profit hospital.
Yes, of course, hospitals should make the doctors happy – all the doctors, including the endocrinologists who have diabetic patients, the gastroenterologists who care for IBD patients like me, and the oncologists whose cancer patients need hope instead of wall-to-wall carpeting. The surgeons go through something during their residency that makes them feel entitled, and I don't know what that is. It's worse in some than in others, but there are dozens of other physicians practicing at a given hospital that don't act as if they have been anointed or something. They are all working together to provide a service to a community, not to themselves alone.
And that's why I've called this post 'the health care future of Metropolis.' We're each living in our own Metropolis, be it on the east coast or the Great Lakes or the southwest. Every Metropolis has a finite amount of health care resources; some people are happy with the emergency departments at Metropolis's hospitals and some tell horror stories of waiting 8 hours for stitches and antibiotics. It's the same story all across the country, with slightly different players. You only think your particular town is better or worse than the rest. Let's play a little game – you live in one particular Metropolis, and I say what happens to you. :-)
You are at your family doctor's office one day because you can't stand the pain in your knee anymore, and your doctor told you last time that replacement was the only option. You're here to be referred to an orthopedic surgeon. While waiting, you look over a brochure for Metropolis Surgery Center (MSC), which opened about 18 months ago. You see the high-end furnishings and the promises of attentive staff and plasma TVs, and you think to yourself that it might feel good to tell your friends, "I'm going to have my operation at MSC, because they have oak cabinets, and beautiful curtains, and it's all carpeted. And there's even a sofa for my husband to sleep on all night." So based on brochures and news articles, when you need your knee replaced you choose a surgeon who practices only at MSC over another excellent orthopedic surgeon who only operates at University Hospital of Metropolis (UHM). UHM is a teaching hospital and a Level I trauma center, meaning that UHM has met a very stringent qualification procedure outlined by the American College of Surgeons and is one of the best trauma facilities in the country. (Level I trauma centers don't grow on trees – Oklahoma has only one, the OU Medical Center, and that is a big reason why Oklahoma's trauma system has been so poor. But back to the game.)
Your surgery goes well, and you're thrilled with the level of attention you receive at MSC: You got a thick, new bathrobe with matching slippers to wear, you had your own personal nurse with no one to care for but you, and for dessert at your last evening meal you had crème brûlée. The other patients you saw as you made your walks were all surgical patients that seemed to be a lot like you – you didn't see any of those "sick people" usually found in a hospital. Your insurance paid for everything and your knee works just fine. MSC definitely provided top-notch care and you're a satisfied customer. You tell all your friends, especially the friends with bum hips and knees and heart disease.
Six months after your surgery at MSC, your 26-year-old son crashes his car late at night trying to avoid an animal that ran out onto the highway in front of him. He is taken by ambulance to UHM, the teaching hospital, where the emergency physician tells you he has a broken pelvis and a shattered right femur (thighbone), among other serious injuries. The doctor goes on to tell you that if your son had had this accident two months ago, he would have had the best care in the region from a terrific orthopedic surgeon, but now they can't give him the procedure he needs – the surgeon left UHM and MSC lost its Level I trauma status. Why did UHM lose it? Because they couldn't afford it anymore – MSC and other facilities like it had taken more than 70% of the elective and non-emergent surgeries away from them, and they had to cut their budget and staff. UHM's beds are now full of COPD patients, diabetics, cancer patients, and patients in kidney failure; they're losing money so fast that they may have to shutter entire units. Your son probably will be permanently crippled from this accident because MSC doesn't take emergent cases and the nearest Level I trauma center is 300 miles from your Metropolis.
Who is to blame?
All of us. We're all to blame for valuing the almighty dollar over what's best for our communities and neighborhoods. We're all to blame for expecting champagne health care on a tap water budget. We're all to blame for thinking the problems of hospitals and clinics are somebody else's problem, instead of our own problem. We're all to blame because we cannot continue to cut Medicare reimbursements and insurance payments to hospitals while lining the pockets of the wealthiest 1% of Americans and the CEOs of managed-care companies.
If you have a choice for a surgical procedure between the teaching hospital and the Metropolis Surgery Center, think about the real choice you're making, which is actually the future of health care in this country: the choice between what's good for some surgeons and what's good for Metropolis. Remember, too, that you're not just mulling it over in your head while reading this blog – you do it with every choice you make, every day.
Yes, it is that easy to change the health care system – for better or worse.
Copyright 2008 Braised Lambchop
This page was last updated: Tuesday, April 25, 2006 at 2:17:09 PM
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