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From Elsewhere: Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality and man does it tell a story

Last week, CMS, the Centers for Medicare and Medicaid Services, announced the names of hospitals who received bonuses for quality. It also listed the names of hospitals which received penalties. Kaiser Health News has done a great job of covering the story.

Here’s what I find to be the single, most telling thing:

Nicholas Genna, CEO of Treasure Valley Hospital in Idaho, recipient of the biggest bonus, credited close attention to patients, including a low nurse-to-patient ratio and handwritten thank-you notes to patients, along with the fact that the doctors own the hospital. “People answer the phone with a smile on their face,” he said.

If that doesn’t validate…nay…quantify the importance of making patient experience the top priority, I don’t know what does.

Compare Mr. Genna’s comments to those from the most penalized hospital:

Thomas Filiak, the chief operating officer at Auburn Community Hospital in New York, which received the largest penalty, said executives have begun a number of initiatives to lower noise near patient hallways, including putting new wheels on squeaky food carts. “They sounded like Mack trucks going through the hallway,” he said.

One speaks to actions and the other to lip service. Sure, squeaky carts are annoying and may lead to a less than favorable result on one particular HCAHPS question. But ask yourself this, for which of these places would you rather work? At which would you rather seek care?

Don’t get me wrong, I’m applauding Mr. Filiak’s efforts and I’m sure the leadership team at Auburn Community is well poised for a fantastic turnaround — I’m looking forward to reading that story in 2013.

What I’m suggesting is that Treasure Valley’s success is clearly the result of a patient-centered culture, and it shows in how patients feel about them and in turn how Medicare is rewarding those kinds of culture.

via Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News.

Socioeconomic factors and health outcomes in Virginia

  The quality of healthcare matters and it is one of the more difficult things for a consumer/patient to gauge. We can tell if a consumer product is cheaply made, or if a dining experience is sub par. It is harder to observe, research, quantify and compair the quality of healthcare. For most Americans, unless it is a major procedure, or requires services offered at a specialty location, we probably stick close to home. But what if the quality of care close to home is vastly different than even a few hours away?

Another very interesting angle is to consider is if variations in outcomes and quality are not simply in the hands of the provider, but also influenced by socioeconomic factors. Do you have access to high quality food and can you afford it? Do you have access to health education and do you have the means to follow the recommendations? Do work conditions in manufacturing-dominated areas contribute to health issues that aren't as prevalent in professional areas?

This week, the Robert Wood Johnson Foundation released an interactive tool for exploring health outcomes by geographic area. In Virginia, there are some pretty clear relationships between positive health outcomes and medican household income. I've not reviewed enough data to suggest any causalities. For instance, are better care facilities found in more populated areas and therefor those areas have better outcomes? Regardless, the relationship between low income and poor health outcomes is worthy of discussion; particularly as our country continues the debate over national health reform.


New York Times Economic Samples from 2005-2009:

In this case, the colors are inverse. The upper map shows positive health outcomes in white and light green. For instance, Nelson (NE) and Albemarle  (AE) counties. The lower map shows higher household incomes in dark green. For instance: Fredricksburg and Charlottesville metropolitan areas.

The relationship is a little more clear if we look at county by county:

Rank Health Income
1 Fairfax City of Calls Church
2 Arlington Arlington
3 Loudoun City of Alexandria
4 Albemarle Fairfax
5 York Loudoun
6 Alexandria City of Fairfax
7 James City James City County
8 Clarke Goochland County
9 Powhatan Albemarle
10 Mathews Fauquier

source: Health - RWJF, Income - Wikipedia

To be absolutely clear, this is not a scientific study. There are likely many other factors which should be considered including population density, density of qualified healthcare providers, etc. We need to also think about other things that go hand-in-hand with economic disparity. For instance, areas of low income are traditionally associated with fewer healthy options for food and are sometimes classified as food deserts. Areas of high income tend to also have better education, which has a well studied cause and effect relationship to positive health outcomes.

My point in sharing this comparison is simply to call attention to the large variation in health outcomes, even in a single state and to raise the question of socioeconomic factors, as well as variations in clinical quality, as a contributing factor. What do you think?

stuff that matters - cast iron What is it they say about stuff? You don't own it, it owns you. I get that. Did I mention we hired an organizational specialist recently? But sometimes there are things which do matter in our lives. Quality things. Important things. Sentimental things.

I'm a big fan of quality in stuff. Sure, who buys junk, right? Maybe I'm a little more obsessive than most. When I get into something, I tend to research the heck out of it. I keep buying the same make and model of car because I did my research and really like how well it is made. I wear one brand of dress shirt because after 10 years the first one I bought still looks crisp and presentable. I'm a Mac because they tend to break less than other computers I've owned.

Quality doesn't have to mean expensive. In fact, some of the best made things may be the least expensive. Take cooking, you can spend $300 on a single pan (don't ask me how I know). Lately, I've been cooking on cast iron... like a lot. Cast iron is cheap, you can get a great Lodge brand pan at your local hardware or Amazon for $20. Its thick, heavy and feels substantial. You know the handle isn't going to melt in the oven or break off. When properly seasoned, they are better than any nonstick pan for eggs. You can crank the heat all the way up on cast iron pan and never worry about it warping or discoloring. You can smash garlic or pepper corns with the bottom, turn it upside down to heat up tortillas, take it camping and stick it in the fire... see what I mean? These things rock!

By the way, I'm not alone in my adoration of cast iron cookware. Cast iron, like bacon, has become the topic of twitter exchanges in some circles.

I have memories of staying with my mother's parents in the summers as a kid for a week or two each year. My grandmother got up every morning at 4:30 AM. She made breakfast, worked a crossword... well, I'm not entirely sure what all she did. I don't think I've ever been up at 4:30.

By the time I was a kid, biscuits came in vacuum tubes and pancakes in boxes. I think my grandmother probably used those store bought items. I've often lamented the current state of packaged foods as an interesting mix of marketing, generational apathy (get off my lawn!) and connivence. If there was a time when my grandmother got up at 4:30 AM to make biscuits, I'm pretty sure it wasn't because she enjoyed being up that early. Making biscuits is hard work and takes time. When someone came along and put them in that fun , explosive tube, well, game over, sign us up, no more kneading dough! Still, doing things the right way matters. You can't really make southern biscuits without cast iron and you can't really fry a catfish in anything else.

A few months ago my grandfather passed away. He had not been well and I'm truly sure he is in a better place. My grandmother had passed a few years before. When it was time to clean out their home I was asked if there was anything I wanted. "Find me the cast iron pan please."

"Nothing else?"

"Nope, just the pan."

Truthfully, I don't know if my grandmother ever made biscuits in this pan or if grandaddy ever fried a fish in it. It may not be that old, although the markings suggest it is. It was pretty banged up and in need of some care. I ran it through the self clean cycle of my oven and have begun the process of "re-seasoning" it. Its not my only cast iron pan - I have lots. But I find myself using it more than the others. Maybe its the size, maybe its the memories; it just feels right.


Oh, and so this properly qualifies as a food post for me...

The other  night I made the most amazing lamb's liver in the pan. I find lamb's liver is pretty mild and doesn't need a soaking. Sprinkle with sel gris, and dust really well with flour. It helps to really push the flour in like in this pork chop recipe. Let it rest for 10 minutes while you render some pancetta and melt the onions in the pan. Remove the pancetta and onions. Crank the heat to high. Use the pancetta grease in the pan and lay the liver in. When you see crimson pools of blood just starting on the uncooked side, give it a flip. You want liver to be rare; anything else is chalky and tough. When you see crimson on the cooked side, take it out of the pan.

I reduced the heat, splashed in some port and sherry vinegar, added the pancetta, onions and some home cured sauerkraut and warmed it through.