PYA Principal Kent Bottles, MD, gave the keynote address, “Achieving Rapid Cost Reduction & Revenue Improvement by Engaging Clinicians & Administrators,” at the recent Healthcare Financial Management Association’s (HFMA) 2014 Fall Institute in Bloomington, Indiana. In the presentation, he talked about how to engage physicians in all of the efforts needed to respond to the Affordable Care Act and healthcare payment reform.
As patient engagement (aka consumer engagement) earns attention, the question increasingly arises: “Where do we start? What can we do?” More specifically, “What do we mean when we say ‘patient engagement’?” The Patient Activation Measure is a powerful tool for understanding where someone's at and how to interact with them differently.
At the 2014 HFMA National Institute, PYA Principal and Chief Medical Officer of PYA Analytics, Kent Bottles, MD, spoke about the strategies that hospitals and health systems are using to decrease per-capita cost, while increasing quality. In the session, “Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians and Administrators,” Bottles offered tactics for engagement.
Dr. Judith Hibbard presents The Case for Patient Activation - Activate 2017 b...mPulse Mobile
Leading patient activation researcher, Dr. Judith HIbbard, delves deep into the research findings of countless studies to reveal the definition, value and outcomes of patient activation during Activate 2017.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
In 2012 I spoke to this outstanding organization in York, PA, in Robert Wood Johnson Foundation's Aligning Forces for Quality program. Now we're getting back together to see how their work and the patient engagement and empowerment movement have both progressed, and what's next. First exploratory meeting.
As patient engagement (aka consumer engagement) earns attention, the question increasingly arises: “Where do we start? What can we do?” More specifically, “What do we mean when we say ‘patient engagement’?” The Patient Activation Measure is a powerful tool for understanding where someone's at and how to interact with them differently.
At the 2014 HFMA National Institute, PYA Principal and Chief Medical Officer of PYA Analytics, Kent Bottles, MD, spoke about the strategies that hospitals and health systems are using to decrease per-capita cost, while increasing quality. In the session, “Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians and Administrators,” Bottles offered tactics for engagement.
Dr. Judith Hibbard presents The Case for Patient Activation - Activate 2017 b...mPulse Mobile
Leading patient activation researcher, Dr. Judith HIbbard, delves deep into the research findings of countless studies to reveal the definition, value and outcomes of patient activation during Activate 2017.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
In 2012 I spoke to this outstanding organization in York, PA, in Robert Wood Johnson Foundation's Aligning Forces for Quality program. Now we're getting back together to see how their work and the patient engagement and empowerment movement have both progressed, and what's next. First exploratory meeting.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
iWantGreatCare's 7th National Symposium - Building fantastic staff morale, improving quality and reducing costs - took place on Tuesday 21st June at The King's Fund, London.
NHS leaders share their experiences of how they are building excellence in their Trust, reducing costs and growing staff morale by listening to the voice of the patient.
View the slides from these well-regarded delegates:
Alwen Williams, Chief Exective, Barts Health NHS Trust
David Behan, Chief Executive, Care Quality Commission
Dr Nadeem Moghal, Medical Director, Barking, Havering and Redbridge University Hospitals NHS Trust
Liz Mouland, Chief Nurse, First Community Health and Care
Jeremy Howick, clinical epidemiologist and philosopher
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
Changing practice through knowledge translation and implementation science.
Have you asked, told, taught and begged, but your hand hygiene results aren’t changing as quickly as you want? Changing practice is hard! Join CPSI on May 4th for an interactive webinar exploring the fundamentals of knowledge translation and the efforts of Public Health Ontario to change practice through this innovative science. We will also look at how you can impact patient and family hand hygiene efforts through the successful use of campaigns.
Improving the Health of Adults with Limited Literacy: What's the Evidence?Health Evidence™
Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.
This webinar focused on interpreting the evidence in the following review:
Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
Maxime Lê is a graduate of health sciences from the University of Ottawa that has worn many hats for many roles. Chief among them is being a patient advisor for The Ottawa Hospital. Having frequently been a patient and having a passion for health and healthcare, he decided to get involved at The Ottawa Hospital to help improve care, research and advocate for patients. Maxime, while sharing his hands-on experience and insights, answered the questions that healthcare providers, researchers, or prospective patient advisors may have, such as: ''What does it mean to be a patient advisor?'', ''Why is it important?'', and ''What impact does it have?''.
The webinar was followed by an interactive question and answer session.
Patient activation: New insights into the role of patients in self-managementMS Trust
This presentation by Helen Gilburt, Fellow at The King's Fund, looks at why some people are active at managing their health while others are quite passive, and how levels of patient activation impact on health outcomes.
It was presented at the MS Trust Annual Conference in November 2014.
Behavioral Health Staff in Integrated Care Settings | The Vital Role of Colla...CHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: May 06, 2019 | 3 p.m. EST
Experts in psychology, psychiatry and nursing will share ways in which they effectively utilize their roles at the top of their license to monitor and support high-risk patients. By examining these various roles, experts will address how you can effectively support integration at your health center to improve outcomes.
HXR 2016: Designing for Addiction and Recovery -Mary Beth Schoening, Behavior...HxRefactored
This panel is comprised of parents who’ve lost their children to addiction, a parent whose son is in recovery, and individuals themselves in long-term recovery. We will hear directly from them about their struggles, the impact on individuals and families dealing with addiction, as well as their opinions on where the system could benefit from solutions. The addiction issue is complex and would benefit from solutions in many areas. We invite you to join us to hear first hand.
London iCAAD 2019 - Dr Tim Leighton -WHAT IS ADDICTIONS COUNSELLING AND HOW S...iCAADEvents
In the UK, the only widely recognised counselling credential is the generic accreditation offered by BACP. While excellent generic counselling skills are absolutely essential for all addictions practitioners, there is a strong argument that additional skills and knowledge are required to work effectively.
MedCity ENGAGE: Advancing Beyond Patient Engagement to Behavior ChangeBrent Walker
This presentation provides an overview of a psychographic segmentation model and how it has been integrated into an automated patient engagement platform to drive significant patient behavior change to reduce hospital readmissions and enhance health coaches' work with patients who have diabetes or musculoskeletal issues
HXR 2016; Behavior Change Design - David Hoke, WalmartHxRefactored
A space where theory, evidence, policy and practice can come together to enlighten multi-disciplinary stakeholders interested in facilitating meaningful change at individual, group and population levels.
People Helping People - Patient power learning about peer-to-peer healthcar...Nesta
This presentation was delivered at People Helping People - The future of public services - 3rd September 2014. For more information on the event visit http://www.nesta.org.uk/event/people-helping-people-future-public-services
Person-centred care and patient activationNuffield Trust
Richard Owen, NHS England, and Dr Natalie Armstrong of the University of Leicester present on evaluating Person Centred Care through Patient Activation Measure (PAM).
Universal Health Care: Cote D'Ivoire. Africa is not ready for universal private health care. Health workforce is inadequate. Hospitals are lacking resources and crumbling.
Staff training is not up to standard. Opening the door to more people will only increase cost and deteriorate the quality of care further.
Justice or Just Us: Understanding Bias and Managing Health Professional Lice...Harry Nelson
Presentation to the National Medical Association on the issue of bias in Medical Board and other health professional licensing and enforcement and recommendations for preventing and managing investigations.
How the CIHI – CPSI collaborative on hospital harm can support patient safety initiatives in your organization
Most patients in Canadian hospitals experience safe care, but when harm happens there is a significant impact on patients, families, the healthcare team, and the health system in general. Until now, there hasn't been a standard approach to measuring and monitoring harm experienced by patients in hospital.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
iWantGreatCare's 7th National Symposium - Building fantastic staff morale, improving quality and reducing costs - took place on Tuesday 21st June at The King's Fund, London.
NHS leaders share their experiences of how they are building excellence in their Trust, reducing costs and growing staff morale by listening to the voice of the patient.
View the slides from these well-regarded delegates:
Alwen Williams, Chief Exective, Barts Health NHS Trust
David Behan, Chief Executive, Care Quality Commission
Dr Nadeem Moghal, Medical Director, Barking, Havering and Redbridge University Hospitals NHS Trust
Liz Mouland, Chief Nurse, First Community Health and Care
Jeremy Howick, clinical epidemiologist and philosopher
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
Changing practice through knowledge translation and implementation science.
Have you asked, told, taught and begged, but your hand hygiene results aren’t changing as quickly as you want? Changing practice is hard! Join CPSI on May 4th for an interactive webinar exploring the fundamentals of knowledge translation and the efforts of Public Health Ontario to change practice through this innovative science. We will also look at how you can impact patient and family hand hygiene efforts through the successful use of campaigns.
Improving the Health of Adults with Limited Literacy: What's the Evidence?Health Evidence™
Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.
This webinar focused on interpreting the evidence in the following review:
Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
Maxime Lê is a graduate of health sciences from the University of Ottawa that has worn many hats for many roles. Chief among them is being a patient advisor for The Ottawa Hospital. Having frequently been a patient and having a passion for health and healthcare, he decided to get involved at The Ottawa Hospital to help improve care, research and advocate for patients. Maxime, while sharing his hands-on experience and insights, answered the questions that healthcare providers, researchers, or prospective patient advisors may have, such as: ''What does it mean to be a patient advisor?'', ''Why is it important?'', and ''What impact does it have?''.
The webinar was followed by an interactive question and answer session.
Patient activation: New insights into the role of patients in self-managementMS Trust
This presentation by Helen Gilburt, Fellow at The King's Fund, looks at why some people are active at managing their health while others are quite passive, and how levels of patient activation impact on health outcomes.
It was presented at the MS Trust Annual Conference in November 2014.
Behavioral Health Staff in Integrated Care Settings | The Vital Role of Colla...CHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: May 06, 2019 | 3 p.m. EST
Experts in psychology, psychiatry and nursing will share ways in which they effectively utilize their roles at the top of their license to monitor and support high-risk patients. By examining these various roles, experts will address how you can effectively support integration at your health center to improve outcomes.
HXR 2016: Designing for Addiction and Recovery -Mary Beth Schoening, Behavior...HxRefactored
This panel is comprised of parents who’ve lost their children to addiction, a parent whose son is in recovery, and individuals themselves in long-term recovery. We will hear directly from them about their struggles, the impact on individuals and families dealing with addiction, as well as their opinions on where the system could benefit from solutions. The addiction issue is complex and would benefit from solutions in many areas. We invite you to join us to hear first hand.
London iCAAD 2019 - Dr Tim Leighton -WHAT IS ADDICTIONS COUNSELLING AND HOW S...iCAADEvents
In the UK, the only widely recognised counselling credential is the generic accreditation offered by BACP. While excellent generic counselling skills are absolutely essential for all addictions practitioners, there is a strong argument that additional skills and knowledge are required to work effectively.
MedCity ENGAGE: Advancing Beyond Patient Engagement to Behavior ChangeBrent Walker
This presentation provides an overview of a psychographic segmentation model and how it has been integrated into an automated patient engagement platform to drive significant patient behavior change to reduce hospital readmissions and enhance health coaches' work with patients who have diabetes or musculoskeletal issues
HXR 2016; Behavior Change Design - David Hoke, WalmartHxRefactored
A space where theory, evidence, policy and practice can come together to enlighten multi-disciplinary stakeholders interested in facilitating meaningful change at individual, group and population levels.
People Helping People - Patient power learning about peer-to-peer healthcar...Nesta
This presentation was delivered at People Helping People - The future of public services - 3rd September 2014. For more information on the event visit http://www.nesta.org.uk/event/people-helping-people-future-public-services
Person-centred care and patient activationNuffield Trust
Richard Owen, NHS England, and Dr Natalie Armstrong of the University of Leicester present on evaluating Person Centred Care through Patient Activation Measure (PAM).
Universal Health Care: Cote D'Ivoire. Africa is not ready for universal private health care. Health workforce is inadequate. Hospitals are lacking resources and crumbling.
Staff training is not up to standard. Opening the door to more people will only increase cost and deteriorate the quality of care further.
Justice or Just Us: Understanding Bias and Managing Health Professional Lice...Harry Nelson
Presentation to the National Medical Association on the issue of bias in Medical Board and other health professional licensing and enforcement and recommendations for preventing and managing investigations.
How the CIHI – CPSI collaborative on hospital harm can support patient safety initiatives in your organization
Most patients in Canadian hospitals experience safe care, but when harm happens there is a significant impact on patients, families, the healthcare team, and the health system in general. Until now, there hasn't been a standard approach to measuring and monitoring harm experienced by patients in hospital.
North highland himss_hardwiringclinicalfinancialperformance_041315North Highland
North Highland's Ricardo Martinez and Donna Houlne's presentation on "Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician-Directed Transformation"
A system of moral principles that apply values and judgments to the practice of medicine
MCI amended their guidelines of professional conduct, etiquette and ethics for the Doctors
This is a copy of my presentation from the 2012 AAM GIA Professional Development Conference in Palm Springs, California. The topic is marketing to referring physicians. Presenters: Dan Dunlop and Jill Lawlor.
20131210 Electronic Health Records - Is the NHS ready? What about patientsamirhannan
On 12th December 2013, Dr Hannan (GP / family physician) along with Marilyn Gollom (patient) presented this talk to Health 2.0 Manchester. You can watch the talk by going to http://www.htmc.co.uk/pages/pv.asp?p=htmc0519.
As new payment models emerge that emphasize value over volume, providers are being compelled to look more closely at how to motivate patients—especially those with multiple chronic conditions—to actively manage their care, make better decisions and change behaviors. This editorial webinar will explore the relationships between engagement and improved health outcomes, greater patient satisfaction and better resource utilization. Our panel of experts will share proven strategies for building patients' confidence, disseminating self-management tools and making the best use of your care team.
The challenges faced by nursing administrators are many and varies. An overview of such challenges will be helpful in working towards the managerial solutions.
How to Build Your Mitochondrial Medical Homemitoaction
Topics include:
The importance of a medical home for a mitochondrial disease patient.
Definition of a medical home.
How to establish a medical home.
Why a medical home is an important component of good patient advocacy.
Tips on maintaining a healthy medical home relationship.
Wees will describe theses issues primarily from a pediatric perspective, but she will give adult examples as well.
Wees is a patient advocate with Empowered Medical Advocacy. She assists parents and caregivers each week in navigating toward improved quality of life for their child and their families.
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Webinar: “Hospitals, Capital, and Cashflow Under COVID-19”PYA, P.C.
Hospitals and providers need to think creatively, strategically, and long-term about capital and cashflow under the pressures of the COVID-19 pandemic. A one-hour webinar hosted by PYA discussed the current state of capital markets for non-profit healthcare systems, and considerations for capital management, including the role of real estate assets.
PYA Principal Michael Ramey joined Realty Trust Group Senior Vice-President Michael Honeycutt and Ponder & Company Managing Director Jeffrey B. Sahrbeck to present “Hospitals, Capital, and Cashflow, Under COVID-19” In this webinar, they covered:
Hospital industry capital market updates and trends, including how the capital markets are responding to the crisis.
Access to capital under recent regulations.
Cash preservation techniques for hospitals considering real estate operations and assets.
The webinar took place Thursday, April 9, 2020, at 11 a.m. EDT.
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Performance Standards for Antimicrobial Susceptibility Testing
Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians and Administrators
1. Achieving Rapid Cost Reduction & Revenue
Improvement by Engaging Clinicians &
Administrators
Kent Bottles, MD
Thomas Jefferson University School of Population Health
Chief Medical Officer, PYA Analytics
HFMA Indiana Golf Outing & Fall Institute
October 1-3, 2014
Bloomington Monroe County Convention Center
2. Administrators vs. Clinicians
• Proactive planners
• Work well in groups
• Delayed gratification
• Id. with organization
• Establish rules
• Multidisciplinary
• Reactive agents
• Work well 1:1
• Instant gratification
• Id. with profession
• Resent rules
• Specialists
3. Administrators vs. Clinicians
• Collective culture
• Long time frame
• Institution centered
• Influence
• Hospital community
• Expert culture
• Short time frame
• Individual centered
• Control
• Hospital work shop
5. Administrators vs. Clinicians
• Successful organization needs both
• Mayo Clinic dyad successful leadership
• Neither group is more important than the other
• Malignant administrators tend to become cynics
and victims
• Malignant clinicians tend to become narcissists
6. Expert Engineer Culture
Edgar H. Schein, DEC is Dead, Long Live DEC, 2003
• Individual commitment is not to employer
• People, organization, bureaucracy are constraints
to be overcome
• Engineering culture disdains management and
marketing
• No loyalty to customer: if trade-offs had to be
made between building “fun,” “elegant,”
technologically challenging computers and the
needs of “dumb” customers, guess who won?
7. Partnership Requires Negotiation
• You can compete: win/lose
• You can accommodate: lose/win
• You can collaborate: win/win
• You can compromise: lose/lose
8. Margaret Thatcher (b. 1925)
British Conservative politician, prime minister.
Quoted in: Denis Healey, The Time of My Life, pt. 4, ch. 23 (1989).
Ah, Consensus…
To me, consensus seems to be the process
abandoning all beliefs, principles, values, and
policies.
So it is something in which no one believes and to
which no one objects.
9. Unhappy Doctors & Happy Doctors
• “Your doctor’s unhappiness is a catastrophic
problem that the new law didn’t anticipate and is
not prepared to address.” Dr. Marc Siegel,
Associate Professor of Medicine, NYU Langone
Medical Center
• “To us, supporting the ACA makes moral and
medical sense.” Dr. Jeffrey Drazen, Editor-in-
Chief, and Dr. Gregory Curfman, Executive
Editor, New England Journal of Medicine.
10. Dr. Daniel F. Craviotto, Jr.
• Docs in the trenches do not have a voice
• “Damn the mandates…from bureaucrats who are
not in the healing profession”
• EHRs waste time
• Board recertification is time consuming
• Physicians as a group should not accept any health
insurance
11. Dr. Aaron Carroll
• Complaining about not having a voice in WSJ
• “Most people have to choose between doing
God’s work and being in the 1%. Only doctors
get to do both.”
• Board recertification is mandated by doctors
• “It’s tone deaf in today’s economy for people at
the top end of the spectrum to complain so
publicly about how little they are paid.”
• Less than 1% of physicians opt out of Medicare
12. Dr. Aaron Carroll
• Complaining about not having a voice in WSJ
• “Most people have to choose between doing
God’s work and being in the 1%. Only doctors
get to do both”
• Board recertification is mandated by doctors
• “It’s tone deaf in today’s economy for people at
the top end of the spectrum to complain so
publicly about how little they are paid”
• Less than 1% of physicians opt out of Medicare
13. Dan Munro
• His criticisms are not patient-centered
• Orthopedics annual compensation of $413,000
• 84 million non-elderly were uninsured or
underinsured in 2012
• 100 million Americans in poverty or in the fretful
zone just above it
• Half of all doctors believe they are fairly
compensated
14. Old New
• Sickness System
• Health: No Disease
• Acute Disease
• Fee for Service
• Hospital Beds Full
• Hospital Centric
• Doctor Centric
• Doctor Decides
• MD defines quality
• Wellness System
• Health: Wellness
• Chronic Disease
• Value Based
• Hospital Beds Empty
• Community Centric
• Patient Centric
• Shared Dec. Making
• Measurable Metrics
15. Old New
• Cost not considered
• Independent doctors
• Independent hospital
• Med record secret
• Opaque
• Artificial harmony
• Analogue
• Hypothesis-driven
clinical trials
• Decreased cost
• Employed docs
• Integrated delivery
system
• Open access record
• Transparent
• Cognitive conflict
• Digital
• Predictive analytics
actionable correlations
17. Mindset of the Traditional Physician
• My success depends on my individual behavior
• Individual activities lead to personal financial
success
• Individual activities lead to successful clinical
outcomes
• Strong financial and clinical performance of my
parent organization and physician colleagues have
little impact on my personal success
• “Cowboys”
18. Mindset of the Integrated
Employed Physician
• My success is enhanced by collaboration
• Individual activities lead to the financial success of parent
organization
• Individual activities lead to successful clinical outcomes because
of collaboration
• Strong financial and clinical performance of my parent
organization
• And physician colleagues have major impact on my personal
success
• “Pit Crews”
19. Traditional Physician Leadership
• Represent local physician interests at
organization-wide venues
• Secure resources for local physicians
• Rally physicians against perceived enemy
− Hospital administration
− Insurance companies
− Competing physicians
20. Physician Leadership in
Integrated Aligned System
• Holding physicians accountable for performance
• Working as part of a leadership team of the organization
• Supporting decisions they may not personally agree
with
• Modeling behavior that supports the overall
organization goals
• Leader’s job is not to protect, defend, and ensure local
interests that may conflict with overall organization
interests
• Leading in an integrated aligned system is a real job
21. Physicians Agree to:
• Practice evidence medicine
• Meet regulatory, quality, safety goals
• Report quality data and outcomes
• Come to meetings
• Use the EMR
• Accept decisions made by leaders
• Be flexible, share ideas
• Behave as professionals
22. Organization Agrees to:
• Have primary loyalty be to physicians
• Negotiate well to align incentives
• Include physicians in decisions
• Provide clear and timely information (membership
criteria, quality scores, improvement process,
financial performance)
23. Organization Agrees to:
• Provide services & education to ease burdens
• See feedback from physicians
• Maintain confidentiality
• Make meetings worthwhile & engaging
• Create physician leadership training academy
24. Engaging Doctors in the Health Care
Revolution TH Lee & T Cosgrove, HBR
• Noble shared purpose
• Self interest
• Respect
• Tradition
25. Engaging Doctors in the Health Care
Revolution TH Lee & T Cosgrove, HBR
• Noble shared purpose
– Shifts conversation from negative to positive
– Acknowledge need for sacrifice
– Duty to patients preempts other obligations
• Urology patient story at Cleveland Clinic 2008
• Advocate huddles lead to 40% increase in safety event reports
– Mayo Clinic: “The needs of the patient come first”
• Patients come first
• Status quo is unsustainable
• Group action is needed to pursue patient first goal
26. Engaging Doctors in the Health Care
Revolution TH Lee & T Cosgrove, HBR
• Self-interest
– Compensation plans tied to citizenship, quality
– One-year renewable contracts
– Watch for conflicts of interest
– Reward collaboration
27. Engaging Doctors in the Health Care
Revolution TH Lee & T Cosgrove, HBR
• Respect
– Behavioral economics, peer pressure, transparent data
– Partners unmasked data on MD use of imaging led to
15% drop in orders for high-cost tests
– University of Utah transparent patient experience
ratings utilized gradual introduction
28. Engaging Doctors in the Health Care
Revolution TH Lee & T Cosgrove, HBR
• Tradition
– Mayo Clinic dress code
– Physician communication standards
– Organization must be willing to part ways with
physicians who don’t support shared purpose
29. Physician Benefits
• ACO participation (Medicare & Commercial)
• Quality rewards
• FFS quality contracts
• Narrow network participation
• EMR support
• Care Management access
• Leadership development
• Ability to have impact on their future practice
30. Formula for
Organizational Change
D + V x L > R
D = Dissatisfaction with how things are
V = Vision of what is possible
L = Leadership needed for success
R = Resistance to change
31. Symptoms of Resistance
• Superficial agreement with change with no
commitment or follow-through
• Slow progress
• Apathy
• Excuses for lack of engagement or progress
33. Addressing Resistance
• Leaders cross bridge first by coming to terms with
own concerns
• Help physicians let go of expectations that cannot
be met
• Get out the news
• Listen to and honor resistance
34. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Faster, flatter, more interconnected world
• Greater capacity for innovation, self-management,
personal responsibility, and self-direction
• Organizations need employees who have higher
level of independence, self-reliance, self-trust,
capacity to exercise initiative
35. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• There is a mismatch between world’s complexity
and our own
• Reduce the complexity of world
• Increase our own complexity
• Leaders need to run and reconstitute their
organizations (norms, mission, culture) in an
increasingly fast-changing environment
36. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Cardiologists tell patients they will die unless they
change
• Only one in seven are able to change
• There is a gap between what we want and what we
are able to do
• People want to do more than one thing and they
often conflict, we are a living contradiction
• One foot on gas; one foot on brake
37. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Three plateaus in adult mental complexity
• Socialized mind
• Self-authoring mind
• Self-transforming mind
38. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Socialized mind (14%) (32%)
– Team player
– Faithful follower
– Seeks direction
– Groupthink
– Anxiety comes from not being given specific
instructions, from being out of sync with leadership or
community, from worrying what others think of us
39. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Socialized mind (14%) (32%)
• “Although I knew his plan had almost no chance
of success, I saw that the leader wanted our
support.”
• Employees withhold crucial information from
leadership who want to co-create
40. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Self-authoring mind (34%) (6%)
– Leaders learn to lead
– Own compass, own frame (internal seat of judgment)
– Personal code
– Problem solving
– Independent, self directed
– Anxiety comes from not being in control, from being
ridiculed, from not having answers, from getting
information in conflict with my plan
41. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Self-transforming mind (<1%)
– Any one system is incomplete
– Comfortable with contradiction, paradox
– Can deal with multiple systems
– Leader leads to learn
– Problem finding
– Interdependent
– Anxiety comes from realization there is no one truth,
there are multiple truths
42. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Column 1: Improvement goal
• Column 2: Doing/not doing that work against the
goals in column 1
• Column 3: Hidden competing commitments
• Column 4: Big assumptions
43. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Column 1 goal: sources of input (yourself, your
colleagues, your family)
• Column 2: all the things you are doing or not
doing to work against your goal
• Column 3: if I imagine doing the opposite of the
things in Column 2, what is the most scary feeling
that I will have
• Column 4: some will be true, some will be false,
some will be uncertain
44. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• CEO/Father collective immunity
• Column 1 (Improvement goal)
– To be a better listener
– To be able to stay in the present
– To be more patient
45. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• CEO/Father collective immunity
• Column 2 (Doing/not doing against goal)
– I allow my attention to wander
– I start looking at BlackBerry
– I think about best response to what is said
– I think about what person should do rather than listen
46. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• CEO/Father collective immunity
• Column 3 (Uncon. hidden commitment)
– To not look stupid
– To not being humiliated
– To not feeling out of control
– To not make a big mistake
– To not allow someone else to make a mistake
47. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• CEO/Father collective immunity
• Column 4 (Big assumptions)
– I assume limited number of chances with daughter and
they will stop listening if I am stupid
– I assume it is a disaster if kids ridicule what I say
– I assume wife wants me to solve problems she shares
with me
– I assume helping is always a matter of telling others
what to do
– I assume if I cannot be in control, things are going to
get worse
48. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Prescribing narcotics: The doctors’ immunity map
• Column 1 (Commitment)
– Prescribe narcotics appropriately
– Treat pain appropriately
– Not be seen as place to get narcotics easily
49. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Prescribing narcotics: The doctors’ immunity map
• Column 2 (Doing/not doing instead)
– Not taking time to do narcotic contracts
– Writing prescription without taking full history
– Not taking time to take complete pain history when
request comes at end of visit
– Not firing patients from the practice who violate
contract
50. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Prescribing narcotics: The doctors’ immunity map
• Column 3 (Hidden competing commitments)
– Need to stay on time
– Need to believe patients
– Need to be liked by patients
– Need to avoid stress of patient confrontation
51. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Prescribing narcotics: The doctors’ immunity map
• Column 4 (Big assumptions)
– If I’m late, I am an inefficient physician
– If I don’t believe my patients, I am not their ally
– If I respond thoroughly to every request, I will fail at
my other important work
– If I’m not liked by my patients, my reputation will
suffer
– If I don’t ensure all possible pain is treated, I may fail
to reduce suffering
– If I feel stress, I will be unprofessional
52. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• University librarians’ collective immunity
• Column 1 (goal)
– To be less on periphery
– To be less on receiving end of admin decision
– To be more of a full partner with university
administration in governance of university
53. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• University librarians’ collective immunity
• Column 2 (Doing/not doing against goal)
– We do not demand seat at table
– We do not speak up when asked by admin
– We do not proactively develop our own positions on
issues of importance that we know are coming down
the pike
54. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• University librarians’ collective immunity
• Column 3 (Competing commitment)
– We are committed to taking no action that may expose
us as frauds or naïve
– We are committed to not being embarrassed in front of
our clients and bosses
– We are committed to not discovering we lack what it
takes to be real partners in governance
55. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• University librarians’ collective immunity
• Column 4 (Big assumptions)
– We assume president will want to meet with us
immediately and expect us to have answer
– We assume if we say something stupid once, all is lost
– We assume we must be experts right off bat
– We assume leaders are born not developed
56. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• People that have succeeded
• Change both mindset and behavior
• Become focused observers of their own thoughts,
emotions, behaviors
• Mindset changes are in direction of seeing more
possibilities
• Take risks to challenge assumptions; use data
around consequences of new action
• They experience increased mastery, more options,
wider control, greater degrees of freedom
57. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Calendar exercise
• Survey of colleagues, families, friends
• Biography of big assumptions
• Running a test of one’s big assumption
– SMART
– Safe and modest
– Actionable
– Research test
58. Immunity to Change
Robert Kegan & Lisa Laskow Lahey, 2009
• Ladder of inference: our tendency to adopt
inaccurate beliefs based on selective observations,
false assumptions, and misguided conclusions
• Data_Select data_Add meanings_Make
assumptions_Draw conclusions_Adopt beliefs
about the world_Take actions based on beliefs
59. Gamification
• The use of game thinking and game mechanics to
engage users in solving problems
• Competition, achievement, status, self expression,
altruism, closure
• University of Washington FoldIt
• UCSF Benioff Children’s Hospital
• Syandus COPD simulation software
60. What Makes Gamers Keep Gaming
John Tierney, NY Times, Dec 7, 2010
• Why are virtual worlds more interesting than
school work?
• Can games be used to solve real world puzzles
• Why can’t life be more like a video game?
61. What Makes Gamers Keep Gaming
John Tierney, NY Times, Dec 7, 2010
• Why do games create flow so easily?
• Hard fun: overcoming obstacles in pursuit of a
goal
• Instantaneous feedback
• Continual encouragement from computer and
friends
• Players get rewards for progressing to higher
levels
62. What Makes Gamers Keep Gaming
John Tierney, NY Times, Dec 7, 2010
• Gamers fail over and over again
• They remain motivated
• Keep going until they succeed
• Fiero: proud
63. What Makes Gamers Keep Gaming
John Tierney, NY Times, Dec 7, 2010
• “One of the most profound transformations we can
learn from games is how to turn the sense that
someone has ‘failed’ into the sense that they
‘haven’t succeeded yet’.” Tom Chatfield
64. What Makes Gamers Keep Gaming
John Tierney, NY Times, Dec 7, 2010
• Wikipedia took 8 years and 100 million hours of
work
• People play World of Warcraft in a single week
200 million hours
65. Gamification
• Re-Mission game from HopeLab treatment
adherence improvement in children with cancer
• UCSF Benioff Children’s Hospital
– CLABSI cost $16,500 per patient
– LevelEleven Compete app encourages nurses to
compete on mundane tasks associated with good
outcomes
66. Gamification
• Jane McGonigal. Reality Is Broken: Why Games
Make Us Better and How They Can Change the
World. NY: Penguin, 2011
• http://leveleleven.com/2013/07/gamification-to-cut-costs
• http://www.mhealthnews.com/news/gamification-secret-
67. Multicare Health System Sepsis Program
http://www.healthcatalyst.com/success_stories/how-to-reduce-sepsis-
mortality-rates-by-22
• 12 month decrease in sepsis mortality by 22%
• 1.3 million dollars in validated cost savings
• Health Catalyst data approach created algorithm to
define a septic patient
• Teams (clinicians, techs, analysts, quality)
• Severe sepsis order set
• Modified early warning system
• Code sepsis
68. Multicare Health System Missed Charges
http://emrdailynews.com/2010/03/30/multicare-health-system-selects-apollo-data-
technologies-to-automate-missing-charge-recovery/
• Predictive analytics captured $2 million in missed
charges by using algorithms
• Beyond rules-based charge capture software
• Analyze millions of records and provide
simulations
• Determine individual physician billing patterns