This document summarizes the key issues facing rural hospitals in California. It discusses how hospitals have historically played a central role in communities but many are now struggling financially and some have closed. The document outlines several milestones that have impacted hospitals, such as the introduction of Medicare and Medicaid, and changes in legislation and regulations over time. While the state and federal government have attempted to address problems through various programs and acts, rural hospitals continue to face challenges to their survival. There is hope that understanding the issues can help ensure hospitals are supported and communities continue to have access to healthcare.
This is the November 2014 issue of Healthcare-NOW!'s quarterly "Everybody In" newsletter, reporting on important developments in the movement for single-payer healthcare.
The 1,000 Ukes of Light campaign by CHNGNF8.org aims to provide ukuleles and music instruction to cancer survivors to promote healing through music. The campaign will provide 150 ukuleles to survivors around the world for $10,500 through a 4 phase plan: 1) Prepare staff, 2) Implement operating plan, 3) Develop instructional materials, and 4) Assess the program. The goal is to enhance lives of survivors and generate awareness and future funding for the organization's services.
Stephen Shortell: Organizing Health Care for Higher Quality and Lower Costcapstoneconference09
This document summarizes the challenges facing the current US healthcare system and proposes organizing care through accountable care organizations (ACOs) to improve quality and reduce costs. It outlines six redesign imperatives needed for ACOs, including care coordination and use of data for continuous quality improvement. Examples of potential ACO models are provided, as well as ideas for incentivizing provider and patient participation in ACOs to transition to a higher value healthcare system.
A Presentation for The California Program on Access to Care (CPAC) of the UC Berkeley School of Public Health. This presentation is intended to assess where the Safety Net as this state proceeds into full implementation of health care reform.
Presentation by Annette Gardner, PhD, MPH, Study Director
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco
The document provides an overview of the California Occupational Safety and Health Administration (Cal/OSHA). It outlines Cal/OSHA's role in enforcing occupational safety and health standards to protect workers. It discusses employer responsibilities to implement injury prevention programs and train employees. It also outlines employee rights and responsibilities regarding workplace safety. The document notes Cal/OSHA's authority to inspect worksites and issue penalties for violations.
Benjamin Chu: Transforming care in an integrated health systemNuffield Trust
Kaiser Permanente is the largest integrated health care delivery system in the US, serving 8.6 million members. It operates on a capitated payment model that emphasizes preventive care and keeping people healthy. The document discusses how Kaiser Permanente is transforming from a traditional sickness model to a proactive system focused on prevention through team-based and technology-enabled care that is integrated across settings.
California's Early Start program provides early intervention services to infants and toddlers from birth to age three who have disabilities or developmental delays. The program is administered through a collaboration between the California Department of Developmental Services and Department of Education. Early Start services are family-focused and designed to meet the individual needs of each child in natural environments like home and child care settings. Services can include developmental instruction, speech therapy, service coordination and more to support the child's development and the family.
This is the November 2014 issue of Healthcare-NOW!'s quarterly "Everybody In" newsletter, reporting on important developments in the movement for single-payer healthcare.
The 1,000 Ukes of Light campaign by CHNGNF8.org aims to provide ukuleles and music instruction to cancer survivors to promote healing through music. The campaign will provide 150 ukuleles to survivors around the world for $10,500 through a 4 phase plan: 1) Prepare staff, 2) Implement operating plan, 3) Develop instructional materials, and 4) Assess the program. The goal is to enhance lives of survivors and generate awareness and future funding for the organization's services.
Stephen Shortell: Organizing Health Care for Higher Quality and Lower Costcapstoneconference09
This document summarizes the challenges facing the current US healthcare system and proposes organizing care through accountable care organizations (ACOs) to improve quality and reduce costs. It outlines six redesign imperatives needed for ACOs, including care coordination and use of data for continuous quality improvement. Examples of potential ACO models are provided, as well as ideas for incentivizing provider and patient participation in ACOs to transition to a higher value healthcare system.
A Presentation for The California Program on Access to Care (CPAC) of the UC Berkeley School of Public Health. This presentation is intended to assess where the Safety Net as this state proceeds into full implementation of health care reform.
Presentation by Annette Gardner, PhD, MPH, Study Director
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco
The document provides an overview of the California Occupational Safety and Health Administration (Cal/OSHA). It outlines Cal/OSHA's role in enforcing occupational safety and health standards to protect workers. It discusses employer responsibilities to implement injury prevention programs and train employees. It also outlines employee rights and responsibilities regarding workplace safety. The document notes Cal/OSHA's authority to inspect worksites and issue penalties for violations.
Benjamin Chu: Transforming care in an integrated health systemNuffield Trust
Kaiser Permanente is the largest integrated health care delivery system in the US, serving 8.6 million members. It operates on a capitated payment model that emphasizes preventive care and keeping people healthy. The document discusses how Kaiser Permanente is transforming from a traditional sickness model to a proactive system focused on prevention through team-based and technology-enabled care that is integrated across settings.
California's Early Start program provides early intervention services to infants and toddlers from birth to age three who have disabilities or developmental delays. The program is administered through a collaboration between the California Department of Developmental Services and Department of Education. Early Start services are family-focused and designed to meet the individual needs of each child in natural environments like home and child care settings. Services can include developmental instruction, speech therapy, service coordination and more to support the child's development and the family.
The document summarizes the history and role of community health centers in the United States. It discusses how community health centers originated in the 1960s as part of President Johnson's War on Poverty. The first centers opened in Boston and Mississippi in 1965. Over time, community health centers have expanded across the country and now serve over 15 million people, especially low-income and uninsured populations. Community health centers are locally run nonprofit clinics that provide affordable, accessible healthcare to medically underserved communities.
The document summarizes upcoming events at UChicago Medicine in March 2016, including health seminars, farmers markets, and film screenings. It also provides details on UChicago Medicine's "Get CARE" plan, which proposes expanding facilities and services on the South Side of Chicago to improve access to emergency, trauma, and cancer care. This includes restoring 188 hospital beds and redeveloping a hospital into a cancer treatment facility. The plan aims to address capacity issues and reduce health disparities in the community.
In the 1950s, demand for emergency care skyrocketed as health insurance became more widely available and EDs began providing 24-hour coverage. However, care was inconsistent and unsafe due to a lack of specialized emergency physician training. The 1966 National Academy of Sciences report highlighted these issues and increased funding for emergency care. This led to the development of emergency medicine as a specialty, starting with the first emergency department staffed by trained physicians in Alexandria, Virginia in 1961. EMTALA was passed in 1986 to prevent patient dumping and ensure evaluation and treatment for emergency conditions regardless of ability to pay.
Trace the major historical developments of hospitals in the United S.pdfarhamnighty
Trace the major historical developments of hospitals in the United States.
Identify the major historical events of hospitals in a country outside of the United States.
Compare and contrast the history of both countries\' hospitals, and discuss which one you feel
has evolved to more effectively provide patient care.
Be sure to provide rationale for your choice of which hospital more effectively provides care.
Solution
Hospitals in the United States emerged in some institutions such as nursing homes giving health
care to poor patients, these institutions could be run by charities and gave care to poor patients,
leprosy patients and retirees, the care was always marginal case and those patients seeking
admission had to prove his moral worth or find a benefactor as well. At the beginning of the 19th
century and for much of the next century many Americans received medical care at home
mostly, as surgical procedures, births and disease treatments. Most of these people belonged to a
rural society and rarely had the opportunity to visit a hospital. Galbraith, (2006)
Charitabletraditionsso rootedin thehealth systemandled to the
developmentmunicipalitiesrequiredcommunity effortto accommodatepatientswith chronic
diseasesanddisabilitiesstripped. In 1736theyfounded acharitablenursinghomeinNewYorkwith
asix-bedroom; thisalmshouselater becameBellevueHospital. That sameyear wasatCharity
HospitalinNewOrleans. In1829 hefounded thehospitalin Tennesseecurrently
theRegionalMedicalCenteratMemphisand also theoldesthospital. Somepowerful institutionsand
multifacetedmunicipalitieswere foundedinthat year. Althoughthe homesfor elderly
peoplewerethe rootsofAmerica\'s hospitals during thecivilwararoundthe 1960s, there were
hospitalswithdoctors, nurses, professional andspecialized departmentsas well
asdifferenttypesofservices. Dueto social developmentafter theCivil War, the industrial
revolution, immigration andadvances in medicine, the development ofhospitalsin the
UnitedStatesincreased. In the early stageandhalf decadesof the 19th centurywasa period
of\"therapeutic pessimism\" wheredoctors could notadequately treatseriousdiseases. Inthe 1880sit
was discoveredtheasepsisand openednew horizonsfor surgery, also began the bacteriological
revolution, medicine grew, gained respectdoctorsand hospitalsbecame therepresentationof
optimismand authority ofphysicians. Galbraith, (2006)
Today everyhospitalhas itsown tracesandtheir own history,theCambridgeHealth
AllianceinMassachusettsfoundedin 1996, for example, hasrootsinSomervilleHospitalfoundedin
1891,WhiddenHospital(1897)andCambridgeHospital(1917).Another
exampleofKansasUniversityHospitalcurrent, which is due toKansasUniversity School of
Medicine(1880)andBellHospitalEleanorTaylor(1906). Once established
andstaffedbytraineddoctorsand nurses, hospitalsbothpublic andnonprofithospitals, became the
keyto expandthe medical culture. In1920sthehospitalwas wherepeoplehadthe hope thathis
illnesswas treatedand even cured, thenonprofitinstitut.
This document summarizes key facts about hospice and palliative care in Missouri and the United States more broadly. It notes that 90 million Americans have serious illnesses that are expected to double in 25 years. Palliative care focuses on symptom control and communication to address gaps in care for these patients. Hospice represents a team approach to palliative care. Studies show hospice reduces costs and improves outcomes by focusing on patients' goals of care. The document calls for increased access to palliative care programs in Missouri through policies like training and quality programs.
FIX HEALTHCARE AND HEAL THE NATION (Jamie Koufman)Jamie Koufman
The document discusses the history and current state of healthcare in the United States. It notes that healthcare costs have been rising much faster than inflation, taking up a growing share of the economy. The U.S. ranks lower than most developed countries in measures of healthcare system performance. It argues that a national healthcare system is needed to control costs and promote rational markets, and that the for-profit healthcare system has created problems and must be reformed or replaced. A three-tier system that provides basic care for all while allowing private insurance is proposed as a civilized American approach.
The document criticizes the U.S. medical system as being the most ineffective, unjust, inequitable and unethical among wealthy nations. It argues that the 2009 health reforms made the system worse. It provides examples showing racial and socioeconomic disparities in access to healthcare and health outcomes. It also discusses issues like the high costs of the system, medical bankruptcy, and how viewing patients as consumers is problematic.
1) The document is an annual report and agenda from the District of Columbia Hospital Association that honors the heritage of DC hospitals in serving the capital for over 150 years since the US Civil War.
2) It discusses how DC hospitals evolved from temporary facilities during the Civil War to treat overwhelming numbers of wounded soldiers to modern hospitals.
3) The DCHA advocates on behalf of DC hospitals to ensure quality care for residents and visitors, and addresses issues like Medicaid reimbursement rates, nurse staffing ratios, and United Medical Center.
Review the Southeast Medical Center case study found on page 92 of.docxjoellemurphey
The document provides instructions for students to analyze a United States Supreme Court case on the First Amendment using the FIRAC framework. It defines FIRAC as Facts, Issue, Rule(s), Analyze, and Conclusion. Students are asked to select a relevant Supreme Court case, and for each element of FIRAC write a 200-300 word response summarizing the case facts, legal issue, applicable First Amendment rule, analysis applying the law to facts, and conclusion.
This document summarizes an article from Times Magazine about the high costs of healthcare in the US. It discusses the exorbitant medical bills faced by several patients, including a 64-year-old woman and a 42-year-old man from Ohio. It notes that the US spends more on healthcare than the next 10 countries combined. The article questions why hospital bills are so high, particularly looking at the profits hospitals make from implantable medical devices.
Review the Southeast Medical Center case study found on page 92 of.docxronak56
Review the Southeast Medical Center case study found on page 92 of the course text. Of the recommendations found on pages 100-101, select the three which you consider to be the highest priority/most important to the case. Justify your reasoning. Support your opinion with a minimum of two outside scholarly resources. Write a three- to five-page paper (excluding title and reference pages) with your selected recommendations and justifications. The paper must be in APA format.
Southeast Medical Center Case Study
Review the Southeast Medical Center case study found on page 92 of the course text. Of the recommendations found on pages 100-101, select the three which you consider to be the highest priority/most important to the case. Justify your reasoning. Support your opinion with a minimum of two outside scholarly resources
In-Depth Case Study: Southeast Medical Center
The following case study involving a large organized delivery system exemplifies many of the issues described earlier in this chapter.
History and Evolution
Southeast Medical Center (SMC; a pseudonym) was established as a public hospital in the 1920s, just before the Depression. Located in the Southeast, a $1 million bond financed the 250-bed facility. Major expansion projects in the 1950s increased the hospital’s size to 600 beds. Formal affiliation with the local university’s College of Medicine residency program in the 1970s further expanded capacity. Thus, SMC became a public academic health center and subsequently assumed multiple missions of patient care, teaching, and research. Capital improvement programs were conducted during the 1970s, and in 1982, a massive renovation and construction project ($160 million) added 550 beds to the facility. In the 1980s, a 59-bed freestanding rehabilitation center was opened adjacent to the hospital, and a physicians’ office building was constructed next to the hospital. Medical helicopters were also acquired in 1989, expanding SMC’s trauma services. In addition to serving as a regional provider for trauma, SMC also furnishes burn, neonatal, and transplant care for the region.
Responsibility for governance of SMC has shifted over the years. In the early years of operation, a hospital board ran SMC. In the 1940s, the city was given direct control over the hospital. In the 1980s, the state legislature created a public hospital authority (to be appointed by the county commission) to govern the hospital. In the 1990s, the hospital’s board of trustees voted to turn operations of the hospital over to a private, not-for-profit corporation (501c-3), the SMC Corporation. However, oversight for charity care remained with the county’s hospital authority. The SMC Corporation is directed by a 15-member board of directors and essentially manages the organized delivery system through a lease arrangement with the county hospital authority.
Today, SMC is a private, not-for-profit academic health center that is accredited by JCAHO. It also serves as the ...
Medicare was created in 1965 to provide health insurance to older Americans. It has since expanded to cover those with disabilities. The document discusses key events and reforms in Medicare's history including the introduction of HMOs, DRG payments, new benefits like prescription drug coverage, and more recent policies focused on quality and cost-effectiveness such as ACOs, value-based purchasing, and electronic health records. Overall, Medicare has evolved significantly over the decades but maintains its central goal of ensuring healthcare access for millions of Americans.
Slides from a talk at Ryerson University Health Service Management program's 1st Annual Symposium by Dr. Michael Rachlis.
Reproduced here with permission
HANDOUT - Hospice & Palliative Care Missouri Health Net Aug 2009Christian Sinclair
2 page handout for a presentation to Missouri HealthNet (State Medicaid Program) about hospice and palliative care issues. This handout accompanies the slideset also posted to my account.
The document provides 5 story ideas for local news coverage on health reform:
1) Stories of medical bankruptcies in the local community.
2) Profiling local residents on how current health costs affect their care and how reform may impact them.
3) Potential cuts to local health budgets and how that could lengthen wait times.
4) Rationing of care for the uninsured and long wait times for certain procedures and medications.
5) Challenges for those between 50-65 in obtaining health insurance due to pre-existing conditions.
Health System Analysis- Mexico and the United StatesAndrew Nelson
This document provides an overview and comparison of the health systems in Mexico and the United States, with a focus on obesity. It describes key differences between the two systems, such as Mexico having a predominantly public system while the US has a mixture of public and private. It also discusses challenges each system faces in controlling obesity, like the US lacking comprehensive prevention mechanisms and Mexico having infrastructure issues. The document aims to analyze how each country can address obesity within their respective health systems.
The United States health care system has evolved from a tradition of local government responsibility for the poor to a mixed system with both public and private components. Key developments included the rise of hospitals and physicians in the late 19th century, the growth of private health insurance in the mid-20th century, and the creation of Medicare, Medicaid and managed care in the 1960s-1970s to address rising costs and access issues. However, debates continue around the appropriate role of government, consumers, providers and private industry in ensuring affordable, high quality health care for all Americans.
The health care industry in San Francisco is a $28 billion economic engine that employs over 121,000 people. It includes hospitals, biotech companies, medical research, and other services. San Francisco has a tradition of innovation in health care and was a leader in treating AIDS patients. It also has programs to provide care for the underserved and uninsured. Future challenges include changing demographics, technology, and health care reforms, but with community support, San Francisco's health sector will continue to be a global leader in health, healing, and hope.
This report analyzes emergency room (ER) usage data in Kansas City to identify "hot spots" of high ER use. The analysis found that 10 zip codes accounted for 38% of all ER admissions. These hot spots had higher rates of poverty, non-white populations, and preventable health conditions like asthma and influenza. They also had fewer primary care physicians and residents who were more likely to rely on Medicaid or uninsured care. The report concludes that over-reliance on the ER in these communities signals a failure of the healthcare system to provide adequate access to preventative primary care for low-income, minority populations.
Ellen Zane became the CEO of Tufts New England Medical Center (Tufts-NEMC) in 2004 to lead a turnaround. For years, Tufts-NEMC struggled financially and lost doctors while other hospitals merged and grew stronger. Zane worked to improve efficiency and finances, posting an $18 million profit in 2005 after years of losses. However, she remained worried about sustainability given the competitive Boston healthcare market. Zane aimed to create lasting change at the fragile academic medical center.
The same year Amazon celebrated its first birthday, Google was born and Hotmail was launched, Congress passed the 1996 Health Insurance Portability and Accountability act (“HIPAA”). Twenty-one years later, federal and state legislators still struggle to comport the tenets of HIPAA and its progeny with modern-day technology while advancing the national push toward that elusive electronic health record. Whether HIPAA can survive remains to be seen, but with its marked inflexibility, unnecessary complexity, inherent disparity and a cadre of draconian punishments for even the slightest transgressions, the real question is whether or not HIPAA should remain. This program will explore the evolution of HIPAA over the past 21 years and the issues that question the effectiveness of patient privacy laws today.
More Related Content
Similar to The Vanishing Community Hospital: An Endangered Institution
The document summarizes the history and role of community health centers in the United States. It discusses how community health centers originated in the 1960s as part of President Johnson's War on Poverty. The first centers opened in Boston and Mississippi in 1965. Over time, community health centers have expanded across the country and now serve over 15 million people, especially low-income and uninsured populations. Community health centers are locally run nonprofit clinics that provide affordable, accessible healthcare to medically underserved communities.
The document summarizes upcoming events at UChicago Medicine in March 2016, including health seminars, farmers markets, and film screenings. It also provides details on UChicago Medicine's "Get CARE" plan, which proposes expanding facilities and services on the South Side of Chicago to improve access to emergency, trauma, and cancer care. This includes restoring 188 hospital beds and redeveloping a hospital into a cancer treatment facility. The plan aims to address capacity issues and reduce health disparities in the community.
In the 1950s, demand for emergency care skyrocketed as health insurance became more widely available and EDs began providing 24-hour coverage. However, care was inconsistent and unsafe due to a lack of specialized emergency physician training. The 1966 National Academy of Sciences report highlighted these issues and increased funding for emergency care. This led to the development of emergency medicine as a specialty, starting with the first emergency department staffed by trained physicians in Alexandria, Virginia in 1961. EMTALA was passed in 1986 to prevent patient dumping and ensure evaluation and treatment for emergency conditions regardless of ability to pay.
Trace the major historical developments of hospitals in the United S.pdfarhamnighty
Trace the major historical developments of hospitals in the United States.
Identify the major historical events of hospitals in a country outside of the United States.
Compare and contrast the history of both countries\' hospitals, and discuss which one you feel
has evolved to more effectively provide patient care.
Be sure to provide rationale for your choice of which hospital more effectively provides care.
Solution
Hospitals in the United States emerged in some institutions such as nursing homes giving health
care to poor patients, these institutions could be run by charities and gave care to poor patients,
leprosy patients and retirees, the care was always marginal case and those patients seeking
admission had to prove his moral worth or find a benefactor as well. At the beginning of the 19th
century and for much of the next century many Americans received medical care at home
mostly, as surgical procedures, births and disease treatments. Most of these people belonged to a
rural society and rarely had the opportunity to visit a hospital. Galbraith, (2006)
Charitabletraditionsso rootedin thehealth systemandled to the
developmentmunicipalitiesrequiredcommunity effortto accommodatepatientswith chronic
diseasesanddisabilitiesstripped. In 1736theyfounded acharitablenursinghomeinNewYorkwith
asix-bedroom; thisalmshouselater becameBellevueHospital. That sameyear wasatCharity
HospitalinNewOrleans. In1829 hefounded thehospitalin Tennesseecurrently
theRegionalMedicalCenteratMemphisand also theoldesthospital. Somepowerful institutionsand
multifacetedmunicipalitieswere foundedinthat year. Althoughthe homesfor elderly
peoplewerethe rootsofAmerica\'s hospitals during thecivilwararoundthe 1960s, there were
hospitalswithdoctors, nurses, professional andspecialized departmentsas well
asdifferenttypesofservices. Dueto social developmentafter theCivil War, the industrial
revolution, immigration andadvances in medicine, the development ofhospitalsin the
UnitedStatesincreased. In the early stageandhalf decadesof the 19th centurywasa period
of\"therapeutic pessimism\" wheredoctors could notadequately treatseriousdiseases. Inthe 1880sit
was discoveredtheasepsisand openednew horizonsfor surgery, also began the bacteriological
revolution, medicine grew, gained respectdoctorsand hospitalsbecame therepresentationof
optimismand authority ofphysicians. Galbraith, (2006)
Today everyhospitalhas itsown tracesandtheir own history,theCambridgeHealth
AllianceinMassachusettsfoundedin 1996, for example, hasrootsinSomervilleHospitalfoundedin
1891,WhiddenHospital(1897)andCambridgeHospital(1917).Another
exampleofKansasUniversityHospitalcurrent, which is due toKansasUniversity School of
Medicine(1880)andBellHospitalEleanorTaylor(1906). Once established
andstaffedbytraineddoctorsand nurses, hospitalsbothpublic andnonprofithospitals, became the
keyto expandthe medical culture. In1920sthehospitalwas wherepeoplehadthe hope thathis
illnesswas treatedand even cured, thenonprofitinstitut.
This document summarizes key facts about hospice and palliative care in Missouri and the United States more broadly. It notes that 90 million Americans have serious illnesses that are expected to double in 25 years. Palliative care focuses on symptom control and communication to address gaps in care for these patients. Hospice represents a team approach to palliative care. Studies show hospice reduces costs and improves outcomes by focusing on patients' goals of care. The document calls for increased access to palliative care programs in Missouri through policies like training and quality programs.
FIX HEALTHCARE AND HEAL THE NATION (Jamie Koufman)Jamie Koufman
The document discusses the history and current state of healthcare in the United States. It notes that healthcare costs have been rising much faster than inflation, taking up a growing share of the economy. The U.S. ranks lower than most developed countries in measures of healthcare system performance. It argues that a national healthcare system is needed to control costs and promote rational markets, and that the for-profit healthcare system has created problems and must be reformed or replaced. A three-tier system that provides basic care for all while allowing private insurance is proposed as a civilized American approach.
The document criticizes the U.S. medical system as being the most ineffective, unjust, inequitable and unethical among wealthy nations. It argues that the 2009 health reforms made the system worse. It provides examples showing racial and socioeconomic disparities in access to healthcare and health outcomes. It also discusses issues like the high costs of the system, medical bankruptcy, and how viewing patients as consumers is problematic.
1) The document is an annual report and agenda from the District of Columbia Hospital Association that honors the heritage of DC hospitals in serving the capital for over 150 years since the US Civil War.
2) It discusses how DC hospitals evolved from temporary facilities during the Civil War to treat overwhelming numbers of wounded soldiers to modern hospitals.
3) The DCHA advocates on behalf of DC hospitals to ensure quality care for residents and visitors, and addresses issues like Medicaid reimbursement rates, nurse staffing ratios, and United Medical Center.
Review the Southeast Medical Center case study found on page 92 of.docxjoellemurphey
The document provides instructions for students to analyze a United States Supreme Court case on the First Amendment using the FIRAC framework. It defines FIRAC as Facts, Issue, Rule(s), Analyze, and Conclusion. Students are asked to select a relevant Supreme Court case, and for each element of FIRAC write a 200-300 word response summarizing the case facts, legal issue, applicable First Amendment rule, analysis applying the law to facts, and conclusion.
This document summarizes an article from Times Magazine about the high costs of healthcare in the US. It discusses the exorbitant medical bills faced by several patients, including a 64-year-old woman and a 42-year-old man from Ohio. It notes that the US spends more on healthcare than the next 10 countries combined. The article questions why hospital bills are so high, particularly looking at the profits hospitals make from implantable medical devices.
Review the Southeast Medical Center case study found on page 92 of.docxronak56
Review the Southeast Medical Center case study found on page 92 of the course text. Of the recommendations found on pages 100-101, select the three which you consider to be the highest priority/most important to the case. Justify your reasoning. Support your opinion with a minimum of two outside scholarly resources. Write a three- to five-page paper (excluding title and reference pages) with your selected recommendations and justifications. The paper must be in APA format.
Southeast Medical Center Case Study
Review the Southeast Medical Center case study found on page 92 of the course text. Of the recommendations found on pages 100-101, select the three which you consider to be the highest priority/most important to the case. Justify your reasoning. Support your opinion with a minimum of two outside scholarly resources
In-Depth Case Study: Southeast Medical Center
The following case study involving a large organized delivery system exemplifies many of the issues described earlier in this chapter.
History and Evolution
Southeast Medical Center (SMC; a pseudonym) was established as a public hospital in the 1920s, just before the Depression. Located in the Southeast, a $1 million bond financed the 250-bed facility. Major expansion projects in the 1950s increased the hospital’s size to 600 beds. Formal affiliation with the local university’s College of Medicine residency program in the 1970s further expanded capacity. Thus, SMC became a public academic health center and subsequently assumed multiple missions of patient care, teaching, and research. Capital improvement programs were conducted during the 1970s, and in 1982, a massive renovation and construction project ($160 million) added 550 beds to the facility. In the 1980s, a 59-bed freestanding rehabilitation center was opened adjacent to the hospital, and a physicians’ office building was constructed next to the hospital. Medical helicopters were also acquired in 1989, expanding SMC’s trauma services. In addition to serving as a regional provider for trauma, SMC also furnishes burn, neonatal, and transplant care for the region.
Responsibility for governance of SMC has shifted over the years. In the early years of operation, a hospital board ran SMC. In the 1940s, the city was given direct control over the hospital. In the 1980s, the state legislature created a public hospital authority (to be appointed by the county commission) to govern the hospital. In the 1990s, the hospital’s board of trustees voted to turn operations of the hospital over to a private, not-for-profit corporation (501c-3), the SMC Corporation. However, oversight for charity care remained with the county’s hospital authority. The SMC Corporation is directed by a 15-member board of directors and essentially manages the organized delivery system through a lease arrangement with the county hospital authority.
Today, SMC is a private, not-for-profit academic health center that is accredited by JCAHO. It also serves as the ...
Medicare was created in 1965 to provide health insurance to older Americans. It has since expanded to cover those with disabilities. The document discusses key events and reforms in Medicare's history including the introduction of HMOs, DRG payments, new benefits like prescription drug coverage, and more recent policies focused on quality and cost-effectiveness such as ACOs, value-based purchasing, and electronic health records. Overall, Medicare has evolved significantly over the decades but maintains its central goal of ensuring healthcare access for millions of Americans.
Slides from a talk at Ryerson University Health Service Management program's 1st Annual Symposium by Dr. Michael Rachlis.
Reproduced here with permission
HANDOUT - Hospice & Palliative Care Missouri Health Net Aug 2009Christian Sinclair
2 page handout for a presentation to Missouri HealthNet (State Medicaid Program) about hospice and palliative care issues. This handout accompanies the slideset also posted to my account.
The document provides 5 story ideas for local news coverage on health reform:
1) Stories of medical bankruptcies in the local community.
2) Profiling local residents on how current health costs affect their care and how reform may impact them.
3) Potential cuts to local health budgets and how that could lengthen wait times.
4) Rationing of care for the uninsured and long wait times for certain procedures and medications.
5) Challenges for those between 50-65 in obtaining health insurance due to pre-existing conditions.
Health System Analysis- Mexico and the United StatesAndrew Nelson
This document provides an overview and comparison of the health systems in Mexico and the United States, with a focus on obesity. It describes key differences between the two systems, such as Mexico having a predominantly public system while the US has a mixture of public and private. It also discusses challenges each system faces in controlling obesity, like the US lacking comprehensive prevention mechanisms and Mexico having infrastructure issues. The document aims to analyze how each country can address obesity within their respective health systems.
The United States health care system has evolved from a tradition of local government responsibility for the poor to a mixed system with both public and private components. Key developments included the rise of hospitals and physicians in the late 19th century, the growth of private health insurance in the mid-20th century, and the creation of Medicare, Medicaid and managed care in the 1960s-1970s to address rising costs and access issues. However, debates continue around the appropriate role of government, consumers, providers and private industry in ensuring affordable, high quality health care for all Americans.
The health care industry in San Francisco is a $28 billion economic engine that employs over 121,000 people. It includes hospitals, biotech companies, medical research, and other services. San Francisco has a tradition of innovation in health care and was a leader in treating AIDS patients. It also has programs to provide care for the underserved and uninsured. Future challenges include changing demographics, technology, and health care reforms, but with community support, San Francisco's health sector will continue to be a global leader in health, healing, and hope.
This report analyzes emergency room (ER) usage data in Kansas City to identify "hot spots" of high ER use. The analysis found that 10 zip codes accounted for 38% of all ER admissions. These hot spots had higher rates of poverty, non-white populations, and preventable health conditions like asthma and influenza. They also had fewer primary care physicians and residents who were more likely to rely on Medicaid or uninsured care. The report concludes that over-reliance on the ER in these communities signals a failure of the healthcare system to provide adequate access to preventative primary care for low-income, minority populations.
Ellen Zane became the CEO of Tufts New England Medical Center (Tufts-NEMC) in 2004 to lead a turnaround. For years, Tufts-NEMC struggled financially and lost doctors while other hospitals merged and grew stronger. Zane worked to improve efficiency and finances, posting an $18 million profit in 2005 after years of losses. However, she remained worried about sustainability given the competitive Boston healthcare market. Zane aimed to create lasting change at the fragile academic medical center.
Similar to The Vanishing Community Hospital: An Endangered Institution (20)
The same year Amazon celebrated its first birthday, Google was born and Hotmail was launched, Congress passed the 1996 Health Insurance Portability and Accountability act (“HIPAA”). Twenty-one years later, federal and state legislators still struggle to comport the tenets of HIPAA and its progeny with modern-day technology while advancing the national push toward that elusive electronic health record. Whether HIPAA can survive remains to be seen, but with its marked inflexibility, unnecessary complexity, inherent disparity and a cadre of draconian punishments for even the slightest transgressions, the real question is whether or not HIPAA should remain. This program will explore the evolution of HIPAA over the past 21 years and the issues that question the effectiveness of patient privacy laws today.
Better Crazy Than Sick: Regulating Mental Health With or Without the Affordab...Craig B. Garner
This presentation offers and overview of the mental health system in California, from psychiatric acute care hospitals to drug and alcohol rehabilitation centers.
Regulating Rehab: Balancing Mental Health Parity with Mental Health ServicesCraig B. Garner
This document summarizes a presentation given by Craig B. Garner on balancing mental health parity with potential issues in mental health services. It provides a brief history of mental health institutions in California and the US, including asylums and state hospitals. It discusses key laws and acts that shifted treatment from institutions to community-based care, including the Short-Doyle Act, Lanterman-Petris-Short Act, and Medicaid/Medi-Cal expansion. The presentation also reviews the impacts of Proposition 13 and realignment acts on county responsibilities and funding challenges.
This document provides information about the accreditation requirements and processes for DNV GL and CIHQ. It discusses the key steps in applying for and maintaining accreditation, including submitting applications, undergoing on-site surveys, addressing any deficiencies found, and participating in follow up activities. It also outlines the different types of surveys conducted, how deficiencies are classified and addressed, and consequences for organizations like being put on "accreditation at risk" status.
Who's Minding the Store? What Happens When the U.S. Supreme Court Accidentall...Craig B. Garner
The recent Supreme Court decision North Carolina State Board of Dental Examiners v. Federal Trade Commission affirmed an FTC decision targeting anticompetitive conduct of the North Carolina Dental Board. Targeting trade group self-governance, the Supreme Court held that sovereign immunity does not apply if the states fail to exercise appropriate oversight.
The implications of this decision on entities like the Medical and Dental Boards of California, not to mention the State Bar of California, remain to be seen. In an industry like health care where mergers and acquisitions continue with no end in sight, and California law prohibiting the corporate practice of medicine is a fundamental tenet in health care, who will be left to monitor compliance? The implications extend beyond health care, but also into any self-governing, professional trade group. As a result, regulatory oversight will shift from the state level and into the hands of the federal government, and in particular the FTC, which will only monitor when issues of competition arise.
California’s Department of Consumer Affairs oversees 35 professional boards and bureaus, ranging from automotive repair to guide dogs to the medical board to real estate. With the self-governance of each now called into question by the Supreme Court, who will mind the store on behalf of these industries?
The 2010 Affordable Care Act has transformed our nation’s
health care system, creating myriad opportunities for
attorneys and professionals along the way. Now more than ever, attorneys in most fields of practice are
destined to overlap with health care law.
Interested in making the switch from another specialty,
or expanding your health law practice?
Pandemic or Panacea? The Financial Impact of the ACA on the Modern Health Ca...Craig B. Garner
Four years into its evolution, the political debates surrounding the Affordable Care Act continue to engage the nation. From its inception, the impact of the ACA on the changes in health care for individuals has held center stage. However, what will be the fiscal ramifications for the health care industry as a whole? With a revamped emphasis on efficiency and quality of service on the part of providers, transparency for payers and the notion of patient responsibility, how will the industry fare as it transitions from its cost-based legacy toward a performance-based model? Like it or not, America’s new health care structure is here to stay, and so we must be mindful of the collateral damages faced by the industry as the ACA works through its growing pains, while paying special attention to the burdens placed on smaller systems, hospitals and providers who find themselves ill-prepared to weather such storms. This panel will discuss the impact of the ACA on the financial wellbeing of California’s hospitals and physicians.
The Latest Paradigm Shift in Health Care: Providers, Patients and Payers Play...Craig B. Garner
The presentation discusses recent paradigm shifts impacting disputes between providers, payers and patients. The role of alternative dispute resolution in the Affordable Care Act, including compliance
programs and Medicare is included, as well as the enforceability and use of mandatory arbitration agreements.
For attorneys who must litigate the Affordable Care Act, familiarization of its rules can be daunting and unforgiving. Personal instinct and legal experience in fields outside of health law can often be of little value, as contemporary health care law often appears to contradict business law. Drawing from a variety of legal concepts, this seminar will explain what happens when the worlds of health care and litigation collide. The lessons to be learned are to proceed with caution, and remember to honor and obey the newly laid hierarchy at the heart of this epic (and very long) reform law.
Health Care Reform Goes Live: The Affordable Care Act in 2014Craig B. Garner
The document provides an overview of health care reform under the Affordable Care Act (ACA) that goes into effect in 2014. It summarizes the history of health care in the US and the key provisions of the ACA, including the individual and employer mandates, health insurance exchanges, essential health benefits, and reforms to the delivery of medical care through programs like Accountable Care Organizations. The document is intended to educate about how the ACA will be implemented and its impact on various groups in early 2014.
Health Care Reform Goes Live: Day Three in the Current Climate of ReformCraig B. Garner
The document provides a history of healthcare reform in the United States from the 1800s to present day. It discusses the shift from home care to hospital care over time and key acts like the Hill-Burton Act and Medicare. It then summarizes provisions of the Affordable Care Act including essential health benefits, exchanges, the individual and employer mandates, and ways to deliver care like accountable care organizations.
Modern American Health Care: Balancing Performance and Compliance in the Curr...Craig B. Garner
This presentation provides an overview of the Affordable Care Act three years after its passage. It explains how the landmark legislation evolved, what provisions are in place today, and what can we expect in the years to come. The implications for patients, providers and payers are massive, and this presentation is designed to provide a comprehensive overview for anyone interested to learn about health care reform.
The Modern Day Health Care Compliance ProgramCraig B. Garner
An HCCA Web Conference
Identify the impending changes to the core of our nation’s health care structure as a result of the shift toward performance-based initiatives.
Familiarize participants with both safe harbors and potentially costly provisions monitoring fraud and waste, including Stark laws, anti-kickback statutes, RACS, MACs, MICs, and ZPICS.
Demonstrate the positive effect on your bottom line through understanding the benefits of a well-executed compliance program.
In a country of more than 313 million people, the pressures placed on the health care system in the United States are both enormous and complex, as Americans expect a fundamental right to first rate health care without much regard for its cost.
However, the Federal and California governments are mindful of this expense and
take pride in their important role in regulating health care on the West Coast. This is a guide for responding to these investigations.
As the effects of reform continue to implement changes to our nation’s health care structure, providers find themselves forced to act quickly amidst the resultant chaos. Nowhere is the confusion more apparent than when it comes to issues of compliance.
Contact Craig Garner for more information (craig (at) craiggarner (dot) com) or visit
http://craiggarner.com/compliance/.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
3. EVERY HOSPITAL TELLS A STORY
Regardless of whether it serves a small rural setting or
a sprawling urban population, an area’s local hospital
plays an integral role in shaping and defining its
community.
4. THE HEARTBEAT OF A NEIGHBORHOOD
An area’s local hospital is often the driving force of its
surroundings, providing support in times of need while also
creating jobs and stimulating the economy.
many ways, the history of a neighborhood hospital is both the
In
story of its patients and a snapshot of the times in which they
lived.
5. WHAT THE PAST CAN TEACH US
Too often, however, such tales are forgotten once a hospital is forced to close its doors. Still,
there is much to be learned by these now defunct facilities that have cared for America’s
inhabitants and shaped the evolution of her health care system.
6. THE MEANING OF HEALTH CARE, PAST AND PRESENT
These stories emphasize what provision of care has meant in the United States since the first
almshouses tended to the poor and downtrodden in colonial America.
By recognizing the changes affecting our hospitals over time, we are better able to grasp what we
as a nation value in the institution we call health care.
7. HOPE FOR TOMORROW
Such insight will allow us to assist the
hospitals of the future in their struggle for
survival, rather than lament the hospitals
we have lost.
8. THE CHANGING LANDSCAPE OF THE AMERICAN HOSPITAL SYSTEM
• The trend of multi-hospital systems replacing freestanding community hospitals picked up
speed after 1965.
• The five hospital consolidations noted in 1961 ballooned to upwards of 50 per year in the
1970s.
• By the 1980s, an estimated 30% of hospital beds in the United States existed within hospital
systems.
• In 2008, the American Hospital Association estimated that almost half of the nearly 6,000
U.S. hospitals belonged to a hospital system.
9. THE LURE OF CONSOLIDATION
Even many of the non-profit, faith-based hospitals directly
descended from the original almshouses and charity
hospitals of the 18th and 19th centuries have come to seek
refuge in consolidation.
In 1872, there were approximately 75 Catholic hospitals in
the United States.
Today, most of these institutions have been incorporated
into regional “systems” in an effort to survive.
10. CREATING THE IDEAL HOSPITAL
“An ideal hospital would be a small hospital, with small, detached wards, well ventilated, and
with beds far apart, remote from [centers of] population, and surrounded by open walks and
grounds. Hospitals that are situated in the outskirts of towns – in the open field, so to say.”
--Michael Levy, Consulting Member of the Board of Health of France, 1862
12. MILESTONES FROM THE PAST
• The 1946 Hospital Survey and Construction Act (Hill Burton Act)
• The 1965 passage of Medicare
• The 1983 introduction of Medicare’s diagnosis-related groups (DRGs)
• The 1986 Emergency Medical Treatment and Active Labor Act (EMTALA)
• The 1994 Northridge Earthquake
• The 1996 Health Insurance Portability and Accountability Act (HIPAA)
13. CALIFORNIA’S LEGISLATURE RESPONDS
• The Medi-Cal disproportionate share program (DSH)
• The Private Hospital Supplemental Fund
• Distressed Hospital Funds
• Construction and Renovation Reimbursement
Program
• The Hospital Fee Program
• SB 1953
• California’s Physician Outpatient Referral Act
14. THE FEDERAL GOVERNMENT WEIGHS IN
• American Recovery and Reinvestment Act of 2009
• HITECH
• The Affordable Care Act
• Accountable Care Organizations
• Stark and Anti-Kickback Laws
• RACs, MACs, MICs and ZIPCs
• Performance-based reimbursement
21. WHILE CALIFORNIA LEGISLATION MAY SEE THE ISSUES . . .
• “Rural hospitals serve as the “hub of health,” and through
that role attract and retain in their communities physicians,
nurses, and other primary care providers.”
• “The rural hospital is often one of the largest employers in
the community.”
• “Economic development of a rural area is, in part, tied to
the existence of a hospital.”
• “Rural hospitals are an important link in the Medi-Cal
program.”
[Health and Safety Code § 124800]
22. . . . THE SOLUTIONS DO NOT ALWAYS PRESENT THEMSELVES
From CHA’s January 2012 Environmental Scan and View of the Future:
“Components of the health care delivery system, including safety-net and rural hospitals, will become
increasingly fragile unless private marketplace practices and government programs improve. Even with a
recovering economy, most California hospitals face increasing financial challenges.”
Is there hope for the future?
23. HOPE STANDS AT A CROSSROADS
“Hope is the thing with feathers -That perches in the
soul -And sings the tune without the words -And never
stops -at all.” - Emily Dickinson
24. FEBRUARY 1954
An Article from Fortune Magazine:
“Today [physicians] who practice privately are subject to the sort of controversy long familiar to
management . . . . that involves charges of overpayment and hints of incompetence.
Lay gossip about the physician’s abilities and his fees is harsher than it used to be, and articles in
popular magazines are irreverent. . . .
Today, however, the old-fashioned doctor has gone with the old-fashioned family. With new aids to
diagnosis, new treatments, and new drugs, any competent physician can accomplish more and
quicker cures than he can with any amount of bedside attendance. Under these circumstances
patients credit the treatment, not the physician, with keeping him well.”
25. MAY 31, 1987
An Article from the Sacramento Bee:
“Judging from recent media reports, American medicine must be on the verge of utter decay.
Government officials complain that we doctors do vast amounts of unnecessary surgery. We are accused
of inappropriately hospitalizing too many patients and in discharging them prematurely.
We are being harassed by government and big business for over utilizing sophisticated and expensive
medical technology -- while at the same time, the courts hold us liable when we fail to admit a patient
who turns out to be sicker than we originally perceived.
And lawyers and patients consider us negligent and irresponsible if we fail to use sophisticated tests
which would detect early and curable disease.”
26. APRIL 22, 2011
An Article from the New York Times:
“Patients and doctors often complain that appointments are rushed, but the time that doctors spend
with each patient — 16 to 20 minutes, on average — has remained largely unchanged for years.
Instead, patients have gotten sicker and treatments more complex. Half of American citizens have a
chronic disease like high blood pressure or diabetes, and a quarter have two or more such conditions. . . .
For many of their patients, doctors must increasingly rush through a blizzard of questions and tests,
leaving little time for the kind of intimate chit-chat for which doctors and patients alike yearn. Some
patients must schedule two or three office visits to have all of their medical issues addressed.”
27. “History may not repeat itself, but it does rhyme a lot.”
- Mark Twain
29. REMEMBERING OUR MISSION
• The 44 rural counties in California
are home to 5.3 million people (2010
census).
• In 2010, California’s 168 acute care
rural hospitals treated one-third (3.3
million) of all emergency department
visits in California.
• An estimated 1.3 million children live
in California’s rural counties.
30. REMEMBERING THE DIRECTION WE WANT TO AVOID
“Patients displaced by a closing often take
months or years to re-weave the fabric of
their medical services. Vulnerable patients
are made more vulnerable when hospitals
close.”
-Professor Alan Sager, Boston University
School of Public Health
31. CALEXICO HOSPITAL, CALEXICO
Calexico Hospital was one of California’s smallest hospitals in one of the state’s most economically
depressed communities.
After 47 years of service, the 34-bed facility closed in October 1998, leaving the Imperial Valley
border town of 24,000 without a hospital.
The governing body of the hospital was forced to surrender its license to the Department of
Health Services (predecessor to the California Department of Public Health), which cited repeated
violations of state health codes involving record keeping, cleanliness and training of personnel.
Before the hospital closed, Medicare and Medi-Cal had it decertified.
Eight years after the hospital closed, a local jury found for the plaintiffs in a suit blaming the
hospital’s closure on the actions of “rogue” state regulators and awarded Calexico’s owners $12
million.
32. DESERT PALMS COMMUNITY HOSPITAL, PALMDALE
When Desert Palms closed in 1996, the 110,000 townspeople of Palmdale found themselves
without a hospital or emergency department.
With over 90% of Desert Palms’ admissions coming from the emergency department, hospital
administration blamed the closure on the financial impact caused by a disproportionately high
number of uninsured patients and an infrastructure destabilized by the entry of health
maintenance organizations.
33. KINGSBURG DISTRICT HOSPITAL, KINGSBURG
Prior to its closing in May 2010, Kingsburg District Hospital was one of the last remaining rural
hospitals in the San Joaquin Valley.
Since opening in 1961, Kingsburg had managed to overcome bankruptcies and cutbacks to
continue providing essential services to local residents.
34. LINDA VISTA COMMUNITY HOSPITAL, LOS ANGELES
Originally named Santa Fe Coastlines Hospital, this facility was constructed in 1904 to provide
medical care to Santa Fe Railroad employees.
In its early days the hospital thrived, and in 1924 it expanded to accommodate an increased
patient census.
After the Second World War, East Los Angeles County slowly transformed into a less affluent
area, and in turn the hospital found itself with less funding.
By the 1980s, Linda Vista Community Hospital was regularly treating a fair number of gunshot
wounds and stabbings from surrounding local neighborhoods.
Further changes in hospital demographics and an increase in uninsured patients ultimately forced
the hospital to stop accepting ambulance runs in its emergency department. Finally, in 1991, the
hospital ceased operations.
35. ROBERT F. KENNEDY MEDICAL CENTER, HAWTHORNE
Treating patients in California’s South Bay for over 70 years, RFK Medical Center was a
comprehensive medical complex with a multi-specialty medical staff and 24-hour emergency
department that provided adult and pediatric care.
When the 274-bed facility shut its doors in 2004, it was the sixth Los Angeles County emergency
department that year to close due to financial concerns, a trend many attributed to the financial
losses incurred by treating uninsured and underinsured patients.
36. SAN DIEGO GENERAL HOSPITAL, SAN DIEGO
Built in 1972 with assistance from the city, the hospital quickly experienced financial difficulties
due to its largely uninsured and underinsured patient population.
Struggling for nearly 20 years as Southeast San Diego’s only hospital, high debt and lack of
government funding ultimately forced a shutdown in 1991.
In the words of City Councilman Wes Pratt: “It’s a shame we can spend billions liberating Kuwait
but we can’t find the funds to free our citizens from disease and inadequate health care right
here in America.”
37. SANTA TERESITA HOSPITAL, DUARTE
In 1930, the Carmelite Sisters of the Most Sacred Heart founded Santa Teresita Hospital as a
sanitarium.
By the mid-1950s, it had upgraded to an acute care facility.
In 1964, the hospital added a skilled nursing facility and continued to expand, including the
construction of an office center in 1981 and surgery wing in 1986.
The hospital closed its 30-bed acute care facility in January 2004, citing California’s
implementation of statewide nurse staffing ratios as a contributing factor.
38. TUOLUMNE GENERAL HOSPITAL, SONORA
Forged by an informal partnership between local governments and merchants, this hospital
formed one of the oldest health care “systems” in the nation.
Tuolumne was built in 1849, offering a range of medical, surgical and diagnostic services.
On July 1, 2007, Tuolumne General closed its ER and discontinued all ancillary services, citing
financial difficulties incurred from operating an emergency department.
Prior to its closing, a study concluded that only 41% of Tuolumne’s emergency department visits
were actual emergencies.
39. BE MINDFUL OF WHAT WE CANNOT CONTROL
• The national economy
• Labor disputes
• Seismic activity
• An evolving digital world
• The uncertainty of health care reform
• A changing climate for compliance
Maintain perspective
40. NAVIGATING THROUGH CHANGES - THEN
In 1987, the House of Representatives, Select Committee on Aging and the Task Force on the
Rural Elderly noted that the delivery of health care in rural areas is complicated by
geography, economy and public policy.
• The DRG system was blamed for putting the elderly at great risk, as older patients
were released from the hospital much faster, or not admitted at all.
• Medicare’s Prospective Payment system reimbursed rural hospitals at a lower rate
than comparable urban facilities for care provided to an elderly patient with the
same illness.
• Rural hospitals did not usually benefit from a teaching adjustment to the DRG.
41. NAVIGATING THROUGH CHANGES - THEN
“Some argue that as many as 1,000 hospitals will close by the end of this decade,
resulting in a decline in the training of needed medical personnel, and the creation of
serious problems of care to select populations and communities. They argue, for example,
that the hospitals that are especially at risk of closure are the small rural hospitals, many
of which are the only providers of medical care to their local communities. . . . In contrast,
others argue that rural . . . hospitals . . . through adapting to these changes and through
increasing support of their local communities and state governments, will not have to close
but, rather, will reshape their mission and continue to provide needed medical care.”
-Health Affairs, Fall 1986
42. NAVIGATING THROUGH CHANGES - NOW
• The DRG system will be replaced beginning in October 2012.
• Under the Affordable Care Act, CMS will start paying hospitals Medicare “bonuses” based
upon overall performance, adherence to quality measures, patient satisfaction and total
spending per beneficiary efficiency levels.
• This epic change is designed to transform a system that has historically been based on cost
and volume into one that focuses primarily on quality and performance.
• Funding for value-based purchasing comes from base operating DRG reductions (1% in 2013,
1.25% in 2014, 1.5% in 2015, 1.75% in 2016, and 2% thereafter).
• Hospitals with poor performance ratings may be excluded from bonus opportunities.
43. NAVIGATING THROUGH CHANGES - NOW CONTINUED
• A hospital’s chance of survival in Medicare’s new world may ultimately depend on the
sophistication and implementation of its core systems (both technical and practical), leaving
little room for error.
• In this vein, Medicare’s hospital value-based purchasing program may create a disadvantage for
freestanding community hospitals, many of which lack the resources of larger, better funded
institutions needed to both implement and monitor all of the components established by
Medicare to be eligible for reimbursement based on quality and performance.
44. NAVIGATING THROUGH CHANGES - NOW CONTINUED
• Lacking the necessary resources to effectively combat rising health care costs and ever-
expanding regulatory oversight, the smaller facility must be savvy in its approach to our
nation’s new reimbursement structure if it is to maintain its existence.
• In order to survive, this once iconic institution must find ways to adapt to a constantly
evolving health care system for which health care conglomerates appear better suited.
45. THE AFFORDABLE CARE ACT’S TRILLION DOLLAR GAMBLE
“The affordable care act helps stop health problems
before they start.”
-HHS Secretary Kathleen Sebelius
The Affordable Care Act promotes:
• Pilot programs
• Preventative health care services
• Forward thinking research
46. EMBRACING TECHNOLOGY
• In 1951, the UNIVAC I was the first commercial computer to attract widespread public
attention. The manufacturer, Remington Rand, sold 46 units at more than $1 million each.
• In 1961, DEC’s PDP-1 sold for $120,000. The company manufactured 50 units.
• “Lisa” by Apple Computer sold for $10,000 in 1983. The following year Apple introduced its
Macintosh at the price of only $2,500.
Similarly, a time may come when we will understand the concept of “meaningful use” and
hospitals can enjoy the golden age of digital medical records, as well as the innovations and
efficiencies the follow shortly thereafter.
As the health care industry continues its push toward electronic health records, we must be
mindful of the speed with which technology changes, and the dilution of privacy expectations
that progress from generation to generation.
47. EMBRACE INNOVATION
The modern day hospital does not exist in a vacuum, nor do the constantly moving parts and
pieces contained therein. The OIG’s push toward vigilance in response to its perceived
climate of fraud and abuse should be balanced by equal attention to efficiency and
performance.
• Lean Six Sigma
• Fresh air and sunshine
• The ACO application
• Best practices in health care
In this digital age, never underestimate the value of “analog,” especially when responding to changes.
49. EMBRACING COLLABORATION
Border 2012 – This 10-year program takes a bottom-upward, regional approach to bringing together a
wide variety of stakeholders in an attempt to prioritize sustainable actions and improve the environment
of the border area between the United States and Mexico (www.epa.gov/usmexicoborder).
• Goal #1: Reduce Water Contamination
• Goal #2: Reduce Air Pollution
• Goal #3: Reduce Land Contamination
• Goal #4: Improve Environmental Health
• Goal #5: Emergency Preparedness and Response
• Goal #6: Environmental Stewardship
50. EMBRACING COLLABORATION CONTINUED
• Administration
• Health care practitioners
• Employees
• Vendors
• Your community
• Patients
Always be mindful of the doctor/patient relationship, from Marcus Welby, M.D. to Gregory House, M.D.
51. EMBRACING GRANT FUNDING
California Endowment Grant Programs
•
California Wellness Foundation Grants
•
California Wellness Foundation Program
•
HELP II Financing Program
•
Humana Foundation Community Grants
•
Medicare Rural Hospital Flexibility Program
•
Rural Community Assistance Corporation
•
Sierra Health Foundation Leadership Program
•
Small Rural Hospital Improvement Program (SHIP)
•
Student/Resident Experiences and Rotations in Community
•
Health Program (Cal-SEARCH)
• Wells Fargo California Grant Program
Additional information is available on the Rural Assistance Center website
(www.raconline.org).
52. TRAINING NEW HEALTH CARE PRACTIONERS
On February 13, 2012, the National Health Service Corps
(NHSC) awarded $9.1 million in funding to medical students
who commit to serving as primary care doctors in
communities with limited access to care.
“This new program is an innovative approach to encouraging more
medical students to work as primary care doctors. This is an
important part of the Administration’s commitment to building the
future health care workforce.”
-HHS Secretary Kathleen Sebelius
54. Garner Health, LLC
1299 Ocean Avenue, Suite 400
Santa Monica, CA 90401
T. (310) 458-1560
F. (310) 694-9025
E. craig@craiggarner.com
W. craiggarner.com