Author Archives: Dianne Savastano

Recommended Reading: Atul Gawande

In a recent article, Atul Gawande reflects on technology/electronic medical record systems and their impact on the physician patient relationship:

“And yet it’s perfectly possible to envisage a system that makes care ever better for those who receive it and ever more miserable for those who provide it.”

“We can retune and streamline our systems, but we won’t find a magical sweet spot between competing imperatives. We can only ensure that people always have the ability to turn away from their screens and see each other, colleague to colleague, clinician to patient, face to face.”

Seeking Change From Our “Crazy” Healthcare System

Last month, I attended the Simmons Women’s Leadership Conference in Dublin, Ireland. It was a wonderful experience and an opportunity to both renew old friendships and make new connections with interesting and accomplished women from around the world.

Two conversations in particular — both healthcare related — made a strong impression on me for their contrast with the state of healthcare here in the U.S.

The first was with Rachael, an Irish poet who shared the story of her “Ma,” who had developed Dementia. They had lived together for a long time, until her mother’s cognitive abilities declined to the point where she needed to transition to a long-term care facility.

I asked for more details about the experience and Rachael was incredibly complimentary about the care her mom received — before, during and after her transition. She said the transition was smooth, the care was fabulous, and the staff was very well trained. She described a sense of peace with the situation and never once mentioned cost.

The second conversation was with Joan, a colleague from Switzerland. She described how her father had transitioned to an “alternative living environment” following a severe illness and how issues related to access and quality of care were never a concern.

She went on to describe how in Switzerland, healthcare service is universal and is based upon the mandatory holding of health insurance by all citizens. When I told her about the average cost of healthcare for US citizens who do not have employer sponsored health insurance, she was aghast.

We need to acknowledge what’s working — and be honest about what isn’t

Upon my return home, I jumped right back into the deadlines that were looming for Medicare and Affordable Care Act Open Enrollment and reconnected with some clients who have incredibly complex healthcare situations. Soon after, I read this article about how life expectancy in the US is declining.

What a contrast with the simple and pleasant healthcare experiences of my new European friends!

It reminded me of a segment from a favorite HBO Series, Newsroom, in which the anchor, when pushed for an authentic moment, blurts out that the US is not the greatest country in the world. He goes on to back that up with data regarding life expectancy, infant mortality, and more.

This is not to say that we don’t live in a wonderful country! But if we ever hope to improve our healthcare system, we need to acknowledge what isn’t working, look to examples from around the world, and make changes to improve our circumstances.

Two Suggestions

Maureen Bisognano, from the Institute for Healthcare Improvement (IHI), states that part of the answer will be in overcoming the cognitive biases that slow the adoption of innovative practices. She said that one of the most effective ways to combat the common refrain of, “That sounds great, but it wouldn’t work in our context,” is to visit other places in person. Those experiences help open minds and nudge people into innovating.

Another solution may be to put design thinking at the heart of change. Don Berwick, president emeritus of the IHI, argues that the first step is to let go of previous assumptions. Things like, “If we just try harder, we’ll have success.” Instead, he believes we must be more curious, more accepting of uncertainty, and willing to emulate designers who pay attention to how people use and experience their surroundings.

Berwick believes that all health leaders should have training in design thinking in order to achieve a genuinely human-centered health system. This means seeking input from patients and providers for every innovation. Real co-design, he says, means using patient and staff expertise and passion to empower self-care, as opposed to simply getting users to comment on a preformed plan.

Final Thoughts

When it comes to making significant and lasting improvements to our healthcare system, it’s tempting to throw up our hands in frustration and assume that we are simply stuck with our current, imperfect model. I understand the urge as I guide my clients through the healthcare bureaucracy every day.

But I try not to think in those terms. If anything, my experience last month raised my hope that as innovative Americans, we can learn from others and make the kind of improvements necessary to give our citizens the consistent, affordable, top quality healthcare we all deserve.

As we embark on all the holiday festivities our family has planned, I find myself reflecting back on an incredible year, and also planning ahead for 2019. One thing I hope to do, is keep an open mind, overcome biases and continue to work to make our healthcare system better. Please join me in any way you can.

Recommended Reading: Working Beyond Age 65

Although there are general rules surrounding Medicare enrollment, if you and/or your spouse remain working beyond the age of 65, the timing for enrollment in Medicare Parts A and B has some nuance to it. In addition, if you remain working and contribute to a Health Savings Account (HSA), there may be tax implications.

As always, a customized assessment of your unique situation and that of your spouse is critical to making the right decisions at the right time.

This article discusses some of the issues.


This article provides insight on speaking with your employer if you are over the age of 65 and remain working.


Finally, I’m often asked if I recommend HMO plans through the ACA marketplace or through Medicare Advantage Plans for Medicare recipients. My standard answer is, “It depends on individual circumstances.”

Overall, my goal for individuals choosing these plans is for them to fully appreciate the guidelines and restrictions involved. This allows them to work within them and to anticipate and budget for out-of-pocket costs that will occur as care is accessed.

More on this topic, here.

Creating the “Perfect Patient Experience”

Recently, I attended a program at Simmons titled, “Is Bigger Better in Health Care? As mergers increase, how should we respond?” A panel of three economists discussed topics such as horizontal and vertical integration, the role of competition, anti-trust issues and value-based contracting. It was a great discussion, but one that approached healthcare solely from a macro perspective.

I, on the other hand, tend to look at the industry from the ground up. That’s why, as I was listening, I couldn’t help but think: “But how does this impact us, as healthcare consumers, who are finding our way through an incredibly complex system, so we can get good quality healthcare, when we need it, without going bankrupt?”

Eventually, I got to thinking of my dad and his terrific experience this past summer, when he had a knee replacement.

Before, during and after surgery

When it became clear my dad had a problem with his knee, we went back to the same orthopedic surgeon who did a fabulous job three years ago when dad needed a hip replacement. The surgeon is well educated, very experienced, and was wonderfully communicative about both the procedure itself, as well as what my dad needed to do before and after surgery to have a positive outcome.

My dad was going back to the same hospital where he had great inpatient experiences and outcomes previously (good news!).

On the day of surgery, everything went like clockwork:

Mom, dad and I arrived at 6:15 AM; he was in the operating room by 9:00 AM; he was in his room by 12:30 PM; he was up in the chair by 1:30 PM having some fluids for lunch. (See photo).

By 1:30 PM the next day, he was back home and comfortable.

All in all, it was a “perfect patient experience.” But, as you might imagine, these things don’t happen by accident. Let’s look at why dad’s experience went so well.

The Perfect Patient Experience

On the “Quality, Performance and Safety” link of the hospital’s website, it states that, “Every day, we strive to provide a perfect patient experience. When we find areas where we can improve, we have mechanisms in place to make improvements.” It goes on to describe The Albright Read Institute for Healthcare Improvement Science and Medical Research (ARI) that advances the hospital’s commitment to process improvement.

This Institute is one example of many quality improvement efforts underway in healthcare settings. You may have read about The Institute for Quality Improvement (IHI) or the Hoshin Planning Process and Lean Management, all quality improvement efforts implemented in healthcare settings around the world.

In the hospital my dad was in, and while serving on the Patient Family Advisory Council previously, I had the privilege of participating in a major quality improvement effort. This institution had a culture of excellence and improvement, and we felt it.

Here are some of the things that contributed to our satisfaction with my dad’s experience:

  • Excellent pre-surgery communication about where to go and what to do to prepare, including detailed instructions about pre-medications and skin preparation.
  • Pleasant and informative staff members who greeted us on arrival and told us what to expect, every step of the way.
  • Inclusion of me and my mom in the pre-op meetings with the surgeon and anesthesiologist.
  • Warm blankets – not only for my dad, but for my mom as well, who was cold from the air conditioning.
  • On-time surgery.
  • An electronic communication board in the waiting room that allowed us to “follow” where my father was – from the OR, to the recovery room, and to his room – so we didn’t have to wonder.
  • A post-op visit from the surgeon, in a private space, to review my dad’s experience and to outline what to expect next.
  • A welcome by the primary nurse responsible for his post-operative care, resulting in us feeling like she was taking care of all three of us, and not just my dad.
  • Helpful staff on my dad’s unit, all of whom welcomed my check-in calls at midnight and 5:00 AM the next morning.
  • Inviting my mom and me to arrive early the next morning to participate in his physical therapy evaluation and the discharge decision.
  • Excellent discharge instructions, covering pain control, plans for homecare services, and when to see the doctor for a follow-up appointment.
  • No more than a five-minute wait for the wheelchair transporter to take us downstairs and help us into the car. (This one really hit home for me. Many times, I have waited up to an hour with patients awaiting discharge.)

As I said, a perfect patient experience!

Evaluating your healthcare options

The Agency for Healthcare Research and Quality (AHRQ), an agency of the U.S. Department of Health and Human Services (HHS), defines quality in health care as:

  • Providing the best care
  • Providing the most appropriate care
  • Achieving the best outcomes for all patients

When obtaining care from a physician practice or from a hospital, look for a commitment to quality by asking about quality initiatives. Expect transparency about them.

Specifically, ask about…

…how (if it’s a physician practice) change efforts surrounding preventive care and management of common chronic diseases such as high-blood-pressure or diabetes are measured and initiated. Just as important, ask how patients experience care.

…electronic medical record systems and how information gets communicated during transitions of care.

…how quality is measured and what impact it has on the way insurance companies pay.

…Patient Family Advisory Councils and how patients participate in quality improvement efforts.

…how feedback is shared with physicians and staff.

…how the organization compares to national and state benchmarks of quality.

Conclusion

Yes, our healthcare system is complicated! But we, as consumers, need to be assertive, do our homework and assess the quality of care we plan to access, thus making informed decisions.

The culture of an organization and how it resonates with you and your needs is important. That organization may not always be around the corner, but as my dad’s wonderful recovery can attest to, the extra effort is worth it!

Recommended Reading: Medicare Costs

As we assist clients who are enrolling in Medicare for the first time, we consider many things. The articles below discuss some of those considerations.

Health Savings Accounts (HSAs) and Medicare

If you have an HSA and will soon be eligible for Medicare, it is important to understand how enrolling in Medicare will affect your HSA.

COBRA

When some of our clients retire before they turn 65, they often ask about COBRA coverage in comparison to obtaining their own insurance through the Individual/Family market. There are many nuances to COBRA, and these require careful investigation as people are making choices.

Here is some general information about COBRA.

Medicare Advantage Plans

Changing the way we pay for healthcare by aligning incentives is critical to reducing cost.

This article describes some examples of the way physician groups are attempting to keep their members healthy and reduce costs for Medicare recipients.