You Need a Specialist to Choose a Specialist.

 Some years ago I spoke at an American Hospital Association meeting to a large group of hospital executives and trustees. The first slide of my presentation was a picture of a 747 jumbo Jet. The question I asked was, “Why would I start my presentation with an aircraft to an audience of hospital leadership?” Then I asked, “How long would we Americans tolerate a 747 jumbo jet crashing every day-and-a-half?” The response was obviously universal -  we would not. My next comment was that if you do the calculation, that was the number of hospital deaths caused by nosocomial (hospital generated) viruses. I was reminded of this story when I saw the article published by Jane O'Donnell in “USA Today” on May 15, 2019. The articles caption was “Low-rated US Hospitals are Deadlier due to Mistakes, Botched Surgery, and Infections.” 400-600 passengers aboard a 747


The analysis that is the centerpiece of this article is generated from 2600 US hospitals since 2016. As the article states, "What the findings reveal is that some of the nation’s most dangerous medical centers have become even riskier for patients." This data was compiled by Leapfrog Group that issues grades on hospitals based upon safety and quality. Leapfrog grades from A to F. This is a more stringent grading system than the federal government as the federal government doesn't issue failing marks.

GradesThe American Hospital Association, the trade group for the hospital system in America, defended its member hospitals saying improvements are being made. The defense of the system at large by the AHA is consistent with what all trade groups do to defend the status of their membership. However, Leapfrog, having no duality of purpose, was able to utilize a rigorous evaluation system to rank the patient care. As can be expected, many of the hospitals that ranked poorly in the study claimed that their results were impacted by the fact that they care for sicker and less affluent patients. However, the Leapfrog study is risk adjusted to reflect the degree of severity of illness of the patient population being served. 

The importance of this study is it gives us a clear understanding of the disparities in quality of care that persists in the healthcare system that pose very significant risks. The reality is health systems that have gained a reputation for excellence attract the brightest and the best physicians and ancillary health care personnel. All hospitals do not have the same level of service in each of their specialties. For example, if a patient has a heart condition Cleveland Clinic and other institutions of their stature stand out as providing the most advanced coronary care. Yet, if a patient is diagnosed with cancer, Sloan-Kettering and M.D. Anderson would come to mind as centers of excellence. However, if a patient needs care in one of the preeminent hospitals for pulmonary medicine, National Jewish in Denver, Colorado, would be a top choice.


Community hospitals in smaller to medium size cities, throughout our nation, face the daunting task of providing services in a multiplicity of specialties while lacking the "bench strength" of centers of excellence located in major metropolitan areas. This reality is leading many major corporations to develop Direct Contracting relationships with centers of excellence for the provision of more complex healthcare services for their employees. They have discovered it is much more cost-effective to transport a patient out of a community facility to a center of excellence as that decision results in improved outcomes and a healthier workforce. Further, because this results in fewer readmissions and complications, the overall cost of delivering high-quality care is actually less expensive. 


Click to Download a PDF on the Concierge HealthCare Management Model 

We at Curus have been aware of the issues raised in the Leapfrog study from the time we created our company. Our approach has always been to pursue excellence in the delivery of care because there can be no compromise with our health. The Curus model is of increasing value in small to medium-size communities where patients need to make critical health decisions without the availability of centers of excellence. We, by nature, place our trust in our primary care doctor and follow their instructions as to the choice of procedures and specialists. However, with the growing consolidation of healthcare systems, the choice of preeminence in the medical subspecialties is increasingly limited to centers of excellence. The advances in medicine have been so extraordinary that specialists are being required to limit their expertise to a subspecialty within a specialty. An example of this process is clearly seen in orthopedic surgery. While many community hospitals have highly skilled orthopedic generalists, in the centers of excellence there are sub-specialists in knees, ankles, hips, shoulders, hands, and beyond.


Wikipedia Ortho subspecialty

Thus, being referred to a generalist in a specialty no longer provides the level of skill of that of a sub-specialist has who only focuses on a specific area within that specialty. The process of choosing the right healthcare provider and the right facility has become much more complex in this age of increasingly focused expertise. As these trends continue, people are going to need to have a health manager at their side to make the critical decisions on where to obtain care.


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The article quotes a husband whose wife suffered irreversible brain damage in a poorly performing facility, "If a hospital is rated an F, it's an incredibly good indicator what's going on in that hospital: what the culture is and what the quality and safety of that hospital is. You're not going to go out for a D rated steak dinner or a chicken Alfredo rated C.” Certainly, when it concerns our health we should always seek the best that the healthcare system has to offer. These days, knowing who that is requires professional expertise


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Filed Under: Insider, Health Management, doctor shortages, healthcare quality, patient satisfaction, changes in healthcare, medical access, chattanooga

Is retirement the ultimate goal?

I am often asked when am I going to retire? Since I have achieved the age denoted as "senior citizen" it is a fairly legitimate question. Yesterday as I was pondering what I would like to write about in this month's Health Points, I came upon a lead article in the "Wall Street Journal" entitled "The Case Against Early Retirement". To delve into the philosophical -  I have often thought there are two phases to later life; and I define them as, "living or waiting to die". As Richard W Johnson states in the opening of the article, "Most people look forward to retirement, a reward for decades of hard work. But like many other pleasures, it may be bad for your health. It may even kill you."

"How can that be? How can working longer be good for your health? After all, many people dream of-- and plan for-- retiring early. Strenuous, stressful work can wear people down and damage their health. On the other hand retirees can relax and reinvigorate themselves. They have time to follow their passions and pursue activities that enrich their lives."  -Richard W. Johnson


Boston collge mortality statisticsThe reality is many retirees lose a sense of life purpose that they derived from their chosen employment. They lose the social interactions that occur in most workplaces and they become sedentary and inactive. Our jobs subtly force us to maintain a high level of mental agility that defers and delays those signs of aging such as forgetfulness and memory loss. From a societal perspective there is a transformation from being a provider to being a consumer. As we alter our self perception as a valued contributor we increase our sense of mortality. This increases our sense of vulnerability both physically and financially. In many instances we have too much time to think and each minor change in how we feel becomes exaggerated as an impending health event. This sends us increasingly to doctor’s appointments for both real and perceived health events.


For those who have retired and moved to retirement communities in Florida, Arizona, California their visits to physicians become an important activity. The critical issue becomes does the physician hear them or does he/she become more insensitive as a result of the volume of aging patients they consistently examine. I recall very early in my career as a lawyer I tried criminal cases, as appointed counsel, in what was known as Recorders Court that only handled criminal matters. I, being a young lawyer, pursued those cases with all the enthusiasm and a sense of justice that had been inculcated in law school. Soon I realized that the judges had become cynical and jaded. The concept of “innocent until proven guilty” was not the premise upon which the cases were heard. More often than not it was "guilty until proven innocent".


 Closeup portrait, overwhelmed, busy unhappy stressed female health care professional, funny looking doctor holding big clock running out of time exhausted, isolated red background. Healthcare reformThe physicians who treat aging patients face the same challenge as they listen to aging patients, many of whom are lonely, explaining their aches and pains. The doctors face the dilemma of trying to determine if these are actual or perceived health issues. That is why we see so many cases of overmedication in senior citizens.

The physicians who are pressed for time seek the path of least resistance and will write a prescription for the perceived illness. The patient who is visiting various doctors is then uncertain as to whether the problem is resolved or exacerbated by the medication.


Senior woman at home figuring out income tax-1One could then argue, as we work longer we extend our lives because we have less time to be consumed with the aging process and its maladies. We have the benefit of responsibilities to others to focus our attention. Our state of mind has such an incredible impact on our physical health. As we continue to feel productive and useful we preserve our health and defer our decline. A Study published in the Lancet concluded that a a longer lifespan could be linked to a sense of meaning and purpose in life. 


Too often, at Curus,  we have seen that less would be better than more in the prescribed medications being taken. Too much medication has a tendency to lead to both cognitive and physical decline. It is entirely possible that too much time on our hands can indirectly lead to too much medication being prescribed.  We at Curus pay particular attention to the list of medications our older members have been prescribed. Our clinical pharmacist plays a particularly pivotal role in the evaluation of the health status of our senior citizens.


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If the prescription for healthier aging is a sense of self, contributing to others and meaningful social interactions; working longer should be an important part of this prescription.



Filed Under: mental status affects health, Mental Health, elder care, retirement, retirement health