Can a Large Not-for-Profit Hospital System be a Monopoly?

Today on its website, Kaiser Permanente discusses the Wall Street Journal's story regarding Carilion Health System, a large not-for-profit hospital system in southwestern Virginia and whether it has created a monopoly for health care services in the area. Read on:

"According to the Journal, not-for-profit hospitals, which account for the majority of U.S. hospitals, receive tax exemptions and "are supposed to channel the income they generate back into operations, while providing benefits to their communities." However, not-for-profit hospitals have "come under fire from patient advocates and members of Congress for "stinting on charity care, even as they amass large cash hoards, build new facilities and award big paychecks to their executives," the Journal reports.In the case of Carilion, the Department of Justice in 1989 filed a failed antitrust lawsuit in an effort to block a merger between Carilion and a local hospital over concerns that the move would create a monopoly on health care services in the area. Almost 20 years later, health care costs in the area are "soaring," and health insurance premium rates in the area have increased from the lowest in the state to the highest, the Journal reports. Carilion charges four to 10 times as much for some health care services as other providers in the area, but, with eight hospitals, 11,000 employees and $1 billion in assets, residents in most cases must seek care through the hospital system or travel outside the area. In addition, although Carilion receives about $50 million annually in tax exemptions, the hospital system spent only $42 million in charity care in 2007 and only $30 million in 2006. Carilion officials maintain that the hospital system does not have a monopoly on health care services in the area because of competition from Lewis-Gale Medical Center, a hospital owned by for-profit chain HCA. In addition, "Carilion says it charges more for certain procedures because it has to subsidize operations such as an emergency department and treatment for the uninsured," according to the Journal. Carilion CEO Edward Murphy also said that the increase in health care costs in the area is part of a national trend and has resulted from overuse of services"(Carreyrou, Wall Street Journal, 8/27).

Universal Healthcare is a big issue in Campaign '08

Emily P. Walker, Washington Correspondent, MedPage Today, published the following article from Denver regarding Sen. Hillary Clinton's stance on universal healthcare and its mention in her speech at the Democratic National Convention last night.

" Despite tortuous battles during the presidential primaries over the nuances of healthcare reform, Sen. Hillary Clinton was ringing in her support for Sen. Barack Obama's goals at the Democratic National Convention here.
In a so-called unity speech last night, Clinton said that she ran for president in part to "create a healthcare system that is universal, high quality, and affordable so that parents no longer have to chose between care for themselves or their children or be stuck in dead-end jobs simply to keep their insurance."
She added, "I can't wait to watch Barack Obama sign a healthcare plan into law that covers every single American."
Clinton, who was in charge of the failed healthcare reform initiative during her husband's presidency, was scheduled to headline a forum today called "Winning Healthcare Reform in 2009."
Earlier yesterday, some figures in the entertainment world took advantage of the massive press turnout here to draw attention to the plight of children with type 1 diabetes in developing nations.
Among the famous faces were film stars Susan Sarandon, Anne Hathaway, Zooey Deschanel, and Matthew Modine, and hair-guru Paul Mitchell.
The celebrities are all part of the Creative Coalition, a Hollywood non-partisan political and social advocacy group.
At the luncheon, sponsored by Creative Coalition, a clip of a documentary was shown, called "Life for a Child," produced by the International Diabetes Fund and drug-maker Lilly. It tells the story of kids living with type 1 diabetes in Nepal.
Still earlier, Family USA responded to new Census Bureau figures that showed that more Americans had health insurance coverage in 2007 than in 2006.
Families USA, which advocates universal healthcare access, said the increase in insured Americans stems in part from people trading in their employer-sponsored plans for Medicaid.
In fact, healthcare coverage for workers is getting worse, said Ron Pollack, executive director of Families USA. According to Pollack, in 2000, 64.2% of the public was covered by employer-sponsored insurance. In 2007, it was reduced to 59.3%.
"As employer-sponsored health coverage continues to erode, it is important that meaningful healthcare reform become the top and earliest domestic priority of the next president and Congress," said Pollack. "

Can anyone bail out Grady Memorial Hospital in Atlanta?

Grady Memorial Hospital has been a thorn in the side of Atlanta's healthcare community and city, county and state government for many years. Noone has been able to "fix" Grady's health. Grady does have a new CEO named Michael Young, the former president and CEO of Erie County Medical Center Corporation in upstate New York, and I think that he may be the man to heal Grady. Many have profited from Grady's woes. It appears that PricewaterhouseCoopers had a large bounty at stake in the event they can improve the hospital's profitability. My favorite healthcare blogger, Sarah Rubenstein at the Wall Street Journal takes on the Grady issue. Read on.

"PricewaterhouseCoopers has taken on the job of helping fix Grady Memorial Hospital, the public hospital in Atlanta that has been bleeding money for years. The firm had hoped to save Grady $65.5 million in 2008, but the hospital fell $7.7 million short of a mid-year goal, according to a report obtained by the Atlanta Journal-Constitution. By year end, Grady could miss out on $10 million to $20 million in savings because of the setbacks, the consultant said.
Here are problems the AJC lists from an August presentation on the hospital:
“Cultural and behavioral barriers regarding accurately charging patients for services rendered.”
“Inefficient contracting process; Missing sense of urgency and accountability; Lack of aggressiveness with vendors.”
Resistance from physicians involved in surgery, delays due to time needed to address executives’ concerns and difficulty recruiting and retaining qualified staff.
A “higher degree of uncertainty than typical,” and delays in starting initiatives.
Consulting firms themselves have a cost. As of early August, PWC had won $6.2 million in fees through a two-year contract that pays the firm as much as one-fifth of what it saves Grady, according to the AJC. The consultant could make up to $26 million, but will earn less if it saves less. Still, PWC has saved Grady more than $34 million between October and June 30, the report said."

Online office visits may be a wave of the future

Can you imagine having a doctor's appointment over the internet instead of getting into the car, driving to the office, parking the car and waiting to see the physician? Sounds enticing for minor ailments. The following written opinion of Benjamin Brewer, MD in favor of online internet office visits is published in today's Wall Street Journal.

"My patient probably would have rather been anywhere else. He and his wife were in my office to discuss his erectile dysfunction for the first time. He looked uncomfortable. For a guy who doesn't go to the doctor much, a medical office can seem as foreign and intimidating as the dark side of the moon. His exam was normal, but he needed to quit smoking. Would it have been easier for you to fill out a questionnaire on the Internet and skip the office visit? I asked. "You bet," he replied.

The way I see it, he didn't really need to come in at all. He needed a risk assessment for heart disease, a prescription for medication, counseling and help with stopping smoking. The results would have been the same online or in person.

How would you feel about "visiting" your doctor online for routine medical issues such as allergies or sinus infections, or potentially embarrassing ones like erectile dysfunction?
The average American's health-care experience is fraught with high cost, poor service and uncertain quality. But the prudent practice of medicine online would improve health care on all three counts.

Patients want access to safe, reliable medical care on the Internet, just like banking, shopping or booking a flight. Eighty percent of the public want doctors to use email to communicate with patients, but only 9% of physicians actually do that even occasionally. I think 20% of my routine office visits could be handled safely and less expensively over the Internet. There is nothing magical about the four office walls that make face-to-face visits superior. Demanding an in-person visit for every little thing is based on tradition and consensus opinion -- not science.
Doctors trot out excuses about why they don't use the Internet as a tool for working with patients. I think doctors' big fear is that the online discussions with patients will eat up time, with little or no extra payment for the service. A big impediment is that in most states it is illegal to prescribe drugs for a patient based on an online evaluation. That seems strange to me because physicians have been prescribing medicines by telephone for simple things without the safety net the computer provides. Of course, there have been cases of inappropriate prescribing of narcotic medications in my home state, Illinois, and others. And regulators put the clamps on even legitimate use of Internet medicine without a face-to-face physical exam.
The medical establishment has been reluctant to embrace online medicine. Indeed, medical societies and the Federation of State Medical Boards have taken a very aggressive position against Internet prescribing in the name of patient safety. In their world, only in-person visits are thought to be safe.

Are the boards of medical examiners' policies really protecting patient safety or only mandating face-to-face office visits as economic protection for doctors, I wonder. If I tried to prescribe ED drugs today based on an Internet questionnaire and email correspondence, the state medical board could take my license away and fine me thousands of dollars for every patient I treated.
I have no desire to be a Viagra prescription mill. I bring up the medicine because ED care over the Internet is probably the most studied of online options.

There are broader applications for Internet treatment beyond ED. And to be absolutely clear, there's no evidence that only face-to-face office visits are safe, effective and high-quality.
Traditionalists in medicine may be afraid to learn how good Internet medicine can be. One of the first substantial studies of Internet medicine was conducted by the University of Utah and published this month in the journal Mayo Clinic Proceedings. The researchers compared traditional office treatment of erectile dysfunction versus Internet practice.
The patients treated online had no face-to-face exam. The traditional doctors had the benefit of a computerized record system but they still lost out to the Internet doctors, who took a more thorough history and provided more counseling with the aide of a standardized Internet-based system.

Internet practice for ED was equal to traditional office practice or safer in all areas studied.
As a small-town doctor who still makes house calls, the prospect of an Internet practice is quite a departure from business as usual. As the Internet-savvy population ages and the number of primary care doctors dwindles, the demand for safe online medicine will grow. Until the regulators come around to the advantages of Internet medicine, patients will continue to miss work over minor ailments and I'll keep seeing them at the office."

10 Items Which Undo Proper HR Documentation

Proper documentation is essential in human resources. Failure to properly document any issue may lead to your failure to defend or file a lawsuit. The

HR Manager's Legal Reporter published a list of items that sink HR documentation. Here are the top ten:

"1. Unsigned or undated documents. This is the number one failure in documentation. Sign and date everything! Have the employee do the same.

2. Illegibility. You didn't go to med school, so leave the scrawl to the doctors. In court, neatness counts!

3. Late documentation. Judges and juries look askance at disciplinary or other reports written weeks or months after the incident they describe.

4. Inaccuracy. That document looks perfect, but the facts are wrong. Even one error makes the entire document suspect.

5. Unsupported conclusions. Don't write, "Worker X was drunk" without documenting the reasons you think so, e.g. "liquor on breath, slurred speech." Statements by objective witnesses will buttress your conclusion even more.

6. Waffling. If Mike isn't making 200 widgets per hour, don't just write, "Mike's performance must improve." The judge will ask, "Improve from what to what?" Be specific.

7. Don't make excuses. Statements such as "You failed-but I know we've all been pushing hard lately," may win you a nice guy award, but it won't win your case.

8. Don't lie ... even to be nice! Saying someone was let go due in a layoff rather than for cause, if there was cause, can backfire big time in a wrongful termination suit.

9. Be consistent. If you've written up Sally for an infraction, you'd better have written up everyone who did it. Otherwise you're open to a charge of discrimination.

10. Don't over or under focus. Writing up every tiny infraction makes you seem petty. But writing only the job-ending incident makes you appear emotion-driven."

Ten Important Steps Before Terminating an Employee

One of the most unpleasant experiences as a manager is to terminate someone's employment; especially if you like the employee personally. It is never easy. It is important not to let emotions get in the way and stick to corporate protocol. The following tips from HR Factfinder set forth an excellent foundation for handling the process. Check it out.
"90 percent of discrimination charges are discharge-related. The reasons are obvious: Terminations cause hard feelings, create economic need, and destroy feelings of loyalty, says today's expert. What can HR do?
Expert James W. Bucking, partner and co-head of the Employment Department at Foley Hoag LLP in Boston, blogging on HR FactFinder, offers 10 tips for handling terminations and avoiding lawsuits. Here's some of what he says.

1. Know the Facts. As an employer, you have broad authority to compel employees to talk to you. Take advantage of this right, says Bucking. Talk to supervisors, co-workers and subordinates, and make a record of what they tell you. Speak with the employee involved because it's a lot better to know his or her story at the time of termination than to hear it first at a deposition.

2. Review ALL the documents. Be especially wary of "stellar" performance reviews, says Bucking. Also review the disciplinary records of other employees in the same job or area. "There may be perfectly good reasons for treating employees who seem similarly situated differently, and you need to consider these differences in advance," he says. Also, look everywhere documents concerning the employee may exist, including the files, electronic records, and e-mails of the supervisor and everyone else involved.

3. Create new documents. "Sometimes the problem with a termination is that there are few documents supporting your decision. "There is nothing wrong with creating such documents-in fact, it is a good idea," Bucking writes. But never make things up on or backdate the documents you create.

4. Beware the electronic scourge. Many people and documents are typically involved in discharge decisions, and today's technology preserves every bit of the "untidy, behind-the-scenes process." Litigation discovery can reveal it for the world to see. Have an attorney involved at all stages, Bucking advises, as this brings things under attorney/client privilege. If an attorney is not involved, then avoid creating a permanent electronic record.

5. Don't lie. "The worst thing to do when terminating an employee is to be dishonest as to why. Yet this is a common mistake," Bucking says. Like most people, employers hate confrontation and hard truths, so firing for poor performance is often disguised as a layoff. "But most discrimination allegations turn not on direct evidence (like racial slurs), but on 'pretext,'" he says. "An employer gives a false reason for termination, creating the inference that the real reason was unlawful."

6. Don't be cruel. To you, a termination may be just business, but there's no way to avoid an employee taking it as personal. That's likely to lead to a lawsuit, where "cold-heartedness does not play well before a judge, and especially a jury," Bucking says.

7. Conduct the termination respectfully. Don't fire in public. Instead, be as private, respectful, and decent as possible.

8. Have backup. Two people should be present at the termination, says Bucking, and both should take detailed notes. Record anything material that the employeesays, and also what you say, especially on the reason for your action. Be sure that what you tell the employee agrees with your previous oral and written statements.

9. Pay all compensation. Make sure that all monies due to the employee are paid immediately. In many states, all compensation owed must be paid on the day of discharge.

10. Don't forget about non-compete, non-disclosure, severance, and other agreements. Make sure you live up to any obligations to departing employees, and make sure they understand any obligations they owe you. Bucking also suggests considering new agreements such as a release from legal action based on the termination. "It may be a great investment to pay a few weeks of severance for absolution from litigation," he says.In an article on HR.BLR.com, private investigator George Scharm offered some other helpful termination tips, including:--Never fire someone while you're angry. You want to diffuse emotion, not compound it.--If an employee has a poor relationship with his immediate supervisor, get someone else to conduct the firing.--Plan every step of the meeting in advance: what you will say, how you will respond if the employee reacts with anger or hysteria.--Beyond forestalling litigation, as Bucking suggests, severance pay can also be an investment in company security. Be courteous, but firm. Leave nothing open to negotiation.--Have the exit preplanned. Escort the employee out the door and to his or her car."

Medicare..Can Physicians Save Move and Improve Care?

Anna Wilde Mathews, a blogger for the Wall Street Journal tackles a tough issue which is the subject of constant buzz in the healthcare community..Medicare reform. It seems a group of doctors participated in a pilot program run by the Centers for Medicare and Medicaid Saving which offered efficient practices incentive payments. Check it out.

"Washington is revving up for a big debate next year over health care — which, realistically, is likely to end up centering around some form of Medicare reform. Everybody wants to somehow save money while also improving care. Proof that trick can be performed consistently in the real world is hard to come by, despite the flurry of concepts and buzzwords being shopped to congressional staffers as the hope for tomorrow.

Some encouraging data are just out from a closely watched demonstration project on incentive payments for doctors being run by the Centers for Medicare and Medicaid Services. The project focuses on 10 physician group practices that can earn extra money by improving efficiency and hitting various quality benchmarks.

The groups scored nearly perfectly on quality measures for diabetes, heart failure and coronary artery disease, with half achieving the targets for all 27 bogeys, and all of the groups meeting at least 25. But only four achieved the CMS efficiency targets and won the extra payments tied to saving the government money and achieving quality standards.

The savings were measured in a typically convoluted way-– the doctor groups got the bonus if the growth of the demonstration participants’ Medicare costs was at least 2% slower than the growth for other beneficiaries in their geographic areas.

John Pilotte, the CMS project director for the pilot, told the Health Blog he felt the savings results were still “very positive,” and better than the first year, when just two groups achieved the goal. Still, he added, “it sort of underscores the challenges and the difficulties in managing care for the Medicare population.”

So what worked? Pilotte and officials from a number of the clinics flagged various things, including those policy-wonk favorites: chronic disease management and coordination of complex cases.

Theodore Praxel, a medical director at Wisconsin’s Marshfield Clinic, one of the four savings-bonus winners, said there was “no single answer,” but he gave a lot of credit to yet another wonkish fave, an electronic medical record that helped track and alert personnel to what services patients needed. He also pointed out that savings from better prevention of health problems can take years to show up."

Stanford Study Proves Running Slows the Aging Process

I do not enjoy running but I do enjoy how I feel when my run is completed. In addition to the endorphins running releases, running also slows the aging process. Stanford released the following regarding its long term study. I think I'll go for a run this afternoon.

"The Stanford University School of Medicine has released the results of a long-term study that explores how a lifetime of running affects the aging process. The multitude of benefits derived from running have surprised even the research team.
In 1984, James Fries, MD, and his team of research colleagues enlisted 538 runners, all older than 50, and a similar group of nonrunners. Each year since then, the study participants have completed questionnaires about their personal lives, including their ability to groom, dress, and walk themselves as well as to their ease in getting up from a chair and gripping various objects. Their running patterns have been documented through the years as well.
When the study began, the runners averaged about four hours of run time each week. Twenty-one years into the study, run time has diminished to only 76 minutes per average week but the runners were still reaping the benefits of their active lifestyle nonetheless.
After 19 years of study, only 15% of the runners had died, from any cause, compared to 34% of the group of nonrunners. As was expected, the rate of death due to cardiovascular disease was much lower in the group of runners but the running group also had fewer deaths attributed to cancer, infection, and neurological disease, among others.
By the 21st year of the study, participants in both the running and nonrunning groups had started bearing signs of advanced age. They are now all in their 70s and 80s. What has proven to be quite remarkable is that the age of decline is dramatically later in the runners than in the nonrunners.
The onset of initial disability occurred 16 years later, on average, in the group of runners than in the group not running. Even more surprising is that, as age advances, the gap between the health of the runners versus the health of the nonrunners widens, in effect compressing the ill effects of old age into the shortest amount of time possible.
Indeed, it was Fries’ theory of “compression of morbidity” that led to the study in the 1980s. At that time, critics of the new running craze said the exercise would lead to injuries of the knee and other joints that would cause osteoporosis and other crippling disabilities as age advanced.
Fries’ thoughts were that a lifetime of regular exercise, such as running, would extend the runner’s life while enhancing vitality and improving its quality at the same time. His extensive study has proven his hypothesis correct.
Fries is emeritus professor of medicine at Stanford’s medical school and is the senior author of the paper describing his study of running. The Archives of Internal Medicine carries the full details in its August 11 issue.
The National Institute on Aging and the National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded grants for the Fries study."
Source: Stanford School of Medicine and Medheadlines Posted August 13, 2008

Keep Moving to Keep Your Brain Stimulated

As the baby boomer population grows older, the good news is that they are living longer. The downside is that statistics show that 1 in 8 adults over age 65 are affected by Alzheimer's disease. As a person living with a parent with the disease, I personally understand the implications. According to the following article written by Caryn Rabin in the New York Times, mental and physical exercise do help your cognitive functions as you grow older.

"AMERICANS may worry about heart disease, stroke and diabetes, but they downright dread Alzheimer’s disease, a recent survey found.
For good reason. One in eight adults over 65 is affected by the disease. Those who are spared know they may end up with the burden of caring for a parent or a spouse who is affected. Even though the number of older adults with dementias is rising rapidly, only a few drugs that have been approved to treat symptoms are on the market, and they slow down the disease but do not cure it.
Researchers, however, are more optimistic than ever about the potential of the aging brain, because recent evidence has challenged long-held beliefs by demonstrating that the brain can grow new nerve cells.
“For a long time, we held the assumption that we’re born with all the nerve cells we’re ever going to have, and that the brain is not capable of generating new ones — that once these cells die we’re unable to replace them,” said Molly V. Wagster, chief of the Neuropsychology of Aging branch of the National Institute on Aging. “Those assumptions have been challenged and put by the wayside.”
The birth of new nerve cells, she said, “has been shown to occur in the adult — not only in adult rats and monkeys, but also in older adult humans.” Most of the areas that show neurogenesis and that have been investigated so far are important for learning and memory, particularly the hippocampus, she added.
So how does one stimulate neurogenesis?
Scientists do not have all the answers, but studies of older people who have maintained their mental acuity provide some clues. They tend to be socially connected, with strong ties to relatives, friends and community. They are often both physically healthy and physically active. And they tend to be engaged in stimulating or intellectually challenging activities.
The big question is whether they remain mentally alert because they engage in these activities, or whether they are able to engage in these activities because they are cognitively intact.
“We don’t know whether this is an example of reverse causation or not — it’s probably a two-way street,” said Bruce S. McEwen, who heads the neuroendocrinology lab at Rockefeller University in New York.
But some interventional studies that have introduced older adults to exercise regimens have reported remarkable results. Researchers at the University of Illinois at Urbana-Champaign recruited a group of sedentary adults between the ages of 60 and 75, assigning half of them to an aerobic exercise program that met three times a week to walk, while a control group did anaerobic stretching and toning.
The scientists measured the group’s cognitive function before and after the six-month program and found improvements among those who had done the walking.
“Six months of exercise will buy you a 15 to 20 percent improvement in memory, decision-making ability and attention,” said Arthur F. Kramer, a professor of psychology at the University of Illinois. “It will also buy you increases in the volume of various brain regions in the prefrontal and temporal cortex, and more efficient neuronetworks that support the kind of cognition we examined.”
Other studies have found improvements in cognitive function after a combined regimen of physical exercise and cognitive training.
But skeptics say there is no guarantee that intellectual stimulation will prevent Alzheimer’s disease or other forms of dementia. “Maybe it does, but I don’t think we have a shred of evidence,” said Dr. Robert N. Butler, a psychiatrist and gerontologist who is president of the International Longevity Center-USA. “What it does is maintain good health,” he said, adding, “I don’t think we can go much further than that.”
But there is consensus among scientists on a few recommendations for action that, most agree, cannot hurt.
Regular physical activity may improve brain function, both by increasing blood flow to the brain and stimulating the production of hormones and nerve growth factors involved in neurogenesis. Animal studies have found that physically active animals have better memories and more cells in their hippocampus. Exercise also plays a role in countering diseases like Type 2 diabetes, which increases the risk of dementia. Cholesterol and hypertension, which affect vascular health, also need to be kept in check.
Seeking out stimulation through interesting work, volunteer opportunities or continuing education is beneficial. Travel, read, take up a new language or learn to play a musical instrument. Staying socially connected is also associated with brain health, as is managing stress effectively. Chronic stress can lead to the rewiring of areas of the brain that are involved in emotion, memory and decision-making, Dr. McEwen said, “and the brain becomes more biased toward more anxiety, more depression, less flexibility in terms of decision-making and becomes less able to store information.”
Most scientists recommend eating a Mediterranean-style diet, including fish and nuts containing omega-3 fatty acids, antioxidant-rich fruits and vegetables, olive oil and possibly some red wine. (Blueberries are also recommended.) Some also suggest avoiding playing games like football, because of the risk of head injuries, staying away from pesticides and insecticides that contain neurotoxins and not drinking excessively.
“Another thing that’s important as people get older is to maintain flexible attitudes and be willing to try new things,” said K. Warner Schaie, who in 1956 started the Seattle Longitudinal Study, which follows the psychological development of participants through adulthood. “You have to expect things will shift over time and won’t be the same as when you were young. Those who manage to roll with the punches, and enjoy change rather than fighting it, tend to do well.”

What do McCain and Obama have to say about employer sponsored health coverage?

I am a fan of the Wall Street Journal's healthcare blogs. Today Sarah Rubenstein tackled the question about the candidates' stands on employer sponsored health coverage. Check it out.

"When it comes to health insurance, it’s usually easier to have an employer provide it than to buy it for yourself. So when health-policy advisers for Barack Obama and John McCain participated in an online debate on WSJ.com about their bosses’ respective health care plans, much of the focus was on how each plan would affect the employer-sponsored market.
A quick backgrounder: Obama wants private plans and one new government-run plan to compete to sell insurance, with government subsidies for low-income customers. McCain would change the tax treatment of health insurance in a way that would encourage Americans to buy insurance on the open market, eliminating the current bias toward employer-sponsored coverage.
Naturally, each debate participant thought the opposing candidate’s plan would do more harm than good to employer-sponsored coverage. But here’s what they said about their own men’s plans:
David Cutler, Obama’s adviser, said that Obama’s plan will “shore up the employment-based system, not tear it down: lower premiums that firms face through investments in information technology and prevention; create a setting where individuals and small firms can buy insurance the way that large firms do; make sure that insurers cannot exclude firms because one employee is sick.”
Jay Khosla, McCain’s adviser, said McCain’s plan “simply aims to bring equity and choice to our healthcare system, including allowing American families to keep their current coverage. The McCain plan gives American families a $5,000 refundable tax credit ($2,500 for individuals) to give them more choices to purchase portable coverage that would stay with them from ‘job to job’ or ‘job to home.’ His plan directly and comprehensively addresses the single biggest threat to [employer-sponsored insurance] –- rising costs.”"

Employee Compensation Issues for Small Business Owners

One of the major issues discussed with our clients is salary. It is particulary an important subject in today's economy. In the Atlanta medical community, most office managers want to pay competitive salaries, especially for hard to fill positions such as RNs. I found the following article, by Michael Alter posted on the Human Resources Blog in Inc. magazine, very informative about setting salary levels.

"Compensation is a hot-button issue for employees, but it's an even bigger deal for small-business owners these days. With shrinking profits in this tight economy and costly benefits hanging over your head, there's no room for error in defining employee salary levels. Here are some tips on how to set your salary levels.
I run a payroll service and as you might expect, I hear a lot of feedback from our small-business customers regarding employee compensation.
My conversations with business owners have made one thing clear -- many business-owners struggle with the right amount to pay new employees.
It's a tricky issue. Overpay your employees and profits may drop. Underpay your employees and you'll get inadequate employees or you'll lose them over time to the competition.
The bottomline? Today's competitive business environment necessitates a solid basis for defining compensation levels. Here are a few things to consider when you define the target salary for a new hire.

National Salary Averages Are Irrelevant
Always think local. National salary averages mean nothing if you are located, say, in a small town in Kansas. In fact, salary levels for any given position are very location dependent.
If you are doing salary research, it's imperative that you look for salaries in your town or in towns that are very similar to yours.
Similarly, salary ranges vary considerably by industry. When looking at salary benchmarks, it's important to only look at those from your industry whenever possible.
In addition, the job description, not the job title, should be on center stage when researching salaries. It's what the person will do and what's at stake that matters, not the title that will go on their business card.

Online Salary Wizards
So where can you go to research salaries and why is salary research important?
Before prospective employees start interviewing, they will often check out online salary calculators such as the Salary Wizard at Salary.com.
To understand the expectations of your prospective hires, it's important that you find out what the online salary wizards are saying.
Unfortunately, some of the salary estimates that come from these online tools are way off the mark. In part, that's because the salary wizards are usually geared toward larger businesses, not small businesses. They also are usually bases on title, rather than job responsibilities.
For example, a customer of ours who owns a small PR firm informed me that the Salary.com salary wizard pegged the average starting salary for a Media Relations Specialist in Chicago to be $45,000. In fact, he explained, a more typical range for that particular position is $25,000 to $32,000.
How's that for a scenario? You are ready to offer $31,000, near the high end of what you believe to be the salary range for a position, and the employee, armed with what they believe to be the right salary, says they'd like to get $45,000.
As you can see, regardless of whether the online salary wizards are right or not, it's well worth your time to find out what they say you should be paying.
If what you'd like to pay and what the online salary wizards say you should pay are way out of whack, you'll do well to check some other sources and be ready to present that data to any misinformed candidates.

Industry and Trade Associations

Industry trade associations and HR organization are an excellent source for salary data. Most have undertaken extensive industry salary surveys and have salary data that you can access and evaluate. A quick call to your industry trade association will help you find out if they have the data you are seeking.
You can also ask for the data from associations you don't belong to. In many cases, the results of comparative salary surveys are available on association websites.
Peer Organizations
Talking to peers about current salary levels is always a good idea. Look for an organization that you don't compete with. Maybe you own an ice cream shop and the guy next door owns an apparel store. Since you are not directly competitive, you should have no problem sharing salary information for positions like a bookkeeper. By finding out what your peers are paying, you can get a good sense for market salary rates.

Competitive Research
Getting data about what your competitors are paying their staff is a much tougher assignment but it's doable. When a competitor advertises a position for hire, you might give their HR manager a call and ask what the salary range is for the position. Borderline unethical? Not really. This is routine competitive intelligence gathering in my opinion.

Think In Terms of Ranges
You should always have a salary range that you are willing to pay for any given position. Locking in on a single number is a mistake.
The reason you need to think in terms of salary ranges is that every job candidate has slightly different experience. You should be willing to pay more for a more experienced candidate because, in theory, their prior work experience will make them more productive in your organization relative to a worker with less experience.

Ask Candidates About Salary Before You Tell Candidates About Salary
It's always best to ask prospective recruits what their salary expectations are. Ask early in the interviewing process to avoid a scenario in which you both invest a lot of time only to find out that your expectations are completely misaligned.
Don't ask what a prospective employee wants in the way of salary. Instead, ask them what they need. Your top recruit might desire to earn $75,000 but maybe they only need to earn $55,000. Knowing what they need can help you to define the right salary.
Don't forget that compensation is much more than just cash. You need to tout the benefits of working at your organization and make sure prospective employees understand that value proposition. This can include typical HR benefits such as good health insurance but it should also touch on opportunities for advancement in the organization, training, mentoring, a friendly and fun work atmosphere, and the work itself.

Revisit Your Salaries Often
Salary ranges change constantly based on supply and demand. In a bullish economy, talented recruits are a scarce commodity and you may have to pay higher salaries. In bearish times, you can pay less. Currently, because of the economy, it's a buyer's market for employees. In other words, you can afford to offer a lower salary this year relative to prior years.
If your salary levels are based on research you did years ago, you'd do well to take a fresh look at current salary levels.
If you are not sure what to pay, my recommendation is that you err on the side of paying more than the market because talented and motivated employees can do amazing things. There a lot of areas in business where you can scrimp but paying your employees shouldn't be one of them."

Thoughts about Social Network Sites for Business

I am a fan/student of technology, the internet and any new and exciting trends for business. I have been researching the use of social networking sites for business purposes and have even joined Linked In and My Space and have linked them to my website. I think the following article by Karen E. Klein in Business Week aptly discusses this subject. Enjoy.

"To get the most out of social networking sites, small companies should look past the hype, set concrete business goals, then start experimenting. Social networking online seems to be exploding: Facebook, LinkedIn, Twitter, Digg, and so on. When I ask how these sites can help my business, the answers can be vague. I am trying to relate it to face-to-face networking, which includes sharing ideas, information, and resources with other businesses. Are these sites useful for those goals? There is only so much time in my day and I need to use it effectively. —B.H., Scarborough, Me.

You are correct that social networking is a rapidly growing, headline-grabbing phenomenon. The question for entrepreneurs is how to tap into this trend as a business opportunity, rather than simply a way to connect—or reconnect—with people, says Peter Delgrosso, strategic vice-president for corporate communications with Web.com (WWWW).
"For the most part, these social networking sites should be viewed as complementary to your online presence. Think of it as a nice-to-have, not a must-have," he says. "When used properly, it is something that can gain your business some attention. However, you need to realize it shouldn't be seen as a replacement to your traditional online presence."
Greg Sterling, of Sterling Market Intelligence, considers social network sites primarily for meeting people, asking for advice or referrals and, carefully, doing online marketing. The uses vary by application or site, he notes: "Sites such as LinkedIn can be helpful in connecting with people you want to meet for one reason or another. Twitter and Facebook can be helpful when you're trying to notify a group of people about something you want to promote or about a happening of some kind."

Find Your Networking Niche

Take a few minutes—it doesn't have to be extensive—to look over the top sites and experiment to see what works for you. Even an hour or two a week can help you figure out which sites you like best and are most effective for your particular business. "The viral nature of social networking is quite extraordinary and something that can garner a lot of attention to your efforts in a hurry," Delgrosso says.
He thinks the best site for both networking and human resources purposes is LinkedIn. "The site requires some résumé creation, then offers the opportunity to link in to other like-minded professionals. When used selectively, it can be a very powerful tool for identifying new business partners, new employees, or simply building your personal or business presence," he says.
For gaining exposure to larger audiences, he recommends Facebook: "Consider establishing or joining a network on Facebook based on your business or industry category to tap into people's affinity for the topic. By doing this, you'll cut through the clutter and clearly establish your niche, keeping the interaction focused on the specific subject matter."
Rick Julian, CEO and chief creative officer of Quo Vadis, a startup brand communications agency, says he's getting a positive return on his investment from using social media sites for the past year. "It puts a human face on your business and allows people to get an impression of what a relationship with you would be like. When all things remain equal, people want to work with people they think they'll have an interesting relationship with," Julian says. His firm is represented on five major social networking sites, including YouTube (GOOG) and his blog, and a couple of smaller ones.

"Geometric Extension" and Search Optimization
It sounds like a full-time job, but Julian points out that you can cut and paste some of your content from site to site. "If I put up a YouTube video to create awareness, I might have some discussion on YouTube with the responders and then also put it on my blog, on my Facebook company page, and promote a link to it on Twitter. Just by generating that single asset, I've populated all those networks with content without having to come up with an original piece of content for each of them. There's a geometric extension of your reach," he says.
Robert Jenson, CEO of the Las Vegas-based realty firm the Jenson Group, takes a strictly corporate approach to social networking. "Rather than blogging stream-of-consciousness opinions or using the venue as a diary of sorts, I educate visitors on important, universal industry matters. I try my utmost to ensure the content I post is not just applicable and of interest to those in Las Vegas, where I operate, but also to any real estate consumer nationwide," he says.

He puts bylined articles he's written on his own blog and on social networking sites and uses them to establish his credibility as a real estate expert. "This serves as a 'risk reliever' for both prospective consumers and business affiliates, while also increasing my chances for media coverage by establishing myself as a reliable expert source," Jenson says.
Last, but definitely not least, is the value of social networking sites to search engine optimization (BusinessWeek, 6/20/08). The more sites that include your name and link back to your Web site or blog, the higher your profile rises in search engines, where more and more of your customers are likely to find you, Jenson says. "

13 Tips to Keep Your Employees Happy and Motivated

In today's economic environment, employee retention is crucial. Employee turnover can seriously affect your company morale and your bottom line. The following are tips from "99 Ways to Keep Employees Happy, Satisfied, Motivated and Productive", by noted HR author Peter R. Garber.

1. Have a Family Day at Work. An employee's family provides critically important support for the employee. Yet many families have never even seen where their spouse, parent, or child goes each day to work. By having a day when you invite your employees' families to visit the workplace, you can help bridge this gap.

2. Present Employees with a Shirt or Jacket with the Organization's Logo.You might be surprised how much pride employees have in the organization they work for. Presenting everyone with a jacket, T-shirt, or cap with the organization's logo and name creates a way for employees to express this pride and feel more a part of the team.

3. Sponsor a Health Fair for Employees. Sponsoring a health fair at work provides an easy and convenient way for employees to benefit from important health screening tests that they might not otherwise receive. In most cases you will find that sponsoring a fair is not expensive, as many of the services are available free or at minimal cost through local health agencies and organizations.

4. Offer Discounted Family-Oriented Activities for Employees. Offering discounts for family-oriented activities at local recreational facilities or businesses, either by negotiating group rates or by subsidizing the costs for your employees, can be a relatively inexpensive and popular benefit.

5. Allow Employees to Work Flexible Hours. Trying to balance the responsibilities of both work and home can create many scheduling problems for employees. One of the best ways you can help your employees deal with their many responsibilities is to allow them to work more flexible hours, when possible.

6. Offer CPR Classes. Offering employees training in CPR and other emergency first-aid treatment can be the most valuable benefit you can provide in the event that these skills become needed in a real-life situation.

7. Include Pictures of Employees in Company. AdvertisementsIncluding pictures of employees in the company's ads or other publications can be not only effective public relations but also a morale booster in the organization. If your product advertising illustrates family members, you could extend this concept to the families of your employees as well.

8. Sponsor a Ridesharing Program. With gas prices out of sight, it's a good time to consider sponsoring a ridesharing or carpooling program at work.


9. Ask Employees for Their Opinions.There's a great deal of wisdom in the opinions of people throughout an organization. Tap into it. Ask employees on all levels for their suggestions, feelings, opinions, and concerns, relative to their jobs and work. Caution: Be prepared to respond. Don't start this program and then ignore the input!

10. Redecorate Break Rooms and Cafeterias. Redecorating a break room or cafeteria where employees spend their rest periods and meal times helps them feel that the organization understands that they work hard and deserve a quality space during time away from their jobs.

11. Reduce the Amount of Employees' Paperwork. People are often overwhelmed with paperwork. How much of each employee's paperwork is absolutely necessary?

12. Publicize the Company's Efforts to Protect the Environment. People are thinking green today, and they want their companies thinking that way, too. Let both your employees and the public know what the organization or company is doing to protect the environment. That could include contributions to environmental groups, clean-up initiatives, recycling programs, waste reduction, emissions control, regulatory compliance, voluntary efforts, or legislative support.

13. Offer More Cross-Training Opportunities for Employees. Most employees want to have more variety in their jobs. Gen X and Gen Y employees in particular want to keep developing new skills. Cross-training provides variety as well as development of broader skills. People also gain a better appreciation for what their co-workers' jobs involve by "walking a mile in their shoes." And, you get people who can take over one anothers' posts if needed.Share Your Comments

Dermatologists Reportedly Offer Two Tiered Skin Care

I read the Schwitzer Health News Blog and found the following topic discussed on the blog to be quite interesting. According to the blog, The New York Times reported that dermatologists are now serving first class and second class services and "it is fast becoming a two-tier business in which higher-paying customers often receive greater pampering."

Excerpt:
"In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.
In other offices, cosmetic patients spend more time with a doctor. And in still others, doctors employ a special receptionist, called a cosmetic concierge, for their beauty patients.
Dr. David M. Pariser, a dermatologist in Norfolk, Va., and the president-elect of the American Academy of Dermatology, said some practices did maintain preferential policies for cosmetic patients.
“The message is that the cosmetic patient is more important than the medical patient, and that’s not a good message,” Dr. Pariser said.
At a time when dermatologists are trying to advance the idea of a national skin cancer epidemic, such a two-tier system is raising concerns that the coddling of beauty patients may divert attention from skin diseases."

Get Your Daily Workout in a Pill Rather Than a Treadmill?

We all have such busy schedules.....work, family, errands and such. Sometimes it is difficult to schedule a work out before or after a hard day at the office and sometimes we are just not motivated to do so. Well, for those of us who feel this way, exercise in a pill may be on its way. In Friday's Wall Street Journal, Mark Schoofs and Ron Winslow wrote about physical fitness in a bottle:

"Exercise in a pill."
That's how researchers are describing two drugs that apparently mimic the effects of physical exercise on the body, raising prospects of new treatments against diseases, new ways to cheat at sports, and new rationalizations for couch potatoes to stuff themselves at brunch.

In a series of startling experiments in mice, the drugs improved the ability of cells to burn fat and retain muscle mass, and they substantially prolonged endurance during exercise. Using one of the compounds for just a month, even sedentary, couch-potato mice improved their endurance running by a staggering 44%. Some mice that combined a month of exercise with the other drug bolstered their long-distance running by about 70% over untreated mice.
One of the drugs is already in late-stage human trials for other purposes, and the mouse experiments raise hopes for new strategies to protect people against obesity, diabetes and muscle-wasting diseases such as muscular dystrophy.

But underscoring the risks, one of the compounds has been withdrawn from human trials because of toxic side effects, and researchers said that the drugs could easily be abused by competitive athletes to enhance their performance. Researchers have already devised a test to detect them in blood and urine.

A spokesman for the World Anti-Doping Agency said in a written statement that, following policy, it wouldn't say when the test would go into use. But the statement noted that "a number of anti-doping organizations, including the International Olympic Committee, store doping control samples of their events for eight years for potential future retesting." A spokeswoman at GlaxoSmithKline, which developed one of the drugs, said that if athletes get their hands on the drug, "they won't be getting it from us."

The exercise-pill study, published Friday in the journal Cell, was conducted on mice, and it is possible that the drugs may show less benefit, or even none at all, when applied to humans. Still, the underlying genetic switches activated by the drugs appear to be the same in humans and mice.

The researchers examined how the drugs acted on the cellular and molecular level, but they also evaluated the simple ability of mice to run on a treadmill. Unlike humans who may suffer a motivational issue before exercise, "mice are very good at running as far as they can," said principal investigator Ronald Evans, a researcher at the Salk Institute for Biological Sciences, La Jolla, Calif., and the Howard Hughes Medical Institute. "When they get exhausted they just stop running. They can't run any more."

First, Dr. Evans and his team gave the mice a drug known as GW1516, which used to be under development by GlaxoSmithKline as a drug against dyslipidemia, a disorder affecting cholesterol. Side effects forced the company to scuttle it, a Glaxo representative said.

Still, the drug enabled mice to run for more than three hours, compared with less than two hours for untreated control mice. But this drug's effect occurred only when the mice also got regular exercise; sedentary mice got no benefit from the drug. "This is the no-pain, no-gain drug," said Dr. Evans.

Based on research into the genetic switches that control endurance muscle cells, Dr. Evans and his team decided to give the mice a second drug: AICAR, or acadesine, which was recently licensed by Schering-Plough Corp. and is in late-stage trials for the prevention of problems that can occur during coronary surgery. This drug enabled even sedentary mice to run longer, as if they were in good physical condition. "That is the true couch-potato experiment," Dr. Evans said.

Anabolic steroids, often abused by athletes, enhance the performance of fast-twitch muscle cells -- those that provide power and speed. The two drugs being researched are among the first compounds shown clearly to improve the slow-twitch muscle cells used in endurance activities. Whereas fast-twitch muscle cells burn sugar, slow-twitch cells primarily burn fat, which means they could help combat obesity. Previously, resveratrol, found in red wine, was shown to enable mice to run farther, but exactly how it works on slow-twitch muscles isn't clear. A person would also have to drink "hundreds of bottles" of wine to get enough resveratrol to improve athletic performance, said Dr. Evans.

Patients who are bedridden or wheelchair-bound "can't exercise, and this would give them some of the benefits," said Joseph Hornyak, associate professor of physical medicine and rehabilitation at the University of Michigan at Ann Arbor. But the pills would be unlikely to provide all the benefits of real exercise. "People who exercise have lower levels of depression and higher bone density," said Prof. Hornyak. "Whether or not this pill would confer those benefits, we don't know."

The broadest appeal of the drugs may be for gain-without-pain preeners who would sooner pop a pill than strain themselves or a hamstring. Such "off-label" use is "not only a real possibility but a probability," said Dr. Evans.

HIPAA and EOB's and Electronic Records, Oh My!

Every practice manager has nightmares about HIPAA and the implementation thereof in his/her practice. The journey from paper to paperless medical records present more challenges. The insurance companies, and as related below in the Wall Street Journal Blog, share the same challenges.
Insurer Sends Patient Info to the Wrong People
Posted by Sarah Rubenstein
"Those worried patient-privacy advocates may have a point. In yet another example of the health industry mishandling private patient records, Blue Cross and Blue Shield of Georgia sent some 202,000 explanation of benefits letters to the wrong addresses last week, the Atlanta Journal-Constitution reports.
The letters, which were mistakenly directed to the addresses of other policyholders, included names and insurance identification numbers of patients as well as the names of the doctors and other medical providers they were using, the AJC reports. A small proportion of the letters also had Social Security numbers, a spokeswoman for the company told the paper.
Vulnerability to identity theft is one concern. But EOB letters are especially sensitive from a privacy standpoint because they contain some treatment information.
And this is one of a steady stream of mistakes by the health-care industry when it comes to protecting electronic data. Blue Cross and Blue Shield of Georgia told the AJC that a computer system change was to blame, and it’s taken steps to avoid the problem in the future."