HealthGrades Quality Study Identifies Hospitals in Top 5% in Nation; Cities That Have Highest Concentration of Top Hospitals

Patients Treated at HealthGrades Distinguished Hospitals for Clinical Excellence Have 30% Lower Chance of Dying
How does the quality of care at hospitals in your area compare? Find out with HealthGrades second annual list of America’s Top Cities for Hospital Care. HealthGrades is the leading provider of information to help consumers make an informed decision about a physician or hospital. The independent rankings are based on a comprehensive study of patient death and complication rates at the nation’s nearly 5,000 hospitals.

As part of its tenth annual HealthGrades Hospital Quality and Clinical Excellence study, HealthGrades identified those hospitals performing in the top 5% nationwide across 26 different medical procedures and diagnoses, then ranked cities by highest percentage of these Distinguished Hospitals for Clinical Excellence™.

Selecting a Top Hospital Matters

In an environment where one in seven Medicare beneficiaries is harmed as a result of their hospitalization (Source: Department of Health and Human Services) and patients are fearful of the very institutions that are entrusted with saving their lives, it is important to identify and acknowledge those hospitals that are leading the way in reducing mortality and complication rates and to provide consumers access to this information.

For the communities themselves, these hospitals have significant impact. In some instances, the top cities named in this report can make the claim that almost half of their hospitals provide this level of care including: Baltimore (47%), Phoenix-Prescott (44%), Cedar Rapids (43%), and Richmond, Virginia (43%).

In addition to selecting the best hospital, it is also important to become educated on potential complications and learn how to protect yourself during a hospital stay.

How Did Your City Rank? What Hospitals In Your City Made the Grade?

“Today’s healthcare consumer expects access to credible, independent information about the quality of care available to them,” said Kristin Reed, MPH, HealthGrades vice president of hospital ratings and study author. “HealthGrades is proud of its longstanding tradition of educating the American public about both the gaps in quality of care among hospitals, and with actionable information about the top-performing hospitals in their communities.”

Distinguished Hospital Facts

• Distinguished hospitals can be found in 38 states.
• The cities with the highest percentage of Distinguished Hospitals are found in 26 states. Distinguished hospitals had 30.07% lower mortality rates and 1.86% lower complication rates after adjusting for patient severity of illness.
• If all hospitals performed at the same level as Distinguished Hospitals for Clinical Excellence, 165,704 Medicare lives could have been saved in just three years and 6,800 inhospital complications avoided.

About HealthGrades Hospital Quality Distinctions

As part of this study, HealthGrades evaluates each of the nation’s 5,000 nonfederal hospitals in 26 procedures and diagnoses, allowing individuals to compare their local hospitals online at www.healthgrades.com. HealthGrades hospital quality distinctions are independently created; no hospital can opt-in or opt-out of being evaluated, and no hospital pays to be evaluated. Mortality and complication rates are risk adjusted, which takes into account differing levels of severity of patient illness at different hospitals and allows for hospitals to be compared equally.

Click here to view HealthGrades Top Cities for Hospital Care

Click here to view HealthGrades Methodology for selecting top hospitals

If used correctly, computer-assisted coding can help hospitals alleviate inefficiencies.

As computer-assisted coding (CAC) is deployed by an increasing number of hospitals, its effect on coders is coming into focus. The evolution of workflow changes, productivity increases ahead of ICD-10, and fear of diminishing job prospects are all buzz-worthy topics.

Workflow Changes
The existing workflow within many hospitals could be slowing down coders. Chris Casto, vice president of Dolbey Systems, says coders are currently using what he calls “buckets” of information. “They’re working out of the HIS [hospital information systems], a lot of times they have to log in to nurses’ notes, and they log into billing systems to look at chargemaster codes, so the workflow is really disjointed in a lot of ways.”

Casto believes CAC adoption helps pull those buckets together, giving the coder one place to go for information. “In that fact alone, they really do see, I think, a streamlined workflow because they’re not in multiple applications,” he says. “They’re not logged in all over the place. Everything they need to see is in one place, and it has to be that way for CAC to function effectively.”

Accessing information from multiple sources is indeed an efficiency issue for today’s coders, says June Bronnert, RHIA, CCS, CCS-P, director of professional practice resources at AHIMA. “CAC has the capability to pull all that into one place. Coders may go to one place vs. going to three or four or five,” she says. “That part has increased their efficiency because now the information they need is in a single location.”

Bronnert says the effects of CAC implementation on hospital workflow may depend on how activities are structured and recommends facilities examine their processes. “Start with documentation,” she says. “How is it generated? Is it handwritten? How much is electronic? And what systems is it in?” This will help determine where productivity gains and efficiency improvement are most needed, Bronnert adds.
“[CAC] is going to radically change the overall workflow,” says Gail I. Smith, MA, RHIA, CCS-P, “because coders are not going to be producing the code—they’re going to be verifying what the computer gives them.”

Smith, president of Gail I. Smith Consulting in Cincinnati and an ICD-10-CM/PCS faculty trainer for AHIMA, believes CAC adoption will remove the rote work from coders’ plates. “That easy stuff that we waste our time on, the computer can assign it if it needs no human interaction,” she notes.

And because coders will be freed from baseline coding tasks, they’ll be able to take on what Smith describes as more of an auditing role where strong decision-making skills will be essential. “It really forces the coder to work at a higher level,” she says.

John Ryan, MD, president of PLATOCODE, whose US operations are based in Los Angeles, says many of the clerical portions of a coder’s job are removed in a CAC environment. “Rather than having to scuffle through documentation and enter codes, you become an auditor,” he says. “The case comes up, and it’s as if the gremlins have been through and assigned a whole lot of codes, and the coder’s job is to make sure they’re correct.”

Coders will no longer start from scratch, Bronnert says. “Now they say, ‘Yes, this is the valid code for that, and it should be assigned,’ and they identify it within the tool that it’s the appropriate code,” she says, adding that coders’ roles are changing from conducting initial read and scans to “becoming an auditor, a validator.”

Bronnert believes it’s important that coders understand the technologies involved, and that “CAC is not an encoder,” although the two tools can work together and “a lot of them are doing that now.”

“You’re almost a detective in a way,” Smith says. “You have to be willing to challenge what the computer comes up with and, in some respects, investigate why it led down that path.” She believes having a user-level understanding of how the software works would be beneficial. “It’s another skill set for coders,” she notes.

With the fundamental shift from code entry to code review, Casto believes coders “still need to be on top of their game because the software isn’t going to be as good as your best coder. It will make mistakes. We expect that, and that’s why we need the coder to catch them.”

Casto isn’t sure the audit function coders assume in a CAC environment is necessarily a new skill, but says, “It’s a different way to spend your day.”

Productivity Improvements and ICD-10
For hospitals whose documentation resides mostly in an electronic format, the adoption of CAC is likely to be less onerous, says Bronnert. “The CAC engines are designed to work with electronic documentation, so it’s a smoother initial process vs. if you have handwritten documentation that has to be scanned,” she says, adding that facilities able to avoid that extra step may gain greater efficiencies than those stuck with scanning handwritten material.

“There is certainly a direct correlation between the hospitals that have prepared to implement CAC and those that are well down the road with their EHR implementation,” Casto says, “because the technology they’ve needed to put in place and the processes they’ve needed to adopt to make their electronic health record work and to meet meaningful use are absolutely in line with what we need for CAC.”

Casto says hospitals that have either adopted EHRs already or are moving toward EHR implementation are “perfect candidates for computer-assisted coding.”

Mark Morsch, vice president of technology at OptumInsight, says CAC works best when at least some of the information is available electronically. “Most facilities today have a hybrid record, where some data is paperless, some may be scanned, and some may still be on paper. The more information that can be made available digitally, the more you can take advantage of automated coding,” he says.

By consolidating documentation into a single software platform, Morsch sees other benefits for coders. “Productivity gains from these new processes are helping hospitals now and will be imperative as we move to ICD-10 with an eightfold increase in codes,” he says.

Coders are presented with codes assigned by the system, and those codes include highlights that link each code to the supporting evidence in the clinical documentation. Coders then review the CAC-generated codes and accept or correct them based on their expertise. “CAC transforms the role of the coder from the task of full coding to a reviewer or auditor of coding,” Morsch says.

As an ICD-10 trainer who travels around the country, Smith says, “I’m seeing more and more hands go up when I ask, ‘Who’s implementing CAC?’”

Some of those decisions to adopt CAC are a result of the looming ICD-10 deadline. “[Hospitals] are trying to counteract the loss of productivity with removing those rote coding decisions,” she says, adding that there will likely be spin-off roles or entirely new areas of responsibility generated on the back end, including “looking at reports and looking at trending as another double-check” while the technology and its use mature and become more widespread. “There are lessons to learn, and we don’t know what those are yet,” Smith says.

Additional efficiencies generated by CAC adoption can be found elsewhere in the revenue cycle chain. Casto points to the technology’s ability to better “scrub” charts before they leave a facility as a way to reduce the number of disputed claims, citing one customer who experienced an 80% reduction in denials. “I think many of them have their eye on the future, which is ICD-10, and they know they’re going to have troubles there if they don’t get ready. But right now they can utilize the software to better prepare themselves and solve some immediate problems,” he says.

The Job Market
Let’s get to what, for some, is the elephant in the room: Does the adoption of CAC mean that a hospital needs fewer coders? “Every hospital has its own productivity standards on what they expect,” Bronnert says. “From what I’ve heard from those hospitals for years now is that it’s not that they need fewer [coders].” Instead, Bronnert sees coders being used more effectively and at a higher skill level. “They become even more valuable to a facility. I don’t see their roles or positions diminishing at all. I see them flourishing,” she says.

Smith says some early CAC adopters have reported demonstrable increases in productivity. “I think what’s going to happen is we’re going to need less entry-level coders, but we’ve been seeing that trend for years,” she says, adding that CAC will exacerbate the differences between new and experienced coders.

Although CAC and ICD-10 are “really two different subjects, they intersect with CAC,” Smith says. “Even if we didn’t implement ICD-10 in 2013, there’s definitely a need for increased productivity.”

Ryan doesn’t believe CAC reduces the number of coders a facility requires to stay on top of its workload. “CAC means they’re going to be able to cope with the changes in ICD-10, and clearly there are no fewer coders required if that’s the thinking you adopt,” he says.

Typically, when implementing CAC, hospitals don’t drop the number of coders on staff, Ryan says. Instead, coding departments are better equipped to handle vacations and other coder absences. “The second thing is that a lot of facilities are bringing on contract coders, who are expensive,” he says, adding that productivity gains brought about by CAC allow hospitals to “rationalize their use of expensive external resources.”

A third reason Ryan isn’t buying the idea that fewer coders will be needed with CAC is that existing coders may now finally have the time to make more use of their expertise and get involved in clinical documentation improvement.

“I think anybody who’s running a coding operation or has any oversight over a coding department knows that they certainly would not let any well-qualified coder out their door right now,” Casto says. Instead, he believes facilities that implement CAC “want to take the coders they have and get some extra bandwidth out of them.”

By implementing CAC, facilities may be able to work through backlogs, eliminate some outsourcing costs, and enable the existing workforce to be more productive. The software could also allow organizations to be better prepared for ICD-10 by affording them extra time for training. “A lot of them just don’t have that luxury right now,” Casto says.

New to Coding? Listen Up.
A handful of CAC providers are working with various educational institutions to introduce the technology into the curriculum, but the practice is far from universal. Ryan believes the number of available CAC products is too vast to make familiarity with any one platform a game-changer. “The CAC market, although I’ve been in it for 20 years, is still very young,” he says, “and people are still finding their way. I think it’s difficult for the training institutions because it’s the early days, and there are a number of competing models.”

“I think it’s a time of transition,” Bronnert says. “Right now, I don’t think [CAC training] is enough of a factor in the job market. Maybe in another three to five years it could be.”

While Bronnert hasn’t heard from students that a lack of CAC training has hampered their job searches, she says, “I think that students should learn about the technology because it’s becoming more mainstream.” From the educational provider’s standpoint, she believes schools “are becoming aware of the technology as well and starting to incorporate it at some level into their programs.”

Smith doesn’t believe adding CAC principles to educational programs would be much of an adjustment. “We can very easily change our focus in education to giving students the codes and saying, ‘Is this wrong or is this right, and why?’ It’s not like you have to throw your curriculum away,” she says.

Smith suggests that instead of focusing on efficiency during the coding process, educators could work on cultivating students’ ability to dissect documentation and work backward from the code itself. “I would love to see education programs transition to more CAC-simulated activities so the students feel more comfortable and confident in their role,” she says. “That can be done in the safe learning environment of the college, so they can practice their skills and there’s not such a gap between education and industry.”

— Julie Knudson is a freelance business writer based in Seattle.

Most of the Medicare fee-for-service demonstration projects launched in the past two decades using disease management and value-based payments have failed to reduce costs, says a report issued yesterday by the Congressional Budget Office.

“In nearly every program involving disease management and care coordination, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program, when the fees paid to the participating organizations were considered,” the report stated.

Further, while it noted that projects where care managers had substantial direct interactions with both physicians were more likely to reduce costs, the size of those reductions weren’t enough to offset the care managers’ fees.

Of the 10 demonstrations studied, six in disease management and care coordination, and four in value-based payments, the only one to show savings was a project that bundled payments for heart bypass treatment. In all, the heart bypass program reduced Medicare’s expenses for the procedure by about 10 percent with no significant changes in patient outcomes.

“The Heart Bypass demonstration yielded savings because Medicare was able to negotiate bundled-payment rates with the seven hospitals and the relevant physicians on their medical staffs that were lower than the separate payments that they otherwise would have received,” the report noted.

There were two other demonstration projects associated with different models of paying for heart bypass care, both of which didn’t show savings. According to the CBO, the key factor that affected the results was the nature of the incentives offered to providers. While the bundled payment demonstration showed savings at all seven participating hospitals, the demonstrations that paid bonuses to providers on the basis of their quality scores, estimated savings, or both, produced little or no savings.

The CBO also noted specific approaches taken in some of the demonstration projects that showed promise for savings if applied broadly to help achieve the program’s goals, including:

• Gathering timely data on the use of care, especially hospital admissions;
• Focusing on transitions in care settings;
• Using team-based care;
• Targeting interventions toward high-risk enrollees; and
• Limiting the costs of intervention.

In the end, it may be the very structure of how Medicare pays for services that was the biggest culprit, the CBO concluded.

“Demonstrations aimed at reducing spending and increasing quality of care face significant challenges in overcoming the incentives inherent in Medicare’s fee-for-service payment system, which rewards providers for delivering more care but does not pay them for coordinating with other providers, and the nation’s decentralized healthcare delivery system, which does not facilitate communication or coordination among providers,” wrote Lyle Nelson of CBO’s Health and Human Resources Division, on the CBO’s Director’s Blog.

“The results of those Medicare demonstrations suggest that substantial changes to payment and delivery systems will probably be necessary for programs involving disease management and care coordination or value-based payment to significantly reduce spending and either maintain or improve the quality of care provided to patients,” concluded Nelson.

The jobs picture last month improved overall — and the health-care sector, which has been a bright spot throughout the downturn, continued to grow.

As the WSJ reports, nonfarm payrolls rose by 200,000 people in December as the unemployment rate, calculated using a separate survey, fell to 8.5% from 8.7% in November.

Here’s the full report from the Bureau of Labor Statistics.

Job growth at private employers outstripped job losses in government. The health-care industry added 22,600 jobs in December, following a revised increase of 16,000 jobs the previous month. (Originally the government reported a slightly larger November gain of 17,200, as we reported.)

Data from the BLS show the type of facilities that are hiring, but not the specific types of jobs being added. For example, the report shows that hospitals added 9,800 jobs, but doesn’t reveal whether those are physicians, IT support staff or janitors.

Ambulatory health-care services added a net 11,300 jobs as doctors’ offices, outpatient care centers and home-health services all added positions.

Nursing-care facilities shed about 500 jobs. But the broader category of nursing and residential-care facilities overall gained a net 1,500 jobs in December.

Click here to read more information about OIG’s most wanted health care fugitives. In all, they are seeking more than 170 fugitives on charges related to health care fraud and abuse.

A Look Ahead Points to Increased Risks; Regulatory Expectations; Reputational Fallout

PORTLAND, Ore., Jan. 5, 2012 /PRNewswire via COMTEX/ — Hospitals and healthcare organizations will need more than a couple of aspirin to ready themselves for 2012. Industry experts representing healthcare law, privacy, security, regulatory and data breach were asked to forecast healthcare data trends for 2012. The overall forecast? Protecting patients’ protected health information (PHI) should be viewed as a patient safety issue. If the right actions are not taken, experts predict healthcare data breach will reach epidemic proportions this year.

2011 was the year when most physicians had mobile devices; when healthcare became one of the most-breached industries; and the Department of Health and Human Services Office for Civil Rights (OCR) cracked the whip with investigations and multi-million-dollar fines for organizations that didn’t meet their patient privacy obligations.

Top 2012 predictions in healthcare data:

Healthcare organizations will not be immune to data breach risks caused by the spread of mobile devices in the workforce, according to Dr. Larry Ponemon, chairman and founder, Ponemon Institute. In the recent benchmark study, 81 percent of healthcare providers say they use mobile devices to collect, store, and/or transmit some form of PHI. However 49 percent of those admit they are not taking steps to secure their mobile devices.

Class-action litigation firestorms are imminent, says Kirk Nahra, partner, Wiley Rein LLP. Class-action lawsuits will be on the rise in 2012, as patients are suing healthcare organizations for failing to protect their PHI. 2011 saw several class-action lawsuits for organizations, some of which involved business associates, due to breached patient data. Regardless of the outcomes, these lawsuits are a significant risk and tremendous expense for companies affected by them.

Social media risks in healthcare will grow, according to Chris Apgar, CEO and president, Apgar & Associates, LLC. As more physicians and healthcare organizations move to social media to communicate with patients and promote services, the misuse of social media will increase as will the risk of exposure of PHI. Often healthcare organizations do not develop a social media use plan and employees represent a significant risk, potentially exposing PHI through their own personal social network pages. These risks can lead to patient vulnerabilities, data breaches, civil penalties, loss of business and more.

Cloud computing is not a panacea; technology is outpacing security and creating unprecedented liability risks, suggests James C. Pyles, principal, Powers Pyles Sutter & Verville PC. With fewer resources, cloud computing is an attractive option for healthcare providers, especially as Health Information Exchanges (HIE) increase. However, privacy and legal issues abound, such as compliance with HIPAA privacy and security regulations and allocation of liability when a privacy breach occurs. A covered entity will need to enter into a carefully written business associate agreement with a cloud computing vendor before disclosing protected health information and should ensure that it has adequate cybersecurity insurance to cover the direct and indirect costs of a breach.

Growing reliance on business associates will create new risks, believes Larry Walker, president of The Walker Company. Economic realities will force healthcare providers to continue to outsource many of their functions, such as billing, to third parties or business associates (BA). However, BAs are considered the “weak link in the chain,” when it comes to data privacy and security. 69 percent of organizations that participated in the Ponemon study have little or no confidence in their business associates’ ability to secure patient data. Third-party mistakes account for 46 percent of data breaches reported in the study.

Organizations risk reputation fallout, according to Rick Kam, president and co-founder of ID Experts and chair of the American National Standard Institute’s (ANSI) “PHI Project,” a project to research the financial impact of a healthcare data breach. Identity theft and medical identity theft resulting from data breach exposure are causing patients financial and emotional harm, often resulting in patients seeking out different medical providers. According to the Ponemon study, the average lifetime value of one patient is more than $113,000.

Mobile will explode in healthcare, believes Christina Thielst, health administration consultant and blogger. The use of tablets, smartphones and tablet applications in healthcare is growing exponentially. Nearly one-third of healthcare providers use mobile devices to access Electronic Medical Records or Electronic Health Records (EMR/EHR) systems, according to a CompTIA study. Providers will need to balance usability, preferences, security and budgetary concerns, as well as adopt written terms of use with employees and contractors using personal devices at work.

Increased emphasis on willful neglect leads to increased enforcement of HIPAA, according to Adam Greene, partner, Davis, Wright, Tremaine LLP. The focus over the next year will be on the 150 HITECH Act audits and publication of the final rules implementing modifications to the HIPAA regulations. But the biggest changes may be at the OCR investigative level. Expect OCR to more aggressively pursue enforcement against noncompliance due to “willful neglect” starting in 2012, resulting in a sharp uptake in financial settlements and fines in the coming years. 2012 will be the year that OCR expects everyone’s training wheels to have come off their privacy and security programs.

Privacy and security training will be an annual requirement, says Peter Cizik, co-founder and CEO, BridgeFront. Healthcare organizations have gotten better at putting procedures in place, but staff are still not following them. Because the majority of breaches are caused by human error, not technology failures, targeted training and awareness programs are one of the most effective ways to prevent data breaches.

Rise in fraudsters will increase fraud risk education, according to Jonnie Massey, supervisor, Special Investigations Unit, Oregon Dental Service (ODS) Companies. Pressure, opportunity and rationalization: these three dangerous elements of the triangle can lead to committing a healthcare-related crime. During hard economic times, there are more fraudsters and more opportunities for them to gain or keep a healthcare benefit they are not entitled to. Educating those at risk for fraud and communicating consequences may deter someone from stepping over the line or help those at risk to prevent them from being a victim of healthcare fraud.

Healthcare organizations will turn to cyber liability insurance, according to Christine Marciano, president, Cyber Data Risk Managers LLC. As healthcare organizations continue to implement their EHR systems, they will consider options to protect themselves and their patients. When a healthcare organization or other HIPAA covered entity suffers a data breach the cost can be damaging not only to an entity’s bottom line, but also to the reputation of its brand. With the increased vulnerabilities and as part of a data breach response plan, healthcare organizations will increasingly turn to a cyber security/data breach insurance policy.

These top forecasts support the 2011 Benchmark Study on Patient Privacy and Data Security, by Ponemon Institute, that found the frequency of data breaches in healthcare organizations surveyed increased by 32 percent, costing the U.S. healthcare industry an average of $6.5 billion. For a free copy of the report, visit http://www2.idexpertscorp.com/ponemon-study-2011/

SOURCE ID Experts

Nearly all healthcare organizations responding to a survey — 96% — reported that patient or related information has been lost, stolen, or otherwise compromised within the last two years.

The number of data breaches involving protected health information rose by 32% from 2010, according to interview data published online by the independent privacy and data protection group the Ponemon Institute.

Three out of 10 respondents (29%) said a data breach resulted in medical identity theft — up 26%.

And two out of five respondents (41%) blamed data breaches on employee negligence — not following data-handling procedures, sloppy mistakes, and using unsecure electronic devices — and 49% reported lost or stolen devices. Third-party errors were responsible for 46% of breaches.

Information was collected through interviews with senior-level staff at 72 healthcare organizations regarding data loss and theft experiences at their facilities. Sites included parent holding companies of healthcare organizations, parts of a healthcare network, and individual hospitals or clinics. Staff interviewed included security, administration, privacy, compliance, finance, and clinical personnel. An average of four staff members were interviewed per site.

Breaches were most often detected by an employee (51%), but were also detected through audits and assessments (43%) and patient complaints (35%).

More than half of respondents said they had little or no confidence that all breaches were detected (55%), and 57% had little or no confidence that all patient data loss or thefts had been detected.

A growing number of healthcare facilities — more than 80% — use mobile devices to transmit, store, and/or collect protected patient health information, but half of respondents said those devices were unsecured, the institute wrote in a statement accompanying the report.

They found that 22% of organizations say their budget is sufficient for minimizing data breach instances. And although 83% of hospitals have a written policy and procedure for contacting authorities in the event of a data breach, 57% didn’t think the policies were effective at curbing breaches.

The researchers outlined steps for patients and organizations to secure data and prevent future breaches, loss, or adverse effects of a loss. For patients, this included:

• Reading Explanation of Benefits and Medicare Summary Notices for missing goods or services
• Keeping online account passwords secure by using different passwords for each account, and making passwords not easily guessable
• Avoiding phishing emails, texts, and phone calls that may compromise personal data
• Contacting government agencies to keep a flag on personal files
• Monitoring financial accounts for suspicious activity

For healthcare organizations, they suggested:

• Creating inventories of private health data, including information about how that data is collected, used, stored, and disposed of
• Establishing an incident response plan that designates roles and creates guidelines in the event of a breach
• Reviewing contracts and agreements made with third-party information handlers

The study was limited by a number of factors. Data were collected through self report, and only a small segment — 14% — of healthcare organizations contacted responded to an interview request. Results of interviews were skewed to larger-sized groups. Interviews were mostly limited to staff tasked with protection, security, privacy, and compliance. The researchers also noted that some normatively important variables were omitted from the analyses.

Healthcare presents a number of urgent challenges that executives can no longer afford to put off. I was considering what advice to give CEOs facing this brave new world when I heard a remarkable speech at the National Center for Healthcare Leadership’s annual event. Michael Dowling, the president and CEO of NorthShore-Long Island Jewish Health System, made some incredibly prescient points upon receiving the NCHL’s Gail L. Warden Leadership Award.

Mr. Dowling believes we are at a historic crossroads in healthcare that demands not just run-of-the-mill courage, but truly gutsy action. What he said brought tears of recognition to my eyes. The following points incorporate some of his views with some of my own on dealing with a time of fast-paced change that, if you don’t watch out, will knock you off-balance.

Don’t live in denial.

Healthcare leaders need to step up to the plate and cope with change. Mr. Dowling warned the industry is about to undergo significant change, and I couldn’t agree more. Undertaking a few changes here and there, he said, isn’t going to pass muster. Many of the changes we face will come through the Affordable Care Act –– a law that faces many challenges, including a Supreme Court review next spring, followed by an election that could bring a new party into the White House and Senate. Faced with these unknowns, some healthcare leaders are simply not willing to undertake any change at all. They want to wait until they know exactly what new regulations under the law are going to be. They are, sadly, frozen in place.

This is a losing strategy. Whatever happens in the Supreme Court case or even if there is a new administration, many facets of the healthcare law are likely to stay in place. The wind of change is blowing. We face an unyielding trend toward creating new modes of healthcare to keep costs in check, and it won’t go away. Hospitals or systems that hold back now will be left in the dust. There is going to be much less money to throw around in the future, Mr. Dowling warned. Healthcare leaders are going to have to do more with less.

Take risk and make it your friend.

A hospital CEO has to take chances. Great leaders make mistakes and you probably will, too, but it won’t be the end of the road for you or your institution. We’ve all gambled at some point in our careers. Of course, make sure when you take risks you have as much data at your disposal as possible. You want the percentages to work in your favor. But great leaders do not succeed by shying away from risk, and they can’t be afraid to make changes, when necessary. Mr. Dowling argued that some CEOs will have to start all over again, turning their organizations upside down, if necessary. I wonder how many CEOs would have the courage to pull it off. Your watchword should be: “Learn to cope with change.”

Break down the silos.

No organization can function properly unless everyone is on the same wavelength. It’s easy to stay in your own silo, where we can deal with people just like you, in your own comfort zone. But this won’t move an organization forward. A football team or any kind of sports team has no chance of winning if each member goes off in his or her own direction. The silo mentality is very powerful and hard to break free from. It is up to the CEO to break the silos down. The culture of the institution, whether in the non-profit or for-profit sector, won’t be enough. This kind of work requires an extraordinary effort. It involves persuading everyone to embrace the mission and vision of the organization, as set by the CEO. You might start by putting up a sign that says, “No silos here!”

Behave like a CEO.

It is up to you to set the tone and the culture of the organization you are leading. That takes intestinal fortitude and a great deal of transparency. Tell everyone in the organization what you intend to do and why you feel it is in their best interests. That sounds rational enough, but many leaders let others take charge while they busy themselves with other matters both inside or outside the campus. Too many CEOs forget the main mission of any hospital or hospital system is to take care of people and make them well. In many cases, this is why they chose the field of healthcare.

Treat patients as customers.

A lot of people in healthcare are still allergic to seeing patients as customers. Caught up in old-fashioned ways of thinking, they continue to believe healthcare is somehow different from a business. The fact is that when you are ill, you want to be treated with dignity and respect, just like a customer is treated. Too many times, patients are treated like an afterthought and not the main purpose of the institution. All patients should be accorded first-rate service no matter what their station in life. They are human beings who came to your organization for comfort, relief and healing. Customers are the lifeblood of any business. Whether or not we like to think so, what we do is a business. We should all accept that fact.

Communicate with everybody.

Communicating doesn’t just mean talking to people in the C-suite; it means reaching out to every last person in the institution and keeping in mind every last patient who comes through. Follow the lead of other industries that have learned the art of keeping customers and employees engaged by making sure each patient and each employee is fully informed about everything that affects them. Be honest and forthright with information and let people know what is going on. Secrets, innuendos and muddled communications should be stopped immediately. These channels, though unofficial and unauthorized, can destroy the organization if allowed to flourish. Inspire your people by letting them know how proud you are to be serving them and how you are going to make the hospital the best it can be.

Tolerate dissent.

Embrace those who would disagree with you. Make sure they know what you are trying to do and how you intend to carry out your strategic plan. Quite often, people who disagree with you simply need to be better informed about what you are trying to do. When you explain yourself to people, it disarms them. Sometimes even your most stalwart opponents become your strongest allies. Always be willing and open to those who oppose what you are trying to do. Make sure they are, if anything, over-informed on matters so they can never say you hid your plans from them.

Having a well functioning workforce means setting your people free. Build strong teams and turn them loose to do their jobs. Mr. Dowling said a true leader understands that without quality people dedicated to the mission of the organization, the goals that have been staked out will never be met.

Always be visible.

Great leaders never shirk from being visible. Too many CEOs think they should stay in their offices. In fact, they should be doing the exact opposite. The real mission of any hospital lies outside the corporate offices, where your patients are and your services are actually provided. To have any hope of inspiring people, you have to be willing to enter into their realm and be with them as often as possible. This kind of work could be called “walk-around management.” Be as visible as you possibly can. That alone will give people inspiration and make them feel special!

Reach out to the community.

Be willing to talk to community groups as often as you can. Let the community know what its hospital is all about. Speaking takes time but if people understand your mission and the challenges you are facing, they will be more willing to assist you. It takes an extraordinary amount of time but it is absolutely necessary. One of your biggest potential problems you face is a community that does not understand your mission and vision. A hospital or health system cannot survive without the support of its community.

Be proud of healthcare!

Healthcare is the greatest force for good in the world, and it will always be. You are a key player in the business of serving others. Let them know what your standards are and how you plan to overcome the obstacles and challenges this great industry faces. You are desperately needed to lead. The reason people come into healthcare is to serve others, but CEOs also came into healthcare to be challenged. For a true leader, this is a great time to be a healthcare CEO. Relish it and shine –– and never, but never, give up. Healthcare needs more leaders like you!

With every one of these points, inspired by a very perceptive healthcare visionary, the message is: Don’t let change happen to you. This is not a time for half measures. It is time to take all of the bold dreams you have been shying away from but secretly knew were on-target and make those dreams your own.

SOUTH PORTLAND, ME – A panel of ICD-10 experts spoke Friday at a conference co-hosted by the New England Health Information and Management Systems Society and Maine Healthcare Financial Management Association in South Portland, Maine, giving advice about the five ‘gotchas’ that can wreak havoc on the best-laid plans for implementing the new coding system.

Janet Sayers, HIM/compliance manager at Applied Management Systems, Andrew Adams, senior manager at Ernst & Young and Dan Roy, ICD-10 project manager at MaineGeneral Health warned against these five potential pitfalls:

Reporting:

Don’t take managers at their word when they tell you that their reporting won’t be affected by ICD-10. Dig a little deeper, and you’re likely to find they don’t understand things well enough to know just how much they will be affected.

Overlooking impacted areas:

It’s not just the clinical side of hospitals and health systems that will be hit hard by ICD-10. Some experts suggest that the only areas that won’t feel the effects are the cafeteria and housekeeping.

Teaching old dogs new tricks:

Don’t underestimate the impact on your organization’s coders who could need as much as 50 hours of training to become comfortable with ICD-10’s codes. Incentivize and support your coding staff.

Preparing for impact on productivity:

Learn a lesson from Canada, which reports it took six months to return to pre-conversion productivity levels. Budget for reduced productivity.

Communicating with IT vendors:

Smaller vendors, in particular, may not be as prepared for ICD-10 as they let on. You need a contingency plan because if a vendor is not ready in time, it will negatively impact your organization.

We expect healthcare executives to set the tone at their organizations and to inspire their teams into becoming the best providers in the region — or the country. But that’s not always how things shake out. Sometimes these leaders run astray, taking the hospitals’ finances or reputations down with them.

Read on to see who made this year’s list.