Saturday, December 28, 2013

Of the G-8 Heads of State, who uses linkedin best?

Of the G-8 Heads of State, who uses linkedin best?
Please take the survey in the right margin.  Heads of States are listed.  On mobile devices, you may need to select “view full website”. Thanks AH

Thursday, December 19, 2013

WiFi, a Precursor to FCC Decision?

The United States Federal Communications Commission (FCC) “regulates interstate and international communications by radio, television, wire, satellite and cable in all 50 states, the District of Columbia and U.S. territories.”
The FCC is lifting the ban on inflight calls to and from passengers aboard aircraft.  The decision will allow individual airlines to decide whether or not to allow these calls.  In other words, while the FCC will not ban calls, an airline can impose its own ban.

My questions have nothing to do with whether or not this is a good idea.  My questions are about the introduction of passenger accessible WiFi on aircraft.  If you want to participate, you do not have to answer all of the questions below.
1.       What are the technical differences between VOIP and other data that may have caused interference in aircraft systems.  Interference was the stated focus of the original policy?
2.      Should VOIP from aircraft be a separate regulatory issue from other types of communication and why?
3.      Please provide comments on whether or not putting onboard WiFi for customers was a precursor to the FCC decision.


Tuesday, December 17, 2013

FDA Releases a Final Rule for UDI and Accredits GS-1

The FDA issued the following email to UDI and GUDID Email Subscribers on 12/17/2013:

FDA has accredited GS1 as an issuing agency for the issuance of Unique Device Identifiers (UDIs).  FDA may accredit other issuing agencies in the future.  FDA will only accept UDIs that are issued under a system operated by an FDA-accredited issuing agency.  Please check the UDI website at: for a list of FDA-accredited issuing agencies. 

Good work GS-1.   Follow the links in the text above for the details and to learn more.  Click the Unique Identifier label beneath this post to get background on the decision.

Saturday, December 14, 2013

Purchasing Fraud And Theft By Employees

I turned the corner in my white sedan.   It was a sturdy car with bouncy springs and had once been a police vehicle.  How appropriate, “Because the scene at this old shed looks bad, real bad!” 

This large closed-in shed had started off as an ill-kept open shed in the middle of a field outside a small West Texas town of about 230,000 people.   The area was high plains with few trees compared to the place of my youth.  Cotton fields spanned north, south, east, west and every combination of compass designation possible.  Most of the cotton was picked and the fields were dusty.  Wind would pick up the dust and tumbleweeds and blow them across the plains just like in the old western movies.   

Homes and a youth center were within a short walking distance from the shed.  Sometimes, there was a man out there, cleaning up around it.  Sides were put on it.  The place got locked up.  Kids couldn’t get in there and play around, possibly get hurt.  I was glad to see the shed covered and tidied up.    There was little activity after the sides went up.   

That day though, it seemed the world converged on that shed.  Specifically, the law enforcement world... unmarked cars, cars marked with local and state law enforcement insignia, military security vehicles, blue suits, brown suits, military suits, black federal authority looking suits… and there was me driving by in my old white police car.  One side of the shed was down.  Inside the barn were cars, a conversion van, and a boat.  That was only what I could see.  

I asked some friends what was going on.  All replied with some version of, “I don’t know, but it ain’t good!”  There was this one person who worked in the military contracting office; he was very tight lipped.

The next day, I found out that a federal contracting officer had been charged with pulling one of the oldest tricks in the book.  It’s probably been around since the first chief or monarch asked an administrator to buy something.  The contracting officer was alleged to have created a business then awarded contracts to his business.  Reportedly, when his lifestyle did not match his federal job, it drew suspicion.

In this case, the contracting officer’s scheme was somewhat sophisticated.  Again, reportedly, it was only the lifestyle that gave him away.  Recent cases in the press and others that often don’t make the press aren't sophisticated at all.  They seem... well, you tell me a  good word for it?
1.       Equipment comes in and goes out of businesses with no accountability simply because it doesn’t meet a minimum dollar value.
2.      Services are bought and never received.
3.      Credit cards orders are on paper only and are neither monitored nor audited properly.
4.      Good repair parts end up on online auctions.. 

I am not talking about the one or two items.  I do see reports of those who have been charged with crimes involving less than five thousand dollars.  So, someone is probably watching the gate in some of those instances.  However, I read cases where fraud had been going on for years and involved hundreds of thousands of dollars that are traced back to an employee.   The property value of the assets in that old shed was one hundred thousand dollar US, minimally. reports that employee theft costs as much as five percent of annual revenue (written in 2010).   Employee theft and fraud are billion dollar problems in the United States.   

Yes, honest employees are important.  One needs policy and checks and balances that are performed, too.  Reconciling a cash drawer is a check and balance process.  Wouldn’t you reconcile your cash drawer regardless of the cashier?  That’s just good practice that one does day in day out, period.  So, what’s the issue? Are managers so overwhelmed that simple checks and balances are not seen as important because they are simple?  Is it negligence?  What do you think?  What's the solution?

Tuesday, December 10, 2013

RFID/RTLS Transcendent or Something Else? A Year Later

The response to my op-ed, RFID/RTLS Transcendent or Something Else?, brought some interesting comments from the audience.  

Mostly, that using RTLS/RFID information in writing performance standards  could be a good idea. The rebellion against the idea centers around trust and the relationship between workers and management.

Over one year after my original op-ed and in light of the NSA international data collection controversy, has this changed your perception?  Please share how?  New participants are welcomed.

Read the original op-ed and comments at  I appreciate your participation in this discussion. 

Sunday, December 8, 2013

A Dear Walk Down Memory Lane With Big Data

Lava Kafle’s social media updates keeps me informed on the progress of Deer Walk Inc. Deer Walk Inc is a software development company focused on maximizing the ability of the healthcare industry to find strategic and actionable meaning in Big Data.

Recently, I clicked on his link to a Deer Walk video that sent me on a dear flashback.  “Also, there were conflicts that could never be properly resolved because only bits and pieces of information were available at any given time. We were trying to put together a puzzle with missing pieces and no picture of what the end product was even supposed to look like. ... these tools reminded me of the systems I had used in the late 1980s.”  Al Hardy, 2012

I will not steal the thunder from Deer Walk's video, but it gets a hardy ain’t that the truth from me.  I will say that precise and consistent data collection over time points to trends, helps maximize outputs, and empowers people from the basement to the C-Suite.   All these have positive effects on competitiveness, organizational effectiveness, and even the workplace environment.

Please share your thoughts and experiences in the comments section.

Monday, December 2, 2013


After receiving an executive summary Healthcare/Pharmaceuticals Asset Management Market, Global Forecast 2017, I went back to review the company that published this research, Markets and Markets.  I wanted to get a better understanding of how the company’s interview of me (April 2013) fit into their approach to market segmentation.

Markets and Markets provides research for the following segments:
   -Energy and Power
   -Food and Beverage
   -Medical Devices
   -Advanced Materials
   -Semiconductor and Electronics
   -Automation and Process Control
   -Telecom and IT
   -Consumer Goods
   -Automotive and Transportation
   -Banking & Financial Services
   -Aerospace & Defense
   -Healthcare IT
   -Agriculture Industry
   -Engineering Equipment Devices
They provide information to clients through reports and subscriptions.  They provide services through consultants.

Kaushik Kochhar, Madhusudhan(Madhu)Pendyala, and Harinder Mehta, spoke with me about Healthcare/Pharmaceuticals Asset Management Market, Global Forecast 2017. Kaushik is the Manager for Strategic Growth and Business Development (Healthcare IT). Madhu was the research associate on this report as well as others such as: North American Nuclear Medicine/Radiopharmaceuticals & Stable Isotopes Market, Global Additive Manufacturing Market, and Global Healthcare/Pharmaceuticals Asset Management Market and Global Nerve Repair & Regeneration Market.  Harinder manages business development for the sub-domains of Medical Devices, Bio-Technology, Pharmaceuticals, and Healthcare.

“Across the life-cycle of a brand” is a phrase on the Markets and Markets website that caught my attention. Asset Management for plant systems and equipment is all about well-managed phases of each life-cycle. A brand shares similar characteristics. A brand can be purchased.  A brand has to be maintained.  A brand is utilized.  A brand can be retired.  A brand can be resold once the owner no longer wants it.  There are similar life-cycle risks associated with something as massive as a skyscraper just as there is with something that has no physical mass, like a brand. So, how does market segment approach in the report help companies manage the life-cycle of their brands?

Kaushik, Madhu, and Harinder walked me through Markets and Markets approach. This market research is a global assessment of the RFID and RTLS markets. They cover the operational application, hardware, and software for passive and active technologies. The strong impact of this technology on cost saving in hospitals and pharmaceutical industry, enhanced work flow management, patient & staff safety, is assumed to be the major drivers of this market. Markets and Markets affirms that this research is conceptualized and 
implemented to help their clients:
1.       Understand how to leverage existing markets
2.      Find new markets
3.      Find channel partners. 

The report is one way Markets and Markets communicates the results of that process.
I read through the executive summary of Hospital Pharmaceutical/Asset Management Market. First, the executive summary suggests how you should look at the report in the Key Takeaways section. Next, it takes the reader through a description of the report. 

The Report Description helps the reader to see how the research approach was conceptualized, planned, and implemented.  The Healthcare Asset Management Market is segmented by:
- Application: The purpose of the sold system (Example: Patient Management)
- Product: The positioning hardware and software (RFID/RTLS) 
- Geography: North America, Europe, Asia, and Rest of the World (RoW). RoW is Africa, Pacific Countries, Middle-East, and Latin America (LATAM).
The Pharmaceutical Market is broken down similarly.

The document’s Methodology summarizes Markets and Markets’ approaches to determining market share, market size, and key data points.  As part of the process, they used both top down and bottom up approaches to “calculate global market size”. For growth estimates, they used company financial reports, order information, paid databases, company websites, interviews, and press releases to collect data for analysis and display in the 130 or so tables displayed in the document. 

Reading farther into the document, Markets and Markets’ reports on regulations and burning issues for key segments. These can help drive the market to grapple with the issues and look for solutions in regards to compliance, risk mitigation, and protecting financial projections.  Customers will look for brands solutions.

Chapter 7 discusses the competitive landscape with the list of companies that are engaged in acquisitions, mergers, and collaborations. How is brand image maintained in stiff competition without understanding how the game is being played?

Chapter 8 contains company profiles of 15 companies involved in RFID and RTLS.
Though there are similarities between the life-cycle of physical assets and brands, there are significant differences as well.  One major difference is the information required to increase ones’ chances of a good outcome. This is especially so in terms of growth.  Successfully expanding a facility to increase customer capacity by 500 per day is much simpler than increasing your brand image to draw those extra 500 customers per day.  The team I spoke with from Markets and Markets confidently emphasized the stated company goal in this regard, “We aspire to assist our clients in achieving sustainable growth by providing incisive business insights into their respective markets.”

To find out more about the report, click here Add hardyamc “to specific field of interest” to get a 5% discount.

Tuesday, November 12, 2013

Telemetry on Your WiFi Network?

Is it wise to put Telemetry and other medical networks on your facilities WIFI? Posted by Clark Cash on the linkedin group Asset Management, Healthcare.

What do you think are the critical factors in making this decision?


Friday, October 4, 2013

Dr. Maria Hester, The Right App-titude

Dr. Maria Hester is a hospitalist (hospital-based physician) and the Principal of Savvier Health, LLC.  Dr. Hester joins Doctors Ketcherside and Creese in responding to the question, “What does healing mean to you?”

I am continually fascinated by these physicians who take an idea, bring it into fruition, and infuse that idea into every aspect of a brand.  For Dr. Hester, that means becoming a catalyst for or fostering patient empowerment whenever and wherever possible.  In her practice, her books, and her mobile apps, she encourages patients and families to:
1.       Take an active role in the healing process
2.      Learn how to communicate key information to physicians

Dr. Hester writes about empowerment in trade publications and blogs as well.  She is published on IMNG Medical Media, 913life,, and through Jennings Wire.  Her ideas behind empowerment have very much to do with the reasons she switched from pursuing a biomedical engineering degree at Purdue to medicine.  Initially, she resisted going into medicine though her father and brothers are physicians.  “I needed to talk to people, to ask them questions, to see their expressions, help them; yet, I wanted to still pursue my love of science.”  The direct contact with helping people was not there in biomedical engineering.  Medicine allowed her to combine all of the above.
This desire to better communicate with patients helped form her definition of healing.  “Healing is body, mind, and spirit.  It is one thing for a physician to prescribe a treatment or medication.  The science is crucial but the patient will more likely get a good outcome if the patient is compliant and believes in the potential results.  Patients will likely have better outcomes if they communicate effectively with their physicians and take their medications as prescribed.” This takes being active - a certain amount of savvy from the patient that leads to empowerment.

“Patients may not realize that their recovery or managing an illness can be much better,” remarked Dr. Hester.  The feedback she receives from patients helps her with increasing the useful inventory in her medical bag with, what she calls, a multi-pronged approach to healing. 

For example, a person goes to the doctor.  He may be given a questionnaire to fill out, but not really remember all the answers.  The doctor orders some tests.  Medication or treatment is prescribed.  He pays the bill and is out the door without serious understanding of how to get better.  “The patient has the ability to change that flow.”

I asked, “Is that how you see apps for mobile devices as being effective - in changing that flow?  I mean, you are spending a lot of time developing them.”
“Apps are part of our medical future.  Apps are fast.  Apps are easy.  You have access to information on the go, seconds here, minutes there.  Those seconds and minutes can save your life by helping you to learn many things about your health. “

“So, knowledge is a path to health empowerment,” I added.  “But people need a tool or two?”

“Yes.  Some patients do not know much about their condition or remember all of their medications.  It can be a headache for the providers.  It’s going to be a long time before doctors and nurses have universal access to medical records.  The apps are tools owned and controlled by the patient.” 

“What would an app do?”

“It should be encrypted.  It should have reminders.  Patients depend completely on the physician to call about results.   Before an appointment, a patient can record blood sugar readings, blood pressure, list of medications and dosages, new symptoms or questions that come up beforehand.” 
“Like the questions you forgot to ask?”

“Little tidbits of information add up that can make a difference in your health.”  The more relevant tidbits the better, a forgotten question is a tidbit that could be important.

Her current app is Patient Whiz. The app is owned by the user and helps to further empower users by giving them a way to input medical history, current concerns, medications, and appointments with audible alerts all in one place.  There are helpful external links as well.  

One function of the app which particularly caught my attention was the list of questions that helps app owners capture information about particular symptoms in a way that should be more useful to the physician. Take abdominal pain for example, the app takes the user beyond just the location of the pain.  The app guides the user to answer questions like:
- when did the pain start?
- what eases the pain?
- what makes it better?
- does it radiate? from where?

“The app enables the patient and doctor to move past so much back and forth in gathering the basic information and move to other meaningful exchanges.”  The app has useful links for the user to gain knowledge about conditions and medications as well.

The app offers a method of carrying key information when traveling, especially so in the case of those being treated for chronic conditions or undergoing treatment.  Users can print this information as well.

“Healing is a multi-pronged approach.”   There are forks in the road… choices.  Only a portion of those choices has to do directly with the medical and support staff.  “The patient must become more inquisitive, compliant, knowledgeable, and involved.”  These patient actions have a great deal to do with the road taken and where that road leads.  Dr. Hester’s mobile app, Patient Whiz, offers a method of assisting physicians and patients to develop options and make choices that keep them on the road to better health.  Patient Whiz is available on iTunes and will soon be available for Droid devices.   

Security Conference, Chicago, IL

The ASIS Conference was held in Chicago, IL, USA, September 24-27, 2013.  ASIS is the acronym for the American Society of Industrial Security.  However, ASIS is an international organization.  This was my first trip to ASIS.  It wasn’t on my original agenda but after hearing about six times, “Al, you should be there!” I decided I'd better go. 

I was traveling in Tennessee when I made that decision.  The decision required driving a car to catch a train to Chicago very early in the morning. It was pitch black.  My GPS announced with reassurance, “You have arrived.”  I looked to the left, darkness.  I looked in front of me, darkness beyond my headlights.  I looked to the right.  About 60 meters up a road the size of a bike path, I saw a light.  I thought, Surely not?  I drove up the path to a shelter.  I wouldn’t call it a trailer though it could be mistaken for one.  There was no visible sign of any activity. This was the train station.   Wait here two hours for a train…?  I travel with the capability to access two different major mobile carriers.  There was no signal on one and the other kept dropping my call.  I changed my reservations on my way to the next station.  Other than that, train service was great.

I arrived at ASIS late morning.  Registration was a breeze.  The staff was helpful though I never did actually find a booth number.  The conference really did help me begin to understand the security industry and its many aspects.  Exhibitors were great and offered many good contacts.  They taught me about some very interesting technologies and capabilities.  As always, it’s now a matter of converting some of those opportunities.      

Wednesday, July 10, 2013

Healthcare Readmissions – A Simple Cure for Prescriptions

A Physician Practice's survival and independence can hang on: 1) meeting expanding regulatory compliance; 2) growing market share; 3) anticipating the persistent threats of reimbursement cuts; 4) reducing expenses and, 5) optimizing net revenue!  The probabilities of achieving all of these worthy objectives are greatly increased by improving outcomes and making patients happy!

The skill of diagnosing and developing a reasonable treatment plan is only as successful as the patient’s willingness to comply with it.  So, providers must expand their mechanisms of influence to increase compliance, outcomes and satisfaction! 

There are new tools to help achieve patient compliance with prescribed drugs.  Fortunately, it can help solve  “survival kit” objectives!  The system should be simple; where, as you write scripts, the patient’s medical record is updated and their prescription is being filled for pick-up at check-out as they schedule their next appointment.  Also, a patient should be called within 24 to 48 hours after discharge to:
- document compliance
- answer questions
- update records
- schedule a private (billable) medication assessment
- confirm follow-up appointments and set up renewal prescriptions through a courier or mail service

For more information, send an email to

Wednesday, July 3, 2013

Part 2, Limited Warranty on Patient Care

In Part 1, Michael Ryan and I discussed:
1. The definition of readmissions - CMS defines readmission as “an admission to a subsection (d) hospital within 30 days of a discharge from the same or another subsection (d) hospital.”
2.  Parties affected by the readmission penalties - If a hospital receives Medicare funds, the readmission reduction initiative applies… most likely.

In Part 2, Michael and I discussed 
3.  A concern from blog readers – how does patient responsibility figure in the readmissions scenario?
4.  How are penalty rules applied?
5.  Grants associated with reducing readmissions

 How does patient responsibility figure in the readmissions scenario?  It’s not as clear as one may think.  Here is a real example.  The names were changed.

    I received a call one evening from a couple very close to my family.   As you may have guessed, I was writing.  Raoul is an entrepreneur that has owned a stable business for 30 years.  Mae has a Master’s Degree and has received awards for her work.  They have health insurance.  
    Mae didn’t even bother to greet me.  Worry sent her into a high-pitched, high-geared request for help.  When she stopped, I asked her to start again.
    Mae responded, “You remember that Raoul had a knee replacement right?”
    “He wanted me to call you.  Something is not right.  It’s very swollen.  It looks so tight.  He’s in pain.”
    “So why are you calling me?” I asked.  “You should be calling the doctor or the hospital.  I’m sure they gave you the number.”
    “I looked. I didn’t see anything.”
    I knew that it was possible but not probable that the hospital had not given them anything.  
    “They gave you a bag, right? What happened when you got home?”
Mae fell silent.  Then, “Wait a minute.”
    I could not hear what she was doing.  Moments later, “I found something.  I’ll call you back.”
    “Don’t call me.  Call the doctor!”  
    She hung up.

What happened?  In getting home and comfortable, trying to make sure that everything was fine, key paperwork got separated.   The conversation prompted something in her mind that helped her locate the documents.

This incident could have ended in a preventable readmission.  Instead, Raoul and Mae were able to avoid an unplanned visit and had a good recovery.   So, was the incident totally the fault of Raoul and Mae?  Please share your thoughts in the comments area. 

Michael Ryan stated that this could be very typical of what happens.  “Discharge instructions are given to patients when they go home.  The instructions may contain subsets of instructions on diet, wound care, after visits, sometimes who to call, etc.  Even the most diligent patient is sometimes caught in a situation where they may not have read the discharge instructions.  Even when they do, discharge instructions can conflict.  The instructions may come from different sources or applications.   Hospital staff may not have read through all the instructions to insure there are no conflicts.  The instructions should be reviewed and put in layman’s terms.  This could help reduce readmissions as well.”

“Michael, can you give us an example?”

“I will give you one example.  A person was readmitted because of a surgical wound.  The instructions stated that the wound should be ‘dressed’ with a particular antibiotic.   Three days later, the patient ended up back in the hospital because the instructions did not say to put on a new bandage.

“Here, it appears that the patient sought to follow the instructions to the letter.  It may have been something as simple as not really knowing what dressing a wound meant.”  

Michael went on to say hospitals can’t take for granted that the average patient will understand instructions simply because they pulled it from a source.  

Readmission prevention from a policy standpoint is a work in progress at every level.  The penalties are meant to bring attention and action to reducing them.  The Centers of Medicaid and Medicare Services (CMS) looks to cut cost for hospital acquired infections and readmissions.  Michael stated that these 2 areas account for $25B USD in readmission costs.  One implication is that these payments could be counted as revenue for hospital, not leading to a comprehensive push by the respective providers to reduce them.

Let’s put that $25B in perspective.  Between 2009 and 2011, the Federal government sent about $90B to the states.  So that’s a little more than 1/4 of 2 years of funding.  

Michael remarked, “CMS sought to figure out a starting point to measure readmission reduction.  They acknowledge that readmissions will never go completely away.”  

CMS uses a code called DRG (Diagnosis-Related Group) to identify targeted categories: Acute Myocardial Infarction, Heart Failure, and Pneumonia.   What follows is a mathematical story that has a progression of ratios as the plot.  Among those ratios is a comparison of payments for readmissions over payments for discharges.  To restate, CMS  compares the amount of money that it has paid to a particular hospital at which  beneficiaries/clients were treated and discharged.  CMS then compares how much they have paid for treatments that landed their beneficiaries back into the hospital.   If the hospital exceeds CMS’ target, up to 1% is deducted from the hospital reimbursements for 2013.   The maximum penalty will increase to 2% in 2014. "The penalty is a three year rolling average which goes into effect the beginning of each fiscal year," stated Michael.

Also, there are positive incentives meant to help reduce readmissions.  This takes the form of grants.  The grants are administered through Hospital Engagement Networks (HENS).  This initiative is a joint public and private collaborative.  HENS work at the Federal, state, and regional level “to keep patients from being harmed while in the hospital and heal without complication once they are discharged.” – CMS Website

Monday, June 24, 2013

Protecting Your Assets from Loss

Reliability data can extend the safe and efficient operation of your assets while reducing your cost.  Should insurance companies take this into account when settling on property loss?   Please share your thoughts.

Friday, May 24, 2013

Limited Warranty on Patient Care

Through provisions in the Affordable Care Act (ACA), The Centers for Medicare and Medicaid (CMS) is preparing to save $11,000,000,000 over the next ten years by incrementally cutting reimbursements for preventable readmissions and hospital acquired conditions. These cuts are in the form of penalties.  Insurance companies are likely to follow using the same methodology as CMS, helping to push healthcare facilities to reduce readmissions. In turn, this should better assure a patient that he or she will have fewer complications and remain on a healing path once discharged from hospital. 

The policies to reduce readmission, in my opinion, establish a kind of “limited” warranty as a side effect.  Whether you agree with the analogy or not, both a warranty and the pending cuts have 4 things in common.
- The user/patient
- Placing a great product or service on the market
- A great support team in place
- Preventing losses by mitigating risks to the lowest possible levels attainable 

The perception of the patient affects the latter 3 points.  How does the patient treat the product after it has left the lot or rather, the lobby?  How does the patient continue to enjoy the value of a service once it has been rendered?  For example, a sponsor pays for your class but you sleep through it.  The class is held after a starchy lunch.  The speaker talks at you as if trying to put a 2 years old to sleep.  The room is warm.  The lights are dim and there is no smell of brewing coffee drifting in from anywhere.  You have a responsibility to stay awake but the company giving the class could really have structured the class better.  Where does that line fall when it comes to readmissions? After all, a patient's behavior can result in a readmission.  Should a patient be penalized?
So, I spoke with Michael Ryan, CEO of CareTrax, about how ACA addresses readmissions in this regard. Specifically:
1.         The definition of readmissions
2.        Who is affected by the penalties
3.        How the penalty rules are applied
4.        Grants associated with reducing readmissions

Michael stated, “The Centers for Medicare & Medicaid Services, CMS, defines readmission as an admission to a subsection (d) hospital within 30 days of a discharge from the same or another subsection (d) hospital.”

What's it really like to work in U.S. Healthcare Click Here one Testimony
Again, this answer underlines the need for me to have this discussion with Michael.  The official government answer is within the tradition of the best bureaucratic answers which transcends through the political hierarchy of global nation-states; never answer a question without creating the need to be asked another question.  He knew both the official answer and how to interpret for and assist the rest of us in managing our stakes in readmission policies.  If a hospital receives Medicare funds, the readmission reduction initiative applies… most likely.

Michael explained readmission by putting it in context to the subject.  “When a patient arrives at hospital within 30 days of being discharged, even from another hospital, there is an assessment as to whether the condition has anything to do with the previous treatment.  Depending on what’s found, the new diagnosis and treatment may be classified as a preventable readmission.

I asked, “How does a hospital know if the patient’s condition has anything to do with the previous treatment?”

“Codes,” he answered simply.  Diagnosis and treatments are assigned codes.  These codes go into a patient’s medical records.  Codes serve as:
- The basis in which a patient’s healthcare is paid
- A standardized way of communicating the patient’s diagnosis and treatment
- A method of storing information in electronic medical records that can be queried with some certainty

“Examining these codes aides the process of determining a connection with the previous discharge.”  He explained further, “CMS has identified about 17.4 B in preventable readmissions costs due to infections, mistakes, and bad practices.  The projected savings is $11.4B based on CMS data which show that 50% of readmissions are preventable.  CMS previously paid for what it sees as preventable readmissions and seeks not to do this anymore. 

“CMS acknowledges some issues with readmission and bases the penalties on readmission numbers above the national averages listed in policy.  It started the penalties in October 2012.  They will continue to phase them in to 2017.  In phase 1, CMS focuses on 3 diagnosis groups:
-Acute Myocardial Infarction
-Heart Failure
* Acute Myocardial Infarction – Interruption of the blood supply.  Heart tissue can die or become damaged.

Other groups will be added in the future.

My closing remarks for this segment: Any trip back in hospital related to those conditions above makes for a bad day.   To think that a good percentage of such may be preventable is not very assuring.  As far as putting a great service in the market place… well, clearly, this implies that there is work to be done. 

In the next segment, Michael Ryan and I will discuss how the penalties are assessed and discuss further readmission as it relates with patient versus hospital responsibility.

Part-2 Limited-Warranty on-Patient Care