Clipping 2, New Leader Same Problems Persist

Origins of the OIG and Concerns from the Beginning

The Office of the Inspector General (OIG) Report Number 8H1-A28-072, Date: February 17, 1998 continues our history lesson on the Veterans Health Administration by discussing its very own origins.  Just a reminder, OIG Report Number 8H1-A28-072 was prompted by the Senate Oversight Committee to look at the practicality/common sense of how programs were structured and managed.  It is important to note that the OIG was to keep both the VA secretary and the Senate Oversight Committee informed.

In 1978 Congress passed the "Inspector General Act of 1978," Public Law (P.L.) 95-452, which established an OIG in the Veterans Administration².

The OIG’s charter requires the creation of independent and objective units:

(1) to conduct and supervise audits and investigations relating to the

[Department’s] programs and operations;

(2) to provide leadership and coordination and recommend policies for

activities designed (A) to promote economy, efficiency, and effectiveness in the administration of, and (B) to prevent and detect fraud and abuse in,such programs and operations; and

(3) to provide a means for keeping the [Secretary] and the Congress fully

and currently informed about problems and deficiencies relating to the

administration of such programs and operations and the necessity for and

progress of corrective action³.

DM&S managers were concerned about the OIG's role in overseeing medical care

quality. In June 1980, Congressional hearings examined the OIG's capacity to

investigate health-related matters, as well as VA's proposed establishment of an

Office of Medical Inspector (OMI), which would report to VA's Chief Medical

Director (CMD). DM&S managers proposed that DM&S clinicians provided medical

care oversight through traditional peer reviews by health care professionals. The

CMD believed that, because of the CMD responsibilities outlined in Title 38, United

States Code, any efforts to oversee or evaluate quality of health care within DM&S

should be conducted under that authority⁴.

Congressional representatives and the General Accounting Office (GAO) expressed

concerns about maintaining independence and objectivity when oversight efforts

were governed within DM&S. At the same time, the OIG expressed concerns

about the burden of medical oversight responsibilities that might overwhelm the

already heavy OIG workload⁵.

#NewSameProblem 

Clipping 1, New Leader Same Problems Persist

#NewSameProblem  Over the next few weeks, I will publish clippings from old Inspector General Reports, General Accounting Office Reports, and Congressional Testimonies.

Here is Clipping 1 from Office of the Inspector General (OIG) Quality Management in the Department of Veterans Affair, Veterans Health Administration, Report Number 8H1-A28-072, Date: February 17, 1998.  The Office of the OIG gives us a history lesson in this report

A. History and Legislative Overview

In the 1970s, VHA [formerly the Department of Medicine and Surgery (DM&S)] established and operated a QA program called the Health Services Review Organization (HSRO)1. HSRO programs featured internal review processes in VA medical centers (VAMCs), as well as external reviews of VAMCs. Together, these external and internal processes comprised VA's Medical QA Program.

"The HSRO consisted of a two-faceted program. The HSRO - Systematic Internal Review (SIR) Program was an integrated QA process that was conducted by VAMC employees."

HSRO-SIR functions and elements consisted of essentially four mandatory parts: 

• Continuous Monitoring included reviews and analyses of medical records, surgical cases (tissue), blood services, therapeutic agents and pharmacy, laboratory, radiology and nuclear medicine, psychiatry programs, commitment usage, restraint and seclusion usage, infection control, surgical and anesthetic complications, autopsies, mortality and morbidity, rejected applications for care, and patient incidents;
• Patient Injury Control reporting included incidents, and QA investigation for unexpected or unfavorable events such as suicides, 1 homicides, falls, assaults, abuse, neglect, allergic reactions, unexpected deaths, and surgical complications;
• Utilization Review; and,
• Credentialing and Delineation of Clinical Privileges,.

Congress addressed "independence" and objectivity issues associated with this structure in 1978.  More on this later….  But, think about the how this oversight may have or should have changed how business was conducted on a daily basis.  It would be great to hear from someone who worked in the VA at that time.

http://www.amazon.com/Veterans-Administration-RTLS-Recommendations-Success-ebook/dp/B00A0MS5MS/

VA Medical Centers - Change the Leader Same Problems Persist

Newt Gringrich said it on CNN's Crossfire about the VA Medical Centers- paraphrased, we have a congressional problem.  Acquisition law needs to be rewritten.  

Here is an excerpt from The Veterans Administration RTLS, Recommendations for Success,

"The other issue is specific to government acquisition rules when undertaking such a process involving RTLS solution providers in a healthcare environment.  Contracting officers contend with so much that it can be hard to tailor an acquisition process that results in returning distinguishable solution-focused responses."   See other recommendations in  http://www.amazon.com/Veterans-Administration-RTLS-Recommendations-Success-ebook/dp/B00A0MS5MS. 

Though the e-book is about RTLS, the research reveals the same persistent problems from managing staff performance to leveraging key data. Click here to see the plannedtransformational vision.

THE GLOBAL SICKCARE SYSTEM

“We have a sickcare system and not a healthcare system.  You can’t just jam more stuff into a sickcare system.”  Dr. Arlen Meyers’ remarks came quickly and without reservation.  With all the polarizing politics about American healthcare, it is easy for such a statement to be seen as partisan.  In this point, Dr. Meyers has broken through and bounded far beyond those sorts of arguments. 

Dr. Meyers is President and CEO at the Society of Physician Entrepreneurs and Director, University of Colorado CITI Digital Health Consortium.  He is a practicing surgeon and otolaryngologist, professor, and entrepreneur.  He helped create the Society of Physician Entrepreneurs (SOPE) to help others more than just physicians:

- push beyond the concepts of what we think is possible

- pull together what we currently know into ecosystems that are both scalable and meaningful to the patient and those who treat patients.    

Dr. Meyers and I met through social media.  A member asked about the best practices in using electronic medical records in the patient environment.  Dr. Meyers responded, “1.  Show up for the patient appointment on time.  2.  Sit down and talk to the patient.   3. Avoid using the EMR as much as possible.”  By his other posts in various forums, I could see that there was more to this statement that just the bad and worthless EMR rhetoric one so easily finds. 

Dr. Meyers purports, “The experience people value the most is experience in the exam room.”  Everything else is secondary and must support that experience.   It isn’t so much as not liking EMR, it’s a much larger issue of how an EMR interfaces with physicians.   He asserts that the physician interface should be providing “decision support and actionable information.  Within the time constraints of the few moments I have with a patient and with limited resources available, how does the EMR optimize and maximize the quality of that experience.”  Revenue, expense, and meaningful data should be captured while enriching the patient to physician experience not detracting from that experience.  It’s not a matter of if it can be done; rather, someone needs to get it done.

Spend time with the patient. Less Focus on finding a way to charge the patient for every little thing...via the physician....  The complaints sounded familiar.  So I asked, “Listening to what you are saying, seems that many of the same issues surfaced at the rise of the HMO.”

            He replied, “There have been various experiments to try and do that.  HMOs were one of them.  That was more about rationing healthcare.  I don’t think what’s working out now will work either.  And in reference to the social media post, in order for things to change we don’t just need new technologies - hardware, software, and digital health technologies, we need new business models.  We need new ecosystems.  We need a regulatory apparatus which allows those things to grow.”

Dr. Meyers has similar perspectives on wearable devices as well.  Great inventions but…  “How is this helping the patient or the doctor?  By integrating it into the patient record?  This is different from a health diary in which a patient may take blood pressure readings or records when certain symptoms occur.  These are devices capable of transmitting data on a continuous basis.  Some people have the expectation that the data will be beamed into the respective patient’s medical record in real-time.  Who gets it and what do you expect them to do with it?  It’s not scalable as currently presented.”      

The conversation transitioned a bit.  Dr. Meyers elaborated on the role of technology in healthcare.  There were two ideas.  The first idea, not a problem.  The second was something that gave me pause. I wasn’t comfortable with it at all.  At least, not until I had time to think about the context of what Dr. Meyer’s view of how healthcare should look.

The first, Dr. Meyers stated, “Healthcare education is mostly hospital based.  The business cases and regulatory apparatus are geared toward a hospital based care.  This is a sickcare system.  Admission into the hospital should be seen as a failure in healthcare.

“If I attach a monitor to my car, I could get substantial discounts if I behave on the road. If we go to wearable medical devices, hook them up and give money or credits to adhere to care plans and avoid hospital stays based on that data.  Make it easy to be healthy with minimal effort on the consumer’s part, and save money.  The policy apparatus should support that.”

Then he started into the second idea, the one that gave me pause.  That is, a machine diagnosis.

Dr. Meyers continued. “As technology helps us get smarter in making more predictive diagnoses, the computer can connect the dots better than I can.  So, what is there left for me to do when it comes to diagnoses?”

Read part 2

THE GLOBAL SICKCARE SYSTEM - Coming Up Next Week on Asset Management for Healthcare

THE GLOBAL SICKCARE SYSTEM - Coming Up Next Week on Asset Management for Healthcare - An Interview with Dr. Arlen Meyers, President and CEO at the Society of Physician Entrepreneurs and Director, University of Colorado CITI Digital Health Consortium, don't miss it. 

http://www.amazon.com/Veterans-Administration-RTLS-Recommendations-Success-ebook/dp/B00A0MS5MS/

Coming Up on Cinco de Mayo at AMHC

Coming Up on Cinco de Mayo (5 May) at AMHC, Part 2 of 2 with Allan Hess, Developing a Brand? Spend Your Money Wisely. 

Part 2 will discuss:

• maintaining brand value
• retiring a brand and some closing thoughts from Allan. 

 In the meantime, click here to read part 1.

- Click here to read the original article that sparked thoughts on the lifecycle of a brand.

- Click here to find my book on Asset Management

- Click here to my whitepaper on the U.S. Veterans Health Administration’s issues with asset management programs and policy

PART 2 IS UP NOW http://assetmanagementhc.blogspot.com/2014/05/part-2-developing-brand-spend-your.html

Part 2, Developing a Brand? Spend Your Money Wisely.

Part1 introduced Allan Hess, discussed the definition of a brand, and what entrepreneurs should be doing to establish a valuable brand, especially during the initial phase.  

Begin Part 2:
“So, Allan, in maintaining and using a brand, what are some key concepts there?”

            “You have to move toward a Type A personality when it comes to your brand.  It’s a control thing because you don’t want people recreating your brand logo, jingle, or whatever.  Your brand is your image, and you need to manage it, or its value can be lost quickly. Don’t place a logo on any and everything.  That mistake can be made by employees, owners, executives, even business partners or well-meaning people trying to do a good thing.  Going back to the food scenario, placing your logo on the bottom of a baby diaper may not be a good idea.”

“Yes, especially a custard or chocolate shop….”

Allan chuckled.  “So, control the look, the feel, the sound of your brand, not for control sake, but for consistency – to build that correct mental (brand) image.”   

“Okay, Allan, we have talked about the creation of a brand and some of the physical presentations of that brand.  We have hinted at maintaining the value of a brand.  What happens when a brand needs to be retired?

“As far as value, basically, don’t let your brand or brand representation be associated with anything that does not support your core business and direction.

“Retiring a brand, sometimes it’s not about retiring a brand as one would normally see it.   That is, replacing one logo and name with another.   Sometimes it is subtle tweaks.  The physical representations of the brand logo or slogan may change to keep current.

            “At other times, when it comes to retiring a brand, a new direction does require retiring everything that is associated with a poor customer experience.  The automobile industry gives a great example of an old brand retired because of perceived quality and reliability issues.  With lean initiatives and manufacturing improvements, a better company emerges.  That may be time to retire a brand to reinforce the new image of quality or just a different company.  This would be similar to the case of Datsun changing to Nissan."

The Nissan GT-R is one of my favorite cars.  I figured I could work that in effectively. “I understand that happened quite some time ago.  But, I did notice that, more recently, Nissan re-launched the GT-R with a price structure that would seem to be a better fit for Infiniti, their luxury brand.  I think that is very interesting.  I saw one on the street before I knew the new model was out.  I thought, ‘What’s that?’  A few luxury brands went through my mind but nothing really fit.  I maneuvered in traffic to get a better look.  ‘Nissan! You gotta be kidding me.’   My view of the Nisan brand changed that day.  The history, the race videos, successfully pitting the Nissan GT-R against other brands that cost hundreds of thousands of dollars more, Usain Bolt’s gold GT-R announcement, I say that’s a great way of maintaining and utilizing a brand.

  

“One can be retired as part of an acquisition as well, continued Allan added. “There are cases where the acquired brand takes the lead because of the strength of the brand.  This was the case with SBC Communications and AT&T.  AT&T had a long history of telecommunication development and global brand recognition. The consumer did not know the SBC brand.  It was better to leverage the AT&T brand than to establish the SBC brand to the consumer.”

“Allan, thanks for your time.  Can you give us a wrap up of some key points on the lifecycle of a brand?”

“You are welcome, Al.  I’ll be glad to. 

1.                          Your brand tells a story.  To businesses that are relatively new to seeking customers inside the U.S., there is a difference between translating a story well and telling a story well.  Translations are not enough.  I suggest investing in someone you can relay your value proposition in a way that resonates with the population.

2.                         Know your current audience and your future audience. Understand what they are looking for, and what they think.

3.                         Build your brand assets to consistently convey the image that you want, in the most economical manner. Work to get it right the first time, while understanding that as a company grows, the brand assets may need to change to reflect that growth and positioning.

4.                         I always recommend to work with a professional marketing company with experience in branding. That logo designed by your neighbors kid might be fine, but maybe not, or maybe it needs the right tag line or slogan to solidify it and make it more powerful.

5.                          Lastly, be a Type A about your brand; control the look and the feel of the physical representations – The logo and any tag line, image, jingle etc. and be diligent in where and how you allow it to be used. The brand assets are your image, your promise to the market. You need to deliver on your promise.

“Understand that it is often difficult, expensive and even prohibitive to fix a broken brand. I strongly recommend getting experienced professional marketing/branding assistance.  Don’t be afraid to spend money, and do it wisely with where you are at the moment.”