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Geisinger officials explain the business case for making DNA sequencing ‘routine’

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https://www.fiercehealthcare.com/hospitals-health-systems/geisinger?mkt_tok=eyJpIjoiWVRjek1HTTFOVEF6TURJMyIsInQiOiJha0JoaUJROUd4XC9pQitHd1plTkw1NHAxNVlNXC9RZ3h3M0lnNFdrczdFbERaaHNKVFpQRkUwVWtmREYwYjVuMEplT0JiT3lMaXpNQWNKTzhlOW5jbmgzSVwvcllTcGw2S0ltK2VNYzgrQTlSVzhSc2dwNFVVS3d0QUtOTmQyK0U1WSJ9&mrkid=959610

Geisinger Health System faciliity

It wasn’t that long ago that the cost of DNA sequencing was measured in the millions of dollars.

Even a few years ago, when the cost fell closer to a few thousand dollars, it was largely used for research purposes or reactively as a tool for patients who’d already fallen ill.

Now, Geisinger President and CEO David Feinberg, M.D., said the time and cost is finally right to make whole exome sequencing a “routine” part of screening for patient diseases.

“We didn’t want to wait,” Feinberg said, adding the sentiment was shared by doctors.

On Sunday, he announced the company would expand the testing, starting with a pilot of about 1,000 patients within the next six months before scaling the service to all patients in its facilities across Pennsylvania and southern New Jersey. “We just thought there would be too many lives lost if we waited until we really wrapped it all up in a neat bow in a research capacity.”

And, Feinberg said in a call with reporters on Monday, Geisinger will pay for the tests.

“We believe, but we have not yet proven, that this is cost-effective meaning the cost of the test is going to be offset by catching people earlier in their disease course or eliminating a disease,” Feinberg said.

Officials estimate the cost per patient per test are between $300 and $500.

About half of the $7.5 billion health system’s business involves its integrated care model involving its own doctors and insurance, but officials said it will cover the cost of the test no matter who insures the patient.

In all, Geisinger said it has set aside a few million dollars from both donors and its insurance arm to scale the use of the tests.

“Our gut feeling is that we’ll be able to show that it’s sustainable and actually a decrease in costs overall,” Feinberg said.

So far, in a research collaboration with Regeneron Pharmaceuticals that involved amassing data from 200,000 people, Feinberg said the organization found it could identify medically actionable findings in the genome before patients became sick in about 3.5% of patients. Officials said they eventually expect as many as 10% to 15% of patients might benefit from testing.

Just how will it actually work? Currently, when a patient goes into their doctor’s office and their cholesterol is checked, they are asked if they’ve had a colonoscopy or mammogram.

“We just want to add to that list: ‘Well, I think it makes sense to do whole exome sequencing on you so we can understand your genes and prevent something,” Feinberg said.

The cost of the wraparound services to this sequencing such as the cost of all the genetic counseling, the analytics, the return of results to patients is expected to be covered by insurance coverage in the same way as if a patient who has a positive test finding and requires a follow-up visit with a doctor, he said.

“We think we’ve worked out the process so that when those mutations do become discovered when we see them in our patients and population, we have a process of getting that information back to the doctor and back to the patient and really sophisticated ways of doing genetic counseling, so that we can scale it,” Feinberg said.

 

 

 

The Proliferation of Meetings

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http://www.leadershipdigital.com/edition/daily-management-leadership-2018-05-09?open-article-id=8205026&article-title=the-proliferation-of-meetings&blog-domain=execupundit.com&blog-title=execupundit

… One said, “I cannot get my head above water to breathe during the week.” Another described stabbing her leg with a pencil to stop from screaming during a particularly torturous staff meeting. Such complaints are supported by research showing that meetings have increased in length and frequency over the past 50 years, to the point where executives spend an average of nearly 23 hours a week in them, up from less than 10 hours in the 1960s. And that doesn’t even include all the impromptu gatherings that don’t make it onto the schedule.

Read the rest of “Stop the Meeting Madness” at Harvard Business Review.

https://hbr.org/2017/07/stop-the-meeting-madness

 

 

12 Killers of Good Leadership

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http://www.leadershipdigital.com/edition/daily-management-leadership-2018-05-09?open-article-id=8205197&article-title=12-killers-of-good-leadership&blog-domain=ronedmondson.com&blog-title=ron-edmondson

 

 

In my experience, and some I learned the hard way, there are a few killers of good leadership.

I decided to compile a list of some of the most potent killers I’ve observed over the years. Any one of these can squelch good leadership. It’s like a wrecking ball of potential. If not addressed, they may even prove to be fatal.

It’s not that the person can’t continue to lead, but to grow as a leader – to be successful at a higher level or for the long-term – they must address these killers.

Here are 12 killers of good leadership:

Defensiveness – Good leaders don’t wear their feelings on their shoulders. They know other’s opinions matter and aren’t afraid to be challenged. They are confident enough to absorb the wounds intended to help them grow.

Jealousy – A good leader enjoys watching others on the team excel – even willing to help them.

Revenge – The leader that succeeds for the long-term must be forgiving; graceful – knowing that “getting even” only comes back to harm them and the organization.

Fearfulness – A good leader remains committed when no one else is and takes risks no one else will. Others will follow. It is what leaders do.

Favoritism – Good leaders don’t have favorites on the team. They reward for results not partiality.

Ungratefulness – Good leaders value people – genuinely – knowing they cannot attain success without others.

Small-mindedness – Good leaders think bigger than today. They are dreamers and idea people.

Pridefulness – Pride comes before the fall. Good leaders remain humbled by the position of authority entrusted to them.

Rigidity – There are some things to be rigid about, such as values and vision, but for most issues, the leader must be open to change. Good leaders are welcome new ideas, realizing that most everything can be improved.

Laziness – One can’t be a good leader and not be willing to work hard. In fact, the leader should be willing to be the hardest worker on the team.

Unresponsiveness – Good leaders don’t lead from behind closed doors. They are responsive to the needs and desires of those they attempt to lead. They respond to concerns and questions. They collaborate more than control. Leaders who close themselves off from those they lead will limit the places where others will follow.

Dishonesty – Since character counts highest, a good leader must be above reproach. When a leader fails, he or she must admit their mistake and work towards restoration.

A leader may struggle with one or more of these, but the goal should be to lead “killer-free”. Leader, be honest, which of these wrecking balls do you struggle with most?

What would you add to my list?

It’s not just physicians and nurses, non-clinical staff are in short supply for medical practices too

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http://www.healthcarefinancenews.com/news/its-not-just-physicians-and-nurses-non-clinical-staff-are-short-supply-medical-practices-too-0?mkt_tok=eyJpIjoiTjJVeE5qbGtPRGxqWWpCayIsInQiOiJNeTArWTFYc1EzRUV5bGduRm92dzR6VG9RNjl4XC9wMHI0eDZNUHRtTjJjMFNieHYySGFqYUZ6d2VYdVpNTlplYXdhS1N4UmY1ZUdaOFwvbE5vNzdwQmFvNjRIZGpQdFgwRHE5KzlvQnY2V2xsTHVaMGliUVdHT2s2aUJFN3pUYzNLIn0%3D

More than 60 percent of respondents say their organizations have a hard time recruiting non-clinical staff, MGMA says.

Nursing and physician shortages aren’t the only staff challenges providers are facing. According to a new STAT poll from the Medical Group Management Association, a majority of healthcare organization leaders said their group can’t find enough qualified applicants for non-clinical positions either.

The poll was conducted on May 1, 2018 with 1,299 applicable responses.

More than 60 percent of respondents said their organizations had a hard time recruiting non-clinical staff. The reasons include larger organizations offering better pay, low unemployment rates and difficulty recruiting in rural areas. One respondent said “recruiting millennials is a completely different game” and another cited lack of future career advancements in the billing and coding field.

“Lack of medical training in colleges and technical schools and reliance on ‘on the job training’ means less qualified non-clinical applicants,” MGMA said.

Other reasons include competition from other medical groups, hospitals and health systems as well as competitive pay from other industries that trigger turnover.

One-third responded they haven’t experienced this shortage, citing low turnover. Those respondents also said they had increased wages to retain staff, MGMA said.

A past poll has shown this high-turnover is prevalent in front-office staff, which some experts have argued are the face of a practice and the first ones to interact with patients, often setting a tone for the care episode making it a crucial influence of patient satisfaction.

When there is high turnover, new employees are often not as well-versed in office policies and procedures because they likely haven’t been there very long. This can lead to mistakes, inaccuracies and bumpy interactions with patients who expect staff to know operations inside and out. It can also lead to costly errors not just on the part of new employees, but veteran staff who are busy training and juggling multiple tasks at any given moment. The trickle down effect could mean patients wait longer to be seen, appointments go longer and collections and claims may be riddled with mistakes.

Medical group leaders know that it isn’t just doctors and nurses who make their practices successful and run smoothly, so they would be well-advised to treat retention of non-clinical staff with urgency.

Since a third of respondents reported lower turnover after raising wages for non-clinical staff, decision-makers for practices may want to consider researching current competitive rates for these positions and potentially raising wages such that staff would be less inclined to seek higher-paying employment elsewhere.

Practices also might consider how else to boost employee benefits and the workplace environment so that employees experience greater satisfaction. Turnover leads to operational hiccups, less efficient service for patients and lower satisfaction rates.

“While finding qualified candidates is a challenge for medical groups, practice leaders can begin by assessing how they are approaching retention of their best employees and mitigating turnover before it becomes an issue,” MGMA said.

 

Gubernatorial Hopefuls Look To Health Care For Election Edge

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Gubernatorial Hopefuls Look To Health Care For Election Edge

 

California’s leading gubernatorial candidates agree that health care should work better for Golden State residents: Insurance should be more affordable, costs are unreasonably high, and robust competition among hospitals, doctors and other providers could help lower prices, they told California Healthline.

What they don’t agree on is how to achieve those goals — not even the Democrats who represent the state’s dominant party.

“Health care gives them the perfect chance to crystalize that divide” between the left-wing progressives and the “moderate pragmatists” of the Democratic Party, said Thad Kousser, a political science professor at the University of California-San Diego.

Consider the top two Democratic candidates, who both aim to cover everyone in the state, including immigrants living here without authorization.

Lt. Gov. Gavin Newsom — billed as a liberal Democrat — supports a single-payer health care system. That means gutting the health insurance industry to create one taxpayer-funded health care program for everyone in the state.

But former Los Angeles Mayor Antonio Villaraigosa has called single-payer “unrealistic.” He advocates achieving universal health coverage through incremental changes to the current system.

Under California’s “top-two” primary system, candidates for state or congressional office will appear on the same June 5 ballot, regardless of party affiliation. The top two vote-getters advance to the November general election.

A poll in late April by the University of California-Berkeley Institute of Governmental Studies puts Newsom in first place with the support of 30 percent of likely voters, followed by Republicans John Cox, with 18 percent, and Travis Allen with 16 percent. Trailing behind were Democrats Villaraigosa, with 9 percent, John Chiang with 7 percent and Delaine Eastin with 4 percent. Thirteen percent of likely voters remained undecided.

Health care is in the forefront of this year’s gubernatorial campaign because of recent federal attempts to repeal the Affordable Care Act, which would have threatened the coverage of millions of Californians, said Kim Nalder, professor of political science at California State University-Sacramento. California has pushed back hard against Republican efforts in Congress to dismantle the law.

“There’s more energy in California around the idea of universal coverage than you see in lots of other parts of the country,” Nalder said. Democrats and those who indicate no party preference make up almost 70 percent of registered voters. Those voters care more about health coverage than Republicans, she said.

“Whoever is most supportive [of universal health care] is likely to win the votes,” she said.

The top Republican candidates, Cox and Allen, are not fans of increased government involvement, however. They favor more market competition and less regulation to lower costs, expand choice and improve quality.

“Governments make everything more expensive,” said Cox, a former adviser to former House Speaker Newt Gingrich during his presidential run. “The private sector looks for efficiencies.”

California Healthline reached out to the top six candidates based on the institute’s poll, asking about their positions on health insurance, drug prices, the opioid epidemic and hospital consolidation.