Scripps Health to launch $2.6B expansion

https://www.beckershospitalreview.com/facilities-management/scripps-health-to-launch-2-6b-expansion.html

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San Diego-based Scripps Health is planning a $2.6 billion expansion — the largest construction project in the organization’s 125-year history.

The expansion will include constructing a $1.3 billion replacement hospital for Scripps Mercy Hospital San Diego; a new seven-story patient tower for San Diego-based Scripps Memorial Hospital La Jolla; and a three-story acute care structure at Scripps Memorial Hospital Encinitas (Calif.). In addition, seismic retrofitting construction is planned for Scripps Mercy Chula Vista (Calif.) and Scripps Green Hospital in San Diego.

“This is our vision to build the health care system of the future — starting today,” said Chris Van Gorder, Scripps president and CEO. “Our focus is on delivering the right care in the right setting that reflects the changing health care needs of the communities we serve across the San Diego region.”

Scripps Health will also build two Scripps MD Anderson outpatient cancer centers in a move to deepen its affiliation with Houston-based MD Anderson Cancer Center.

The expansion projects, none of which break ground until 2021, will be financed by operating revenues, borrowing and fundraising.

“As systems look to the coming decades, they are forced to make big bold choices now.  Do they want to still be dominant systems in 25 years and how much investment in structure and building is needed to remain a great system. This reflects a bold exciting choice by Scripps and its leadership,” said Scott Becker, JD, publisher of Becker’s Hospital Review. 

93-year-old California hospital to close over inability to meet new seismic standards

https://www.beckershospitalreview.com/finance/93-year-old-california-hospital-to-close-over-inability-to-meet-new-seismic-standards.html

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Community Medical Center Long Beach (Calif.), which opened in 1924 and is part of Fountain Valley, Calif.-based MemorialCare Health System, will close in the near future due to the inability to retrofit the hospital to meet California’s seismic standards.

When MemorialCare acquired Community Medical Center Long Beach in 2011, officials knew it had seismic challenges. However, the hospital consulted with seismic experts, structural engineers and architects as part of recent seismic studies, which revealed the fault running below the hospital is larger and more active than previously known, hospital officials said Monday, according to The Grunion. This means the hospital will not meet California’s new earthquake safety requirements for acute care hospitals, which go into effect June 30, 2019.

John Bishop, CEO of the three MemorialCare hospitals in Long Beach, said because the wide fault zone is under the majority of the hospital campus, no work can be done to make the hospital viable, according to the Long Beach Post.

“We are all saddened that the findings were not more encouraging for the future of Community Medical Center Long Beach,” said Mr. Bishop. He said MemorialCare has no choice but to close the hospital. However, he said hospital and city officials will work together on transition plans to meet the needs of the community.

“Nothing involved in this was an elective decision. We had no choice,” Mr. Bishop said. “I’m saddened by this, but I want to assure Long Beach residents MemorialCare continues to be dedicated to providing the healthcare the city needs.”

Mr. Bishop said hospital officials will discuss the matter with city officials to determine how long the hospital and its emergency department will remain open, according to the report.

Don’t Nudge Me: The Limits of Behavioral Economics in Medicine

Don’t Nudge Me: The Limits of Behavioral Economics in Medicine

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Whenever I talk to physicians about outcomes that are worse than you’d expect, they are quick to point out that noncompliance — when a patient does not follow a course of treatment — is a major problem.

Sometimes prescriptions aren’t filled. Other times they are, but patients don’t take the drugs as prescribed. All of this can lead to more than 100,000 deaths a year.

thorough review published in The New England Journal of Medicine about a decade ago estimated that up to two-thirds of medication-related hospital admissions in the United States were because of noncompliance, at a cost of about $100 billion a year. These included treatments for H.I.V., high blood pressure, mental health and childhood illnesses (it can be difficult to get children to take their medicine, too).

To address the issue, researchers have been trying various strategies, including those rooted in behavioral economics. So far, there hasn’t been much progress. A systematic review published five years ago in Annals of Internal Medicine looked at all kinds of trials that tried to improve patient compliance. It found some limited successes in improving patient compliance in different disorders, but most of the trials were small and not easily generalized outside the research setting.

A more recent Cochrane review concluded that “current methods of improving medication adherence for chronic health problems are mostly complex and not very effective.”

At first glance, behavioral economics — the basis of Richard Thaler’s recent Nobel Prize in Economics — seems like a rich field of potential solutions. People tend to do things, like donate organs, when it’s the default option as opposed to something they need to request. They tend to be less likely to miss appointments if you tell them how many other patients show up for theirs. They tend to be more likely to engage in preventive behaviors like using sunscreen if you focus on the benefits, not the harms. Many are turning to ideas like these to improve medication adherence.

But those excited about the potential of behavioral economics should keep in mind the results of a recent study. It pulled out all the stops in trying to get patients who had a heart attack to be more compliant in taking their medication. (Patients’ adherence at such a time is surprisingly low, even though it makes a big difference in outcomes, so this is a major problem.)

Researchers randomly assigned more than 1,500 people to one of two groups. All had recently had heart attacks. One group received the usual care. The other received special electronic pill bottles that monitored patients’ use of medication. Those patients who took their drugs were entered into a lottery in which they had a 20 percent chance to receive $5 and a 1 percent chance to win $50 every day for a year.

That’s not all. The lottery group members could also sign up to have a friend or family member automatically be notified if they didn’t take their pills so that they could receive social support. They were given access to special social work resources. There was even a staff engagement adviser whose specific duty was providing close monitoring and feedback, and who would remind patients about the importance of adherence.

This was a kitchen-sink approach. It involved direct financial incentives, social support nudges, health care system resources and significant clinical management. It failed.

The time to first hospitalization for a cardiovascular problem or death was the same between the two groups. The time to any hospitalization and the total number of hospitalizations were the same. So were the medical costs. Even medication adherence — the process measure that might influence these outcomes — was no different between the two groups.

The researchers in this trial deserve praise for their frank assessment of their results, as well as for trying to brainstorm ways in which they might achieve success in the future. Getting patients to change their behavior is very hard. In the past, we’ve tried making drugs free to patients to get them to adhere to their medications and improve outcomes. That failed. We’ve tried lotteries (as in the study above) to nudge people to achieve better compliance. That failed.

Maybe financial incentives, and behavioral economics in general, work better in public health than in more direct health care. There have been successes, after all, with respect to weight loss — although these seemed to disappear over time. We’ve also seen promise with respect to smoking cessation, although these come with caveats as well.

Experts caution that the interventions that achieve success are often very intensive. They demand a great deal of attention, and can be quite expensive. Moreover, they are very focused, usually on a single issue or condition.

The problem is that health has so many moving parts. The health care system has even more. Trying to improve any one aspect can make others worse. Behavioral economics may offer us some fascinating theories to test in controlled trials, but we have a long way to go before we can assume it’s a cure for what ails Americans.

The Seven Deadly Social Sins

https://en.wikipedia.org/wiki/Seven_Social_Sins

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The Seven Deadly Social Sins
explained by Arun Gandhi, grandson of Mohandas Gandhi

POLITICS WITHOUT PRINCIPLES

Gandhi said those who firmly believe in nonviolence should never stand for elections, but they
should elect representatives who are willing to understand and practice the philosophy. Gandhi
said an elected representative is one on whom you have bestowed your power of attorney.
Such a person should be allowed to wield authority only as long as s/he enjoys your
confidence. When politicians indulge in power games, they act without principles. To remain in
power at all cost is unethical. Gandhi said when politicians (or anyone else, for that matter)
give up the pursuit of Truth they, or in the case of parties, would be doomed. Partisan politics,
lobbying, bribing, and other forms of malpractice that are so rampant in politics today is also
unprincipled. Politics has earned the reputation of being dirty. It is so because we made it dirty.
We create power groups to lobby for our cause and are willing to do anything to achieve our
goal. Not many among human kind have learned how to resist temptation, so who is to blame
for the mess we find ourselves in?

WEALTH WITHOUT WORK

This includes playing the stock market; gambling; sweat-shop slavery; over-estimating one’s
worth, like some heads of corporations drawing exorbitant salaries which are not always
commensurate with the work they do. Gandhiji’s idea originates from the ancient Indian
practice of Tenant Farmers (Zamindari). The poor were made to slog on the farms while the
rich raked in the profits. With capitalism and materialism spreading so rampantly around the
world the grey area between an honest day’s hard work and sitting back and profiting from
other people’s labor is growing wider. To conserve the resources of the world and share these
resources equitably with all so that everyone can aspire to a good standard of living, Gandhi
believed people should take only as much as they honestly need. The United States provides
a typical example. The country spends an estimated $200 billion a year on manufacturing
cigarettes, alcohol and allied products which harm people’s health. What the country spends in
terms of providing medical and research facilities to provide and find cures for health hazards
caused by over-indulgence in tobacco and alcohol is mind-blowing. There is enough for
everyone’s need but not for everyone’s greed, Gandhi said.

PLEASURE WITHOUT CONSCIENCE

This is connected to wealth without work. People find imaginative and dangerous ways of
bringing excitement to their otherwise dull lives. Their search for pleasure and excitement often
ends up costing society very heavily. Taking drugs and playing dangerous games cause
avoidable health problems that cost the world hundreds of billions of dollars in direct and
indirect health care facilities. Many of these problems are self-induced or ailments caused by
careless attitudes. The United States spends more than $250 billion on leisure activities while
25 million children die each year because of hunger, malnutrition, and lack of medical facilities.
Irresponsible and unconscionable acts of sexual pleasure and indulgence also cost the people
and the country very heavily. Not only do young people lose their childhood but innocent
babies are brought into the world and often left to the care of the society. The emotional,
financial, and moral price is heavy on everyone. Gandhi believed pleasure must come from
within the soul and excitement from serving the needy, from caring for the family, the children,
and relatives. Building sound human relationships can be an exciting and adventurous activity.
Unfortunately, we ignore the spiritual pleasures of life and indulge in the physical pleasures
which is “pleasure without conscience.”

KNOWLEDGE WITHOUT CHARACTER

Our obsession with materialism tends to make us more concerned about acquiring knowledge
so that we can get a better job and make more money. A lucrative career is preferred to an
illustrious character. Our educational centers emphasize career-building and not characterbuilding.
Gandhi believed if one is not able to understand one’s self, how can one understand
the philosophy of life. He used to tell me the story of a young man who was an outstanding
student throughout his scholastic career. He scored “A’s” in every subject and strove harder
and harder to maintain his grades. He became a bookworm. However, when he passed with
distinction and got a lucrative job, he could not deal with people nor could he build
relationships. He had no time to learn these important aspects of life. Consequently, he could
not live with his wife and children nor work with his colleagues. His life ended up being a
misery. All those years of study and excellent grades did not bring him happiness. Therefore, it
is not true that a person who is successful in amassing wealth is necessarily happy. An
education that ignores character- building is an incomplete education.

COMMERCE WITHOUT MORALITY

As in wealth without work we indulge in commerce without morality to make more money by
any means possible. Price gouging, palming off inferior products, cheating and making false
claims are a few of the obvious ways in which we indulge in commerce without morality. There
are also thousands of other ways in which we do immoral or unethical business. When profitmaking
becomes the most important aspect of business, morals and ethics usually go
overboard. We cut benefits and even salaries of employees. If possible we employ “slave”
labor, like the sweat shops and migrant farm workers in New York and California where
workers are thoroughly exploited. Profit supersedes the needs of people. When business is
unable to deal with labor it begins to mechanize. Mechanization, it is claimed, increases
efficiency, but in reality it is instituted simply to make more money. Alternate jobs may be
created for a few. Others will fall by the wayside and languish. Who cares? People don’t
matter, profits do. In more sophisticated language what we are really saying is that those who
cannot keep up with the technological changes and exigencies of the times do not deserve to
live–a concept on which Hitler built the Nazi Party. If society does not care for such people,
can we blame them if they become criminals?

SCIENCE WITHOUT HUMANITY

This is science used to discover increasingly more gruesome weapons of destruction that
threaten to eventually wipe out humanity. The NRA says guns don’t kill people, people kill
people. What they do not say is that if people didn’t have guns they wouldn’t have the capacity
to kill as quickly or as easily. If hunting can be considered a sport, it is the most insensitive and
dehumanizing sport on earth. How can killing animals bring fun and excitement to anyone?
This is pleasure without conscience. When we cease to care for any life, we cease to respect
all life. No other species on earth has wrought more destruction than man. Materialism has
made us possessive. The more we possess the more we need to protect and so the more
ruthless we become. As punishment, we will kill if some one steals to buy bread. We feel
violated. But we will not bother our heads to find out why, in times of plenty, people have to live
in hunger. In order to protect and secure our homes, our neighborhoods, our countries from
attacks, we use science to discover frightening weapons of destruction. The debate over the
use of the atom bomb on Hiroshima and Nagasaki is a question that falls under this category.
War is sometimes inevitable only because we are such ardent nationalists that we quickly label
ourselves by our country of origin, by gender, by the color of our skin, by the language we
speak, by the religion we practice, by the town or the state we come from and so on. The
labels dehumanize us, and we become mere objects. Not too long ago even wars were fought
according to rules, regulations, ethics and some semblance of morality. Then Hitler changed
the rules because of his monumental hate and the rest of us followed suit. Now we can
obliterate cities and inhabitants by pressing a button and not be affected by the destruction
because we don’t see it.

WORSHIP WITHOUT SACRIFICE

One person’s faith is another person’s fantasy because religion has been reduced to
meaningless rituals practiced mindlessly. Temples, churches, synagogues, mosques and
those entrusted with the duty of interpreting religion to lay people seek to control through fear
of hell, damnation, and purgatory. In the name of God they have spawned more hate and
violence than any government. True religion is based on spirituality, love, compassion,
understanding, and appreciation of each other whatever our beliefs may be — Christians,
Jews, Hindus, Muslims, Buddhists, Atheists, Agnostics or whatever. Gandhi believed whatever
labels we put on our faith, ultimately all of us worship Truth because Truth is God. Superficially
we may be very devout believers and make a tremendous public show of our worship, but if
that belief, understanding, compassion, love and appreciation is not translated into our lives,
prayers will have no meaning. True worship demands sacrifice not just in terms of the number
of times a day we say our prayers but in how sincere we are in translating those prayers into
life styles. In the 1930’s many Christian and Moslem clergy flocked into India to convert the
millions who were oppressed as untouchables. The Christian clergy stood on street corners
loudly denouncing Hinduism and proclaiming the virtues of Christianity. Months went by
without a single convert accepting the offer. Frustrated, one priest asked Grandfather: After all
the oppression and discrimination that the ‘untouchables’ suffer under Hinduism, why is it they
do not accept our offer of a better life under Christianity? Grandfather replied: When you stop
telling them how good Christianity is and start living it, you will find more converts than you can
cope with. These words of wisdom apply to all religions of the world. We want to shout from
roof-tops the virtues of our beliefs and not translate them into our lives.

The problem with American health care is the care

The problem with American health care is the care

A bipartisan health care deal recently brokered by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) would give states greater power over health policy. But even if this nascent legislation falters, states will likely see their influence grow through actions of the Trump administration.

If state governors are going to be in the driver’s seat, they should understand something that Congress, with its narrow focus on insurance coverage, seems to have missed: the main problem with American health care is the care. Although it is important to have stable insurance markets, changes to coverage or benefit design will ultimately do little to reduce costs or make Americans healthier.

Our health care system is stuck in the 1950s, when the prevailing epidemics were polio and influenza. Today’s public health challenges are chronic diseases like diabetes, obesity, and opioid addictionHalf of all adults — 117 million Americans — have a chronic condition; the projected cost is $794 billion in lost productivity alone between 2016 and 2030.

For the most part, chronic diseases aren’t caused by microbes but by problems for which there are no pills or vaccines: deeply rooted personal, social, financial, and behavioral issues, messy, real-life problems like job layoffs, eviction notices, or loneliness. These issues have a profound effect on health, particularly in working-class communities where health care costs are high.

Our health care system hasn’t caught up with the evolving face of disease in America. It is still mostly a workforce of doctors and nurses who dutifully treat patients in hospitals with expensive drugs and high-tech medical devices. If we could reconfigure health care to detect and address the root causes of costly illness, health reform would be a true success.

Several initiatives have laid a path forward. This year, the Center for Medicare and Medicaid Innovation will begin Accountable Health Communities, a five-year grant that enables hospitals and doctor’s offices to check their patients for real-life issues that affect health. Once these have been identified, community health workers — trained laypeople from local communities — would help support patients and connect them to resources like housing or child care. This type of support can have a profound effect on health and lower costs.

In a recent study, my colleagues and I found that a community health worker program called IMPaCT lowered hospitalizations by 30 percent and reduced cigarette smoking, obesity, the severity of diabetes, and mental illness. This model yields a 2-to-1 return on investment, which has prompted large health systems and payers to invest millions in scaling it up.

The current debate around state waivers is focused on limiting health insurance coverage or scaling back essential benefits. Maine has joined Wisconsin, Kentucky, Arkansas, and Utah in submitting waiver applications that impose premiums for Medicaid beneficiaries and coverage lockouts that bar them from re-enrolling in health insurance coverage if they lose it because of unpaid premiums. Maine anticipates that its proposed waiver would lose its members a collective 55,000 months of coverage.

Instead of this approach, governors could apply for waivers to shift Medicaid funds into programs that screen for and address root causes of health through hospitals and doctor’s offices. These programs could yield significant cost savings while improving health, instead of cutting coverage.

Reshuffling insurance coverage schemes as a way to reduce costs is basically a shell game — a dangerous one — that does little to address the core ills of the system. It would be a wasted opportunity if health care reform did not also transform the way we deliver health care so Americans can have better health at lower cost.