
Cartoon – I want all of you to change



Each year, Forbes publishes its annual “Forbes 400 list,” which profiles and ranks America’s wealthiest people based on their estimated net worth.
Here are 16 individuals working in healthcare who made this year’s “Forbes 400″ list.
Note: This list includes ties.


People might be forgiven for thinking that the Affordable Care Act is the federal government’s boldest intrusion into the private business of health care.
But few know about a 70-year-old law that is responsible for the construction of much of our health system’s infrastructure. The law’s latest anniversary came and went without much notice in August.
The Hill-Burton Act was signed into law by President Harry S. Truman on August 13, 1946 — and its effect on health care in the U.S. was nothing short of monumental. Perhaps more importantly, it stands as an example, warts and all, of how a bipartisan Congress can forge compromises to bolster American infrastructure and boost the well-being of our people.
Known formally as the Hospital Survey and Construction Act, Hill-Burton started as a Truman initiative. In November 1945, only two months after the official end of World War II, he gave a speech to Congress outlining five goals to improve the nation’s health. The first and least controversial of these called for constructing hospitals and clinics to serve a growing and rapidly demilitarizing population.
Hill-Burton provided construction grants and loans to communities that could demonstrate viability — based on their population and per capita income — in the building of health care facilities. The idea was to build hospitals where they were needed and where they would be sustainable once their doors were open.
Over the subsequent decades, new facilities sprang up all around the country, including many in the 40 percent of U.S. counties that lacked hospitals in 1945.
By 1975, Hill-Burton had been responsible for construction of nearly one-third of U.S. hospitals. That year Hill-Burton was rolled into bigger legislation known as the Public Health Service Act. By the turn of the century, about 6,800 facilities in 4,000 communities had in some part been financed by the law. These included not only hospitals and clinics, but also rehabilitation centers and long-term care facilities.
In 1997, this type of direct, community-based federal health care construction financing came to an end. However, numerous Hill-Burton clinics and hospitals still exist around the country, specifically financed by a part of law to provide care to those unable to afford it.
A month after enactment of the law, Truman, a Democrat, appointed Republican Sen. Burton to the Supreme Court in a bipartisan gesture that doesn’t seem imaginable in today’s polarized political landscape. And consider this: Burton was unanimously approved by the entire Senate the same day he was appointed. With no committee hearings! He joined the court the very next day.
“Hill-Burton speaks to an earlier time in our history when the American people and those who represented them had confidence that government could do good things,” Markel said. “And that makes it all the more phenomenal to me.”


A commitment is a decision made once.

One of the many challenges facing today’s healthcare strategists involves convincing the C-suite and leadership teams, as well as the entire organization, to implement a new strategy. Even when the new idea is supported by abundant data and there are excellent reasons to embrace the strategy, far too often change is a hard sell, and even harder to make happen.
In fact, change is painful, not only for organizations but also for the individuals working within them. Choosing a new direction, moving into new markets, altering processes in order to embrace MACRA or shifting to value-payment models may all be necessary–but very challenging to implement. Many times, people prefer to stay wedded to old ideas and prior strategic directions.


Some of the most well-known hospitals in the nation rank among the worst in preventing deadly Clostridium difficile infections, according to a new Consumer Reports analysis.
The publication analyzed C. diff infections at hospitals across the country, based on data reported to the Centers for Disease Control and Prevention between 2014 and 2015. It found well-known teaching hospitals like the Cleveland Clinic, Baylor University Medical Center in Dallas, Brigham and Women’s Hospital in Boston and Cedars-Sinai Medical Center in Los Angeles had the lowest or second-lowest ranking, indicators that these hospitals fall short against the national benchmark to control such infections.
“Teaching hospitals are supposed to be places where we identify the best practices and put them to work,” Lisa McGiffert, director of Consumer Reports‘ Safe Patient Project, said in an announcement of the findings. “But even they seem to be struggling against this infection.”
The report analyzed data from more than 3,100 U.S. hospitals and found that more than a third received a low score for C. diff infection control.
Only two large teaching hospitals, Mount Sinai Medical Center in Miami Beach, Florida and Maimonides Medical Center in Brooklyn, New York, earned top marks from Consumer Reportson controlling C. diff.


As payment models shift and other industry changes shine a spotlight on regulatory concerns, it’s becoming more and more common for hospitals and health systems to use in-house attorneys.
These legal experts are becoming a C-suite mainstay, too, according to an article from Becker’s Hospital Review, as roles like chief legal officer gain importance.
“Gone are the days where CEOs could afford to say, ‘I hate lawyers,’ or, ‘I don’t want to deal with lawyers,'” Werner Boel, principal and practice leader of legal services at executive search firm Witt/Kieffer, told Becker’s.
Though smaller hospitals may not be able to afford an in-house team, many larger systems are investing in a group of attorneys. Having on-site legal advice beyond general counsel, for example, can help hospitals navigate mergers and increased oversight from institutions such as the Centers for Medicare & Medicaid Services related to privacy and anti-kickback laws, Boel told Becker’s.
Boel emphasized the need for a true team, according to the article, as having a group of lawyers with diverse regulatory knowledge is key to helping hospitals weather any number of storms. Other executives must also be open to the legal team’s advice, and must actively engage with them on legal matters, Boel said.
A knowledge of regulatory matters can also benefit the executive team, according to the article, as roles like compliance officer and even CEO are increasingly filled by people with a legal background. These leaders have the right mix of experience to help guide change in hospitals under the constraints of healthcare reform, Boel said.