Friday, October 29, 2010

the setting

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Our annual tradition...

The company you keep

I remember a lesson my own mother taught me years ago.  As a child, I was lamenting my own lack of progress in improving my competitive basketball skills and her simple but high impact advice was: "If you want to become a better basketball player, make sure you play with people better than you are."  Upping your game happens when, in the case of basketball, you compete against higher calibre players.  It's a compelling lesson about role models and pushing yourself beyond your comfort zone.

Earlier this year, I had an opportunity to meet the CEO and CFO of the VNA of Central Jersey.  The initial conversation with Mary Ann and Kevin pertained to some information system issues they had been grappling with, but then eventually covered a broader range of topics.  I made a mental note that a follow-up and more in depth discussion might be helpful.

Yesterday, in a high rise office building overlooking the sun soaked southern tip of Manhattan, members of our respective teams had an opportunity to have that discussion.  The impromptu cellphone photo above includes the participants.

VNACJ, like the Visiting Nurse Association of Boston, is a 100+ year old organization (actually, they are celebrating their centennial anniversary this coming year) with a mission and quality focus.  Like the VNA of Boston, they experienced financial hardship some ten years ago after the Feds radically restructured the Medicare reimbursement system.  And like the VNA of Boston, they have persisted and adapted and grown.

Our conversation covered a very broad range of topics, including strategy, operations, policy, communications, financial, marketing and sales, and information technology.  As noted previously and frequently in this blog, the home health care industry will be undergoing significant financial and other challenges in the coming few years and learning from colleagues who are tackling the same challenges has proven to be a helpful and, in some cases, eye opening experience.  We're most thankful to our friends in New Jersey for taking the time to meet with us and for hosting such an informative and enjoyable event.  It felt like time well spent.  And it reminded me of my mother's words from years ago...

Wednesday, October 27, 2010

The churning...

The above was sent to me by my friend, Gerry... and it got me to thinking.

I have a London Fog rain coat I purchased in the early 1990s and I swear it looks as good as the day I bought it.  We have a second refrigerator in our garage and it's 26 years old and working perfectly.  There's a TV set in my house that's also 26 years old and it's not going into the dumpster until it dies.

Now as for electronics gadgets (phones, computers, cameras, etc.), none of the ones I use are much older than a year or two.  The problem is that the technology keeps getting better and cheaper... and newer and flashier alternatives are always being announced and brought to market.  And once they get there, the prices precipitously drop and quickly.  Thus creating the churning.

If you type "iPad" into the search box on this blog, you'll see that I've written affectionately about mine on many occasions.  It's a real life changer and I love it.  Or loved it.

The problem?

This is the recently announced 11 inch screen Apple Macbook Air.  It's just slightly more expensive than the highest end iPad, but this is a real computer.  Full Mac operating system.  Full keyboard.  But still light and tiny. Long battery life and instant on.  A person could dump the laptop and the iPad and converge into this one device.  On the surface, it makes a ton of sense.

But, churning does not.

Dan Gilbert speaks about "what makes us happy?"  Hint: it's not having a lot of choices.  Here's the link to his 21 minute video.

When you focus on the tool, you can lose sight of the task.  Case in point: newer and better digital cameras do not, for the most part, improve the quality of the craft.  Newer and better digital gadgetry does not, for the most part, alter the prospects of success in creating the manuscript, balancing the checkbook, presenting the slideshow, browsing the web, answering emails.... or whatever it is that you do on that device.

There is an entire movement dedicated to the less is more school of thought.  Online booksellers are full of guides on how to simplify your life and based on their sales stats, it looks as though many people are reading them.  

Wonder what you think about it.  Feel free to comment...

Tuesday, October 26, 2010

Fence sitting and social media

About a year ago, I jumped head first into the world of social media, starting this blog, tweeting, blipping, facebooking and connecting with everybody I've ever met via linkedin.  My thought was that although I wasn't clear whether social media ultimately will prove out as a valuable tool... or whether we'll look back upon it the way we do bell bottoms and mood rings, it was worth a try.

After about six months, I made an assessment by looking at google analytics data and it confirmed that there was enough value in the blog to continue and that the other social media tools helped support it.  Employees here read the posts and people from around the industry check in periodically as well.  On occasion, I receive emails from people looking for health care services, which is the most gratifying and important reason for continuing.

But I do find myself more often than not thinking about that mood ring issue and sitting upon a fence regarding whether this is worth a continued investment of time and energy.  Here at the VNA of Boston, I gain a range of reactions that literally run from "total waste of time" to "I read your blog every day... keep it up."

This morning, I attended a breakfast presentation hosted by our friends at Solomon McCown.  The focus was on crisis management in the age of social media.  The panel included Linda van der Pool as moderator (Boston Business Journal), Perry Hewitt (Harvard University), Brian Leary (McCarter & English), Ashely McCown (Solomon McCown), Jeff Moriarty (The Boston Globe), and John Pepper (Boloco).  In short: their comments pushed me off the fence and toward a fuller embrace... for a while at least.  Here are some of the more interesting points:

Ashley: Johnson & Johnson will be long remembered as a company that managed its crisis (tainted Tylenol) with success.  Immediately after reports surfaced of trouble, employees took to the streets with megaphones warning citizens to return all product.  Boy Scouts were deployed in service projects to churches and other settings to get the word out.  The CEO was highly visible and immediately so.  BP will be long remembered for its failure.  It took seven days before the company tweeted on the issue.  The CEO?  Gone.

John: It's important to be authentic, real.  There's so much pablum out there, you can only stand out if you're interesting.  His goal in social media is to be "a little off center."

Perry: You may be conspicuously absent if you don't engage in social media.  An unhappy customer may post something negative on YouTube, so it's vital to post your counterargument right there next to it.

Ashley: It takes time to build loyalty.  The time to do it is before the crisis.  Toyota had 81,000 Facebook friends at time of the first recall.

John: It's not about the number of Twitter followers.  "It's about the quality of the listening."

Ashley: Asked about the risks of social media, she noted that "there is more risk in not doing it."

Jeff: One risk is that someone can impersonate you or parody your company.  Active and effective countermeasures need to be developed.

Brian: 53% of HR reps check Facebook status to vet candidates.  Watch what you post there.

Now before I forget, let me go tweet about all this...

When David becomes Goliath

This was a fascinating and exceptional commercial back in the early 1980s when Apple Computer was trying hard to fight the massive market dominance of Microsoft and DOS/Windows-based computers.  Touting their "better" technology, they tried hard to combat the perception that the monolithic giant had played mind control tricks on the general public.  Here comes the bright, colorful, attractive, speedy, powerful... Apple to throw a wrench, or more specifically, a sledgehammer, into the face of Goliath.

A quarter of a century later, Microsoft appears to be back on its heels, fighting the internet juggernaut called Google and the technology maven called... Apple.  Apple's iTunes distribution channel is one of the most powerful and ubiquitous in the world.  Their iPhone just surpassed Blackberry in terms of world market share, iPad is the fastest selling device in history and Macbooks are beginning to outnumber Windows computers on college campuses.

Microsoft has got to be worried.  VERY worried.  Their Windows 7 OS has tried to correct the perception of mediocrity while they have focused on fixing their gaming system (XBox) quality control woes.  But, it is clearly struggling.  For them to survive (yes, survive), they need to correct the inadequacies of their technology first.  But then, they need to cast Apple as the new Big Brother and hit away.

Meanwhile, Google watches...


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Monday, October 25, 2010

Highland Home

Yesterday's Boston Sunday Globe (see here) featured the Visiting Nurse Association of Boston's very own Jenny and Colin Highland, describing them as "ardent do-it-yourselfers."  In addition to bringing their talent and skill to patients in and around the Boston area every day, these young parents have been very busy decorating, fixing and restoring their home.  According to the article: "One peek inside their 1920s Colonial-style house in Milton, and you get the message that something special has gone on."

I had an opportunity to conduct a few home visits with Colin last year and had no idea that he is "a Renaissance-type man who’s an artist (landscape canvases), woodworker, carpenter, gardener, and poet."

Well done to Jenny and Colin!

Tuesday, October 19, 2010

The VNA of Boston is Elite!

From an email just sent to all of our employees:
I am pleased to announce that the VNAB has been once again named as an Elite Agency by OCS HomeCare. The HomeCare Elite identifies the top 25 percent of agencies with winners ranked by an analysis of performance measures in quality outcomes, quality improvement, and financial performance. As a 2010 HomeCare Elite agency the VNAB ranks among other leading home care providers across the country.

Amanda Twiss, CEO of OCS HomeCare had this to say: “The 2010 HomeCare Elite winners continue to demonstrate a commitment to providing their patients with the best possible care while performing at the highest level. We congratulate the VNA of Boston on being one of the top home care agencies in the country.”

We have decades of experience as a leader in home health care --- providing excellent care to all who need us. It is because of YOU, our incredibly skilled and dedicated nurses, therapists, social workers, administrative and professional support staff that have gotten us to where we are. I firmly believe that it is the excellent and high value care that you all provide that is critical to the success of reforming our health care system and we should be proud to be a leader in that effort.

As you all know, we recently kicked-off our 125th Anniversary with our Heroes in Home Healthcare Gala. I would like to share with you what I mentioned to our guests that night:

“125 years ago, by the harbor in Boston, a revolution began. A revolution that blazed across this country in the name of teaching, healing and advocating for those who ‘fall through the cracks’. We’d love to celebrate this evening a world where cracks such as these no longer exist. Where a compassionate society has adequately reformed its system to allow for high quality health care services to be available to all of its most vulnerable members... and where better performing, more conscientious caregivers are rewarded for investing in programs and improving lives.”

As a 2010 HomeCare Elite the VNAB IS being recognized and rewarded for your hard work. There is still much work to be done and cracks still exist, but each day we work towards making them smaller. On behalf of the VNAB and the patients you serve every day THANK YOU.


Monday, October 18, 2010

35 years ago... this very minute

Received a call from my brother tonight asking if I had any idea what the two of us were doing 35 years ago tonight.  Based on an announcement on the classic rock station in town (verified via a google search later), we were able to confirm that precisely 35 years ago this very evening, we attended a Boston Garden Jefferson Starship show.  Anybody remember Grace Slick?  

Stands out for me because it was my very first live show and I was rabid about the Starship, most especially about the particular song linked below (this vid appears to be an '80s rendition).  Memorable also because of the opening act.  This Boston show was just before they exploded.  Stevie Nicks and Lindsey Buckingham had just joined the struggling Fleetwood Mac and released a new record.  I remember being impressed by the mysterious, swirling Nicks and the maniacal guitar playing of Buckingham.  I proceeded to buy their "new" self-titled album within days of the show.  That album stood for thirteen years as the longest running number one album on the charts.


Sunday, October 17, 2010


Clark's Pond

Less and less likely

Despite Liam's note that "we'll see ya again in some other world, another time" at the end (as best I can make out - I can understand him perfectly when he sings, but not at all when he talks), a reunion tour seems less and less likely.  It's the Noel-Liam love-hate relationship thing.

Too bad, though because if you've never seen Oasis live, you haven't been to a live show.  Mate.

Saturday, October 16, 2010


Consider this a classic Before and After.  I've recently become fascinated by the aging process and as I stumbled upon Mr. Joel singing his break-out hit when it was brand new and then again more recently, I was struck by the visual (and audio) impact of 33 years...

Wednesday, October 13, 2010

The high cost of cutting costs...

I had an opportunity to attend a Boston Chamber of Commerce breakfast meeting this morning, featuring the four candidates for Massachusetts Governor.  In attendance: Charlie Baker, my old boss at Harvard Pilgrim, Deval Patrick, current governor, Tim Cahill, the recently controversial independent conspiracy theorist candidate, and... ah... the other one.

The other one is Doctor Jill Stein who is running as the Green-Rainbow Party candidate and who has absolutely no chance of winning.  As such, it's very easy to dismiss the perspective she brings to the race.  But this internist, community adovcate and respected author actually adds an important voice and I for one was interested to hear what she had to say this morning.  And although she received no applause (as did the current Governor when he dropped a very stirring "this is a profound distraction" remark related to the allegations that former Cahill operatives were working with his own campaign to undermine Baker's efforts) and her turn at the mic often felt more akin to a polite obligation than an opportunity for the audience, she did make one very interesting point. 

Dr. Stein's platform includes a proposal that the current Medicare system for seniors be converted into a national system for all populations.  Citing the fact that "this system just works" and cuts administrative hassles, she compared the 250 "workers" at Massachusetts General Hospital to merely 3 at a similarly sized hospital in Toronto.  The 250 at MGH sort through the multitude of requirements and paperwork associated with generating clean bills and pursuing payment for services rendered.  In Canada, that work takes just three individuals, leading to, per this candidate, a greater ability to apportion the funds toward medical care or savings.

It's an interesting point.

Managed care was designed to, among other things, control the growth of medical spending.  In our own agency, the number of individuals who oversee our managed care operations outnumber the resources devoted to other much, much larger payers. 

The new, emerging health care system contains provisions for the creation of new accountable care entities, pilot payment reform programs, and quality-based reimbursements.  The goals are to improve care while expanding access.  Oh yes... to cut costs too.  To Dr. Stein's point, if administering these programs becomes overly complex and the documentation demands expand (as we've recently seen in home health care with the adoption of tighter and more complicated OASIS requirements), then savings can rapidly evaporate or even reverse as the MGH-Toronto hospital example highlights.

Cutting costs is good.  Adding administrative burden... not so good.

Sunday, October 10, 2010

One for a Sunday morning

I'm a sucker for catchy pop tunes that make me play drums with my index fingers on the top of the steering wheel.  Here's the latest culprit.

And a nice message about the enduring power of that which endures.

Friday, October 8, 2010

This is what Quality looks like...

Good news about our private care company.  For more information, click here or call 781-431-1484.
Wellesley, MA – VNA Private Care, a private-pay home care agency based in Wellesley, MA and affiliate of the Visiting Nurse Association of Boston is among the first in the state to earn Accreditation from the Home Care Alliance of Massachusetts. The alliance, which represents 170 home health and elder care agencies across Massachusetts, has created an accreditation protocol to promote quality services, ethical business standards, and superior employment practices in an industry that lacks meaningful licensure in the Commonwealth of Massachusetts even while it grows in popularity.

“We are proud to be in the initial group of home care agencies earning this accreditation demonstrating VNA Private Care’s commitment to quality,” said Rey Spadoni, President and CEO of the VNA of Boston and Affiliates. “Peace of mind for our clients is paramount and this accreditation from an independent expert will help promote the advantages of keeping people independent in their homes and communities with the superior care we provide.”

The Home Care Alliance launched this Accreditation Program for Private Pay agencies (agencies that are not paid by Medicare or Medicaid), in July. Agencies seeking accreditation are required to submit documentation to show that they meet standards established by the Alliance.

The standards were developed over several months in consultation with 14 agencies throughout the Commonwealth. Training requirements, administrative protocols, and business practices are among the categories that the Alliance reviews for accreditation.

“We wanted to provide leadership for an area that is becoming more and more important to the health care delivery system in Massachusetts,” said Patricia Kelleher, Executive Director of the Home Care Alliance of Massachusetts. “These standards highlight our agencies’ best practices, and will help guide members of the public as they choose who will take care of their loved ones in their homes.”

Rationing is bad, bad, bad...

(photo courtesy of

Highly successful businessman and founder of Staples, Tom Stemberg, made some interesting comments recently regarding the United States health care system.  The Boston Herald, from which this post is drawn, recently wrote about this here.

According to Mr. Stemberg:
I think we have to confront a very unfortunate reality in this country: We’re doing a tremendous amount of elective surgery on people for whom that election probably is no longer affordable.

If a citizen is 80 years old and wants to have elective surgery, knee surgery to pick an example, because they think an artificial knee will help them walk the golf course better, they should have every right to do it, but they should be paying for it. The national government should not be paying for those kinds of things
We used to have an active and vibrant and moderately successful phenomenon in this country called managed care.  Providers were paid a capitated (usually severity adjusted) monthly payment to take care of an entire covered population's health care needs.  Because additional cost savings could be derived by "carving out" specific categories of care (it all began with mental health services, then pharmacy benefits were next, followed by diagnostics, and then...) and businesses didn't want to restrict (er, ration) care to employees, it all fell apart.  There was a public backlash against managed care as being overly restrictive and perennially penny pinching and so, that phenomenon gave way to a return to fee-for-service health care. 

During the recent health care debate, mere suggestions that empowered governmental (or even private) bodies would review and make recommendations regarding coverage options and treatment protocols raised cries of "rationing" and "death panels" and so many of the most restrictive components of the bill were pared back.  Let's face it: we just don't like rationing... or anything that even remotely smacks of it.

Unfortunately, while the expansion of coverage provisions go into effect right away, health reform legislation has the cost control provisions being phased in over time.  Some provisions call for changes in how providers are paid, setting up quality-based payment mechanisms and new accountable care organizations designed to capture the full and global payment to cover services for a defined population... much as capitation was designed to do in the former system.  As has been discussed here, we'll need to make sure we understand and avoid the pitfalls of the past as we build the next system.

Now back to Mr. Stemberg.  I wonder how his comments cited above will play to a population totally and completely unwilling to entertain any system that even remotely involves rationing.  It could be argued, particularly if you're the 80 year old golfer he mentions but who can't afford a new knee, that a loss of Medicare coverage for said joint replacement surgery is going to feel a lot like rationing... particularly since you can get that knee covered today.

For the health care provider community, which is perceived as being largely inefficient and, in some cases, profoundly greedy, the cost cutting measures of health reform legislation need to be about more than an endless stream of straight reimbursement cuts.  Many of us have driven ourselves hard to become lean and no one would accuse the organization I work for as being greedy.  Just the same though, we're expecting nearly 5 percent cuts each year for the next several.  Those are cuts we know we can't sustain.

No rationing.  Full coverage for everybody.  Unrestricted access to every provider.

It just won't add up.


Wednesday, October 6, 2010

Six from Big Texas

Comments from the National Association for Home Care & Hospice in Dallas forthcoming.  In the meantime, some images...

Sunday, October 3, 2010

A Great Night...

Last night, we kicked off our 125th Anniversary in high style. Here are some excerpts from my opening remarks. More to follow soon.

Thank you for joining us tonight as we celebrate and commemorate our 125th anniversary of healing, caring and serving.

It is a distinct privilege to have joined the skilled clinicians, the dedicated staff and managers, the exceptional members of our board of directors and the many friends and supporters of our organization over this past year as we look back on our storied past... and ahead... to a very bright future.

As you will hear tonight, the Visiting Nurse Association of Boston story is one that is full of personal accounts of bold actions, of risk-taking and sacrifice, and of endeavoring to make lives better. You will also hear and see a common theme: that this is one place where no challenge has been too daunting and no need too difficult to tackle. It is in that spirit then that we honor three individuals who exemplify in the clearest and most direct manner possible, all that we strive to stand for and achieve. John Auerbach, Dr. Bob Witzburg, and Jackie Jenkins-Scott.... tonight we honor you and we thank you. Now I could describe in endless detail what it means exactly to be a Hero in Home Healthcare, which is the official theme of this event, but instead, I’ll just simply say: listen to the introductions of these three exceptional individuals and then you will understand well enough.

125 years ago, by the harbor in Boston, a revolution began. A revolution that blazed across this country in the name of teaching, healing and advocating for those who ‘fall through the cracks’. We’d love to celebrate this evening a world where cracks such as these no longer exist. Where a compassionate society has adequately reformed its system to allow for high quality health care services to be available to all of its most vulnerable members... and where better performing, more conscientious caregivers are rewarded for investing in programs and improving lives. But those cracks still do exist. Some... are even getting bigger. Different populations within our City of Boston show marked differences in health status... and access to sometimes even basic care is lacking still. An aging generation confronts infirmity alone and with fear. And too many of our patients depart from our hospitals sicker and more bewildered than ever about who they can trust and turn to for help.

Those cracks still do exist... and some are even getting bigger. What to do... what to do?

The Visiting Nurse Association of Boston has been here... for 125 years in fact. And.. we will be here.

With your help, we can make this better.

Enjoy the evening. And thank you for being here tonight.

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