Lourdes Health Blog

 A message from Alexander J. Hatala, President and CEO, Lourdes Health System.

Voters rank health care along with the economy as the two most important domestic issues, both nationally and in New Jersey. As the national elections near for President and seats in the U.S. Senate and House of Representatives, candidates are unveiling proposals on how to make health coverage affordable and available to all, particularly those who are uninsured.

Regardless of the details, the success or failure of any plan is dependant upon whether it is adequately and fairly financed. Up to this point, a patchwork of state and federal initiatives, along with ever increasing financial commitments from non-profit healthcare providers such as Lourdes, have been able to fend off catastrophe.  However, these stop-gap measures are just delaying the inevitable and crippling the nation’s health system. True reform is necessary.

Many believe that access to affordable health care should be a right and not a privilege. It should be available and accessible to every United States citizen, with special efforts made to assure that the poor and vulnerable are not left behind. The consequences of being uninsured are significant. This is particularly true for children, who are less likely to receive treatment for common illnesses. Both uninsured adults and children are less likely to receive preventive care, while uninsured patients are up to four times as likely as insured patients to require both avoidable hospitalizations and emergency hospital care.

On the local level, as New Jersey faces a budget crisis, cuts to the provision of care to the uninsured are inevitable. While it may sometimes seem difficult to sort through all of the details of the issues, here are some important facts you should know: 

• Although New Jersey has the second highest median income in the nation, 15 percent of New Jerseyans lack health insurance, tying it with West Virginia, Idaho, Alabama and Wyoming for the nation’s 19th highest rate of uninsured residents.
• By law, hospitals in New Jersey must care for all patients regardless of their ability to pay. Our state, with Oregon, is one of only two in the nation to mandate this coverage.
• The cost of hospitals to provide charity care to uninsured patients in New Jersey is more than $1.5 billion annually. The state reimburses hospitals about half that amount.
• Statewide, there are 78 acute-care hospitals; all but two are nonprofit.
• Almost 50 percent of hospitals in New Jersey are operating in the red, while the latest figures available for hospitals nationwide show that 18 percent are losing money.
• Since 1997, a total of 15 acute-care hospitals have closed their doors, including a number that closed in 2007 and additional facilities slated to close in 2008.

As a Catholic healthcare provider, we are committed to advocating for a just and equitable system that ensures medical care for all. I am worried about the ability of hospitals to continue to serve their mission - providing quality care to everyone without limits and variations based on age, race, ethnicity, financial means or health or employment status. 

In order to help educate the public, over the coming months I will be providing updated information on our Web site about the health care issues that affect you.

We hope to gain your support for this cause and utilize our website as a key source or information about healthcare issues.   

No one could ever complain that they don’t know how I feel. Take this picture for example. I was probably around five years old, Down the shore in Wildwood. Grandmom had ticked me off for some reason. I feel good looking at this picture. Makes me feel like I was born this way.

Marketing directors use this look a lot. We often need to express our displeasure and having a look that will get one action is important. We are constantly evaluating, sizing things up. At the same time, we have people relentlessly coming at us–selling, complaining, wanting more, better, faster. No wonder we’re all in a bad mood.

The challenge of being in my line of work at a place like Lourdes is that they expect associates (i.e., employees) to provide a level of courtesy that exceeds your average job. Some days it is really hard. This is actually the hardest part of my job. I used to have my own business and we would fire customers we didn’t like. Can’t do that here. And when you have vendors or salespeople who are eating up your time, its nearly impossible. People who work near me can attest to that.

So it is a bit of a tightrope–trying to be nice, or at least professional–when people are getting on your last nerve.

Friday we had our quarterly leadership development institute. It is sort of a retreat day where we focus on a particular topic or issue. This one was a reflection of last year’s accomplishments and next year’s goals, but the day began with a presentation of a report, the result of a effort by the New Jersey Hospital Association to obtain an independent and objective analysis (a “warts and all” review) of the state of New Jersey’s hospitals. They chose Accenture, which I think did a great job.

Before I worked at Lourdes, I worked for a hospital trade association and I’ve seen a lot of reports. Some can be self-serving, but this one is quite good because it demonstates that everyone needs to try harder in order to make real improvements in the in the delivery of care.

Up until now, I’ve spent my healthcare career in Pennsylvania. When I started at Lourdes last year, I could tell that the regulatory environment was much different, and in particular the organization of physicians and their relationships with hospitals. The Accenture presentation helped to clarify those differences and to point out how public policy, government programs and compensatory behavior conspire to create circumstances that impact hospitals, and more importantly, the patients they serve.

As just one example: New Jersey ranks 33rd in the use of hospice care among Medicare patients in the last stages of life. That means a lot of things. It means patients are probably being overtreated. It can mean that doctors and nurses are failing to have good, honest discussions with families. It means families and patients are not facing reality and demanding that “everything be done” when in fact the compassionate and decent thing would be to make sure the patient is provided as many dignified and pain-free last days as possible.

A summary of the report can be found at: http://www.njha.com/publications/HCNJ/HCNJV15No6.pdf

Looks like the holidays took a bit of a toll on our blog. If everyone else has been like me, the new year started out busy and hasn’t let up. And it doesn’t look like it is easing up any time soon. Lots to do. The March issue of our Physician’s Practice Magazine supplement had to get done and we were running late. We needed to get the ad out for our first heart month event, and two presentations, not the least of which the big “Our Blog Test Kitchen” talk at the “Using the New Web 2.0 for Corporate Communications” seminar at Philadelphia University.http://www.prwebfire.com/

Personally, I had a great time and learned a lot. It was also very inspiring. Great company all around. Met some nice people from our friends at Fox Chase and got to see our buddies from Main Line Health. Also present, Mr. Al Paul Lefton, President of one of Philadelphia’s premier advertising agencies. I had to tell him how much I respected him as a result of a Philadelphia Business Journal profile a few years back. In it, he talked about how their agency does not participate in awards contests. I can’t tell you what a refreshing move that is, especially these days. All of those agency awards are a big scam. It’s like kindergarten where everybody winds up with a prize. You pay to enter and are pretty much guaranteed something when you leave at the end of the dinner. Plus, the award winners are not required to demonstrate any ROI for the client. Don’t get me started.

Christopher Barger from IBM gave a terrific keynote, with lots of content and good examples, including a mention that some of IBM’s 250 bloggers are focused exclusively on healthcare. I checked it out and will be linking some of them, and their links, very soon. IBM has quite a vision as to how blogging fits into the corporate structure, and it was good to hear him end his talk with some tips on when not to blog–which was kind of where I was headed with my presentation. One of his points was not to blog if you don’t have a goal in mind.

In preparing my talk, I was thinking about the reasons we became involved in this project, and one of them was that it allowed us to provide a new media outlet to reflect the mission and values of this organization.

The conference offered lots of value-added information. I feel lucky to have been there and that we were given this opportunity. For those who missed what I had to say, here’s the cribnote version what I said. I explained:

1. How we got involved
2. Why we got involved (one of them–it was a way for us to reflect our values and mission through new media)
3. The process we used to gain buy in and get it rolling
4. And yeah, we’re glad we did it.

I finally figured out how to link files (hooray), and at the conference I got a good explanation of the whole RSS feed thing, so I promise next post I’ll add some content.

Also learned one other thing. We need to keep this more regular, so I need to check in with our bloggers. And I think it is time to perhaps search for a few more to lighten the load.

Nothin’ Left To Lose*

Imagine feeling so trapped and scared as a young man in 1968 that you enlist to go to Vietnam because you feel your chance of living is better there than on the street in front of your home? One wintry morning in 1978, I met such a man in an encounter that shattered the arrogance of my youth.

The two of us sat there in that cold and unfriendly room, part of a veterans’ psychiatric hospital 30 miles outside of Philadelphia. We sat there, face to face: one white, one black. There were similarities between the two of us. He was 28, I was 22. He was from West Philadelphia. I was from Northwest Philadelphia. He remembered Ritchie Allen, a Phillie who routinely rocketed homeruns out of Connie Mack Stadium. And so did I.

But it is the contrast that gnaws at me. I was the doctor. He was the patient. My father was a prominent surgeon who, to this very day, I idolize as my greatest role model in life. He only remembered seeing his father twice. He dropped out of high school at the end of 10th grade. I graduated from an exclusive prep school.

In the fall of 1968 , as a boy of 12, I loved to watch the Dallas Cowboys. In the fall of 1968, as a boy of 18, he enlisted to go to Vietnam to avoid being shot and killed by a rival gang on the streets of West Philadelphia.

The session was meant to be one in which a young doctor polished his interviewing skills by speaking with a patient dealing with mental illness. The hospital was filled with Vietnam veterans, so all 20 of my other medical school classmates were also conducting their own interviews on that day. The young man opened up “I enlisted to go to Vietnam because I thought my chances of living would be better there than on the streets of West Philadelphia with the gangs. I knew that I had made a mistake when the plane was flying me into Vietnam and I saw all the bombs going off in the distance.”

He was quiet and very sensitive. His voice quivered and his words were somewhat guarded, all so consistent with his story of violated youth. On this day, the doctor had no words of wisdom. On this day the doctor did the learning.

Today, I am a physician in an urban health center. I have carried his words with me across 28 years in time. They have never gone far from me. Periodically I have thought of him, although his name I have long forgotten. He taught me great humility on that day and I hope that I have carried that humility to the bedside of every patient for whom it has ever been my privilege to care. I now remember him as one of my greatest teachers in medical school.

I sit here in my office in Camden, New Jersey. It is on one of the top floors of the medical center and from it I can see far across the Delaware River where I have a clear panoramic view of the City of Philadelphia. Through the eyes of a now 50-year-old man, I see off in the distance that city’s tallest building, Liberty Place. It stretches proudly into the night sky, a well-lit beacon symbolizing the spirit of man reaching to new height. And its name reminds us all of a declaration in support of independence from fear and need so bravely articulated 230 years ago. With the advent of this New Year, so many of us celebrate the wonderful blessings that freedom in America has made possible. I am one of them.

But as I look out my window I do see an expanse of low-income, and even abandoned, housing that unfolds before me. I see Camden, a city known for its poverty and crime. And, in the distance, the City of Brotherly Love which was plagued with nearly 400 homicides in this year. I think of 47 million uninsured Americans struggling in a land of plenty. And I think of the similarities between the Iraq War and Vietnam.

As I look off towards Liberty Place, I think of my teacher and what he taught me that day. We hear so much about freedom these days. In this Holiday Season 2006 there are hundreds of thousands of Americans who will be in far off lands away from family for the cause of freedom.

For a moment I look out my window and think back to the fall of 1968. I see a young black man in the streets of West Philadelphia and he is tired and scared, trapped in a jungle of youth violence and poverty. He makes a decision to go to Vietnam in search of a better life? Perhaps Janis Joplin sung it best: “Freedom’s just another word for nothin’ left to lose.”*

Beautiful Sunsets,

Strawberry Fields

*From “Me and Bobby McGee”- sung by Janis Joplin, 1971; written by Kris Kristofferson

It’s 7:40 a.m. and I am driving south on Haddonfield Road. As I pass the Cherry Hill Mall, I get caught by two red lights, despite the fact that the mall is closed and there is no cross traffic whatsoever. So there is a line of cars sitting, idling, wasting gas, for absolutely no reason except that for some reason we do not have the money to fund an intelligent traffic control system. However, we do have the money to burn gasoline while uselessly idling.

Multiply this by millions of traffic lights in this country, and you get an idea of the amount of gas we waste every day. The irony is, addressing this by improving traffic flow would hardly be a painful solution. On the contrary, it would make everyone’s commute faster. Seems like a win-win situation, especially in view of the fact that dependence on foreign oil is hardly a good thing, right?

The problem is … every time I hit these lights I repeat this same argument in my head. And despite how forcefully or brilliantly I argue the point to myself (I try to keep my lips from moving while I am in the car) the light steadfastly refuses to turn green any time sooner.

It has taken 53 years for this fact of life to sink in. Most of the running commentary in my mind is useless. Now I can certainly write my representative, my local newspaper, or join a conservation group, and take some action. But most of the energy I spend grousing over this matter is purely wasted.

So why don’t I do these things, take some action, but when I am not in control of my immediate situation, learn how to just let it go?

Sometimes when I am in traffic, I picture a long line of ants doing … well … whatever it is ants do. And I picture one of those ants grousing about how slow the ant in front of him is, and why are they building this ant hill anyway, and did you see how that one ant cut him off. The image is so absurd. How self-important that ant is, considering how powerless he is. Of course, I am that ant. That image always brings a smile to my face and I relax.

It all comes down to the serenity prayer: “God grant me the serenity to accept the things I can not change, the courage to change the things I can, and the wisdom to know the difference.”

One of the tasks I do often here is read about medical studies. Have you read the latest medical study released in the news today? If you haven’t, don’t worry. Another contradictory one will be out momentarily.

The problem I’ve found with most medical studies I read about is that they deal with specific drugs or devices treating (or not) such a small number of people with a specific condition, you’re not quite sure what to make of the results. Another study of the same drug looking at a slightly different condition could come up with the opposite result. Therefore, within a short period of time, you could have contradictory headlines: “X drug Reduces Cancer Risk” and “X drug Does Nothing for Cancer.”
Which study do you believe? Your guess is as good as mine. Go with doctors (affiliated with major health systems like Lourdes) and treatments you believe will work and hope for the best.