Re: “Service Line Management: Now It’s Critical” by Geri Aston in January’s H&HN

This is a great article about innovative thinking: organizations that are willing to bend the curve so that the leap to the value curve will come with less pain than their status quo counterparts. Smaller hospitals can explore the value of service lines without a large commitment by simply regionalizing the hospitalist patients and creating an accountable care

unit with the hospitalist, the nurse manager and the case manager as the leadership team accountable for clinical and financial outcomes of that patient cohort. Once the concept of "service line" accountability seeps into the culture of care, it will be easier to expand to a more global strategy.

— Stefani D

Philanthropy and the Second Curve

Re: “The Differences Between First and Second Curve Hospitals” by Paul Keckley in H&HN Daily, Jan. 5

Thanks for a great piece with a great list of key differentiators. I'll add one more to your list: I believe second curve hospitals are also embracing philanthropy — or charitable giving — as a key, strategic, revenue source rather than seeing it as incremental revenue. Progressive hospitals have realized that the ROI on philanthropy outstrips that of clinical service lines and can equal the dollars derived from core clinical operations when compared net to net.

If you figure a hospital today needs to generate about $45 million from operations to put $1 million on the bottom line for reinvestment while a hospital foundation needs to raise about $1.5 million to put $1 million on the bottom line for reinvestment, the power of giving is clear.

Thanks for giving us all a vision of what the savvy and sustainable must do to move from first curve to second curve.

— Betsy Taylor

Consumers Lead the Way

Re: “Treating Patients as Consumers is a Growing Strategy” by Paul Barr in H&HN Daily, Jan. 21

What a novel idea for an industry that has always talked about "putting patients first!"

The physician office has, of course, always been a place for patients to patiently wait. Up the historical point of entry ladder lies the emergency room. Better bring a book. Getting an appointment to see a medical specialist. Get a calendar.

And health insurers? Even they — ranked by consumers as last among 13 different industries surveyed since 2007 — are now talking about becoming "customer-centric."

In the meantime, tens of millions of customers already voted with their feet and moved to walk-in clinics, retail-affiliated nurse practitioners, online primary care physicians and specialists (24x7x365 via phone for $45), freestanding emergency centers and even to Wal-Mart, which is now bundling heart surgery and flying employees and a friend to a half dozen medical centers of excellence with no "co-pays," no travel or lodging costs, and measurably higher clinical outcomes.

Already on their way for health care consumers are major international medical centers of excellence; wearable health monitors (from retail stores), retail walk-in lab tests (with results given directly to the customer), subcutaneous medical history chips (since U.S. health care EMRs rarely connect outside a person's local medical market) and smartphones enabling consumers to connect with medical providers anywhere, anytime.

Even when it comes to end-of-life care, there is a rapidly growing (inter)national movement helping those who choose to "opt out" when it comes to end-of-life medical treatments or research that fail to address the quality of one's life.

— Ron Hammerle, Chairman

Health Resources Ltd.

Troubling Words

Re: "How Choosing Our Words Carefully Can Drive Change in Health Care" by Wendy Leebov in H&HN Daily, Jan. 13

This is so important — thanks for raising this topic. Also, war metaphors such as battling disease, combating illness, on the front lines, war on cancer, etc., are so troubling. We need to evolve to a better way about talking about health.

— Sita Ananth