Re: “Eight New Best-Practice Rules for Hospitals” by Paul Keckley in H&HN Daily, Nov. 3

I'd love to see a No. 9. Old rule: Employees are an afterthought audience after we worry about all others. New rule: Engaged, committed employees are our No. 1 audience, because their work and behaviors are at the heart of quality, productivity, efficiency and customer satisfaction (i.e., variables that go right to the bottom line).

And they can be our best word-of-mouth advocates (or worst critics) in the local market. [This is] particularly relevant as we've watched the U.S. Ebola situation evolve and employee commitment or employee fears have affected hospital actions and reputations from coast to coast. I agree with Paul that the future is bright — for those organizations that harness the commitment and creativity of the people who work for us, rather than viewing them as, according to a speaker I heard recently, "our biggest expense item." They are the front lines; they have the insights and ideas to help health care organizations transform.

— Kathleen L. Lewton
Lewton, Seekins & Trester

Two IT Takeways

Re: “Cellphone Cameras Can Help Doctors to Better Assess Ailments, but Privacy is an Issue” by John Morrissey in H&HN Daily, Oct. 14

While the concepts of "population management" and "care coordination" are key dimensions of the shift to value-based reimbursement, articles such as this one take us down "into the weeds" and show us how to operationalize these concepts.

A key takeaway: The range of needed technology is far greater than an EHR — though that should be the hub technology. While one of the case studies involved home health, it is easy to imagine a nursing facility using similar photo technology to provide higher-quality, more-efficient wound care.

The other key takeaway: The technology has to support a referral/intervention ecosystem, so "Job 1" for hospitals is to develop and manage such an ecosystem. Only then is it necessary to procure, implement and optimize the HIT necessary to support the function of that ecosystem.

Wonderful article: Thought-provoking and it highlights folks who are doing the hard work necessary.

— Les D

Hospitals' Post-Acute Partners

Re: “Improved Nursing Home Quality Ratings Could Help to Cut Readmissions” by Paul Barr in H&HN Daily, Oct. 22

I agree with your commentary today about improving nursing home ratings and how that might help hospitals with their readmission issues. Clearly, the current rating system is woefully inadequate. However, you’re right that partnerships with nursing homes and adding nurse practitioners will take this further.

National Post-Acute Healthcare is creating networks of nursing homes that can deliver on their promises to reduce readmissions. For example:

• With its Bundled Payments for Care Improvement Initiative, CMS is one of the conveners developing a national network of post-acute providers, and training these providers to use several approaches that its partner Mid-Atlantic Health Care, a nursing home chain, has tested and proved effective in its facilities.

• Use a robust EHR system and data mining to identify potential health problems while they are still minor and can be more easily treated.

• Enhance care by increasing the frequency of physician visits, using nurse practitioners and the like.

Their approach won’t be implemented overnight, but it has the potential to go far beyond any rating system and beyond what a hospital can do on its own.

— Linda Harder
Nevins & Associates


An article about patient engagement in the September issue of H&HN contained a misleading sentence. The sentence should have read: The University of Pittsburgh Medical Center was one of the first organizations to set up rapid-response teams back in 2005, following the death of an 18-month-old girl from dehydration and drug misuse, anong other factors, at a hospital that is not affiliated with UPMC.