healthsignals new york

OK, Tim

Well, the queue of drafted, but incomplete posts is way too long and the (much appreciated) complaints about the absence of posts are getting to me. So we're starting up again today.

I've been working on a series of fairly lengthy posts about healthcare budget politics in New York and the feud over how we should get to a smaller sized hospital and nursing home system. Note that it's no longer whether; it's how. I'm betting that this is a very significant change in the public debate.

For decades, it's been the dirty little secret among professionals that New York is way over-bedded. But the hospital and nursing home associations couldn't really admit that in public. The first to break was NYAHSA when they began to talk about "rightsizing" a couple of years ago. But now they're all in on the action. But that also means that the issues which were repressed are bubbling to the surface:

• To what degree can, should, and will unionized facilities get favored treatment in this colossal game of Survivor? Can't we just imagine the "tribal councils" to vote hospitals off the island?
• What are the implications of the upstate/downstate differences in hospital organizational structures? (Downstate, most are part of multi-hospital systems. Upstate, they are not.)
• From a programmatic and economic perspective, which is the better approach, market or regulatory? This isn't just a question of ideology. Would the actual results from the two approaches really differ?
• Which will cause more political damage in the districts that lose facilities, an active regulatory role (you, Mr. Legislator gave the Governor and this commission the authority to close my hospital) or (you, Mr. Legislator stood by while my hospital was forced to close because the market squeezed the life out it)?

But in the meantime, there have been some Medicaid developments I'm mixed up in that are all at the same time, amusing, amazing, promising, and troubling. More on that tomorrow. Not to be a tease, but it appears that a Medicaid paper I wrote a couple years ago is now in the middle of a political brawl between State and County officials. I'm meeting this afternoon with a Senator who sent the paper to county officials all over the State. (What was that old quote about the honor of facing a firing squad?)

I've actually got most of the next post written, but probably shouldn't finish it and certainly shouldn't post it until after I've met with the Senator.

Also on the docket for tomorrow (though it may be very late tomorrow) ...

Part of the reason for my absence the past couple of weeks (yes, it's an excuse and a pretty lame one at that) has been work on a new website. Here you get to read my yammering. But except for a few bold souls, I don't get to read yours. So we've been working on something that I think will be distinctive in the the healthcare environment.  Stay tuned.

And thanks for your patience.

 

Long lapse about to end

Pardon the absence. I'll be back with a vengeance in the next couple days.

Out of town

On the road today. More to come on New York's budget, Medicaid in many states and developments in IT

Site improvements?

In the last two months, the number of visits to this site has bumped up. We're now generally averaging 150-200 per day during the week and slightly lower rates on weekends. There was one day earlier this week when we crossed 300.

With an eye toward expanded functionality, I'm meeting in a couple of days with a very capable technical guy with whom I've worked before. Aside from automatically sending subscribers e-mails of each posting (which has already been asked for), are their other technical or display enhancements that anyone's interested in?

Either comment below or send me an e-mail.

Thanks much!

Back

Well, I took a lot longer than planned, then got back and went directly to the Disease Management conference in Boston. I'd hope to post from there about the conference, but socialized instead. So sue me! That's what everyone else does, right?

Lots to catch up on, New York politics, including the primaries and the failure of the State Assembly to override the Governor's budget vetoes, the national debate, and what I saw and heard in Boston.

Taking a short break

Hope everyone's had a great summer. I'm finally getting to take an oft-delayed break the week after Labor Day. So despite how far behind I am, no posts.

Open mike

There's a long list of issues & news to discuss: more on Medicaid, the Medicare pharmaceutical discount cards, the prospects for Federal budget activity post-election, long-term care single point of entry, financial distress and managerial turnover at public hospitals, and on and on.

But I'm bailing out early today. Personal treat.

So you're on your own. What do you want to see discussed? What would you like to see researched? Leave a comment.

And have a good weekend ...

Site activity

FYI, on day 1, April 1st, there were a few over 180 hits. On Friday there were over 200. On Saturday, there were about 280. And on Sunday, there were 340. Kind of surprising on a weekend, but maybe that's when folks get a chance to explore.

This is never going to be a site with millions of viewers. But it's a gratifying beginning.

Anonymous comments and posts

I received a pithy comment yesterday by e-mail disagreeing with one of my posts. I'm going to post it shortly, but want to set the ground rules for my posting on behalf of people who prefer to remain anonymous.

I'd prefer that you all post your own comments. However, from time-to-time I will make exceptions based on the following criteria:

1. The person has a good professional or personal reason to remain anonymous.

2. I personally know the person and trust their judgement and motivation.

3. The comment is something worth repeating, offers a distinctive insight, or challenges something that I have said.

4. I will identify the fact that I'm posting on behalf of someone who prefers to remain anonymous.

5. I'll reveal whether I'm quoting exactly or paraphrasing the comment I received.

6. If it's new information, I'll try to check it out independently before posting.

Any other suggestions?

Some process stuff ...

This site has been developed and is operated by Signalhealth, LLC. In the hopes of encouraging an online health policy debate in New York, we've developed it even before our own web site. See also "About Me."

Here are some pointers that may help you in using this site.

1. At the bottom of each post, you'll see "comments" with a number in (parentheses). The number shows the number of comments that have been made that are attached to that particular post. To see the comments, just click "comments" and scroll through them. To make your own comment, scroll to the bottom of the comments and you'll see where to fill in the blanks. You can preview what you write before posting. Yes, we ask for your e-mail address and it will show on the site. However, though it will work if clicked and it shows visually, it's protected against the automated systems which scan for such addresses so you should be protected against getting even more spam. You're responsible for your own editing.

2. From a technical perspective we do have the ability to edit and/or remove posts or comments after the fact and to block users at particular IP (internet protocol) addresses. I hope it isn't necessary.

3. If you would like to take up a new topic, point to some other online material, or whatever, send me an e-mail and I'll consider posting it for you. Yes, that's a bit awkward for the moment and there are other technologies that are more decentralized, but this was the easiest and cheapest way to get this going. I can also schedule a delayed posting so that you could send me the material for later release.

4. From time to time, I'll leave an open posting so that users can comment on any topic they care to without confining themselves to the topic of a particular post.

5. I'll be adding to the listings on the left side. Feel free to suggest additions.

6. To e-mail me, click the link on the left side.

Anything else? Make a comment.

Thanks and have fun. I hope this experiment is helpful.

John