Spring. . .

Spring is here! And the upper valley is in a heat wave. Who would’ve thought it could be 80 degrees in April?
We are approaching the midterm of spring semester at TDI and that means graduation is just around the corner. I have been so busy this year that time has flown by and I cannot believe it is almost time to move on and start using the information I have learned here. During this year we have learned to identify issues in health care, how to track these issues, the process of analyzing them, and implementing strategies to fix the problems. I look forward to using my knowledge in the coming years of health care reform.
Betsy B.

Clinical Microsystems

TDI is fortunate to have the geographic proximity and the support from leaders at Dartmouth-Hitchcock Medical Center. We have the option of taking a Clinical Microsystems class in the Spring which I was told by several alumni and former professors was one of the electives not to miss. Taught by some of the leaders in quality improvement, Paul Batalden and Gene Nelson, we learn the fundamentals to create and redesign health care microsystems in the efforts to improve delivery of care to the patients, patient's satisfaction, and attain better outcomes for the patients.

Even better, we are given the opportunity to work with a "site" that gives us the chance to apply some of the skills we are learning in the classroom and apply them to a real microsystem. Building on our communication, research, and quality improvement skills, we enter our designated site with the guidance of committed leaders in that field that share the same vision for improvement and better patient care. In the past recent weeks, my partner and I have visited the Ultrasound department right across the street at DHMC and spoken to the director, the head sonographer, and an Ultrasound scheduler to better understand the wait times in this microsystem. We soon will be able to follow patients to get a first-hand look at how we can make a patient's visit to an Ultrasound a delight every time (the Kano Model)! Working side-by-side with the staff of the microsystem and getting the opinions of those that interact with this department from the mesosystem and macrosystem gives us an incredible insight into make every step of the process patient-centered, and efficient, and effective. 

We are really lucky here at TDI to get these opportunities. 

-Shaili

Dartmouth in DC

Staying current on healthcare reform is a key focus at TDI. We read the recent journal articles, white papers, and policy briefs that guide key decision makers in Washington, D.C. and elsewhere. Our instructors also keep us abreast of happenings since they influence these debates directly (see the 2nd headline here re: Dr. Fisher's testimony: North Shore LIJ Health System testifies before House Ways and Means Committee...). Sometimes though, it's hard to keep up with how the theories we talk about in class here in New Hampshire are applied.

Julie Lewis stepped in today to show how TDI works in the real world. She spoke at the Dartmouth Medical School about the stimulus package, and how she and other TDI leaders are advising politicians on what to do with the healthcare-related financial outlays in the bill. Julie is very connected to what's going on in Washington. She has worked with Nancy Pelosi to direct quality improvement policy for the American College of Surgeons. Julie now serves as Director of Health Policy at TDI and manages TDI's partnership with the Brookings Institution. She's also very accessible to students. I've met with her a few times to review my resume and plan job-search strategies. Julie showed how relevant TDI is in today's healthcare reform debates, and she's part of the reason why it's exciting to be a TDI student right now.

-Sam W.

The snow is melting...

The snow is melting around Hanover and TDI classes are back in full swing.

Sorry for the break in posts over the last few weeks. Most of us were focused on finals during the middle of March and then spring vacation provided a break in the action. Some students went on vacation, a few stayed in New Hampshire to work on projects, and others mixed business and pleasure. For example, one student spent part of her spring break interning in Washington DC, and I spent a week vacationing in Mexico then stopped in New York City to deliver a presentation before returning to school.

Now that school has started, most are wrapped up in thesis and internship projects. Despite the workload, there's still time for extracurricular adventures. One group spent Sunday hiking up to Tuckerman's Ravine, skiing the headwall, and biking out. Although I missed that excursion, I reserved some time yesterday to attend a talk delivered by visiting scholar Dr. Milt Weinstein, and then to watch the NCAA finals with a friend who's a UNC alum. It's a busy time for TDI students but we still make time to enjoy the non-classwork opportunities in the area.
-Sam

Healthiest Nation in One Generation

In conjunction with National Public Health Week 2009, the American Public Health Association has initiated a campaign to build a foundation for healthier nation.

http://www.generationpublichealth.org/

This video is short and well done. It hits a lot of the points we've been talking about all year.

Case Mixing and Hospitals

We had a discussion recently in our course Strategy and Financial Management of Health Care about how various insurers (state, private, self-pay) pay for medical care and how hospitals charge different rates for each of them. This has less to do with desire on the hospital's part to treat customers differently, and more to do with the fact that the government can set what they will pay for a given service at pretty much any level they want. As a result, Medicare and Medicaid payments usually do not even meet the break even point for the care that is given. Therefore, hospitals are forced to pass of this deficit to private insurers and self-paying patients.

We then discussed two ways in which this effects health care. The first is that branches of medicine that cater primarily to lower-income or older individuals (Psychiatry for instance) are far less profitable than other areas of medicine. This results in many hospitals avoiding providing this service or having to pursue more lucrative fields in order to subsidize the losses they suffer by offering those services. The second area has to do with public policy. When states make cuts to Medicaid (like what may happen in NH) they often due so by reducing their reimbursement rates for procedures. Since the volume of care being given does not change, hospitals have larger deficits from Medicaid procedures. This results in them increasing their charges to private insurers (who are happy to pass the charge onto their customers) and self-payers. As a result, attempts to balance budgets by cutting Medicaid can be essentially the same as raising taxes, as the costs are passed back to the consumers and taxpayers.

A week in the life . . .

A week in the life . . .
TDI is a very busy place with new things happening all the time. I thought it would be good to share an average week for a student here at TDI. . .

A class dealing with the strategic and financial management is required for the MPH degree and optional for the MS students. This class allows us to work in small groups and get inside various health care organizations and study their financials and management techniques. This past week began with a conference call to the CEO of Concord Hospital in Concord, NH. On this particular call, the CEO was very open about the hospital current financial growth as well as goals for the near future. That evening I went to co-ed intramural basketball game at the Alumni Gym. TDI is known for dominating all intramural sports and several opportunities to participate arise during the year.

Tuesday morning I attend The Economics of Health Care with a great instructor. We watched the movie “SiCKO” and tried to identify themes discussed in the movie relating to the U.S. economy as well as other countries. After class I began work on a white paper, much like the white paper submitted by our faculty for the Obama administration. However, we are allowed to choose a topic of interest- I went with the release of dimethylmercury during from coal and oil-fired power plants. This includes the laws, regulations, key stakeholders, and recommendations that I would give to policy makers.

The middle of my week consisted of a trip to Montpelier, VT for my internship at the Vermont Attorney Generals Office. I get to watch policy making happen and watch public policy proposals move through the legislature. Currently, I am helping to formulate the Vermont Pharmaceutical Disclosure Act for public use.

I had class all day on both Thursday in Friday. Class discussions revolved around strategies hospitals use in health care to stay competitive, the States Childrens’ Health Plan (SCHIP), and mercury poisoning from fish- great timing for my white paper.

Overall, it was a very productive week. TDI allows for incredible opportunities and variety while keeping life busy.

Betsy B.