Home / All Post

Wednesday, 4 May 2016

Princess Health and My Recent Paper on Linoleic Acid in Adipose Tissue. Princessiccia

Add Comment
Linoleic acid (LA) is the predominant polyunsaturated fat in the human diet, and it's most concentrated in seed oils such as corn oil. LA accumulates in fat tissue, and as with many of the nutrients we eat, it is biologically active. In a new paper, we systematically review the studies that have measured the LA concentration of fat tissue in US adults over time. We show that the LA concentration of fat tissue has increased by approximately 136 percent over the last half century.

Susan Carlson, PhD
In 2011, I posted a graph on my blog in which I summarized some of the studies that have measured the LA content of fat tissue in US adults over time (1). It showed a remarkably consistent upward trend. Last year, a University of Kansas nutrition researcher named Susan Carlson contacted me and asked if I had published my findings in a scientific journal, because she wanted to cite the trend in one of her papers. I said I hadn't published them, but that I would love to do so together.

Read more �

Princess Health and Stanford hospital is first in Kentucky to go back to laughing gas, or nitrous oxide, to relieve the pain of childbirth. Princessiccia

Add Comment
Photo: Abigail Whitehouse, Interior Journal
Ephraim McDowell Fort Logan Hospital's Birthing Spa in Lincoln County is the first in Kentucky to offer nitrous oxide, often called laughing gas, as an alternative pain relief measure for women during childbirth, Abigail Whitehouse reports for The Interior Journal in Stanford.

Dr. James Miller, the unit's medical director, told Whitehouse that the Birthing Spa aims to provide support and comfort to mothers during labor and that nitrous oxide, which was commonly used for this purpose in the 1950s until epidural anesthesia became popular, provides another option to help decrease anxiety and pain during childbirth.

"We in our unit found, when we started hearing again about the nitrous oxide, that it just fit really well with our philosophy of trying to offer choices to moms," Miller told Whitehouse.

Miller said that while epidurals continue to be used most often during labor for pain management, the procedure comes with some risk and are expensive.

"Epidurals cost a lot and haven't shown the benefits. And they changed labor from a low-risk setting to a high-risk setting," Miller told Whitehouse. "With an epidural, we know that it drops the mom's blood pressure, so they have to have an IV ahead of time and load up on fluids to try to prevent the drop in blood pressure, and then it can still happen. Then you have to monitor the baby's heart tones."

In addition to nitrous oxide, the Birthing Spa also offers alternate options for pain management during childbirth, including: water births, which he said have been proven to lower cost and shorten the length of labor, showers big enough for two with multiple shower heads, a nursing staff trained to "almost function as a doula," a beautiful garden to walk in, and massage chairs. The unit also offers epidurals or an alternative intravenous medication for pain.

Miller noted that nitrous oxide, which is delivered through a mask, allows laboring mothers control over their pain management because they can put it on and remove it as needed; it can also be used earlier in the process than an epidural.

Miller told Whitehouse, "It's very fast acting so when the pain is starting to contract, they start breathing the medicine and within seconds it takes effect and then as the pain resolves, they take the mask away and the medicine wears off that quickly too."

Tuesday, 3 May 2016

Princess Health and May 3rd, 2016 A Hopeful Response To The New York Times Article On Dr. Hall's Biggest Loser Season 8 Study. Princessiccia

Princess Health and May 3rd, 2016 A Hopeful Response To The New York Times Article On Dr. Hall's Biggest Loser Season 8 Study. Princessiccia

Add Comment
May 3rd, 2016 A Hopeful Response To The New York Times Article On Dr. Hall's Biggest Loser Season 8 Study

I sat in the waiting room of the surgery center with mom yesterday morning as we waited for her name to be called. The Today Show was on the television and mom was asking questions about that amazing day I'll never forget. "Did you meet Al?" Unfortunately, no. "Did you meet that other guy?" No, Matt was taking a day off. Our mother-son Today Show Q&A was cut short by, "Beverly, come this way..." I once again reassured mom she was in good hands and this procedure was going to be okay, "I hope so," --It will mom, I love you. "I love you, too, son." And off she went into a patient only area.

And then it was just me, sitting there, watching Today on NBC--and making my way around my phone. I checked email, connected with my private support group via Facebook and thought about lunch plans. It wasn't very long in the waiting before I noticed a news headline for an article in The New York Times by Gina Kolata, picked "especially for me," all about Kevin Hall PhD's study on Season 8 Biggest Loser contestants. The study was over a period of the last six years. And since I've experienced my personal study over the last seven years, I was immediately drawn in to every single word Dr. Hall and this article presented.

The study, monitoring the season 8 contestants, documented the regain most experienced post-show. It concluded the same as similar studies: The body can and does develop a weight "set-point," and for those of us who lose weight, it means our bodies are constantly pushing back to this set point.

While the experiences of my exploration, or "research," if you will, agreed with much of this scientific study, specifically about the body having a set-point weight, I was extremely disappointed in the overall hopeless tone of the article's conclusion. The truth isn't hopeless. I've lived it. I'm living it every day. Trust me, there's plenty of hope. 

Instead of hope, I immediately recognized the fuel for self-defeating rationalizations of which I'm very familiar. I talked myself into staying near, at or above 500 pounds for almost two decades, I know all about self-defeating rationalizations. These self-defeating thoughts, especially when supported by scientific research and presented in a publication respected the world over, become even more powerful. I wonder how many people read this same article and then released their embrace of taking extraordinary care?

To conclude our body will find a way to return to this set-point, as if it's a given, without exploring the role of personal responsibility/behaviors/and habits, not to mention the monumental effects of our necessary mental/emotional transformation, or lack of, was, in my opinion, potentially damaging to the millions of people embracing their plans and holding on to hope for a life at a healthy body weight.

Because, if we're biologically programmed to regain back to this set point, then why bother?

A friend of mine who struggles with weight issues, sent me a text about the study first thing this morning, "...it's a little bit frightening."  Her message wasn't the only one. By days end, I had received several messages and engaged in a couple of conversations about the study. Several things came up, words like depressing and frightening, and the common question: Is what I'm doing pointless?  No, it isn't pointless.

The following is an excerpt from the archives of this blog. In it, I describe my own discovery of this "body weight set-point" and I offer my answer to the question: Are we destined to return to a life of morbid obesity?

From The DDWL Archives-April 17th, 2015:

I don't know when it happened. At some point, I believe, I fried the circuits responsible for regulating my body weight. I hit 500 pounds before age 20 and although it took a lot of over-eating, late night fourth (and fifth) meal eating, an occasional binge and zero intentional exercise to accomplish this, I didn't consider the quantity of food at any one setting should have warranted such a morbidly obese body weight.

I remember reading an article when I was twelve years old about the worlds heaviest man. Reading about his typical day of food just wasn't ever me, at twelve--at twenty, or thirty-five. A dozen eggs, a pound of bacon and a loaf of bread for breakfast? In my late teen years, as the scale crept above 500, I'm sure some might have imagined I had similar eating habits, but no, never did. Perhaps I just spread mine out a little more. But here's the kicker:

At a certain point, I stopped gaining. My body settled between 500 and 515 for years on end while I did absolutely nothing to lose weight or maintain the weight. It was as if I found my body's "set point." And it seems this is where my fried body-weight regulating circuits want me to be, naturally.

I have zero doubt, if it wasn't for this turnaround period from relapse/regain over the last year, I would be back between 500 and 515 by now. Not a shred of doubt. I was headed that way in a hurry.

Recently, a medical paper was published in the Journal Lancet Diabetes & Endocrinology. And it was written about in a CBS News Interactive piece by Jessica Firger. Below is an excerpt from the article:

"Although lifestyle modifications may result in lasting weight loss in individuals who are overweight, in those with chronic obesity, body weight seems to become biologically 'stamped in' and defended," Dr. Christopher Ochner, lead author and Assistant Professor of Pediatrics and Psychiatry at the Icahn School of Medicine at Mount Sinai in New York, said in a press statement.

The authors of the paper say we need to change the way we think and talk about obesity, and use language reflective of the fact that being morbidly obese is a chronic disease. Like addictions to drugs and alcohol, patients can overcome it but shouldn't expect to be "cured."

"Few individuals ever truly recover from obesity; rather they suffer from 'obesity in remission,'" Ochner says. "They are biologically very different from individuals of the same age, sex, and body weight who never had obesity."

Those of us with chronic obesity have a body weight that is "stamped in and defended." Sounds very familiar to me. I wasn't surprised when I read the article. Not one bit. I knew about this from living it.

It's incredibly easy for me to regain weight. If I suddenly stopped intentionally exercising and tracking my consumption, even without binge episodes, I truly believe my weight would consistently creep upward. Maybe not as fast as it did in the middle of binge city-relapse/regain, but with the same ultimate destination between 500 and 515 pounds.

So now what?

Are we doomed to gain it all back because that's the curse of chronic obesity?

Is there any hope at all?

First of all, there is hope for long term recovery. I know people who have done it (maintained their weight loss) for ten, twenty and nearly thirty years. It does take work. And no, it's not fair. And that's precisely where our success starts.

Acceptance. If I'm constantly resistant of the elements I must practice each day because it's not fair that so and so can eat a truck full of food and never gain an ounce, then I'm in big trouble.

It is what it is. I've discovered the quicker this acceptance is fully embraced the quicker I can continue enjoying life at a healthy body weight. Something so effortless to some requires daily attention and diligence for someone like me.

They key, I believe, is finding a way--a plan you can truly enjoy. If you read this blog regularly, you see everything I eat. I do not feel deprived in the least. I love what I'm eating. And it's plenty.

I've set the boundaries of my plan and I hold them sacred. I must always hold them sacred. No sugar, daily food tracking and calorie budget management, regular exercise and most importantly, support. Exchanging support with people like me who are in this deal right alongside, is critically important. Writing this daily blog is also a strong source of support and accountability.


Acceptance to me, means these elements of my recovery become more than habit, they become woven into the fabric of my life, for the rest of my life. There isn't a finish line. There isn't a declaration of some big final victory.

I must never try to live someone else's normal. I must live my normal. This is my normal. And you know what? It's all good, even with the set point weight my body tries to gravitate toward if I don't stay on top of it.
----------------------------------

What would happen if we gave our individual plans the same level of reverence as someone in successful recovery from drugs and alcohol gives their sobriety? 

I've been getting the answer to that question for the last two years. When I started applying this importance level was when I consistently starting shedding my one hundred sixty-four pound regain/relapse weight, plus lost an additional twenty-three pounds and today, I continue to maintain a very nice weight range--and I've maintained this healthy weight range for over eight months. It's all documented--every single day, right here in this blog.

And I always keep in mind--I'm not cured and I don't "got this." My continued success isn't guaranteed. If I continue making what I do each day, important, then I have a really good chance at continued weight maintenance.

Another excerpt from very early in the archives is a message of hope to anyone getting started:

I've been doing a bunch of tough thinking lately about why some struggle so hard while others seem to be so solidly on their way. Why some say they �get it,� but continuously give in to the temptation that's trying to take this away.

I think it's actually harder for people who are exceptionally smart.

Let me explain: It's nearly impossible for someone to really learn something if they already believe they know. Especially when the solution has been broken down into very simple terms and easy to understand mental exercises. It can't be that easy, they might think.

And so their search continues---looking for books and articles to break it down into slices that challenge their intelligence. Some people insist on complicating things. It doesn't have to be complicated. It can be easy if you accept that it can.

Once you turn off the excuses. Once you accept 100% responsibility for your behaviors with food. Once you become completely self-honest about your consumption. Once you realize the importance of consistency. Once you stick to a lower level of calories. Once you commit to a real exercise schedule, once you do these things�it's almost impossible not to succeed. And yes, you have to fight. You have to bring out the fight inside and often times battle that little devil on your shoulder. If any of these vital components are not in place, it can seem very difficult.

You must not forget that I'm a food addict. You must realize and remember that I too spent my entire adult life until now, struggling the same way. I was out of control.

So if you read my words these days and think, Oh Sean, you make it sound so easy don't you? Never forget from where I've come. And realize that if I can get to this place, then it's not impossible for you to get here too.

And you don't have to understand everything to get started. I didn't. (I still don't!)

I didn't know or practice anything but the very basics on day one. You might even say I was going through the motions at first. Along the way these simple truths came out about my past failures and all of a sudden things started making sense. I started to have a better understanding of why I always struggled before and why I was struggling less now. Epiphanies started happening, they're all documented...go back and read them.

So if you're trying to get everything in order in a way that makes complete sense before you start succeeding, you're complicating the process. The things that must be rock solid from day one are your commitment to fight. Your resolve must be �iron-clad.� Your desire to succeed must exceed your desire to binge. It's that importance level thing again. Set it dramatically high. And fight for your life. Defend this journey from those evil thoughts within that threaten your success along this road. And find comfort in the fact that you will learn things and have epiphanies along the way that will catapult you onto different levels of understanding. But in the beginning you must fight. It's a fight worth fighting, it really is.
--------------------------
Okay--back to Dr. Halls study and the article from The New York Times. His study's conclusion, compared to my experience, was spot on. Yes, spot on. I believe 100% the body weight set point is scientific fact for many of us.

I also believe, with nothing more than my own experience to back it up, that our metabolisms can actually improve dramatically depending on what we're putting in our body.

My maintenance calorie budget is 2300 per day. This level, at one time, would have resulted in weight gain for me--but instead, it's now keeping me in a very nice range. How is that possible?

Is it the abstinence from refined sugar? Is it the food selection? Is it the water consumption goal each day? Or is it all of the above? I don't know. I've never claimed to have all the answers. But what I do know for sure is, there's hope. There's plenty of reasons to keep taking extraordinary care.

What I didn't like was the hopeless tone of the overall piece.

I was also appalled by the nine hour workout days on The Biggest Loser. My heart broke for fellow Oklahoman Danny Cahill while reading about the workout schedule he so desperately tried to maintain post-show. It was TV, I get it--there was a schedule--a time frame for hitting these milestones--but my question is this:

How did this approach affect each contestant's metabolism and biological makeup? The weight set point is real, sure--but is what we're doing--the method we choose, making dramatic contributions to the complications explored in the study?  

I've always been big on "consistency beats intensity" and "simple is sustainable." I've rarely worked out for longer than an hour in one day. And still, dramatic results happened. The lessons embedded in all of this reminds me of the age old tortoise and hare story.

I'm passionate about sharing my experiences, perspectives and philosophies along this road. First and foremost, it helps me stay accountable and grounded in support. When someone let's me know how it's helped them, too--that's simply one of the most beautiful bonuses.

The sad thing is this: Hundreds of thousands, if not millions, will read the New York Times article about this study, and likely, less than a thousand will read this blog post. Countless people will feel discouraged by the findings and the idea that regain is a biological certainty. By comparison, few will read this blog's real life study of the last seven years. And you know what?

That's okay. 

Because again, my number one concern is my continued recovery and successful maintenance of a healthy body weight. I'll continue doing what I do, regardless. And as time passes, and I maintain the fundamental elements that keep me well each day, it will strengthen my philosophies and understanding of this entire experience.

I'm simply passionate about effectively communicating a message of hope. I hope that comes through loud and clear.
--------------------------------------------------------------

I make my way to the doctor's office in the morning for my maintenance weigh-in. I'll have the complete weigh-in update in tomorrow night's edition.

Today's Live-Tweet Stream:




































Thank you for reading and your continued support,
Strength,
Sean

Princess Health and Prescription drug addiction not only comes at a personal cost to individuals, but also at an enormous cost to employers. Princessiccia

Add Comment
By Melissa Patrick
Kentucky Health News

With nearly one of three opioid prescriptions being abused, employers are not only subsidizing the cost of these drugs, they are also paying for the fallout that results from the abuse, according to a new study.

"The personal impact that opioid painkiller abuse takes on individuals, their friends, and family is absolutely tragic,� Kristin Torres Mowat, senior vice president of health plan and strategic data operations for Castlight Health, the health-information firm that led the study, said in a news release. �This crisis is also having a significant impact on the nation�s employers, both in the form of direct and indirect costs. From higher spending on healthcare, to lost productivity, to the dangers associated with employees abusing medications in the workplace: these are aspects of the crisis that are too often overlooked in the current discussion.�

The study, titled "The Opioid Crisis in America's Workforce," looked at anonymous claims data from nearly a million employer-based health insurance claims between 2011 and 2015, defining abuse as those who received more than a 90-day supply of opioid prescriptions and received prescriptions from four or more providers. It excluded claims that had cancer, palliative care or convalescence care diagnoses.

Graph from "The Opioid Crisis in America's Workforce" report
The study found that 22 of the top 25 cities that abuse opioids are in the rural South. Henderson was the only Kentucky town on this list, as part of the Evansville, Ind., metropolitan area, which had a 7.8 percent opioid abuse rate.

Kentucky ranks fourth in the nation for painkiller prescriptions, at about 130 prescriptions for every 100 people, Christine Vestal reports for Stateline.

So why aren't more Kentucky towns on the list? "Anywhere with a ZIP code is included," Castlight spokeswoman Cynthia Cowen said in an email. "However, in less populated regions, showing the abuse rates may inadvertently lead to patient identification."

The Castlight study also found that on average, 4.5 percent of Americans who get narcotic painkiller prescriptions are abusers, and account for nearly one-third (32 percent) of total opioid prescriptions and 40 percent of opioid prescription spending.

And the cost to employers is huge, estimated at $10 billion annually for absenteeism and poor work productivity, says the report. In 2015, the study found that employers spent nearly twice as much ($19,450) in medical expenses on opioid abusers annually than on non-abusers ($10,853), a difference of $8,597.

The study offered some additional insights, including: baby boomers are nearly four times more likely to abuse opioids than Millennials; poorer people are twice as likely to abuse opioids as rich ones; states with medical marijuana laws have a lower opioid abuse rate than those that don't; patients with a behavioral health diagnosis of any kind are three times more likely to abuse opioids than those without one; and opioid abusers have twice as many pain-related conditions as non-abusers.

The federal Centers for Disease Control and Prevention has called this issue a public-health crisis and has asked doctors to change the way they prescribe opioids, by only prescribing them for three to seven days at the lowest possible effective dose.

According to the CDC, nearly 2 million Americans are abusing prescription opioids, resulting in 16,000 deaths per year. In 2014, the latest data available, 1,087 Kentuckians died of overdoses, according to the Kentucky Office of Drug Control Policy.

The report suggests that employers have a role to play in addressing this through the use of data and analytics to determine prescribing trends that can then help them better understand what their employers needs are as they relate to opioid use and abuse, and then to guide them to appropriate benefit programs to prevent or treat their addictions.

Princess Health and Studies conclude that abstinence pledges do little to cut youth sexual activity, pregnancies, sexually transmitted diseases. Princessiccia

Add Comment
Abstinence pledges�sometimes called purity pledges�don't keep young people from engaging in sex, contracting sexually transmitted diseases or avoiding pregnancy, according to a pair of studies, Denise-Marie Ordway reports for Journalist's Resource. The main problem is that students are not receiving enough sex education. A federal Centers for Disease Control and Prevention report from December 2015 found that "fewer than half of high schools and only a fifth of middle schools teach all 16 topics recommended by CDC as essential components of sexual health education."(CDC graphic)

A 2005 study by Yale and Columbia universities found that 88 percent of youth who take the abstinence pledge engage in pre-marital sex, Ordway writes. "The study found that pledgers were just as likely to get STDs as those who never made a pledge of virginity."

A more recent study, published in April in the Journal of Marriage and Family, found that among students in grades 7 to 12, "as a whole, young women who did not take abstinence pledges and those who did but broke them were equally likely to acquire HPV, a common STD," Ordway writes. "Approximately 27 percent of each group tested positive for HPV. Of the young women who had two or more sex partners, pledge breakers were more likely to have HPV. The difference was largest among women who had between six and 10 sex partners. One-third of women who had not taken a pledge and had six to 10 sex partners tested positive for HPV. Meanwhile, 51 percent of pledgers who had six to 10 sex partners acquired HPV. About 30 percent of pledgers and 18 percent of non-pledgers became pregnant within six years after they began having sexual intercourse outside of marriage."

"In the U.S, the teen pregnancy rate is higher than in any other western industrialized country, according to the CDC," Ordway writes. "At the same time, a growing number of American teens and young adults have been diagnosed with sexually transmitted diseases (STDs). While individuals aged 15 to 24 make up 27 percent of the U.S. population that is sexually active, the CDC estimates that they account for half of the 20 million new infections occurring annually."

Monday, 2 May 2016

Princess Health and May 2nd, 2016 At Ease. Princessiccia

Princess Health and May 2nd, 2016 At Ease. Princessiccia

Add Comment
May 2nd, 2016 At Ease

I took a personal day away from the studio in order to accompany mom to her medical procedure today. She was very nervous, tired and hungry. Still, we found ways to laugh and I think she started to calm down some with a different perspective. The doctor came back with fantastic news--everything was fine! She was so relieved--still tired and hungry, but completely at ease.

Instead of dining out per our original plan, mom allowed me the pleasure of preparing lunch for her while she rested in the easy chair. Mom was excited about the flatbread pizza, saying, "I've seen these on your blog tweets and always wanted to try one." She loved it! And I loved her loving it!

I made my way over to my daughter and son-in-law's new place after my Monday night support group conference call. Everyone was getting together for dinner. It was an opportunity to visit with both of my daughters at the same time (rare) and my little grandson Noah, again!! This is two days in row for visiting with Noah!

My monthly maintenance weigh-in day is coming up on Wednesday morning at the doctor's office. This will be the first monthly weigh-in. I really kind of missed not weighing two weeks ago. But, I think a monthly weigh-in will work better for me. We'll see!

I'm letting the Tweets tell the rest of today's story--

Today's Live-Tweet Stream:






































Thank you for reading and your continued support,
Strength,
Sean
Princess Health and Who Benefits? - Hospital Profits and Quality May Fall, But Hospital Executives' Compensation Keeps Rising. Princessiccia

Princess Health and Who Benefits? - Hospital Profits and Quality May Fall, But Hospital Executives' Compensation Keeps Rising. Princessiccia

Add Comment
Despite recent attempts at health care reform, US health care dysfunction seems to proceed inexorably with ever rising costs, and continuing problems with access and quality.  A likely reason is that those who find the current system personally profitable are in a position to resist real reform.  The people who seem to gain the most from the status quo are top hired executives of big health care organizations.

In particular, stories about huge pay for hospital and hospital system managers continuously appear in the media.  For example, starting in October, 2015, we saw the following headlines:

- Pittsburgh, PA, October, 2015: "Former Highmark CEO Made Nearly $10 Million in 2014, Tax Records Show"
- Regarding Rochester General and Unity health systems in Rochester, NY, November, 2015: "Here's Why Execs Got Millions After Health Merger"
- Regarding the CEO of North Shore-LIJ Health System in NY, November, 2015: "This Guy Makes $10M a Year to Head a Nonprofit"
- In Idaho, February, 2016, "Pay for 9 Treasure Valley Nonprofit Hospital Employees Hits or Tops $1 Million"

Even more interesting are stories that show massive compensation of executives despite their hospitals' apparent poor performance.  Since October, 2015, we also found the following (in chronological order)


Let Go After "Uneven Financial Performance," CEO of Kaleida Health Got $1.6 Million of Severance in One Year, with More to Come

In November, 2015 the Buffalo (NY) New reported that James R Kaskie, the CEO of Kaleida Health, the "largest healthcare provider in Western New York," per its website, was "forced out" when

the board cited a need for a change in leadership amid an uneven financial performance for the system....

Nonetheless,

Kaleida Health paid $1.6 million in 2014 to its former CEO, James R. Kaskie, after forcing him out early last year, according to its most recent federal regulatory filing.

Also,

Kaleida will pay Kaskie 24 months of severance under the terms of Kaskie�s employment contract with the system, John R. Koelmel, chairman of the Kaleida board, told The Buffalo News on Thursday.

Kaskie was paid 10 months of severance plus deferred compensation, which is the $1.6 million reflected in the latest regulatory filing. He will be paid 12 months of severance in 2015 and a final two months of severance in 2016.

Mr Kaskie was paid even better the year before:

Kaskie earned $1.9 million in 2013, his last year as CEO.

Furthermore, other executives who were let go after Mr Kaskie's departure also were very well paid,

Dr. Margaret W. Paroski, former executive vice president and chief medical officer, who was replaced by Lomeo after he took over as CEO last year, $763,552.

Joseph M. Kessler, former executive vice president and chief financial officer, who was replaced by Lomeo, $608,454.
The article explained that

Hospitals, corporations and other entities negotiate severance agreements as part of the employment contracts when they hire top executives
So not only to these executives earn top dollar, but their earnings continue even if they lose their jobs because of poor performance. When asked to explain these levels of remuneration, and contracts that allow executives to get continuing pay even after being "forced out" for "uneven financial performance," John R Koelmel, the chairman of the system's board, said

Companies pay at market. To recruit the best talent, you need to pay at least market.

Public Hospital MetroHealth Medical Center Scored Below Average on Patient Satisfaction and Quality, but CEO Got $1.1 Million

In March, 2016, Cleveland Ohio television station NewsNet5 reported

MetroHealth Medical Center is a public hospital that is supported with $32.4 million of taxpayer money--roughly 5 percent of the hospital's budget.

Also,

a check with a federal database of patient satisfaction levels and quality measures at hospitals across the country found MetroHealth fell below the national average.

Nonetheless, its CEO, Dr Akram Boutos, got $1.1 million in salary, and presumably considerably more in bonuses.

Dr J B Silvers, '"a nationally recognized expert on hospital CEO compensation and professor at Case Western Reserve's business school," who is a MetroHealth board member,

insisted that Dr. Boutros is being fairly compensated when compared to his peers. 

Furthermore,

He admitted the salary is first tied to profits--then a series of other quality measures like patient care, diversity, hospital improvements and employee satisfaction.

But the ties to satisfaction and quality may not bind, because he then tried to explain away the quality and satisfaction data,

Silvers argues those surveys may be misleading.

'Populations like ours, Medicaid populations, uncompensated care--poor people tend to rate organizations lower,' said Silvers.

But then admitted it was really about the money,

'We have to have a target in terms of financial performance because if you don't make the money you can't be in business,' said Silvers.

In Massachusetts, "As Hospital Profits Fall, Executive Pay Soars"

In April, 2016, the Lowell (MA) Sun published a long report on local hospital executive compensation.  It started

It has been a lean couple of years for the region's hospitals.

Drawn by the higher reimbursement rates that insurers pay to academic teaching hospitals, such as those in Boston, more physicians are affiliating themselves with those institutions. Patients are following, and so is the money.

Some community hospitals, including Lowell General Hospital and Emerson Hospital in Concord, saw profit margins drop by more than half from 2012 to 2014.

Other hospitals' financial indicators, like ratios of assets to liabilities, are also weakening,...

However,

As they look to weather those storms and protect their space in a rapidly changing health-care landscape, the boards of directors of the region's hospitals have doubled down on a key investment: their executives.

'Each organization has to make its own decisions about how it can best compete in the marketplace,' said Gary Young, director of Northeastern University's Center for Health Policy and Healthcare Research.

Senior executives of hospitals and health-care systems -- there's a competitive market for that kind of talent ... some would say when organizations run into trouble, they need to spend more to get leaders.'

So,

At Lawrence General Hospital, compensation paid to top non-physician administrators increased 41 percent from 2012 to 2014, according to tax documents. President and CEO Dianne Anderson, who heads the list, was paid a total package of $884,092 in 2014.

Also,

From 2012 to 2014, Lahey Health's non-physician executives saw a compensation increase of 36 percent. A large part of that increase was in the salary of Dr. Howard Grant, who was promoted from president and CEO of Lahey Clinic to president and CEO of the entire Lahey Health system. The system includes facilities throughout northeastern Massachusetts and southern New Hampshire. Grant received $1.7 million in 2014.

In addition,

Lowell General Hospital's executives saw a slightly smaller increase during that three-year span, at 18 percent, although CEO Normand Deschene remains the highest-paid hospital executive in the region with a package worth $1.9 million in 2014. The hospital also pays the taxes on retirement benefits, which are worth hundreds of thousands of dollars, for Deschene and several other executives.

The justifications for these increases in times of financial trouble were similar.  For example, re Lawrence General Hospital,

'Because we're resource-limited, compared to (academic) hospitals, we're even more dependent in these challenging times to bring in somebody who can manage risk,' said Richard Santagati, chairman of Lawrence General's executive compensation committee. 'It takes a different breed and there's real competition for these people ... and once you have them there, you want to keep them because there's a learning curve there that is unique to each hospital.'

Re Lahey Clinic,

'Our executive compensation is comparable to the programs of other, similarly sized health networks and is reflective of the complex role of an executive leader at a leading health system,' Lahey Health said in a statement.

Finally, at Lowell General Hospital, the CEO defended his own pay:

'Lowell General has weathered significant changes in the delivery of health care,' Deschene said. 'At a time when many hospitals have failed, it's very crucial and critical that we have very talented individuals to lead the hospital.' 

The Usual Talking Points Again Invoked

Hospital management used the usual talking points to justify the pay they received,  As I wrote last year 

It seems nearly every attempt made to defend the outsize compensation given hospital and health system executives involves the same arguments, thus suggesting they are talking points, possibly crafted as a public relations ploy. We first listed the talking points here, and then provided additional examples of their use. here, here here, here, here, and here, here and here. 

They are:
- We have to pay competitive rates
- We have to pay enough to retain at least competent executives, given how hard it is to be an executive
- Our executives are not merely competitive, but brilliant (and have to be to do such a difficult job).
So in the stories above, we found, for example:

- Competitive Rates: "you need to pay at least market" (Kaleida), and "there's real competition for these people" (Lawrence General)
- Retention: "you want to keep them" (Lawrence General)
- Brilliance: "the best talent" (Kaleida),  "very talented individuals" (Lowell General)

It appears that those justifying huge executive payments have all been handed these same talking points.

Yet none of them quite make sense.  The brilliance argument is particularly suspect in cases like those above of CEOs whose hospitals' performance was clearly not brilliant according to the metrics supposedly used to judge them. 

Economists Challenge the Management Dogma Justifying Huge Executive Compensation

Furthermore, these talking points seem to derive from decreasingly credible current management dogma about executive compensation propagated by business schools.

The Invisible Hand, or A Hand on the Scales?

For example, writing in the Independent during January, 2016, Ben Chu questioned the market fundamentalist theory that all employees pay has been perfectly chosen by the infallible invisible hand of the market:

When confronted with an outburst of public anger over massive corporate pay for a privileged few, a common response of the libertarian right is to invoke the economics of the free market.

Such spectacular rewards, we�re informed, are delivered by individuals selling their labour in a free market. And because such pay levels were set through this natural process, no one has the moral right to question them. Further, to interfere with such natural processes would be economically inefficient, making us all worse off in the end.

Such contentions are based on

a venerable economic theory [that is] behind this kind of reasoning. At the end of the 19th century, the American economist John Bates Clark hypothesised that in a perfectly competitive economy, demand for labour is determined by its 'marginal productivity' and wage rates are determined by the 'marginal product' of labour.

To translate, if a firm can make a profit by adding another worker to its payroll, it will do so. And the amount a firm will be willing to pay for that labour in wages will be determined by the additional profit the individual worker adds to the company�s bottom line. So if a worker adds a lot of profit, he or she can command a lot of compensation. But if they add only a little profit, he or she will get only a little. This means people with low personal productivity get small amounts. But people with high personal productivity (chief executives for instance) receive big bucks.

For a start, how does a company know what the marginal product of an individual worker is, or will be? This isn�t something that is directly measurable. The vast majority of us work in teams; how is it possible for management to determine our individual contribution to the financial success of that team, or of that team to the company? How can a business know how much of the profit added was due to the individual�s particular skills? The conditions necessary for the Clark theory that everyone gets what they 'deserve' don�t exist.

But isn�t the marginal product of bosses, who make big strategic decisions, easier to measure? The ASI cites the late Steve Jobs of Apple as an employee who was clearly worth a lot. However, there are plenty of other chief executives whose individual contribution is impossible to measure. Yes, the company�s share price might have gone up. But was this because the boss was smart? Or just lucky?

Furthermore,

The economist Dani Rodrik, in his latest book Economics Rules, argues that such broad theories of income distribution by the market are best viewed as intellectual 'scaffolding', adding: 'They are shallow approaches that identify the proximate causes but need to be backed up with considerable detail'.

And there are other theories of wage determination that are likely to be relevant. One important one is bargaining theory. This suggests that those who have political power within a firm can extract more than those without it. Maybe the reason chief executives tend to get paid ever growing multiples of the pay of the average worker is not because they are 'worth it' but because they are powerful. As the economist JK Galbraith put it: 'The salary of the chief executive of a large corporation is not a market award for achievement. It is frequently in the nature of a warm personal gesture by the individual to himself.'

The Dangers of Pay for Performance

In a February, 2016, article in the Harvard Business Review, Cable and Vermeulen challenged the dogma that managers' (and in health care, physicians' and other professionals') pay should largely be based on "performance."

performance-based pay can actually have dangerous outcomes for companies that implement it.

They cited five points based on at least some research evidence to back up their contention.

1. Contingent pay only works for routine tasks. Companies should abolish contingent pay for their top executives because theirs is the least appropriate job for it. Decades of strong evidence make it clear that large performance-related incentives work for routine tasks, but are detrimental when the tasks is not standard and requires creativity.

***

2. Fixating on performance can weaken it. The goal of most executive incentive plans is to focus leaders on hitting goals and achieving outcomes. After all, that�s why it�s often called performance-based pay.' But as researchers have found, if you want great performance, performance is the wrong goal to fixate on.

Several studies have shown that when employees frame their goals around learning (i.e., developing a particular competence; acquiring a new set of skills; mastering a new situation) it improves their performance compared with employees who frame their work around performance outcomes (i.e., hitting results targets; proving competence; seeking favorable judgments from others).

***

3. Intrinsic motivation crowds out extrinsic motivation. When people feel intrinsically motivated, they do things because they inherently want to, for their own satisfaction and sense of achievement. When people are extrinsically motivated, they do things because they will receive bigger rewards. The goal of contingent pay is to increase extrinsic motivation � but intrinsic motivation is fundamental to creativity and innovation.

***

4. Contingent pay leads to cooking the books. When a large proportion of a person�s pay is based on variable financial incentives, those people are more likely to cheat. In academic terms, we would put it this way: extrinsic motivation causes people to distort the truth regarding goal attainment.

When people are largely motivated by the financial rewards for hitting results, it becomes attractive to game the metrics and make it seem as though a payout is due. For example, different studies have shown that paying CEOs based on stock options significantly increases the likelihood of earnings manipulations, shareholder lawsuits, and product safety problems. When people�s remuneration depends strongly on a financial measure, they are going to maximize their performance on that measure; no matter how.

***

 5. All measurement systems are flawed. Incentive plans demand that some metric be used as the trigger for a payout. The problem is that whatever package you construct � bonds, stocks, or bonuses � whatever performance criteria you decide on will be imperfect. For a complex job such as senior management, it is simply not possible to precisely measure someone�s �actual� performance, given that it consists of many different stakeholders� interests, tangible and tacit resources, and short- and long-term effects. Even with HR executives clamoring for enhanced �people analytics� (and technology companies bending over backwards to deliver them) any measure you choose is going to be an inadequate representation of how you would like your CEO to behave.
Note first that these points suggest that the increased use of performance based pay for health care organizations' top managers may explain why many health care organizations actually perform so badly, and point 4 may help explain why pay for performance may actually help increase health care corruption.  

Note further that pay for performance (P4P) for health care professionals has been strongly pushed by many health policy experts, yet all these points also seem applicable to that usage.

Conclusion - Change Will be Resisted

So even when non-profit hospitals and hospital systems perform poorly, their executives continue to receive ever greater remuneration.  The executives, their public relations flacks, and their often compliant boards of trustees continue to cite the same stale talking points to justify their pay.  Yet these talking points are based on market fundamentalist theory and business school dogma whose credibility is increasingly challenged.  In the absence of anyone willing to confront them with these criticisms, the apologists for soaring health care executive pay continue to prattle their tired talking points.    

Meanwhile, as corporate governance expert Robert A G Monks said in a 2014 interview,
Chief executive officers' pay is both the symptom and the disease.

Also,
CEO pay is the thermometer. If you have a situation in which, essentially, people pay themselves without reference to history or the value added or to any objective criteria, you have corroboration of... We haven't fundamentally made progress about management being accountable.


Moreover, top health care executives' power to make warm personal gestures to themselves correlates with the ability to defend this power, per Mr Monks,
People with power are very reluctant to give it up. While all of us recognize the problem, those with the power to change it like things the way they are.
So I expect that many hospital and health system CEOs, like leaders of other big health care organizations, may talk about health care reform, but will avoid talking about, and will likely oppose attempts at real reform using their command of their organizations' marketers, public relations flacks, lobbyists, and lawyers.


We need true health care reform that would enable leadership that understands the health care context, upholds health care professionals' values, and puts patients' and the public's health ahead of extraneous, particularly short-term financial concerns. We need health care governance that holds health care leaders accountable, and ensures their transparency, integrity and honesty.  What we will get is endless resistance to such reform from those who personally profit from the current dysfunctional, and increasingly corrupt system.
Subscribe to: Comments (Atom)