Trust the healthcare marketer who’s been in your shoes

Surveys are one of many means of gathering information from existing and potential customers or patients. While not necessarily as in-depth as focus groups, they can reach a much broader audience and can be far less expensive and time-consuming. And, when done well, they also provide a quantitative look at issues of importance to audiences of interest.

In a 2014 article for The Profitable Practice written by Jamie Smith titled, “How You Can Use Patient Satisfaction Surveys to Improve Performance,” which cites the Medical Group Management Association’s (MGMA) 2013 benchmarking report, Smith writes, “nearly 80 percent of the practices [the MGMA] identified as ‘better-performing’ used patient satisfaction surveys. These high performers were more likely to survey their patients, and to do so more frequently compared to other practices.”

Smith’s article goes on to offer some tips and industry best practices for healthcare surveys that are worth review for any healthcare marketer:

Have the End in Mind

When you set out to compile your survey, you should be thinking in advance of what you hope to get out of your survey. While that may seem obvious, it’s often overlooked. “Many practices survey patients without a clear idea of why they’re collecting feedback and how they plan to use the responses they collect,” Smith says.

Some common areas of focus cited by Smith are:

• Access to care
• Quality of care
• Coordination of care
• Confidence in providers
• Appointment experience

However, healthcare providers obviously shouldn’t feel limited to these areas, and if there are specific areas of concern or emphasis, those should be included as well.

Be Thorough in Getting Your Survey Out

Marketers often have trouble getting a large, representative sample of responses back from surveys, so it’s important to use multiple distribution methods to get as much exposure and responsiveness as possible. Depending on the target audience, your organization may need to spend some time finding the right balance between cost and responsiveness. For example, paper surveys often get higher response rates, but are more costly than online surveys.

Get Straight to the Point

To state the obvious, people are busy. It can be hard to get them to provide useful and sincere answers to a survey if the survey is too long or if the questions require too much introspection and thought. Keep it simple and straightforward and prioritize questions related to your key areas of focus.

Existing Resources

There’s no need to start from scratch when it comes to compiling survey questions. Smith points to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys as the industry standard for measuring patient satisfaction, with the Clinician and Group Provider (CG-CAHPS) survey being the version used to measure perceptions related to care delivered in a clinic setting.

According to Press Ganey, which Smith cites, five questions in particular from the CG-CAHPS are key to evaluating patient satisfaction and loyalty:

1. Confidence in Provider: “Rate your confidence in this care provider.”
2. Coordination of Care: “Rate how well the staff worked together to care for you.”
3. Concern for Worries: “How much concern did the care provider show for your questions or worries?”
4. Listening: “During your most recent visit, did this provider listen carefully to you?”
5. Courtesy: “Rate the friendliness/courtesy of the care provider.”

When conducted properly, patient surveys are a great way to get useful feedback on your organization and make targeted and well-received improvements. By utilizing the tips and strategies above, you can help steer your organization in the right direction when it comes to capturing and capitalizing on patient feedback.

How have you used surveys to effectively attain actionable feedback from key audiences? Share here.

About Us:

Trust…the healthcare marketer who has been in your shoes! Jean Hitchcock has spent more than 25 years at some of the nation’s most respected health systems. As a healthcare marketing and communication leader, she understands your competing priorities. Your strained resources. The pressure to differentiate your services and distinguish your brand. All amid seismic changes in our healthcare system.

Many businesses – hospitals and other healthcare organizations included – see their customer or patient relationships as the most valuable relationships in the organization. Understandably. These groups provide the revenue that keeps the organization going. But there are other key relationships business leaders need to pay close attention to and cultivate as well: employees, investors—and vendors! Yes, vendors, while a source of expense, also have a key impact on your hospital and your ability to meet patient needs and delivery quality care.

Here are some tips for improving your crucial vendor relationships.

Make an Effort

This may sound obvious, but many organizations simply don’t take the time to get to know their vendors on a personal level. As Bob Ronan writes for CIO.com, “taking the time to meet socially with vendors will help you build relationships that will make your work interactions better.” Obviously, it’s not easy to connect on a personal level with a revolving door of dozens or more vendors as you’re continually shopping for the best deal or leveraging one vendor against another. That’s why Ronan also recommends keeping your vendor list to a minimum when practical. “It is hard to have ‘special’ relationships if you have many vendors providing similar services,” he says. “Smaller numbers allow you to spend more money with each vendor and build strong relationships which will result in better service.”

Mutual Respect Builds Mutual Trust

It’s rare to have a completely conflict free vendor-purchaser relationship. Sometimes vendors underperform, under-deliver or just fail to meet expectations. Sometimes purchasers pay late, refuse to pay at all or are just overly demanding and difficult. While these situations can damage and even ruin a vendor relationship, they can also be opportunities to strengthen that relationship if they are resolved effectively. Often an executive level discussion can smooth things over and build familiarity with senior levels of the organizations. The key is to focus on being understanding and respectful.

Common Goals and Teamwork

Jarie Bolander writing for The Daily MBA points out that, “a mutually beneficial relationship requires both parties to understand what each one brings to the partnership. Having a keen insight into why a particular vendor or supplier wants your businesses will make the deal easier to do.” Similarly, Ronan says, “it is worth the time to customize a presentation [to your vendors about your business goals and specific needs]. Talk about the problems you have that you don’t know how you are going to solve. You may be surprised at the result.”

Vendors are just one of the many stakeholder relationships a healthcare organization needs to manage, and while the relationships you have with patients and employees may take center stage, don’t underestimate the importance and potential benefits of a strong vendor relationship.

Have you found ways to strengthen relationships with your vendors? Share here!
About Us:

Trust…the healthcare marketer who has been in your shoes! Jean Hitchcock has spent more than 25 years at some of the nation’s most respected health systems. As a healthcare marketing and communication leader, she understands your competing priorities. Your strained resources. The pressure to differentiate your services and distinguish your brand. All amid seismic changes in our healthcare system.

Burnout. It’s a word that people might use to describe how they’re feeling about their jobs. It doesn’t matter the industry, these days, people are working longer hours for not as much compensation as in the past. The expectations of them to be engaged and connected also are on the rise. Some of this expectation stems from smartphones and the constant ability to always be connected. This leaves employees feeling stressed, overwhelmed, and burnt out.

This is especially true in healthcare. With mergers and consolidations; constant updates in healthcare policies; the impact and expectations tied to ACA, ACOs, HCAHPS and a wide range of other alphabet soup type requirements; rapidly changing technology that offers both opportunities and challenges; battling insurance companies; and new treatments to keep on top of (just to name a few!), it’s no wonder that health professionals at all levels are experiencing burnout.

As health leaders, it’s our job to figure out how to prevent this stress and burnout in our teams. After all, if our physicians, nurses, specialists, and professional staff are burning out, how can we possibly deliver quality care to our patients?

Tamara Rosin discusses how health leaders can take better care of their employees in her Becker’s Hospital Review article “5 ways leaders can help their teams manage stress and burnout.”

1. “Demonstrate and promote well-being practices.” The age-old saying “lead by example,” is very true when trying to promote wellness. If your team can see you taking steps to manage your stress and health, then they will likely look to you as an example to manage their own. Encourage employees to go to a gym or go for a walk on their lunch breaks to help relieve tension. Holding a yoga session in the morning and at night (for different shifts!) can help with relaxation. The possibilities are endless — find a way to motivate your employees to destress!
2. “Encourage workers to disconnect outside of work.” In the age of smartphones and 24-hour access to work emails, it’s important to reinforce the idea of work-life balance. Especially if your team members are working long shifts, urge them to disconnect and rest when they get home from work. Allowing them to spend uninterrupted time with their families, or a hobby, will allow them to destress and come back to work the next day feeling recharged.
3. “Train the brain to manage chaos.” Rosin writes that being mindful of our actions is important in managing stress. If a situation arises that is stressful or overwhelming, encourage employees to take a moment to understand why the moment is frustrating. By knowing the emotion behind it, this allows employees to control their stress, instead of letting it control them.
4. “Debunk the myth of multitasking.” Yes, multitasking as a productivity-booster is a myth. Not only does multitasking contribute to stress and feeling overwhelmed, but it also means the two (or more!) tasks you’re attempting to do at the same time aren’t likely being done correctly. Encourage your staff to take on one task at a time, then have them pause and take a deep breath before moving on to the next task—or patient.
5. “Show empathy and compassion.” Last, but not least, employees need to feel comfortable when confiding in their supervisors if they’re struggling with stress. Don’t tell them to “suck it up,” and don’t tell them to “get over it.” Be there to listen to them, and work with your employees to come up with solutions to combat their stress. You’re all part of the same team, working to a common goal of exceptional patient care — let them know you’re there to help!

Using some (or all) of these tips is crucial for avoiding burnout and having happy, mentally healthy employees. What are you doing to make sure your employees stay healthy and stress-free? Leave your ideas in the comments.

I have spent my entire career, 25+ years in healthcare. At first, I was shocked and then amused by the way healthcare professionals designed healthcare operations, programs and processes. Toward the end of my career, I used to introduce myself at meetings as the “voice of the patient” because everyone else was only thinking from the provider’s point of view.

I took on this role – voice of the patient- for personal reasons. Back in 1988, my youngest brother was a crime victim, and our family was dropped into the world of trauma medicine and then rehab. The circumstances aged my parents by ten years, but made me a devout patient advocate. No one expected my brother to live and the care and attention reflected that assumption. The family was faced with making life and death decisions and getting information or access to my brother’s physicians was difficult. So I took on the role of finding the information we needed, the physicians who were most knowledgeable and eventually coordinating my brother’s care between Florida and Michigan. Right after that, I took my first job in healthcare as Director of Communications for the largest health system in my area.

This job had me front and center on all crisis and patient relations. I worked with hundreds of families who just wanted to be informed of what was happening to their loved ones or share how we fell short of their expectations while hospitalized. This was my hometown and these patients were people I knew. They were going to be heard.

25 years later and I Fast-forward and I have a career in healthcare marketing and communications for a number of outstanding health systems. In marketing, you need to be in sync with your customers, not go out of your way to upset them!

At most of my employers, we used a Ready to Go to Market scale to allocate marketing dollars. If we knew a particular service wanted to be marketed, we would schedule Secret Shopping of the service. We asked the Secret Shopping firm to replicate the patient pathway and tell us how well or poorly we did in terms of a patient experience. Once we had the report, we would work with operations and the clinical staff on improvements needed. THERE IS NOTHING WORSE THAN PATIENTS HAVING A BAD EXPERIENCE THAT YOU COULD HAVE CHANGED!

Vanity numbers like 1-800 Ortho are cute and may speak to the egocentric nature of the clinicians but most consumers will use the main number. So many vanity numbers make it difficult for your call center and therefore the patient phone experience can be jeopardized.

Everyone wants their own website because they think this will make them standout. But for the average patient, they will go to the main website and then search for you. The worse patient experience is multiple websites and phone numbers. In this scenario, providers are assuming:

• Everyone knows the hospital’s names yet only 10% or our lives are spent in them
• That the system brand is not diminished when in fact it is.
• And if they have a physician’s name, they may not have the hospital so they end us using a service line Healthgrades.

Multiple website work against your brand and business development.!

My Secret Shopping programs gave us real time feedback on how we were doing with patients. And very often, we had actually designed the problems!

How many of us have gone to a health system website to find hours and parking information and have to wade through all the accolades and awards won by the system? Or the systems that have different websites for each facility; a patient would have to piece all of them together to understand all that a system provided. And while it is nice to know which medical school a physician attended (didn’t they all attend a medical school?) by reading their profile, it is more important to know the hours his/her practice is open, if they speak other languages and have extended hours. This is the type of outside/in thinking that needs to come to healthcare.

And then, the patient finally gets to the provider and the experience is less than satisfactory. Very well meaning healthcare professionals have designed patient pathways that:

• Had women who needed breast biopsies walking down a hallway, in a hospital gown, with a needle in their breast covered by a Styrofoam cup.
• Sent surgical patients home without any pain medications because they were discharged after the outpatient pharmacy was closed.
• Asked patients not to eat or drink anything after midnight because of an upcoming blood test. When ALL the patients show up at 7 am….wouldn’t you…does the lab staff up? Of course, not that would mean the staffing was not standardized across all shifts.

But these patients were the lucky ones! They made it into the healthcare system.

So what are consumers going to do? They are going to access healthcare by using non-traditional methods to get the care they need. The funny thing is that non-traditional becomes the norm once the general public embraces the new product or process.

Concierge Medical Practices

Access is such a patient issue that concierge medical practices are at an all time high. In some markets, as many as 30% of all primary care doctors in the District of Columbia environs work in concierge practices.

“……….a survey of more than 20,000 physicians by Merritt Hawkins on behalf of The Physicians Foundation found that more than 20 percent of physicians today say they’re either currently practicing concierge medicine or plan to do so in the future.” [2]

More and more patients are willing to pay out of pocket to have access to physicians 24/7, 365 days a year. They have given up on the traditional healthcare processes of waiting weeks for a primary care appointment and months for a specialty care appointment.

Patients can have their medical records from any provider sent to their concierge physician thereby creating their medical home. And guess what? Millennial patients are not looking to health systems to be their medical home; they are going to build these homes based on access, service and value. And that home will reside in their smart phones or tablets.

I am one of those who went to the concierge medicine. I want the same ease of use that I have for my dentist, bank and vet. I am so pleased with the services, that I often recommend concierge medicine to friends. I am with my physician at least 90 minutes for my annual appointment. In the traditional health system model, a physician would have scheduled three to six patients in the same time frame.

Non-traditional Providers Becoming Mainstream

Healthcare providers, read the tea leaves!

• Walmart Announces Ambitious Goal: ‘To Be The Number One Healthcare Provider In The Industry’, Forbes 2014

• Zoc Doc, Online scheduling App– About Us: ZocDoc is the beginning of a better healthcare experience for millions of patients every month. Since 2007, we’ve worked to fix broken systems that get in the way of good care by uniting modern patients and doctors. [3] They will be going public soon.

• Digital monitoring of health– According to the global market research firm Parks Associates, the fitness tracker market is set to nearly triple, reaching
$5.4 billion by 2019. These digital health devices are becoming a part of our socio-cultural fabric; mobile fitness trackers and connected clinical devices will be as common.

I recently wrote a blog about how the Patient Is Not Very Patient and if we do not meet their expectations, they will become impatient and go to another provider.

So, if you are in healthcare operations, keep the voice of the patient in your head at all times. Design clinical treatments with the patient at the center of the discussion and remember, they can’t use the treatment if they can’t get access. And don’t wonder when non-traditional new competitors come into your market; you may have inadvertently invited them in.

[2]

[3] ZocDoc Website

One of the biggest changes a hospital or health system can go through is a consolidation, or merger. From trying to determine how the newly-merged hospitals will be branded, trying to convey that branding to all staff and providers, preserving jobs, and more, the pain and stress of a consolidation is unfortunately felt by all within an organization.

With 2016 upon us, many wish for what will probably not happen in the world of healthcare for a while — they wish for a stable industry. The constant advances and changes in medicine in order to help patients is one thing. The tumultuous nature of mergers and consolidations is completely different. According to John Commins’ HealthLeaders Media article “Hospital Consolidation 2016 Forecast: ‘More of the Same,’” the hope for calmer waters in healthcare isn’t likely to be realized in 2016.

Commins and HealthLeaders Media connected with Kit Kamholz, the managing director with Skokie, Illinois-based Kaufman Hall. According to Kamholz, the rate of consolidations won’t necessarily increase; however, there won’t be a decrease in mergers, either. Kamholz also notes that the hospitals most likely to face consolidation this year, and for years ahead, are smaller hospitals in smaller communities.

Not all community or rural hospitals will face consolidation, of course. For those that will, however, communication is key. Healthcare leaders, aided by communication professionals, can control the messaging surrounding a merger by keeping channels of communication open. Transparency is critical; so is the opportunity for two-way communication. Employees, and other key stakeholders (e.g. patients, community) need to have an opportunity to ask questions and get answers during what can be a very trying time.

Healthcare leaders need to communicate with providers and nurses to address their concerns—and to arm them with information that they can use to answer any questions or concerns patients may have about their care. Likewise, in order to keep talented staff and providers united and committed to staying with your organization, leaders need to listen to their ideas and concerns, and openly discuss new developments in a possible or impending consolidation.

Hiding information will only create distrust within your hospital, and in the community you’re working hard to keep healthy. If you don’t have the support of your team and your community, the outcome of a merger is unlikely to serve anyone’s needs.

Consolidations have become part of the healthcare world, and they aren’t going away. What are you doing to prepare your staff and community for a possible merger? For those of you who have already been involved in a merger, or consolidation, what did you do to ensure a smooth transition? Share here!

The healthcare industry is always in flux. Whether it’s new medicine being tested, new legislation being passed, or health-technology companies entering the industry, the only reliable element of the healthcare industry is change—constant change. The hospitals and health systems that survive these changes are the ones that have a leadership team of great communicators who are ready to adapt to it.

Maureen Bisognano, who is retiring from the Institute for Healthcare Improvement (IHI), where she worked for 20 years. She recently offered hospital leaders five lessons that Marty Stempniak reiterates in his article, “Hospital Leaders Must Adapt to New Roles; Rewrite Rules for Improvement, Says Retiring IHI Chief.” These five lessons are designed to help leaders change their own habits, in order to prepare for bigger changes down the road.

1. Change how you improve your hospital. Often times the same people are the ones involved in any healthcare change discussions. While there’s nothing wrong with this, these voices don’t represent everyone. In order for change to work, people at all levels (from patients, to employees, to board members) should be heard. Holding an open forum for patients, talking with employees of various departments, and administering surveys to patients and staff are good ways of receiving feedback and taking them into consideration when changes are being made.
2. Change the way you listen to patients. “Begin actually listening to the voice of the patient and wondering ‘What matters to you?’ rather than just ‘What’s the matter?’” writes Stempniak. In order to give patients the best possible care, hospital staff need to learn who the patient is as a whole, and not just pay attention to the parts of them that are unwell. By placing patients back at the forefront of care, this will restore a patient’s trust in your health system.
3. Change how you “teach, learn, and see.” Bisognano believed that in order for good caretakers and providers to become great, they need to be willing to try new things and assume new roles. “Clinicians need to move from being the writers of prescriptions and diagnoses to being guides who shepherd patients through the system,” Bisognano said in her final IHI forum. In other words, physicians need to see the importance of the many parts of healthcare, not just treatment. Encouraging providers to be flexible with how they view patient care will also help them be flexible in times of change.
4. Change how our health systems care about patients. Stempniak and Bisognano encourage leaders and providers to work together to determine how they can stay ahead of a patient’s needs. In other words, they need to figure out how to make their systems more proactive in meeting patient needs. This might mean posting weekly YouTube videos about different health issues facing the community, or a blog with featured posts from physicians and specialists. Having resources at a patient’s fingertips and communicating with them in an ongoing, and easily accessible, manner will make it easier for them to trust your organization when changes occur.
5. Change the way we see leadership. Many workplace issues require more than a simple fix. While patients are at the forefront of healthcare, a hospital’s employees aren’t far behind. Heathcare leaders need to recognize when something in their organization isn’t working. Then they need to seek feedback from others about the situation, devise the best apparent solution, and then revise if necessary. Seeing a problem as a process, and not a quick fix, is important for finding the right solution.

Being able to adjust your leadership style to better position you and your health system for change is important. What have you done to prepare your hospital for change? Leave your thoughts in the comments!

I have a very witty friend who is an excellent writer. Once when we were working together, he took a memo from the CEO and literally wrote between the lines. The result was hilarious and the real message the CEO was attempting to communicate. So often corporate communications can morph into a politically correct and not very informative effort. Organizations cannot be fooled; employees are not stupid.

From that moment on, I could not read any memo that started out by saying “it is with mixed emotions”, without getting a grin on my face. So to provide some additional joy during this festive time of the year, I am going to take my top ten favorite comments and provide you with what is between the lines.

1. New project: “But we have never done this before!”
• I am overwhelmed and can’t learn another new thing.
• We have too many changes to deal with right now. Can’t we keep this the same?”
• This is over my head; I am concerned.

2. Market Research Results: “I have a question about the methodology.”
• These are not good results so I will attack the methodology or the presenter.
• I have no idea why these results are bad. It can’t be us.

3. Anything new: “My colleague tried this at his practice and it won’t work.”
• I will bring in a third party to support my position.
• I don’t want to do this but I don’t want to look like I am not on the team.

4. Decision-making: “We need to check with all the stakeholders before we can approve moving forward.”
• Maybe I can slow this down by insisting on consensus.
• Maybe I can water this down so I am not impacted too much.
• By reaching consensus, we will get the least offensive and least effective change.
 

5. Communications Role: “I am managing this department, no one told me I had to communicate all this stuff to staff!”
• I was promoted because I was good at my job. No one trained me on how to be a communicator.
• Communication is hard because I know the staff are savvy.
• I am not comfortable in the communication role of management.

6. Website: “Why can’t our website be like Amazon’s?”
• If I can set unrealistic expectations, I may get what I want via compromise.
• I have never spent much time learning about websites, but I can navigate Amazon.
• I really don’t know what I am talking about I just want to sound like I do.

7. Patient Portals: “Patients can’t have access to their data before we have signed off on it. What if it is wrong?”
• If I have to do this, I will have to get to my patient records faster than I am now.
• Patients aren’t smart enough to have their own data.
• I want to be in control of the patient, not them.

8. Inability to Change: “But we have always done it this way?”
• This is the sister of “But we have never done this before?”
• This company keeps asking me to constantly change. I want to know why we need to this, now!

9. Pure Arrogance: “Here, I am a surgeon, let me tell you how to ________(fill in the blank).”
• I am the smartest person in the room so I should have a say about everything.
• There is no other meaning, just arrogance.

10. Cluelessness: “Patients don’t look at those rating systems.”
• I didn’t know about these rating systems.
• My patients would never rate me poorly. They love me.
• My ratings must be about my office staff, not me.
• Patients don’t believe those ratings.

Lastly,

“It is with mixed emotions…….There are no mixed emotions. The organization wants to appear considerate and respectful. What choices do leaders have? Perhaps:
• They wanted that person to leave,
• The person was unhappy and the organization could not meet their needs
• Given all the change in the organization, perhaps this is an opportunity for the organization to bring in new leadership.
Corporate communications are absolutely essential, particularly during times of change. If you are the point person for Corp Comm, remember to respect your audience and really understand their reaction to your communications.

In my work, I have the opportunity to work with many healthcare systems. In the last few weeks, I have had three experiences that have made me think I was dreaming, healthcare dreaming.

I was at The Annual Healthcare Marketing and Physicians Summit and heard a presentation by Penn Medicine on their integrated call center. Suzanne Sawyer, CMO and her team have done a wonderful job of integrating all their customer channels. By doing so, she has trend information on patient activity, access and a handle on all her marketing efforts.  In my mind, she is on her way to marketing integration heaven!

Recently, I interviewed the CEO of the top health system in the Miami/Dade County area. He spoke quite eloquently about the need for communication during this time of tremendous change in healthcare. He insists that the head of Marketing and Communications report to him and is the message gatekeeper for the system.  He gets it!  He knows that in order to be successful in the future, his system needs to be clear on messaging so they remain the preferred system in the area. His support of social media was so refreshing and this from a man who described himself as a dinosaur with digital anything. I beg to differ.

Lastly, for six months I served as  the interim CMO for a wonderful system in Virginia. They had been without leadership in marketing and communications for some time and were concerned about messaging during this time of change. What I discovered was a leadership team with great vision, openness and heart. Yes, heart. I had begun to think that given all the pressure in healthcare that leadership teams were becoming toxic groups.This system proved that leadership based on integrity and openness can be your greatest asset.

I asked if this was real healthcare and the answer is……it can be. Times of great change are also times of great opportunities. Create the integrated call center that you need despite your organizational challenges. Embrace communications as a core competency for everyone in management. And lastly, values and integrity may be your greatest assets for success in the future. These three organizations are living my healthcare dream.

At this time of the year, the annual CEO message appears in employee emails,  especially healthcare. It is a time of reflection, anticipation and hopefully, hope!

The roller coaster of healthcare rolls along like Mr. Toad’s wild ride. No one really knows what is around the corner. So why are people drawn to healthcare?  Why do people relish the 24/7 pressure, the life dramas and the constant unknowns.

Most people who spend their careers in healthcare speak to the lifelong learning, the fact that lives are saved, rehabilitated or a quality of life is given to those who seek care. It is a calling that compels people to come back, the next day and the next, despite the intense culture of healthcare.

But every rubber band has a breaking point. At what point do we say this system needs to be fixed in a fundamental way. The Affordable Care Act was about access and the wisdom of that legislation will be debated for years.

But when will we look at the use of resources. The role of insurers, pharmaceutical and device companies is never part of the national discussion. Stronger lobbyists?  No healthcare system in America is making double digits profits; these companies are. How much cutting can we do on the clinical side? The provider side is not asked to reduce expenses and in fact, works at odds with that initiative.

I hope in 2015 there is a comprehensive discussion about healthcare with all the players in the room. My suggestion would be to have a patient sit at the head of the table and I believe the conversations would change and the outcomes would be better.

Enough of my introspection and I hope you have a wonderful 2015. Happy New Year!