Tuesday, December 12, 2017
Article 115. Focusing on Reduction of Medicaid Health Care Costs
Focusing on Reduction of Medicaid Health Care Costs
The reduction of State Medicaid health care costs is only a fraction of the total Medicaid costs. Total Medicaid costs for Missouri $9.9 billion of this the conversion of General Hospitals from low patient volume to high patient volume specialized clinics is expected to save only $1billion.
The Medicaid savings is contingent on:
1. The state if not owning the new Clinics must at least manage the clinics.
2. All Medicaid Patients will be required to use the Clinics except in rural areas.
3. Clinics must be located in populated areas to maintain sustained patient volume.
4. Medicaid and Medicare Patients may use the Clinics to get the Patient Volume needed.
I have suggested that the State start with just one General Hospital in a metro area. This is a good way to prove the process but I now want to introduce a second alternative which doubles up on the development of Daily Plans and the necessary facility reorganization. This is done to shorten the time for the State to start gathering savings.
When observing a metro area for implementation of this approach I would look at three or four General Hospitals all centrally located near where most Medicaid patients live. The Idea is to have a plan for converting these hospitals into specialized Clinics.
The Plan:
1. Implement Continuous Improvement Teams in each General Hospital this will take a month before the teams understand the process. The CI Teams are required to aid in designing the Daily Plans while working with the Consultant. The State will provide nursing students to work with the consultant and be trained by him to continue the implementation in other metro areas. The students will act as Facilitators when installing the CI Teams and follow the development of the Daily Plans and the facility reorganization.
2. One year of data will be collected from each hospital showing all procedures done at the hospital. The number of routine procedures done at each hospital will be used to determine where to best locate the routine Clinics. The assumption is that a combination of in-patient and out-patient procedures will be done in each of the selected hospitals.
3. The Consultant and the CI Team (along with trainees) will develop the Daily Plan for each of the routine areas.
4. The Consultant will have the hospital facility plans for each hospital sent to his office. By placing the Daily plans as they are completed over possible hospital locations the process will help to keep the cost of reorganization down with as few changes as possible. At this point an Architect engaged by the state will complete the reorganization construction plan (adding rooms and extra surgery facilities).
5. Three or four completely independent Clinics will be located in each of the original hospitals. Each Clinic will have its own waiting room and other facilities.
6. Procedures such as Cataract Surgery will need to be done in an Eye Clinic. A birthing hospital is not included in the Clinic concept because the patients are not free to chose when the Procedure is to be done. However there is much savings to gained by designing a separate Birthing hospital.
7. After the Daily Plans have been completed and trainees are available hospital facilities in other metro areas may be reviewed and reorganization plans made.
This approach will speedup the process for implementing the new Clinics in the entire State. When the Federal Government recognizes the savings involved nearly all hospitals will be converted to the new Clinic plan. The change will also be demanded by Health Insurance Companies.
Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com
Thursday, November 30, 2017
Article114. Designing Daily Plans & Hospital Reorganization
Designing Daily Plans & Hospital Reorganization
How to get started Designing Daily Plans and Hospital reorganizations. This is a quick look at the decisions to be made and how they can be implemented.
Selecting the Routine Procedure to Start With
1. In Article 113. I have listed 15 possible Procedures that appear to fit the category of being routine and relatively safe. I would select an outpatient Procedure first because it is less expensive when the its time to reorganize the hospital facility.
2. The Enterprise Lean Team (aka Continuous Improvement Team) must be in place and a part of the Procedure team selected and meet at least once a week. More meetings will be required as the design of the Daily Plan progresses.
3. Introduce the Lean Team (CI Team) to the concept of the Daily Plan and the reorganization of facilities to support the Daily Plan. Objective to change a low patient volume/high cost Procedure into a high patient volume / low cost Procedure.
4. The selected Procedure is an entirely separate Procedure from all other Procedures in a hospital environment completely staffed with its own facilities. The reason for not having shared facilities is that the Scheduling would destroy the balanced operations of the selected Procedure.
5. The most basic element driving the design is Patient volume. An entire metropolitan area may be available for certain procedures due to the low cost of the Procedure. This will drive the design of the daily plan to handle more volume and will also increase the facilities required. Early on a Patient Volume survey should be conducted for each of the procedures in the metro area identifying overall patient volume and those expected to use the new facility.
For lower patient volume two Completely separate Procedures may be designed using the same facility. The staff would be trained to do two separate Procedures with two separate Daily Plans alternating between them to keep patient volume stable.
What’s needed to build a Daily Plan?
1. Precise times for all the processes done must be known. To these times a increase of 25% is added as a protection from unintended delays. Remember the objective is to work smarter not harder savings come from the continuous operation of the process not from the speed of the process.
2. First take the time of the doctor or surgeons process as a base time identifying how many patient operations can be done in one day. Then identify all processes leading up to the surgery and those following the surgery. For example if a nurse requires twice as much time as the surgery process then two nurses will be required each preparing a different patient in a different room (two Rooms Required). The resulting Daily Plan will balance all the processes allowing no one to wait on another employee.
Patient backlog means that the staff does not wait on patients. If work times can not be balanced then the extra time a staff person has can be designated as “Preparation Time”.
3. With a sufficient backlog of patients the Daily Plan becomes a smooth running operation virtually eliminating Management intervention for budgeting and Scheduling. Supplies are ordered automatically.
Hospital Reorganization
1. If a general hospital is to be reorganized planning for Hospital reorganization should not be under taken until all the Procedures using the hospital facility are known and least most of them have their Daily Plans completed.
2. If several Procedures are using the same hospital facility then the hospital reorganization will encompass all of the Procedures supporting their Daily plans.
3. If the Procedures can be separated into separate clinic facilities then the reorganization process becomes much simpler. Ref: Cataract Surgery Clinic proposed in Article 110 and Article 111. Designing a High Patient Volume Low Cost Hospital.
Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com
How to get started Designing Daily Plans and Hospital reorganizations. This is a quick look at the decisions to be made and how they can be implemented.
Selecting the Routine Procedure to Start With
1. In Article 113. I have listed 15 possible Procedures that appear to fit the category of being routine and relatively safe. I would select an outpatient Procedure first because it is less expensive when the its time to reorganize the hospital facility.
2. The Enterprise Lean Team (aka Continuous Improvement Team) must be in place and a part of the Procedure team selected and meet at least once a week. More meetings will be required as the design of the Daily Plan progresses.
3. Introduce the Lean Team (CI Team) to the concept of the Daily Plan and the reorganization of facilities to support the Daily Plan. Objective to change a low patient volume/high cost Procedure into a high patient volume / low cost Procedure.
4. The selected Procedure is an entirely separate Procedure from all other Procedures in a hospital environment completely staffed with its own facilities. The reason for not having shared facilities is that the Scheduling would destroy the balanced operations of the selected Procedure.
5. The most basic element driving the design is Patient volume. An entire metropolitan area may be available for certain procedures due to the low cost of the Procedure. This will drive the design of the daily plan to handle more volume and will also increase the facilities required. Early on a Patient Volume survey should be conducted for each of the procedures in the metro area identifying overall patient volume and those expected to use the new facility.
For lower patient volume two Completely separate Procedures may be designed using the same facility. The staff would be trained to do two separate Procedures with two separate Daily Plans alternating between them to keep patient volume stable.
What’s needed to build a Daily Plan?
1. Precise times for all the processes done must be known. To these times a increase of 25% is added as a protection from unintended delays. Remember the objective is to work smarter not harder savings come from the continuous operation of the process not from the speed of the process.
2. First take the time of the doctor or surgeons process as a base time identifying how many patient operations can be done in one day. Then identify all processes leading up to the surgery and those following the surgery. For example if a nurse requires twice as much time as the surgery process then two nurses will be required each preparing a different patient in a different room (two Rooms Required). The resulting Daily Plan will balance all the processes allowing no one to wait on another employee.
Patient backlog means that the staff does not wait on patients. If work times can not be balanced then the extra time a staff person has can be designated as “Preparation Time”.
3. With a sufficient backlog of patients the Daily Plan becomes a smooth running operation virtually eliminating Management intervention for budgeting and Scheduling. Supplies are ordered automatically.
Hospital Reorganization
1. If a general hospital is to be reorganized planning for Hospital reorganization should not be under taken until all the Procedures using the hospital facility are known and least most of them have their Daily Plans completed.
2. If several Procedures are using the same hospital facility then the hospital reorganization will encompass all of the Procedures supporting their Daily plans.
3. If the Procedures can be separated into separate clinic facilities then the reorganization process becomes much simpler. Ref: Cataract Surgery Clinic proposed in Article 110 and Article 111. Designing a High Patient Volume Low Cost Hospital.
Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com
Friday, November 24, 2017
Article 113. Five Year Plan for Missouri Health Care System
Five Year Plan for Missouri Health Care System (MHCS)
Developed by Lawrence Rosier Consulting on November 27, 2017. Ref: LawrenceRosierConsulting Blog Articles 112, 111, 109, 107.
This plan embodies far reaching strategic thinking that overturns false ideas about Health Care and reduces the cost of Health Care in Missouri significantly. Because of the movement from Private for-profit Health care system to not for-profit Missouri government managed hospitals a five year adjustment period is needed. This is an important backup plan that brings Missouri into solvency in health care regardless of what the Federal Government does in a National Health Care plan.
Facts about the current health care system, it is a growth industry that appears to have no limits in cost projections. US Private health care costs double that of European government based health care, neither have the efficient approach embodied in this Plan. Converting from a Private profit based to a not for-profit or government based health care system is expected to reduce Health care costs by 50% due to the reduction in fraud and other efficiency reasons but with increased efficiency I have estimated a conservative 60% reduction in overall health care costs in the new high volume/low cost specialized health care system.
Medicaid
Medicaid costs in Missouri is 9.9 $billion. Only about 10% or $1billion of this cost can be reduced by the efficiency in hospital operations presented in this Plan. Much of Medicaid costs are in long term care where some efficiencies may be implemented by Lean Teams.
Medicare
Medicare however presents a much different view because funding by the Federal Government would go directly to the state of Missouri providing the funding needed to convert private hospitals acquired by the State in its conversion to the Missouri Health Care System (MHCS). An agreement with the Federal government to pay the full amount of Medicare costs to the State until the new efficient system can be developed may be required or the Federal Government might chose funding Missouri’s MHCS. Ref: the example Cataract Surgery Clinic with a 90% decrease in costs at LawrenceRosierConsulting Blog Articles 110,109.
Missouri’s Health Care System (MHCS) Open to all Missourians
As the system grows in the last years of this plan the Missouri Health Care System would be available to all Missourians, open to those with or without insurance. MHCS expected costs to be 20% to 50% less than Private Hospitals. Insurance companies may provide incentives for those insured to use the new system.
Starting the Reorganization
A not for-profit General hospital is selected in a large city. General Hospitals do nearly all procedures therefore they are low volume/high cost facilities. Nearly all routine procedures are removed and reorganized into high patient volume/low cost specialized Clinics. The General Hospital now serves vital care and emergency trauma care patients. How the specialized clinics use the old General hospital space will require a good deal of planning. But the in-patient special clinic patients will require hospital bed space and will most likely remain in the General Hospital facilities while out-patient procedures will be in new individualized Clinics.
List of implementation events for the Missouri State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid patient area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
Lean Teams may require help in designing Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid and $6 billion in Medicare & Regular health care costs for the State.
8. States may also agree to share Daily Plans & facility designs.
Overview of the Missouri Health Care System (MHCS) Plan
Stage 1. The Startup Stage Beginning January 2018
The State Government may acquire General Hospitals under financial stress at little to no cost or enter into an agreement with a private not for-profit hospitals. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired in St Louis, Kansas City and Springfield in stage 1. As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Stage 2. Medicaid and Medicare Patients continued move to new system
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
Stage 3. Accommodation of Patients without Health Care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the new facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the MHCS.
Stage 4. The MHCS will be Available to all Missourians
The expanded MHCS will be available to all Missourians. Health Insurance Companies will gradually require that patients move to the less expensive MHCS. Private Hospitals will still be available for those who want them.
The MHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 to 50 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Criteria for the Selection of Routine Procedures:
Routine Outpatient and Inpatient Procedures
Outpatient Testing and Procedures
1. Radiology/Diagnostic Imaging Including MRI, CT scans, ultrasound, nuclear medicine, mammography and x-ray.
2. Colonoscopy
3. Prenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
4. Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Inpatient Testing and Procedures
1. Appendectomy
2. Natal care (Baby Deliveries)
3. Cesarean section (also called a c-section)
4. Cholecystectomy (surgery to remove the gallbladder)
5. Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
6. Hemorrhoidectomy (surgical removal of hemorrhoids)
7. Hysterectomy (surgical removal of a woman's uterus)
8. Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
9. Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
10. Prostatectomy (surgical removal of all or part of the prostate gland)
11. Tonsillectomy (surgical removal of one or both tonsils)
Savings for Routine Procedures
With Cataract surgery at 90% reduction of costs it appears that there are other procedures where savings were estimated at 60% are now estimated at 70% to 80% reduction in costs. These savings appear to be impossible but this approach has never been considered before.
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesion's. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
Developed by Lawrence Rosier Consulting on November 27, 2017. Ref: LawrenceRosierConsulting Blog Articles 112, 111, 109, 107.
This plan embodies far reaching strategic thinking that overturns false ideas about Health Care and reduces the cost of Health Care in Missouri significantly. Because of the movement from Private for-profit Health care system to not for-profit Missouri government managed hospitals a five year adjustment period is needed. This is an important backup plan that brings Missouri into solvency in health care regardless of what the Federal Government does in a National Health Care plan.
Facts about the current health care system, it is a growth industry that appears to have no limits in cost projections. US Private health care costs double that of European government based health care, neither have the efficient approach embodied in this Plan. Converting from a Private profit based to a not for-profit or government based health care system is expected to reduce Health care costs by 50% due to the reduction in fraud and other efficiency reasons but with increased efficiency I have estimated a conservative 60% reduction in overall health care costs in the new high volume/low cost specialized health care system.
Medicaid
Medicaid costs in Missouri is 9.9 $billion. Only about 10% or $1billion of this cost can be reduced by the efficiency in hospital operations presented in this Plan. Much of Medicaid costs are in long term care where some efficiencies may be implemented by Lean Teams.
Medicare
Medicare however presents a much different view because funding by the Federal Government would go directly to the state of Missouri providing the funding needed to convert private hospitals acquired by the State in its conversion to the Missouri Health Care System (MHCS). An agreement with the Federal government to pay the full amount of Medicare costs to the State until the new efficient system can be developed may be required or the Federal Government might chose funding Missouri’s MHCS. Ref: the example Cataract Surgery Clinic with a 90% decrease in costs at LawrenceRosierConsulting Blog Articles 110,109.
Missouri’s Health Care System (MHCS) Open to all Missourians
As the system grows in the last years of this plan the Missouri Health Care System would be available to all Missourians, open to those with or without insurance. MHCS expected costs to be 20% to 50% less than Private Hospitals. Insurance companies may provide incentives for those insured to use the new system.
Starting the Reorganization
A not for-profit General hospital is selected in a large city. General Hospitals do nearly all procedures therefore they are low volume/high cost facilities. Nearly all routine procedures are removed and reorganized into high patient volume/low cost specialized Clinics. The General Hospital now serves vital care and emergency trauma care patients. How the specialized clinics use the old General hospital space will require a good deal of planning. But the in-patient special clinic patients will require hospital bed space and will most likely remain in the General Hospital facilities while out-patient procedures will be in new individualized Clinics.
List of implementation events for the Missouri State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid patient area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
Lean Teams may require help in designing Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid and $6 billion in Medicare & Regular health care costs for the State.
8. States may also agree to share Daily Plans & facility designs.
Overview of the Missouri Health Care System (MHCS) Plan
Stage 1. The Startup Stage Beginning January 2018
The State Government may acquire General Hospitals under financial stress at little to no cost or enter into an agreement with a private not for-profit hospitals. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired in St Louis, Kansas City and Springfield in stage 1. As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Stage 2. Medicaid and Medicare Patients continued move to new system
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
Stage 3. Accommodation of Patients without Health Care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the new facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the MHCS.
Stage 4. The MHCS will be Available to all Missourians
The expanded MHCS will be available to all Missourians. Health Insurance Companies will gradually require that patients move to the less expensive MHCS. Private Hospitals will still be available for those who want them.
The MHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 to 50 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Criteria for the Selection of Routine Procedures:
- Repeatable processes with the time being the same for
- all patients (relatively routine)
- Sufficient Patient Backlog for Continuous operation
- Daily Plan efficiently designed by each Lean Team
- Balanced Operations
Routine Outpatient and Inpatient Procedures
Outpatient Testing and Procedures
1. Radiology/Diagnostic Imaging Including MRI, CT scans, ultrasound, nuclear medicine, mammography and x-ray.
2. Colonoscopy
3. Prenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
4. Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Inpatient Testing and Procedures
1. Appendectomy
2. Natal care (Baby Deliveries)
3. Cesarean section (also called a c-section)
4. Cholecystectomy (surgery to remove the gallbladder)
5. Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
6. Hemorrhoidectomy (surgical removal of hemorrhoids)
7. Hysterectomy (surgical removal of a woman's uterus)
8. Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
9. Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
10. Prostatectomy (surgical removal of all or part of the prostate gland)
11. Tonsillectomy (surgical removal of one or both tonsils)
Savings for Routine Procedures
With Cataract surgery at 90% reduction of costs it appears that there are other procedures where savings were estimated at 60% are now estimated at 70% to 80% reduction in costs. These savings appear to be impossible but this approach has never been considered before.
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesion's. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
Thursday, November 9, 2017
Article:112. Federal Government and State Health Care Suggestions
Federal Government and State Health Care Suggestions
The Health Care recommendations in this Blog are freely given to be used by the Federal government and the States with only the acknowledgement of its origins.
The Federal Government shall Repeal and Replace the Affordable Health Care Act with the following new National Health Care System (NHCS). The Federal Government shall immediately cease payments to Health Insurance companies. Block Grants may be given to States instead.
Key Characteristics of the National Health Care System (NHCS)
The Role of the Federal Government, the VA and the States
The Federal Government will implement the NHCS by supporting each state’s acquisition and conversion of hospitals to the NHCS requirements. Ref: Articles 109,110.
The Veterans Affaires Hospitals will be reformed to make them more efficient. Veterans will also be able to use the new NHCS state hospitals.
Each State will acquire, reform and manage hospital acquisitions for the NHCS. This will begin in its larger cities where the largest number of Medicaid recipients live. Ref: Articles 107,109,110.
Proposed Implementation Plan for the National Health Care System
The plan is to implement NHCS (by changing from a private based system to a government based system) in stages as it gradually becomes the nations primary health care system. The plan also separates rural health care from urban health care to accommodate the needs of the Nation. We will allow the VA Health Care system to use the NHCS consisting largely of Medicaid and Medicare in the first stage.
Savings
The savings resulting from switching from a Private to a Government System is estimated at 60% of current costs. Medicaid savings is expected to average $1billion for each state. Due to the increased efficiency of the NHCS staffing and
hospital facilities can be reduced by 20% or more in larger cities. General Hospitals in rural areas will be less affected because of low patient volume.
If you have an efficient effective Government Run Health Care system then no private health care company can compete with it because private companies must make healthcare run more efficient than government healthcare. If they can’t do this then there are no profits. If there are no profits in the private system they will drive up the cost of healthcare to get profits. I call our current Health Care system a “fraud based system” because it is largely funded by fraud. Our Fraud Based Healthcare system costs double that of European Government health care systems and even they are not efficient. The present fraud based system cannot be fixed and it is best scrapped as the most costly mistake ever made in health care.
Stage 1. The Startup Stage Beginning January 2018
Each State Government will begin immediately to acquire General Hospitals under financial stress at little to no cost. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired by the state in each major city in stage 1.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the following criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Criteria for the selection of Procedures:
Repeatable processes with the same time for all patients (relatively routine)
Sufficient Patient Backlog for Continuous operation
Daily Plan efficiently designed by each Lean Team
Balanced Operations (no one waits on others to do their jobs).
Veterans will share NHCS hospitals with Medicaid and Medicare patients
Lawrence Rosier Principal Consultant is making the following proposal to States:
In the interest of quickly bringing my recommended reforms to as many States as possible allowing them to benefit in massive savings in regular State Government activities, and in Medicaid and Medicare health care. Saving To each State 60% of current Medicaid hospital costs or an average of $1billion per State.
Each participating State will work through Lawrence Rosier Consulting (to prevent duplicated work) with other states in the development of shared efficiently designed Daily Plans by Lean Teams. This will allow up to 50 Daily Plans to be developed and implemented in the time it would take for only a few Procedures by an on-site Consultant. After review of each State’s developed Daily Plans for a Procedure by Lawrence Rosier Consultants it is made available for implementation to the subscribing States allowing for immediate savings to become available. This is a continuous process until all hospital Procedures meeting the criteria have been completed. Note that the new hospital operations do not require management scheduling and budgeting personnel. Ref: Article 109.
Stage 2. Medicaid and Medicare Patients continued move to NHCS
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
Stage 3. Accommodation of Patients without Health care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the NHCS Facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the NHCS.
Stage 4. The NHCS will be Available to all Americans
The expanded NHCS will be available to all Americans. Health Insurance Companies will gradually require that patients move to the less expensive NHCS Health care system.
Private Hospitals will still be available for those who want them.
The NHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Besides an Emergency function the clinics can serve as place for state wide rural traveling Cataract Surgery teams to do Cataract Surgery. The clinics can also service traveling Dialysis Vans for patients in remote rural areas.
Concurrent Reform of the VA Health Care System
As a government run system the current VA health care system may be worse than that of European health care but they both have the same problems: massive bureaucracy, low efficiency, high patient backlogs and uncontrolled costs. My approach fixes nearly all of the VA’s health care problems including its management problems. This is the same approach that works for a complete US government run healthcare system. Start by implementing this new efficient approach using Enterprise Lean through out the VA Health Care System. See Article 104 and 96.
The Health Care recommendations in this Blog are freely given to be used by the Federal government and the States with only the acknowledgement of its origins.
The Federal Government shall Repeal and Replace the Affordable Health Care Act with the following new National Health Care System (NHCS). The Federal Government shall immediately cease payments to Health Insurance companies. Block Grants may be given to States instead.
Key Characteristics of the National Health Care System (NHCS)
- The NHCS covers all Medicaid Patients and eventually all Americans
- No one will be required to purchase Health Care Insurance but those who can afford it will be required to pay for their own health care or acquire insurance.
- Catastrophic Health Care will be funded by savings from elimination of waste in the current Healthcare system and in the Federal governments operations.
- Catastrophic Health Care will not be funded by individuals purchasing Insurance.
- Insurance Companies will return to their practices before the Affordable Care Act.
The Role of the Federal Government, the VA and the States
The Federal Government will implement the NHCS by supporting each state’s acquisition and conversion of hospitals to the NHCS requirements. Ref: Articles 109,110.
The Veterans Affaires Hospitals will be reformed to make them more efficient. Veterans will also be able to use the new NHCS state hospitals.
Each State will acquire, reform and manage hospital acquisitions for the NHCS. This will begin in its larger cities where the largest number of Medicaid recipients live. Ref: Articles 107,109,110.
Proposed Implementation Plan for the National Health Care System
The plan is to implement NHCS (by changing from a private based system to a government based system) in stages as it gradually becomes the nations primary health care system. The plan also separates rural health care from urban health care to accommodate the needs of the Nation. We will allow the VA Health Care system to use the NHCS consisting largely of Medicaid and Medicare in the first stage.
Savings
The savings resulting from switching from a Private to a Government System is estimated at 60% of current costs. Medicaid savings is expected to average $1billion for each state. Due to the increased efficiency of the NHCS staffing and
hospital facilities can be reduced by 20% or more in larger cities. General Hospitals in rural areas will be less affected because of low patient volume.
If you have an efficient effective Government Run Health Care system then no private health care company can compete with it because private companies must make healthcare run more efficient than government healthcare. If they can’t do this then there are no profits. If there are no profits in the private system they will drive up the cost of healthcare to get profits. I call our current Health Care system a “fraud based system” because it is largely funded by fraud. Our Fraud Based Healthcare system costs double that of European Government health care systems and even they are not efficient. The present fraud based system cannot be fixed and it is best scrapped as the most costly mistake ever made in health care.
Stage 1. The Startup Stage Beginning January 2018
Each State Government will begin immediately to acquire General Hospitals under financial stress at little to no cost. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired by the state in each major city in stage 1.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the following criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Criteria for the selection of Procedures:
Repeatable processes with the same time for all patients (relatively routine)
Sufficient Patient Backlog for Continuous operation
Daily Plan efficiently designed by each Lean Team
Balanced Operations (no one waits on others to do their jobs).
Veterans will share NHCS hospitals with Medicaid and Medicare patients
Lawrence Rosier Principal Consultant is making the following proposal to States:
In the interest of quickly bringing my recommended reforms to as many States as possible allowing them to benefit in massive savings in regular State Government activities, and in Medicaid and Medicare health care. Saving To each State 60% of current Medicaid hospital costs or an average of $1billion per State.
Each participating State will work through Lawrence Rosier Consulting (to prevent duplicated work) with other states in the development of shared efficiently designed Daily Plans by Lean Teams. This will allow up to 50 Daily Plans to be developed and implemented in the time it would take for only a few Procedures by an on-site Consultant. After review of each State’s developed Daily Plans for a Procedure by Lawrence Rosier Consultants it is made available for implementation to the subscribing States allowing for immediate savings to become available. This is a continuous process until all hospital Procedures meeting the criteria have been completed. Note that the new hospital operations do not require management scheduling and budgeting personnel. Ref: Article 109.
Stage 2. Medicaid and Medicare Patients continued move to NHCS
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
Stage 3. Accommodation of Patients without Health care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the NHCS Facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the NHCS.
Stage 4. The NHCS will be Available to all Americans
The expanded NHCS will be available to all Americans. Health Insurance Companies will gradually require that patients move to the less expensive NHCS Health care system.
Private Hospitals will still be available for those who want them.
The NHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Besides an Emergency function the clinics can serve as place for state wide rural traveling Cataract Surgery teams to do Cataract Surgery. The clinics can also service traveling Dialysis Vans for patients in remote rural areas.
Concurrent Reform of the VA Health Care System
As a government run system the current VA health care system may be worse than that of European health care but they both have the same problems: massive bureaucracy, low efficiency, high patient backlogs and uncontrolled costs. My approach fixes nearly all of the VA’s health care problems including its management problems. This is the same approach that works for a complete US government run healthcare system. Start by implementing this new efficient approach using Enterprise Lean through out the VA Health Care System. See Article 104 and 96.
Wednesday, November 8, 2017
Article 111. Designing a High Patient Volume Low Cost Hospital
Designing a High Patient Volume Low Cost Hospital
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. The design is first to be used for Medicaid patients and will save an average of $1billion for each state. Several Hospitals will be required located in the State’s largest cities. Please review the following: Articles 107, 109, 110.
The Procedures chosen will be similar to the Cataract Eye Clinic design in Article 110. The Procedures are completely independent within the hospital and have their own staff and facilities. Should the patient Volume be higher than that of the design the procedure can be redesigned or it can be duplicated with added staff and facilities.
The first order of business is to Identify all the routine hospital and clinic procedures which apply a probable list is included later in this article. Each Procedure will require the same time to perform for all patients deviations from this requirement should be rare. The hospital will have on call its own Urgent Care staff. It will not have an emergency Room serving the public.
The approach is first to find a General Hospital near the areas in the city that has the most Medicaid patients that is willing to completely revise its mod of operation to the new design or to turn over operations to the State so that the State can make the required reforms. This will be most likely a non-profit hospital heavily in debt. It is better to select an existing staffed hospital rather than one that has been shut down because the staff can be formed into Lean Teams who will be important in the design of a Daily Plan for each of the procedures which meets the required criteria.
Role of Lawrence Rosier Consulting:
The current role of Lawrence Rosier Consulting is to enter into an agreement with a State to assist in the choice and the design of the selected Hospital to meet the above criteria. Lawrence Rosier Consulting will train Facilitators to assist in the implementation of Enterprise Lean in the hospitals. The Facilitators will also assist in the design of the Daily Plan for each Procedure and assist in its implementation.
List of implementation events for the State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid for each State.
8. States may also agree to share Daily plans & facilities designs.
Criteria for the selection of Routine Procedures:
Prenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Natal care (Baby Deliveries)
Cesarean section (also called a c-section)
Cholecystectomy (surgery to remove the gallbladder)
Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
Hemorrhoidectomy (surgical removal of hemorrhoids)
Hysterectomy (surgical removal of a woman's uterus)
Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
Prostatectomy (surgical removal of all or part of the prostate gland)
Tonsillectomy (surgical removal of one or both tonsils)
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesions. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. The design is first to be used for Medicaid patients and will save an average of $1billion for each state. Several Hospitals will be required located in the State’s largest cities. Please review the following: Articles 107, 109, 110.
The Procedures chosen will be similar to the Cataract Eye Clinic design in Article 110. The Procedures are completely independent within the hospital and have their own staff and facilities. Should the patient Volume be higher than that of the design the procedure can be redesigned or it can be duplicated with added staff and facilities.
The first order of business is to Identify all the routine hospital and clinic procedures which apply a probable list is included later in this article. Each Procedure will require the same time to perform for all patients deviations from this requirement should be rare. The hospital will have on call its own Urgent Care staff. It will not have an emergency Room serving the public.
The approach is first to find a General Hospital near the areas in the city that has the most Medicaid patients that is willing to completely revise its mod of operation to the new design or to turn over operations to the State so that the State can make the required reforms. This will be most likely a non-profit hospital heavily in debt. It is better to select an existing staffed hospital rather than one that has been shut down because the staff can be formed into Lean Teams who will be important in the design of a Daily Plan for each of the procedures which meets the required criteria.
Role of Lawrence Rosier Consulting:
The current role of Lawrence Rosier Consulting is to enter into an agreement with a State to assist in the choice and the design of the selected Hospital to meet the above criteria. Lawrence Rosier Consulting will train Facilitators to assist in the implementation of Enterprise Lean in the hospitals. The Facilitators will also assist in the design of the Daily Plan for each Procedure and assist in its implementation.
List of implementation events for the State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid for each State.
8. States may also agree to share Daily plans & facilities designs.
Criteria for the selection of Routine Procedures:
- Repeatable processes with the time being the same for all patients (relatively routine)
- Sufficient Patient Backlog for Continuous operation (Medicare patients can be added if needed to maintain patient backlog)
- Daily Plan efficiently designed by each Lean Team
- Balanced Operations
Routine Outpatient and Inpatient Procedures
Outpatient Testing and Procedures
Radiology/Diagnostic Imaging Including MRI, CT scans, ultrasound, nuclear medicine, mammography and x-ray.
ColonoscopyPrenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Inpatient Testing and Procedures
AppendectomyNatal care (Baby Deliveries)
Cesarean section (also called a c-section)
Cholecystectomy (surgery to remove the gallbladder)
Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
Hemorrhoidectomy (surgical removal of hemorrhoids)
Hysterectomy (surgical removal of a woman's uterus)
Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
Prostatectomy (surgical removal of all or part of the prostate gland)
Tonsillectomy (surgical removal of one or both tonsils)
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesions. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
Friday, November 3, 2017
Article 110. Daily Plan For Cataract Surgery Clinics
Daily Plan For Cataract Surgery Clinics
This is an example created by Lawrence Rosier based on his experiences of having cataract surgery. Ref: Articles: 109, 107
This is a design for a Cataract Surgery Clinic to be built in each major city of a State and operated by the State. This is done to reduce health care costs in the State and the Federal Government. The Clinic will reduce the costs expended by as much as 90%. The design of the Daily Plans necessary for the Cataract Clinic also provides examples of how Daily Plans are constructed. Ref: Article 107
The Cataract Surgery Clinic is designed to efficiently process 40 patients per day and meets the required criteria for the implementation of Enterprise Lean and Balanced processes.
Eye Examination Facility Daily Plan
Patients:
40 Patients with appointments each day for eye examinations or for post surgery glasses and
40 Patients with appointments the same day for post surgery exam by Surgeon from the day before.
Facilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Exam Room A Optometrist #1 20 min Exam Eyes for Cataracts or Glasses
Exam Room B Optometrist #2 20 min Exam Eyes for Cataracts or Glasses
Post Surgery C Surgeon #1 10 min Exam Eyes of surgery Patients
Surgeon #1 Trades off Surgery every other day with Surgeon #2.
Facilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Prep Patient Room A Nurse #1 20 min Preps Patients for surgery, eye drops
Prep Patient Room B Nurse #2 20 min Preps Patients for surgery, eye drops
Anesthetist 10 min Anesthetizes Patients
Surgery two Rooms Surgeon #2 10 min Performs Cataract Surgery
Surgery two Rooms Surgery Nurse10 min Supports Surgeon during operations
Recovery Room A Nurse #3 10 min Move Patients,Surgery to Recovery
Recovery Room B Nurse #4 10 min Move Patients,Surgery to Recovery
Ophthalmologist Surgeon does Cataract Surgery in Operating Room #1 while patients are moved from Operating Room #2 and another patient is brought in. With the completion of surgery in operating Room #1 the surgeon returns to Operating Room #2 to perform surgery on the next patient.
Cost Analysis:
Medicare Reimbursement
1. Exam of both Eyes for Cataracts $ 320
2. Cataract Surgery for eye #1 2,400
3. Cataract Surgery for eye #2 2,400
4. Exam of both Eyes for Glasses 320
Annual Medicare Reimbursement $5,440 x 20/day x 200/days per year
= $21,760,000
Annual Estimated Clinic Salary Expenses $1,130,000
Annual Estimated Clinic Operation Costs 1,500,000
Total Estimated Clinic Costs $2,630,000
Annual Estimated Savings = $21,760,000 -$2,630,000 = $19 million
90% reduction in costs
Note: 1. Manager of the Clinic is an Ophthalmologist and fills in when needed for absenteeism or vacations
2. Office personnel are also nurses and fill in when needed
3. Secretaries fill in for Waiting Room Receptionist
4. There is no other supervision required
5. Supplies are ordered automatically
Once the process has been setup it will run automatically as long as it has sufficient backlog of Medicaid and Medicare Patients. The only difference a patient should see between this cataract surgery and that normally done is that there are more people in the waiting room.
Since the Federal Government is unlikely to do anything about the high cost of Cataract Surgery in the near term I recommend that States establish an Eye Clinic in each of their major cities using the Medicare payments to fund the Clinics.
Examples of Major Savings in Cataract Surgery
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons). Drs Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure (both eyes) caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors. The two Surgeons were doing about 200 eye surgeries per day. I give you this example of how little a cataract surgery actually costs in Burma $25 (only for the Lenses) in the US $4800 both eyes.
Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo. Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients. In a week he can perform 40 eye surgeries paid for by Medicare at $2400 each eye. The surgeon is grossing nearly $4 million annually from Medicare. These examples prove that certain health care operations can be reduced significantly in cost.
This is an example created by Lawrence Rosier based on his experiences of having cataract surgery. Ref: Articles: 109, 107
This is a design for a Cataract Surgery Clinic to be built in each major city of a State and operated by the State. This is done to reduce health care costs in the State and the Federal Government. The Clinic will reduce the costs expended by as much as 90%. The design of the Daily Plans necessary for the Cataract Clinic also provides examples of how Daily Plans are constructed. Ref: Article 107
The Cataract Surgery Clinic is designed to efficiently process 40 patients per day and meets the required criteria for the implementation of Enterprise Lean and Balanced processes.
Eye Examination Facility Daily Plan
Patients:
40 Patients with appointments each day for eye examinations or for post surgery glasses and
40 Patients with appointments the same day for post surgery exam by Surgeon from the day before.
Facilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Exam Room A Optometrist #1 20 min Exam Eyes for Cataracts or Glasses
Exam Room B Optometrist #2 20 min Exam Eyes for Cataracts or Glasses
Post Surgery C Surgeon #1 10 min Exam Eyes of surgery Patients
Surgeon #1 Trades off Surgery every other day with Surgeon #2.
Cataract Surgery Facility Daily Plan
Patients: 40 Patients with appointments for Cataract SurgeryFacilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Prep Patient Room A Nurse #1 20 min Preps Patients for surgery, eye drops
Prep Patient Room B Nurse #2 20 min Preps Patients for surgery, eye drops
Anesthetist 10 min Anesthetizes Patients
Surgery two Rooms Surgeon #2 10 min Performs Cataract Surgery
Surgery two Rooms Surgery Nurse10 min Supports Surgeon during operations
Recovery Room A Nurse #3 10 min Move Patients,Surgery to Recovery
Recovery Room B Nurse #4 10 min Move Patients,Surgery to Recovery
Ophthalmologist Surgeon does Cataract Surgery in Operating Room #1 while patients are moved from Operating Room #2 and another patient is brought in. With the completion of surgery in operating Room #1 the surgeon returns to Operating Room #2 to perform surgery on the next patient.
Cost Analysis:
Medicare Reimbursement
1. Exam of both Eyes for Cataracts $ 320
2. Cataract Surgery for eye #1 2,400
3. Cataract Surgery for eye #2 2,400
4. Exam of both Eyes for Glasses 320
Annual Medicare Reimbursement $5,440 x 20/day x 200/days per year
= $21,760,000
Annual Estimated Clinic Salary Expenses $1,130,000
Annual Estimated Clinic Operation Costs 1,500,000
Total Estimated Clinic Costs $2,630,000
Annual Estimated Savings = $21,760,000 -$2,630,000 = $19 million
90% reduction in costs
Note: 1. Manager of the Clinic is an Ophthalmologist and fills in when needed for absenteeism or vacations
2. Office personnel are also nurses and fill in when needed
3. Secretaries fill in for Waiting Room Receptionist
4. There is no other supervision required
5. Supplies are ordered automatically
Once the process has been setup it will run automatically as long as it has sufficient backlog of Medicaid and Medicare Patients. The only difference a patient should see between this cataract surgery and that normally done is that there are more people in the waiting room.
Since the Federal Government is unlikely to do anything about the high cost of Cataract Surgery in the near term I recommend that States establish an Eye Clinic in each of their major cities using the Medicare payments to fund the Clinics.
Examples of Major Savings in Cataract Surgery
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons). Drs Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure (both eyes) caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors. The two Surgeons were doing about 200 eye surgeries per day. I give you this example of how little a cataract surgery actually costs in Burma $25 (only for the Lenses) in the US $4800 both eyes.
Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo. Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients. In a week he can perform 40 eye surgeries paid for by Medicare at $2400 each eye. The surgeon is grossing nearly $4 million annually from Medicare. These examples prove that certain health care operations can be reduced significantly in cost.
Article 109. Implementation of State Collaborative Reforms
Implementation of State Collaborative Health Reforms (updated)
Lawrence Rosier Consulting12143 Cedar Grove Rd. Rolla, Missouri 65401 Phone 573 426 2997 cell 573 578-4716
About Lawrence Rosier: See Article 102. Lawrence Rosier Consulting Blog.
States who are interested in learning more about this collaborative effort or have questions or want to become a subscriber may respond by Email to: LawrenceRosier4@gmail.com
State governments are currently facing large Medicaid health expenditures which most states will find difficult to meet. This is exacerbated by health care cuts by the Federal Government. This collaborative solution would provide an average saving of up to $1billion for each subscribing State annually when fully installed throughout the State (This is obviously a long term saving).
Lawrence Rosier Principal Consultant is making the following proposal to State Governments and other interested parties:
In the interest of quickly bringing my recommended health care reforms to as many States as possible allowing them to benefit in savings in Medicaid and Medicare health care (saving the State 60% of current routine Medicaid hospital costs).
Each participating State will work through Lawrence Rosier Consulting (to prevent duplicated work) with other states in the development of shared efficiently designed Daily Plans by Lean Teams organized for each routine Procedure. This will allow up to 15 or more Daily Plans to be developed and implemented in the time it would take for only a few Procedures by an on-site Consultant.
After review of each State’s submitted Daily Plans by Lawrence Rosier Consultants they are made available for implementation to all of the subscribing States. This is a continuous process until all selected routine hospital Procedures have been developed and made available to all subscribers.
Daily Plans will vary to meet expected patient backlogs which arise by the size of the metro area. Some Daily Plans may simply be doubled to accommodate larger metro patient backlogs. Note that nearly all routine Procedures performed in a metro area may be done by a single hospital due to its low cost for routine Procedures.
After the Daily Plan has been developed it will be used to reorganize the selected General Hospital facility. As many as 15 routine Procedures will need to be organized at the general hospital facility grounds all with access to the ER.
Each Subscribing State will Agree to the following Requirements:
1. Pay an annual modest subscription fee to Lawrence Rosier Consulting in return for access to Daily Plans and Consulting assistance by remote conferencing including training sessions.
2. Enter into agreement with or acquire in each of the state’s major cities at least one Primary Care Hospital that performs routine operations and agrees to implement Enterprise Lean and reorganize to install a Daily Plan for each of their routine Procedures.
3. The reforms include: Enterprise Lean Teams which develop efficiently designed Daily Plans. Daily Plans are not easily developed and should not be developed without input from the Lean Team familiar with the details of the Procedure. This is what makes them so valuable they can be simply implemented by states doing the same Procedures and start receiving the savings. The receiving State may also make continuous improvement to the Daily Plans and coordinate these with the consultant. Ref: Article 110. Example Cataract Surgery 90% reduction in costs.
4. Video Conference training is planed to be available for each participating State’s Facilitators who will facilitate the organization of the Lean Teams for each function and the development of their Daily Plans. Ref: Articles: 110, 107,106, 105, 104, 101.
I Recommend Enterprise Lean
Enterprise Lean developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in State Government Functions. It has also been successfully implemented in the Cleveland Clinic well known for its health care. The process consists of working teams that meet regularly (once a week) to review and discuss how the work they are doing can be improved. For those Lean Teams involved with routine Procedures, their first task is the design and implementation of their Daily Plan. I recommend that Enterprise Lean be implemented throughout each medical facility. Employees become excited about their jobs with their involvement providing continuous innovative solutions to work problems.
Routine Procedure Criteria:
- Repeatable processes (relatively routine)
- Sufficient Backlog of patients for Continuous operation
- Patients must be able to wait in a backlog
- Daily Plan efficiently designed by each Lean Team
- Balanced Operations (no one waits for others to do their jobs)
The savings from the metro hospital is based on high patient backlogs for routine Procedures based on the Daily Plan. High patient backlogs are not available in rural areas. An alternative for rural General hospitals to meet lower patient backlogs is: to train Lean Teams to use several Daily Plans for routine Procedures and be able alternate between them.
Update March 9, 2018:
36 State Governors were contacted by social Media (Twitter) all showed some interest in the project. 15 Governors showed above average interest and 12 Governors were very interested.
Sunday, October 29, 2017
Article 108. Bringing Reform To Inner Cities
Bringing Reform To Inner Cities
By Lawrence Rosier
Ideas for Rebuilding Inner Cities
An examination of the situation of inner city residents yields only one positive thing all many residents have is free time along with an enormous desire to change their current prospects. What they don’t have is nearly everything else.
The approach I recommend for rebuilding inner cities is the creation of safe havens. Environmental enclaves where one is relatively safe and nurturing, education and commerce can be protected.
1. Make Schools Safe for Learning.
Move police stations to the schools across the street if possible. Place cameras everywhere there might be violence in the school. Make the schools the safest place in the city. Open the school libraries and gymnasiums using volunteers after school and at night for tutoring and adult education.
2. Make the School the hub of the Community.
Emphasize cradle to grave education. Education should start with babies in the “Parents as Teachers Program” progress through kindergarten and into the public schools and beyond. The recently enacted “No Child Left behind Program” holds public schools, more correctly teachers, responsible for the educational progress of their students. This is a controversial mandate in the inner city because it will take super human effort by the best teachers to meet the requirements. The corollary to this should be that no bright child should be held back allowing them to skip grades until they are challenged.
This should be the environment which nurturers the students which will attend charter high schools and job training technical schools.
3. Bolster Neighborhoods by Creating a “Sense of Community”.
We need to recognize the importance of the “Sense of Community”. Most high rise tenements built for welfare families fail for this reason. The “sense of community” fails when the majority of the people living in an urban community cannot recognize those who actually live in the area. With increased anonymity comes increased crime that forces the elderly to barricade themselves in their apartments.
The idea of a “sense of community” can be developed by fencing off floors within a high rise apartment building providing a safe haven for those who live there. Place cameras in public areas. Block off through streets creating urban enclaves and provide local police stations with foot or bicycle patrols. Provide recreation facilities for the youth and encourage the development of a micro economy. Active community organizations provide involvement opportunities for citizens of the enclaves developing a source of community pride.
Extreme high crime communities should be gated and fenced with surveillance cameras everywhere. As more and more of the community enclaves are developed gangs and their accompanying crime can be forced into a small enough area where police can get control of the situation.
4. Encourage the Development of Community Micro Economies
A micro economy occurs when local people get together to form small businesses that fill the needs of the community. In many cases the county extension offices as a part of the states university system nurture these small businesses. The State and or the Federal Government may provide the necessary seed money for the startup of the businesses. Micro economies are important because they provide a safety net for the families in the community. The positive micro economy is a much more desirable and less expensive than the crime and drug dealers, which form the negative economy.
Examples of micro economy businesses are day nurseries, home run catalog businesses, gift shops and craft manufacturing. Often festivals and annual community events aimed at bringing tourists to the area bolster these businesses. But for the most part they should be self-sustaining and provide day to day services in the community.
5. Form Community Volunteer Groups to Cleanup the City
Cleanup city streets especially vacant city lots where community gardens can be established. One innovative way of doing this is to have local contractors establish fenced brick yards where used bricks can be purchased from the public. It won’t be long before vacant lots will be brick free for gardeners.
6. City Government Reform
Lowering city property and business taxes establishes a growth program that attracts residents and businesses back to the city. This fuels the creation of needed jobs and bolsters the cities economy. Raising property and business taxes does just the opposite. The revenue to lower taxes is made available when city government is reformed and downsized.
7. Consolidation of City Governments or Urban Secession?
Its all about how to provide better services to urban dwellers with the most efficiency. Most large cities do not provide adequate crime prevention and protection to their city residents fueling the desire for some communities to secede. At the same time there are movements to combine city governments so that services such as fire and police can gain economy of scale. Whether to combine or to secede depends largely on local conditions such as tax bases and economies. Which brings up a third possibility “Government Reform” by allowing local ward committees to manage some local services. And a fourth possibility is for city governments to gain the economies of scale they desire through reciprocal agreements with other cities to share city services.
By not asking the right questions cities and suburban communities can find themselves with even greater problems than they have now. For example an urban community that wishes to secede from a greater metropolitan city to gain local control of its services will need to know if they have enough of a tax base to provide those services. If they don’t then they should pursue the third option to gain local control of some services provided to their community. In other words the metropolitan government should be reformed by allowing decisions on local services to be made at the local level. This is the same Japanese management principle that I have recommended elsewhere to make bureaucracies more responsive by “driving down the decision making power to the lowest level of effectiveness”. This type of arrangement works well where inner city crime is high. and local control can be established by blocking off through streets and in forming gated communities. These communities should have their own police station. The goal here is to establish a “Sense of Community” which I would define as when a majority of the community knows if someone either lives in the community or is an outsider. I have recommended that this method be used to drive crime out of a major metropolitan area by establishing small communities one at a time. Each community would need a micro economy to make it sustainable.
It is to the advantage of some more affluent suburban cities to annex a neighboring depressed city. Especially those that prevent it from growing through expansion.
8. Community Development and Economic Growth
Many small towns and communities often confuse “Community Development” and “Economic Growth” as going hand in hand. They seem to think that all community development projects lead to economic growth. While it is true that enhancement of community services can encourage economic growth indirectly a more focused approach will yield better results.
For example many communities seek out large chain store mall developments while discouraging manufacturing as being undesirable. This may be a good policy if there are nearby manufacturing facilities or tourist sites that can draw outside revenue. True economic growth comes from revenues brought into the community from outside. While large chain stores in fancy malls bring customers from surrounding communities and encourage people to move to the community they also replace the mom and pop stores, which were the foundation of the community. The sales employees may be better off through higher wages and benefits but what you are really seeing happening is a kind of churning of the community’s economy. When the communities leaders grant special tax incentives and other giveaways such as free land to the mall developers there can be a near zero result in economic growth.
The economic churning while for the most part may bring improvement to the community but it cannot match the manufacturing and tourist revenues that is needed for real economic growth. The bottom line is to provide tax incentives for the manufacturing and tourist industries that will bring in revenues from outside the community. The big chain store malls will follow these revenues to the community without the extra incentives.
9. Breathing New Life into Contiguous Depressed City Suburbs
Many older metropolitan cities especially in the mid-west and eastern US have for the last sixty to seventy years experienced the decline of the suburban towns encircling it. These neighborhood towns are mostly independent with each having its own city government charter and school district. The main difference between them is that unlike small rural towns each is composed of a unique socioeconomic level. Some are wealthy prosperous towns contiguous with lower socioeconomic towns that have been in decline for decades. The most prosperous communities unable to expand their city limits have fueled the flight to new suburban communities far from the metropolitan center. Now with wealthy inner cities surrounded by blighted neighboring towns it is time for them enter into a type of “suburban renewal” once thought only done in metropolitan city centers.
The approach here is for a wealthy community to annex a neighboring town disbanding its city government charter and integrating its school district with its own. The advantage for the wealthy city is in obtaining space to expand and grow. While the advantage for the annexed city would be to experience new life and enhanced property values. In some cases just an image change is enough to bring new life to a community. The most viable situations would be where most of the blighted areas would be bulldozed and new homes and businesses built. This whole process has become more capable through the recent US Supreme Court’s ruling on condemning private property for private redevelopment. Before this ruling this would have been difficult if not impossible. While many states have recently enacted laws restricting the application of this new ruling law makers have failed to see the benefits of the ruling.
By Lawrence Rosier
Ideas for Rebuilding Inner Cities
An examination of the situation of inner city residents yields only one positive thing all many residents have is free time along with an enormous desire to change their current prospects. What they don’t have is nearly everything else.
The approach I recommend for rebuilding inner cities is the creation of safe havens. Environmental enclaves where one is relatively safe and nurturing, education and commerce can be protected.
1. Make Schools Safe for Learning.
Move police stations to the schools across the street if possible. Place cameras everywhere there might be violence in the school. Make the schools the safest place in the city. Open the school libraries and gymnasiums using volunteers after school and at night for tutoring and adult education.
2. Make the School the hub of the Community.
Emphasize cradle to grave education. Education should start with babies in the “Parents as Teachers Program” progress through kindergarten and into the public schools and beyond. The recently enacted “No Child Left behind Program” holds public schools, more correctly teachers, responsible for the educational progress of their students. This is a controversial mandate in the inner city because it will take super human effort by the best teachers to meet the requirements. The corollary to this should be that no bright child should be held back allowing them to skip grades until they are challenged.
This should be the environment which nurturers the students which will attend charter high schools and job training technical schools.
3. Bolster Neighborhoods by Creating a “Sense of Community”.
We need to recognize the importance of the “Sense of Community”. Most high rise tenements built for welfare families fail for this reason. The “sense of community” fails when the majority of the people living in an urban community cannot recognize those who actually live in the area. With increased anonymity comes increased crime that forces the elderly to barricade themselves in their apartments.
The idea of a “sense of community” can be developed by fencing off floors within a high rise apartment building providing a safe haven for those who live there. Place cameras in public areas. Block off through streets creating urban enclaves and provide local police stations with foot or bicycle patrols. Provide recreation facilities for the youth and encourage the development of a micro economy. Active community organizations provide involvement opportunities for citizens of the enclaves developing a source of community pride.
Extreme high crime communities should be gated and fenced with surveillance cameras everywhere. As more and more of the community enclaves are developed gangs and their accompanying crime can be forced into a small enough area where police can get control of the situation.
4. Encourage the Development of Community Micro Economies
A micro economy occurs when local people get together to form small businesses that fill the needs of the community. In many cases the county extension offices as a part of the states university system nurture these small businesses. The State and or the Federal Government may provide the necessary seed money for the startup of the businesses. Micro economies are important because they provide a safety net for the families in the community. The positive micro economy is a much more desirable and less expensive than the crime and drug dealers, which form the negative economy.
Examples of micro economy businesses are day nurseries, home run catalog businesses, gift shops and craft manufacturing. Often festivals and annual community events aimed at bringing tourists to the area bolster these businesses. But for the most part they should be self-sustaining and provide day to day services in the community.
5. Form Community Volunteer Groups to Cleanup the City
Cleanup city streets especially vacant city lots where community gardens can be established. One innovative way of doing this is to have local contractors establish fenced brick yards where used bricks can be purchased from the public. It won’t be long before vacant lots will be brick free for gardeners.
6. City Government Reform
Lowering city property and business taxes establishes a growth program that attracts residents and businesses back to the city. This fuels the creation of needed jobs and bolsters the cities economy. Raising property and business taxes does just the opposite. The revenue to lower taxes is made available when city government is reformed and downsized.
7. Consolidation of City Governments or Urban Secession?
Its all about how to provide better services to urban dwellers with the most efficiency. Most large cities do not provide adequate crime prevention and protection to their city residents fueling the desire for some communities to secede. At the same time there are movements to combine city governments so that services such as fire and police can gain economy of scale. Whether to combine or to secede depends largely on local conditions such as tax bases and economies. Which brings up a third possibility “Government Reform” by allowing local ward committees to manage some local services. And a fourth possibility is for city governments to gain the economies of scale they desire through reciprocal agreements with other cities to share city services.
By not asking the right questions cities and suburban communities can find themselves with even greater problems than they have now. For example an urban community that wishes to secede from a greater metropolitan city to gain local control of its services will need to know if they have enough of a tax base to provide those services. If they don’t then they should pursue the third option to gain local control of some services provided to their community. In other words the metropolitan government should be reformed by allowing decisions on local services to be made at the local level. This is the same Japanese management principle that I have recommended elsewhere to make bureaucracies more responsive by “driving down the decision making power to the lowest level of effectiveness”. This type of arrangement works well where inner city crime is high. and local control can be established by blocking off through streets and in forming gated communities. These communities should have their own police station. The goal here is to establish a “Sense of Community” which I would define as when a majority of the community knows if someone either lives in the community or is an outsider. I have recommended that this method be used to drive crime out of a major metropolitan area by establishing small communities one at a time. Each community would need a micro economy to make it sustainable.
It is to the advantage of some more affluent suburban cities to annex a neighboring depressed city. Especially those that prevent it from growing through expansion.
8. Community Development and Economic Growth
Many small towns and communities often confuse “Community Development” and “Economic Growth” as going hand in hand. They seem to think that all community development projects lead to economic growth. While it is true that enhancement of community services can encourage economic growth indirectly a more focused approach will yield better results.
For example many communities seek out large chain store mall developments while discouraging manufacturing as being undesirable. This may be a good policy if there are nearby manufacturing facilities or tourist sites that can draw outside revenue. True economic growth comes from revenues brought into the community from outside. While large chain stores in fancy malls bring customers from surrounding communities and encourage people to move to the community they also replace the mom and pop stores, which were the foundation of the community. The sales employees may be better off through higher wages and benefits but what you are really seeing happening is a kind of churning of the community’s economy. When the communities leaders grant special tax incentives and other giveaways such as free land to the mall developers there can be a near zero result in economic growth.
The economic churning while for the most part may bring improvement to the community but it cannot match the manufacturing and tourist revenues that is needed for real economic growth. The bottom line is to provide tax incentives for the manufacturing and tourist industries that will bring in revenues from outside the community. The big chain store malls will follow these revenues to the community without the extra incentives.
9. Breathing New Life into Contiguous Depressed City Suburbs
Many older metropolitan cities especially in the mid-west and eastern US have for the last sixty to seventy years experienced the decline of the suburban towns encircling it. These neighborhood towns are mostly independent with each having its own city government charter and school district. The main difference between them is that unlike small rural towns each is composed of a unique socioeconomic level. Some are wealthy prosperous towns contiguous with lower socioeconomic towns that have been in decline for decades. The most prosperous communities unable to expand their city limits have fueled the flight to new suburban communities far from the metropolitan center. Now with wealthy inner cities surrounded by blighted neighboring towns it is time for them enter into a type of “suburban renewal” once thought only done in metropolitan city centers.
The approach here is for a wealthy community to annex a neighboring town disbanding its city government charter and integrating its school district with its own. The advantage for the wealthy city is in obtaining space to expand and grow. While the advantage for the annexed city would be to experience new life and enhanced property values. In some cases just an image change is enough to bring new life to a community. The most viable situations would be where most of the blighted areas would be bulldozed and new homes and businesses built. This whole process has become more capable through the recent US Supreme Court’s ruling on condemning private property for private redevelopment. Before this ruling this would have been difficult if not impossible. While many states have recently enacted laws restricting the application of this new ruling law makers have failed to see the benefits of the ruling.
Saturday, October 28, 2017
Article 107. How States Can reduce Costs through Reforms
How States Can reduce Costs through Reforms
Lawrence Rosier Consulting12143 Cedar Grove Rd. Rolla, Missouri 65401
Phone 573 578-4716 lawrencerosier4@gmail.com
See Article 102 About Lawrence Rosier
My Reform Models:
1. General Reform Model (Enterprise Lean, Management budgeting & scheduling and Team Management).
2. Consolidation Model (used where applicable mostly in the Federal Government)
Ref: Article 48, 81. Consolidation in the Texas State government
3. The Effectiveness Test (used where applicable mostly in the Federal Government)
Ref: Article 49
I Recommend Enterprise Lean
Enterprise Lean developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in government processes. It has also been successfully implemented in the Cleveland Clinic well known for its health care. The process consists of working teams that meet regularly to review and discuss how the work they are doing can be improved upon. I recommend that Enterprise Lean be implemented throughout state government. State employees become excited about their jobs with their involvement providing innovative solutions to work problems.
My General Reform Model works best with the following Criteria:
- Repeatable processes (relatively routine)
- Sufficient Backlog for Continuous operation
- Operation efficiently designed (Enterprise Lean & New Management Sys.)
- Balanced Operations, Budgeting, Scheduling, Reporting
Balanced Work Loading
Savings are from working smarter not harder and elimination of wait times.
90% of all inefficiency is from people waiting on others to do their jobs. This because we have come to accept the fact of waiting as just a part of the job. We can eliminate or at least significantly reduce wait times by doing the following:
- Determine the sequence of the flow of jobs from work group to work group.
- Set a reasonable Time for all work groups to process the work.
- Balance the work load by adding and removing personnel so that each work group can do their work within the time set. This balanced process will eliminate wait times.
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons). Drs. Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors. The Doctors were doing about 200 eye surgeries per day. I give you this example of how little a cataract surgery actually costs in Burma $25 in the US $4000 both eyes.
Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo. Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients. In a week he can perform 40 eye surgeries paid for by Medicare at $2000 each eye. The surgeon is grossing nearly $4 million annually from Medicare. These examples prove that certain health care operations can be reduced significantly in cost. By following my approach most routine health care operations can be reduced by 60%.
Third Example:
The developers of Obamacare were only interested in passing the bill and not in trying to reduce US health care costs. US Private health care costs double that of European Government provided health care. This suggests that we move Medicaid and Medicare routine operations to state run Primary care hospital systems where management reforms can be implemented.
These examples prove that there are $billions to be saved in the current Healthcare system by following my recommendations.
My Recommendations to States for making Major Reductions in Health Care Costs
State Government Run Urgent Care and Primary Care HospitalsUrgent Care Hospitals for Critically ill Patients need only to implement Enterprise Lean.
The Process develops Savings in Primary Care Hospitals
Primary Care non-profit Hospitals for Routine non-life threatening operations without an ER, implement Enterprise Lean with efficiently Daily plans. The State may enter into an agreement with nonprofit hospitals to implement these reforms or implement the reforms in state operated hospitals. These hospitals may already be serving mostly Medicaid and Medicare patients. Medicaid estimated savings is 60% of current Primary Care costs, close to $1 billion in the State of Missouri. Ref: Articles: 106, 105, 104, 101.
Government Run Cataract Surgery Clinic Suggestion
The State can establish Cataract Surgery clinics in each of its major cities. Saving 90% of the current cost of Cataract Surgery. This is a massive savings to Medicare and can be funded by the Federal Government.
Rural and Urban Emergency Health Care (Solution to over-run Urban ERs)
Combination: Fire Station, Ambulance and Emergency Health Care Clinic. This approach significantly reduces the cost of over-run hospital Emergency Rooms in Urban areas. The Clinics provide emergency health care for small rural towns.
Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com
Sunday, October 15, 2017
Article 106. US Governments New Budgeting and Management System
US Governments New Budgeting and Management System
Top Down Budgeting Practices
Congressional budget committees at times makes across the board cuts to Federal programs without the knowledge of where cuts can be made and have the least effect on services. Although commendable for its boldness this is a wild and irresponsible attempt at cutting the budget without knowing consequences but it is also a common approach made by the US Government. The key message is that Congress does not know where or how large of cuts to make and still maintain government services.
Once the New Government Management System has been implemented budgeting personnel will know what Departments and Agencies are over staffed and how many personnel are needed to maintain government services. This is where precision cuts have an advantage over across the board cuts. Across the board cuts harms areas where government services are under staffed and has little to no effect on other over staffed areas of the bureaucracy.
Starting with the implementation of Enterprise Lean Teams throughout the government. This reform brings a positive cultural change to the organization. Bottom level functional Lean Team employees become members of Lean Teams and are motivated by empowering them to improve their jobs through innovation. By bringing innovation and continuous improvement to the government’s processes the government will save $billions through increased efficiency both now and in the future. This reform amounts to a win-win situation for government employees as well as the tax payers through employee empowerment and by ending bureaucratic waste. See Article 104. Enterprise Lean and the New Government Management System.
The key activity I require by my Lean Teams that they develop a Daily Plan, a graphic depiction of the processes that they do on a daily basis. This depiction may be in the form of a wall chart where each operation performed by members of the Team are depicted graphically in the sequence that the work is done. The accuracy of the wall chart depends on an accurate time for each process. When the wall chart has been reviewed and no other improvements are known photos of the wall are made and passed to other teams doing the same operations in other government locations. The final wall chart is not carved in stone but available for continuous improvement. This activity gets the highest possible efficiency from the function.
Implementation of The New government Management system
The New Government Management organization will be within the Office of Inspector General organization which I recommend be separated from the Government Departments and reports directly to the Office of Management and Budget.
The new Government Management System is used to set staffing levels and a bottoms-up budget using the Lean Team study data.
First OIG (Office of Inspector General) Analysts will be trained as Facilitators setting-up and organizing each Lean Team. The number of VA Lean Teams will depend on the number of functions within each hospital. An OIG Analyst will be able to Facilitate about 20 Lean Teams. After setting-up the Lean Team the OIG Analyst will monitor and assist in the development of the wall chart. The OIG Analyst will become the manager of his Lean Teams.
The OIG Analyst will be trained to manage about 20 Lean areas:
1. He will work closely with each Lean Team in making improvements including the installation of additional equipment.
2. He will develop and monitor a schedule for each Lean Team based on patient backlogs.
3. He will make a monthly progress report for each Lean Team.
4. He will create a bottoms-up manpower budget for each Lean Team.
5. He will create a annual bottoms-up budget for his functional Lean Teams.
The annual functional bottoms-up budgets are summed establishing an actual min cost at the highest efficiency for the Department all other costs are negotiable.
An Advantage of this Approach
The advantage of this approach is that all actual manpower and operations costs are known creating a minimum known budget. This means that only addition added budget items need to be negotiated and not the entire Agency Budget. It also means that with a steady backlog little scheduling and management is needed. The function nearly runs itself like the health care routine Procedure Clinics.
Where tasks are variable the Lean Teams will be more involved with scheduling and management of daily activities.
Top Down Budgeting Practices
Congressional budget committees at times makes across the board cuts to Federal programs without the knowledge of where cuts can be made and have the least effect on services. Although commendable for its boldness this is a wild and irresponsible attempt at cutting the budget without knowing consequences but it is also a common approach made by the US Government. The key message is that Congress does not know where or how large of cuts to make and still maintain government services.
Once the New Government Management System has been implemented budgeting personnel will know what Departments and Agencies are over staffed and how many personnel are needed to maintain government services. This is where precision cuts have an advantage over across the board cuts. Across the board cuts harms areas where government services are under staffed and has little to no effect on other over staffed areas of the bureaucracy.
Recommended New Bottoms-Up Budgeting and Management System
Implementation of Enterprise Lean TeamsStarting with the implementation of Enterprise Lean Teams throughout the government. This reform brings a positive cultural change to the organization. Bottom level functional Lean Team employees become members of Lean Teams and are motivated by empowering them to improve their jobs through innovation. By bringing innovation and continuous improvement to the government’s processes the government will save $billions through increased efficiency both now and in the future. This reform amounts to a win-win situation for government employees as well as the tax payers through employee empowerment and by ending bureaucratic waste. See Article 104. Enterprise Lean and the New Government Management System.
The key activity I require by my Lean Teams that they develop a Daily Plan, a graphic depiction of the processes that they do on a daily basis. This depiction may be in the form of a wall chart where each operation performed by members of the Team are depicted graphically in the sequence that the work is done. The accuracy of the wall chart depends on an accurate time for each process. When the wall chart has been reviewed and no other improvements are known photos of the wall are made and passed to other teams doing the same operations in other government locations. The final wall chart is not carved in stone but available for continuous improvement. This activity gets the highest possible efficiency from the function.
Implementation of The New government Management system
The New Government Management organization will be within the Office of Inspector General organization which I recommend be separated from the Government Departments and reports directly to the Office of Management and Budget.
The new Government Management System is used to set staffing levels and a bottoms-up budget using the Lean Team study data.
First OIG (Office of Inspector General) Analysts will be trained as Facilitators setting-up and organizing each Lean Team. The number of VA Lean Teams will depend on the number of functions within each hospital. An OIG Analyst will be able to Facilitate about 20 Lean Teams. After setting-up the Lean Team the OIG Analyst will monitor and assist in the development of the wall chart. The OIG Analyst will become the manager of his Lean Teams.
The OIG Analyst will be trained to manage about 20 Lean areas:
1. He will work closely with each Lean Team in making improvements including the installation of additional equipment.
2. He will develop and monitor a schedule for each Lean Team based on patient backlogs.
3. He will make a monthly progress report for each Lean Team.
4. He will create a bottoms-up manpower budget for each Lean Team.
5. He will create a annual bottoms-up budget for his functional Lean Teams.
The annual functional bottoms-up budgets are summed establishing an actual min cost at the highest efficiency for the Department all other costs are negotiable.
An Advantage of this Approach
The advantage of this approach is that all actual manpower and operations costs are known creating a minimum known budget. This means that only addition added budget items need to be negotiated and not the entire Agency Budget. It also means that with a steady backlog little scheduling and management is needed. The function nearly runs itself like the health care routine Procedure Clinics.
Where tasks are variable the Lean Teams will be more involved with scheduling and management of daily activities.
Saturday, September 23, 2017
Article 105. Explaining How We can Afford Health Care
Explaining How We can Afford Health Care
While Congress and the media are wringing their hands on where the money is going to come from for Health Care. There is no reason why we can not have affordable healthcare. The following is a simple explanation of how we can pay for Health Care.The Problem begins with Congress
Congress focuses on one problem at a time: Health Care, Tax reform, balancing the budget etc. The reason is these are very complicated issues but when they do this they miss the big picture and all of these issues are related because you have to have a way of paying for them. These issues are seen as being mutually exclusive, you cannot have Health Care and tax cuts and balance the budget. The false thinking is that there is only so much money that the government has without raising taxes. This is a nearsighted false concept.
Congress focuses on passing legislation and not on managing legislation. That is left up to the “Spenders” the Government Departments that get the budget to run their organizations. This is supposedly monitored by the Office of Inspector General within Each Department. But since the OIG reports directly to the head of the Department nothing is done until a whistle blower goes public then the OIG is asked to look into the Matter. The result is that waste is built right into the system. US Government Waste is in the $Billions. Ref: LawrenceRosierConsulting blog article 88.
Congress’s Problem
Passing Legislation is only one half of Congress’s Job the other half is insuring that the legislation actually works and does the job efficiently. In this half Congress has been a complete failure. The fact is that almost nothing is done to prevent waste and Congressmen don’t seam to care and are seemingly unaware that waste and mismanagement exits. This is because they see it as someone else’s problem and not their own.
The Solution
Once legislation has been passed by Congress the Congressional Budget Office reviews the bill to see if the funding is close to what they think will be required. But instead of sending the budgeted funding directly to the Department for which it was intended it is sent to the new Government Management organization (OIG Analysts) to determine how it will be efficiently used. If too much funding has been approved by Congress the excess funding will be returned to the US Treasury and if not enough funding has been provided the Government Management organization will determine how much extra funding is required and how it will be used.
The New Government Management organization will be within the Office of Inspector General organization which I recommend be separated from the Government Departments and reports directly to the Office of Management and Budget.
The Office of Inspector General's main job is to investigate misuse of Federal Funds this an after the fact investigative organization of waste and mismanagement meaning the investigation occurs after the funds have already been wasted. With the new Government Management organization the investigative function of the OIG will be greatly reduced allowing OIG Analysts to become available to manage the governments business.
Where the Money for Health Care Comes From
By now you should be realizing that the money for Health Care is found in the elimination of waste both in our Healthcare system and in the Federal Government. But even more savings becomes available with the implementation of efficient Health Care and Government Management Systems. While Congress and the media are wringing its hands on the question of where the money is going to come from for Health Care. The answer is simply stop the waste in government and make the Government and Health Care operate efficiently and no new taxes are needed.
Changes needed to Make US Health Care Work
The Major changes that are needed to make the US health care system efficient and affordable.
But first mistakes were made by Democratic lawmakers in the design and passage of Obamacare.
1. They brought in all the major players to get their input: Private Health Care Providers, Health Insurance Companies etc. Sounds good but tells us that the lawmakers did not understand why our Health Care costs so much. Our Private Healthcare System is based largely on defrauding the government to pay for the high cost of health care. Our Fraud based Health Care costs double that of government based European Health Care. It even costs twice as much as our government based Veterans healthcare system. Ref: LawrenceRosierConsulting Blog Articles: 101.
2. Health Insurance Companies did not explain why the insurance of catastrophic Health Care would drive up the cost of premiums. This was the major failure of Obamacare Catastrophic health insurance can become costly due to the unpredictably of the need for long term high cost medical services. When Catastrophic Health Care is combined with regular Health Care premiums are driven up due to the high cost of the Catastrophic Health Care making Health Insurance unaffordable. This became an insurmountable problem when citizens were forced to buy health insurance.
3. They were not focused on bringing down the high cost of healthcare only in passing health care for all. Once Obamacare was passed we are left without a way of paying for it.
Trump Administration
The Trump Administration did not realize the way that Congress normally operates, focusing narrowly on passing legislation in individual areas. This GOP Congress has seen few risk takers, they have focused on proposing quick fixes to Obamacare and failed to see that it could be funded by eliminating waste and implementing management reforms to get efficiency. This puts the responsibility for solving major government problems and introducing innovations in government with the President and his staff.
If the GOP Congressmen had focused on eliminating waste and had implemented efficient government Management reforms first then a more accurate accounting of saving that could be gotten from this approach would have shown that Health Care may be affordable after all. This opportunity was missed because Congress has never admitted that it is responsible for the waste and inefficiency of the US government. The President can correct this problem by implementing recommended reforms in the Veterans Administration as a pilot reform for further implementation throughout the Federal government. Ref: LawrenceRosierConsulting blog articles 104, 101, 96 and 88.
Congress can enact legislation for separating the Departmental Offices of Inspector General in a single watchdog organization with management responsibility for the recommended new Government Management system. Ref: LawrenceRosierConsulting blog articles 104, 96 and 88.
Repeal and Replace Obamacare with this Recommended System
The recommended near term approach is to let the people pay what they can afford for their Health Care. Above that the government will provide catastrophic Heath Care to all Americans in a new Catastrophic Health Care System. Health Care recipients should pay each year for their own health care from private providers up to a specified amount determined by income at several levels. No one is required to buy health insurance. Paying all the health care costs for everything that people want is not possible and should not be provided by the Government. As an option private Health Insurance Companies can compete in providing the minimum coverage up to the catastrophic level if wanted by individuals and companies (as was done in the past). Health Insurance is not provided in the governments Catastrophic system. The Federal Government should not provide healthcare to non-citizens, however State Governments may chose to provide this service.
The key to this system is the elimination of Private Health Insurance and Private Hospitals from the Catastrophic Health Care System. Health Insurance for catastrophic health does not work because profits necessarily drive up insurance rates and co-pays. Private Hospitals have resorted to massive fraud to survive. Congress has not been able to prevent the waste and corruption found in our health care system. Americans simply can not afford or be expected to pay for a health care system that is the most wasteful and expensive in the world. The current health care waste from fraud and abuse has been passed on to the public and not enough has been done to make the day to day health care processes themselves efficient. But now we have the Reforms to be implemented in the VA which makes health care efficient and effective.
This makes possible the Government catastrophic affordable alternative to the current private health care system. LawrenceRosierConsulting Blog Articles: 103,101,97,98
Transition Alternatives
The VA Healthcare system must have reforms fully implemented in all of its facilities and be treated as a separate system providing Vets the health care they need. The VA system changes according to needs of the Vets with age and with injury types. Therefore there is a need to go outside the system for healthcare it cannot provide. This alternative will be the Catastrophic Health Care System that mostly serves those receiving Medicaid. The cost of the Catastrophic Health Care System may be shared with the State Government.
In the future the US Government may pursue the development of a complete government Health Care system for Medicare as an alternative to the current private health care delivery system that is mainly driven by fraud. US Health Care reforms can move to a government run system over the next 10 years similar to Europe but with better management controls. More than $1trillion can be saved by eliminating waste paying for Medicaid, Medicare. LawrenceRosierConsulting Blog Articles: 103, 100, 96.
Catastrophic Health Care should easily Pass both sides of the aisle in Congress. Who is to argue with Health Care paid for by the elimination of waste and a new Government Management system for efficiency.
Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com
Friday, September 8, 2017
Article 104. Enterprise Lean and the New Government Management System
Enterprise Lean and the New Government Management System
Before we discuss the VA reforms it is important that we recognize that the VA Health Care System with all its faults is half the cost of our Fraud Based Private Health care system. There is no conceivable way to bring our Private Health care system under proper management control. My recommendation is that the entire corrupt system be scraped and replaced an efficient government run system such as the reformed VA system.The following is a simple explanation of how the Veteran Affairs reforms of Enterprise Lean and the new government management system will work. This will be the very first finitely controlled government management system employed in US Government history. This approach fits all government operations that are repeatable on a regular basis such as in Veterans Health Care. Other attempts to manage government are from a macro point of view and are valid in cases where world events force new management decisions. But even in the macro decision area operations are of a repeated nature and can be managed efficiently using the Enterprise Lean approach.
Enterprise Lean
Enterprise Lean developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in government processes. It has also been successfully implemented in the Cleveland Clinic well known for its health care. The process consists of working teams that meet regularly to review and discuss how the work they are doing can be improved upon.
The key activity I require by my Lean Teams that they development a graphic depiction of the processes that they do on a daily basis. This depiction, a Daily Plan may be in the form of a wall chart where each operation performed by members of the Team are depicted graphically in the sequence that the work is done. The accuracy of the wall chart depends on an accurate time for each process. When the wall chart has been reviewed and no other improvements are known photos of the wall are made and passed to other teams doing the same operations in other VA Hospitals. The final wall chart is not carved in stone but available for continuous improvement.
Implementation of Enterprise Lean and the New Management system at the VA
The intent is to grow the implementation of VA reforms starting with the kickoff training provided by the Principal Consultant for current employees of the VA.
The VA has an Office of Inspector General (OIG) with OIG Analysts which investigate waste and fraud within the VA hospital system. It is believed that problems of this nature will decrease with the Lean Teams who elect their members by secret ballot and are protected whistle blowers. First OIG Analysts will be trained as Facilitators setting-up and organizing each Lean Team. The number of VA Lean Teams will depend on the number of functions within each hospital. An OIG Analyst will be able to Facilitate about 20 Lean Teams. After setting-up the Lean Team the OIG Analyst will monitor and assist in the development of the wall chart. The OIG Analyst will become the manager of his Lean Teams.
The OIG Analyst will be trained to manage about 20 Lean areas:
1. He will work closely with each Lean Team in making improvements including the installation of additional equipment.
2. He will develop and monitor a schedule for each Lean Team based on patient backlogs.
3. He will make a monthly progress report for each Lean Team.
4. He will create a bottoms-up manpower budget for each Lean Team.
5. He will create a annual budget for his Lean Teams.
An Advantage of this Approach
The advantage of this approach is that all actual manpower and operations costs are known creating a minimum known budget. This means that only addition added budget items need to be negotiated and not the entire Department Budget.
Additional management Improvements can be made to decrease the cost of operations. I have experience in creating an effective Management Team that reduces Bureaucratic redundancy by allowing the Elected Team Leaders to become the bottom level supervisors. Because they are doing what low level supervisors normally do.
Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com
Tuesday, August 29, 2017
Article 103. Proposed Implementation Plan for National Health Care System
Proposed Implementation Plan for National Health Care System
The plan is to implement the National Health Care System (NHCS) in stages as it gradually becomes the nations primary health care system. The plan also separates rural health care from urban health care to accommodate the needs of the nation.
We will combine the VA health care system with a new Catastrophic Health Care system (a government run system) consisting largely of Medicaid and with Medicare in the second stage. Remember if you have an efficient effective VA program then no private health care company can compete with it because private companies must make healthcare run more efficient than government healthcare. If they can’t do this then there are no profits. If there are no profits in the healthcare system private systems will just drive up the cost of healthcare to get profits. Our Healthcare costs double that of European government health care and they are not efficient.
I call our current Health Care system a fraud based system because it is largely funded by fraud compared with a Government Health Care system monitored by Lean Teams. The best example of this type system is the Cleveland Clinic which has implemented Enterprise Lean Teams. See Article 101.
Stage 1. The Startup Stage
As a government run system the current VA health care system may be worse than that of European health care but they both have the same problems: massive bureaucracy, low efficiency, high patient backlogs and uncontrolled costs. My approach fixes nearly all of the VA’s health care problems. Europe does not have this approach yet. If we can fix the VA problems then this approach will work for a complete US government run healthcare system. Stage one is to implement this new efficient approach using Enterprise Lean with a new government management system through out the VA System. See Article 104 and 96.
The government will begin to acquire hospitals under financial stress at little to no cost. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals.
Medicaid patients will share VA facilities and the acquired private hospitals. They will be slowly moved from private hospitals to the Catastrophic Health Care system. VA patients will be served before Medicaid Patients.
Stage 2. Medicaid and Medicare Patients moved to Catastrophic Care Facilities
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of over ten times the current approach.
As this stage progresses Medicaid patients will be served first followed by Medicare Patients in the Catastrophic facilities.
Stage 3. Accommodation of Patients without Health care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the Catastrophic Health Care Facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the National Health Care System (NHCS).
Stage 4. The National Health Care System will be Available to all Americans
The expanded Catastrophic Health Care system (called NHCS) will be available to all Americans. Health Insurance Companies will gradually require that patients move to the less expensive NHCS.
Some Private Hospitals may still be available for those who want them.
The NHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Besides an Emergency function the clinics can serve as place for state wide traveling Cataract Surgery teams to do Cataract Surgery. The clinics can also service a traveling Dialysis Van for patients in remote rural areas.
The plan is to implement the National Health Care System (NHCS) in stages as it gradually becomes the nations primary health care system. The plan also separates rural health care from urban health care to accommodate the needs of the nation.
We will combine the VA health care system with a new Catastrophic Health Care system (a government run system) consisting largely of Medicaid and with Medicare in the second stage. Remember if you have an efficient effective VA program then no private health care company can compete with it because private companies must make healthcare run more efficient than government healthcare. If they can’t do this then there are no profits. If there are no profits in the healthcare system private systems will just drive up the cost of healthcare to get profits. Our Healthcare costs double that of European government health care and they are not efficient.
I call our current Health Care system a fraud based system because it is largely funded by fraud compared with a Government Health Care system monitored by Lean Teams. The best example of this type system is the Cleveland Clinic which has implemented Enterprise Lean Teams. See Article 101.
Stage 1. The Startup Stage
As a government run system the current VA health care system may be worse than that of European health care but they both have the same problems: massive bureaucracy, low efficiency, high patient backlogs and uncontrolled costs. My approach fixes nearly all of the VA’s health care problems. Europe does not have this approach yet. If we can fix the VA problems then this approach will work for a complete US government run healthcare system. Stage one is to implement this new efficient approach using Enterprise Lean with a new government management system through out the VA System. See Article 104 and 96.
The government will begin to acquire hospitals under financial stress at little to no cost. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals.
Medicaid patients will share VA facilities and the acquired private hospitals. They will be slowly moved from private hospitals to the Catastrophic Health Care system. VA patients will be served before Medicaid Patients.
Stage 2. Medicaid and Medicare Patients moved to Catastrophic Care Facilities
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of over ten times the current approach.
As this stage progresses Medicaid patients will be served first followed by Medicare Patients in the Catastrophic facilities.
Stage 3. Accommodation of Patients without Health care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the Catastrophic Health Care Facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the National Health Care System (NHCS).
Stage 4. The National Health Care System will be Available to all Americans
The expanded Catastrophic Health Care system (called NHCS) will be available to all Americans. Health Insurance Companies will gradually require that patients move to the less expensive NHCS.
Some Private Hospitals may still be available for those who want them.
The NHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Besides an Emergency function the clinics can serve as place for state wide traveling Cataract Surgery teams to do Cataract Surgery. The clinics can also service a traveling Dialysis Van for patients in remote rural areas.
Saturday, August 5, 2017
Article 102. About the Author Lawrence Rosier
About The Author Lawrence Rosier August 5, 2017
Lawrence Rosier 12143 Cedar Grove Rd.
Rolla, Missouri 65401
573-578-4716 LawrenceRosier4@gmail.com
In 2004 I became interested in solving government problems and set up a popular Government Reform blog attaining up to 2000 hits per day. The current Blog was begun in 2013 (although with fewer hits) after the first one was abruptly cancelled when the provider went out of business. In 2013 and 2014 I had perfected my approach to government reform and I made a number of proposals to fix Veterans Affairs health care and management problems but all were rejected by the Obama Administration. This postponed my attempt as an independent Consultant in Government Reform. Now with the Trump Administration new opportunities may be available.
Since I have became semi-retired I developed an interested finding an Energy Solution. In 2009 with the worlds reliance on fossil fuels automobiles and electric power generation I wanted to find a technology that could provide breakthroughs in power generation. My research uncovered several hoaxes and some real possibilities.
I focused on the Nicola Tesla/Steven Mark/Edwin Gray/ Don Smith Inventions. I researched this technology thoroughly and found that it was not a hoax. Recently I have followed Don Smith and his invention using a Tesla Coil to generate 160 kilowatts of continuous electrical power while not connected to the grid. The unit was small enough to fit on a kitchen table. Don’s 48 inventions were mostly in foreign countries for individual clients who have welcomed the “New” Electric Technology. See my Abstract: “New” Electric Technology by Lawrence Rosier on my blog: Perpetualelectric.blogspot.com Articles 10, 13, 14, and 15.
Engineering and Consulting Experience
After Graduation form the University of Missouri in 1961 as an Industrial Engineer I was hired by McDonnell Aircraft Co. I did time-studies and balancing the Final Assembly line of the F4 Phantom for 3 years. Then as a mechanical Engineer I designed a mechanism for allowing pilots to eject on the ground after the disastrous Forestall Aircraft Carrier fire in Vietnam. In 1969 in Washington State I served on the staff of: George Parker, Manager of Special Projects, Boeing Co. working with a team that certified the 747 commercial aircraft. I was later a Management Consultant with Alexander Proudfoot and Scheduling Corp. both firms located in Chicago. In my first two weeks on location with Proudfoot I was able to save the client, Clark Equipment of Battle Creak MI, $10 million after discovering that their Production Control Dept. was 50% overstaffed. I was also the Manager of Manufacturing Engineering for Multiplex Company in St. Louis. In 1983 I served on Hal Yost’s staff, President of McDonnell Douglas Missile Systems Co. and later on Vice President of Manufacturing George Masurat‘s staff.
My most significant achievement was my proposal and acceptance by Sanford McDonnell CEO of McDonnell Douglas Corp. of a modification to the company’s Quality of Work Life (QWL) implementation (the forerunner of Enterprise Lean). The modification replaced the existing Bureaucratic organization with a Team Management organization consisting of Steering Management Teams and Functional Management Teams for the entire McDonnell Douglas Missile Systems Co. This Team Management style was enthusiastically received by employees and inspired employee innovation. It was used successfully for over ten years until the sale of the Company to Boeing in the 1990’s.
Education
Education included degrees in Industrial Engineering and Secondary Education graduating with a 4.0 GPA. I was a graduate instructor at the University of Washington Experimental Education Unit where I studied Behavioral Modification.
Family
Lawrence was born August 30, 1938 in McCook, Nebraska. my family moved to Mound City, Missouri in 1940. My wife Sharon a former school teacher and I have no children and I am in excellent heath for my age. I am from a well respected religious family and one of the largest private farm land owners in Missouri. My family installed 19 wind generators several years ago.
Lawrence Rosier is an Independent Consultant registered in the State of Missouri as "Lawrence Rosier Consulting".
Lawrence Rosier’s Ebooks on Government Reform can be purchased through Amazon.com
Lawrence Rosier 12143 Cedar Grove Rd.
Rolla, Missouri 65401
573-578-4716 LawrenceRosier4@gmail.com
In 2004 I became interested in solving government problems and set up a popular Government Reform blog attaining up to 2000 hits per day. The current Blog was begun in 2013 (although with fewer hits) after the first one was abruptly cancelled when the provider went out of business. In 2013 and 2014 I had perfected my approach to government reform and I made a number of proposals to fix Veterans Affairs health care and management problems but all were rejected by the Obama Administration. This postponed my attempt as an independent Consultant in Government Reform. Now with the Trump Administration new opportunities may be available.
Since I have became semi-retired I developed an interested finding an Energy Solution. In 2009 with the worlds reliance on fossil fuels automobiles and electric power generation I wanted to find a technology that could provide breakthroughs in power generation. My research uncovered several hoaxes and some real possibilities.
I focused on the Nicola Tesla/Steven Mark/Edwin Gray/ Don Smith Inventions. I researched this technology thoroughly and found that it was not a hoax. Recently I have followed Don Smith and his invention using a Tesla Coil to generate 160 kilowatts of continuous electrical power while not connected to the grid. The unit was small enough to fit on a kitchen table. Don’s 48 inventions were mostly in foreign countries for individual clients who have welcomed the “New” Electric Technology. See my Abstract: “New” Electric Technology by Lawrence Rosier on my blog: Perpetualelectric.blogspot.com Articles 10, 13, 14, and 15.
Engineering and Consulting Experience
After Graduation form the University of Missouri in 1961 as an Industrial Engineer I was hired by McDonnell Aircraft Co. I did time-studies and balancing the Final Assembly line of the F4 Phantom for 3 years. Then as a mechanical Engineer I designed a mechanism for allowing pilots to eject on the ground after the disastrous Forestall Aircraft Carrier fire in Vietnam. In 1969 in Washington State I served on the staff of: George Parker, Manager of Special Projects, Boeing Co. working with a team that certified the 747 commercial aircraft. I was later a Management Consultant with Alexander Proudfoot and Scheduling Corp. both firms located in Chicago. In my first two weeks on location with Proudfoot I was able to save the client, Clark Equipment of Battle Creak MI, $10 million after discovering that their Production Control Dept. was 50% overstaffed. I was also the Manager of Manufacturing Engineering for Multiplex Company in St. Louis. In 1983 I served on Hal Yost’s staff, President of McDonnell Douglas Missile Systems Co. and later on Vice President of Manufacturing George Masurat‘s staff.
My most significant achievement was my proposal and acceptance by Sanford McDonnell CEO of McDonnell Douglas Corp. of a modification to the company’s Quality of Work Life (QWL) implementation (the forerunner of Enterprise Lean). The modification replaced the existing Bureaucratic organization with a Team Management organization consisting of Steering Management Teams and Functional Management Teams for the entire McDonnell Douglas Missile Systems Co. This Team Management style was enthusiastically received by employees and inspired employee innovation. It was used successfully for over ten years until the sale of the Company to Boeing in the 1990’s.
Education
Education included degrees in Industrial Engineering and Secondary Education graduating with a 4.0 GPA. I was a graduate instructor at the University of Washington Experimental Education Unit where I studied Behavioral Modification.
Family
Lawrence was born August 30, 1938 in McCook, Nebraska. my family moved to Mound City, Missouri in 1940. My wife Sharon a former school teacher and I have no children and I am in excellent heath for my age. I am from a well respected religious family and one of the largest private farm land owners in Missouri. My family installed 19 wind generators several years ago.
Lawrence Rosier is an Independent Consultant registered in the State of Missouri as "Lawrence Rosier Consulting".
Lawrence Rosier’s Ebooks on Government Reform can be purchased through Amazon.com
Sunday, July 23, 2017
Article 101. Why is the US Health Care System the Costliest in the World
Why is the US Health Care System the Costliest in the World?
Government run European Health Care systems are much less costly but can be made more efficient with Enterprise Lean.
I call our Health Care system a fraud based system because it is largely funded by fraud compared with a Government Health Care system monitored by Lean Teams. The best example of this type system is the Cleveland Clinic which has implemented Enterprise Lean Teams. I can explain this by reviewing the routine questions that arise when an Enterprise Lean Team examines their processes.
Question No.
1. Is this process really necessary for the patient?
In a Lean Team based system the question can be focused on the Patient.
In a fraud based system the answer is nearly always yes to add funding needed to pay for hospital operations.
2. Is this the most efficient way of doing the process?
In a Lean Team system the question brings different ideas to the discussion for examination ending in the determination of the best solution.
In a fraud based system the answer is how can we increase the cost to get more funding for hospital operations. This is where we find items such as a roll of gauze costing an exorbitant amount such as $25 and unnecessary tests being conducted for the patient.
3. What are the skill levels needed to do this Process?
In a Lean Team based system the Team will examine what the nurses and support staff are actually doing and assign the proper skill levels required.
In a fraud based system the answer is how can we get by with the skill levels we have without adding cost. There is no oversight to insure that standards are properly maintained.
4. Is Proper billing for medical services being done?
In a Lean Team based system the Medical Services Team will insure proper billing methods.
In a fraud based system patients and Insurance companies are sometimes double billed through a variety of methods such as combining all the individual bills into one large bill followed by billing each of the bills issued separately.
This provides some insight as to what is happening in our health care system and why I recommend that that a properly managed government run health care system with the profit motive removed can be much less costly. See Articles 97. and 98. See also Reform of the Veteran Affairs hospitals Article 96.
Ref: Article 93. "Example of Massive Medicare Fraud". Hospitals throughout the US in large numbers are using sick and confused mostly elderly patients as cash cows billing Medicare for unnecessary treatments. This mass fraud is used to finance hospital operations and building projects.
Government run European Health Care systems are much less costly but can be made more efficient with Enterprise Lean.
I call our Health Care system a fraud based system because it is largely funded by fraud compared with a Government Health Care system monitored by Lean Teams. The best example of this type system is the Cleveland Clinic which has implemented Enterprise Lean Teams. I can explain this by reviewing the routine questions that arise when an Enterprise Lean Team examines their processes.
Question No.
1. Is this process really necessary for the patient?
In a Lean Team based system the question can be focused on the Patient.
In a fraud based system the answer is nearly always yes to add funding needed to pay for hospital operations.
2. Is this the most efficient way of doing the process?
In a Lean Team system the question brings different ideas to the discussion for examination ending in the determination of the best solution.
In a fraud based system the answer is how can we increase the cost to get more funding for hospital operations. This is where we find items such as a roll of gauze costing an exorbitant amount such as $25 and unnecessary tests being conducted for the patient.
3. What are the skill levels needed to do this Process?
In a Lean Team based system the Team will examine what the nurses and support staff are actually doing and assign the proper skill levels required.
In a fraud based system the answer is how can we get by with the skill levels we have without adding cost. There is no oversight to insure that standards are properly maintained.
4. Is Proper billing for medical services being done?
In a Lean Team based system the Medical Services Team will insure proper billing methods.
In a fraud based system patients and Insurance companies are sometimes double billed through a variety of methods such as combining all the individual bills into one large bill followed by billing each of the bills issued separately.
This provides some insight as to what is happening in our health care system and why I recommend that that a properly managed government run health care system with the profit motive removed can be much less costly. See Articles 97. and 98. See also Reform of the Veteran Affairs hospitals Article 96.
Ref: Article 93. "Example of Massive Medicare Fraud". Hospitals throughout the US in large numbers are using sick and confused mostly elderly patients as cash cows billing Medicare for unnecessary treatments. This mass fraud is used to finance hospital operations and building projects.
Wednesday, June 7, 2017
Article 100. Growing Government Reform from the VA Pilot to the Entire Federal Government
Growing Government Reform from the VA Pilot to the Entire Federal Government
Based on Article 99 Reform of the US Government in General and Article 96 the reform of the pilot VA.
The Republican Party has this present unique window of opportunity to bring spending under control and prevent the need to continually raise the debt limit making the US Government financially sound again. My Reform proposals give an overview of how the Trump Administration can bring innovation and reform to the US federal Government saving the tax payers $trillions. The strategy is to Grow Government Reform with the VA Pilot and then spread the reforms throughout the Entire Federal Government.
The Reform process in the current Trump administration has already begun with the new Budget using the approach of first simplifying government using new tools such as the Effectiveness Test to determine how well an item meets the expected results of its originators. Waste from duplication of government efforts by multiple Agencies is yet to be addressed. The process of reform continues with the prototype implementation of Veterans Affairs Hospitals making them efficient through Continuous Improvement.
The Recommended Startup Plan focuses on the implementation of Reforms in the Veteran’s Administration Under the direction of the White House Office of American Innovation lead by Jared Kushner to begin within the first six months of the Trump Administration. This article explains how a single person the Principle Consultant can make this implementation happen without hundreds of consultants swarming all over the government costing $millions and leaving the government after a few years in turmoil. So how can one person effectively reform the US Federal Government. The answer is he can’t without strong Congressional and Presidential support. But it can be done by growing an organization such as the OIG within the Federal Government to become the implementers of the reforms followed by becoming the managers of government. The basic reform process is called Enterprise Lean developed years ago by Toyota and has now been successfully implemented in Minnesota and Iowa State governments.
I propose that a single Principle Consultant such as myself can begin a training program for OIG Analysts first in being Facilitators for setting up Enterprise Lean Teams in each function of the DC Veterans Hospital. Each OIG Analyst will organize several Lean Teams, helping them to elect their leaders and follow on with the building of wall charts(from the 1980s). Now a 60 in. flat screen TV with a modified spreadsheet will serve the same purpose. The Wall Screen allows each Lean Team member to view the entirety of their functional work flows and provide input to improving the function's processes. When the Wall Screen is completed the result is placed into actual use in the hospital's function and after testing a thumb drive of the screen is shared with all VA Hospital's OIG analysts and their Lean Teams. The documented wall screen is not the final method but can be updated by any Lean Team and the improvement be shared with other Lean Teams.
The second part of the OIG training will be in the work measurement of each of the processes that are a part of the function and necessary in building the wall Screen.
A third part of the OIG training will be in the collection of the measured data into a database representing the total hours for the function. As the functions develop their work hours for all the members of the Lean Teams the Departmental database will be collected into what I call a bottoms-up manpower budget. This will be used to determine right-sizing of the function based on patient backlog. From this the OIG Analysts will be schooled in the scheduling needed to meet patient backlogs. We now have the data to manage the Federal Government for the very first time in history.
Critics will argue that this will lead to making VA hospitals employees work harder. But what we have done is simply removed the wait times for employees waiting on other employees, allowing employees to work smarter rather than harder. Working smarter allows for Continuous Improvement in the Lean Teams function. With 90% of VA personnel meeting once a week in Lean Teams Continuous Improvement can result in thousands of what appear to be small fixes such as the: removing red tape or Improvements in patient care to major cost reductions.
Based on Article 99 Reform of the US Government in General and Article 96 the reform of the pilot VA.
The Republican Party has this present unique window of opportunity to bring spending under control and prevent the need to continually raise the debt limit making the US Government financially sound again. My Reform proposals give an overview of how the Trump Administration can bring innovation and reform to the US federal Government saving the tax payers $trillions. The strategy is to Grow Government Reform with the VA Pilot and then spread the reforms throughout the Entire Federal Government.
The Reform process in the current Trump administration has already begun with the new Budget using the approach of first simplifying government using new tools such as the Effectiveness Test to determine how well an item meets the expected results of its originators. Waste from duplication of government efforts by multiple Agencies is yet to be addressed. The process of reform continues with the prototype implementation of Veterans Affairs Hospitals making them efficient through Continuous Improvement.
The Recommended Startup Plan focuses on the implementation of Reforms in the Veteran’s Administration Under the direction of the White House Office of American Innovation lead by Jared Kushner to begin within the first six months of the Trump Administration. This article explains how a single person the Principle Consultant can make this implementation happen without hundreds of consultants swarming all over the government costing $millions and leaving the government after a few years in turmoil. So how can one person effectively reform the US Federal Government. The answer is he can’t without strong Congressional and Presidential support. But it can be done by growing an organization such as the OIG within the Federal Government to become the implementers of the reforms followed by becoming the managers of government. The basic reform process is called Enterprise Lean developed years ago by Toyota and has now been successfully implemented in Minnesota and Iowa State governments.
I propose that a single Principle Consultant such as myself can begin a training program for OIG Analysts first in being Facilitators for setting up Enterprise Lean Teams in each function of the DC Veterans Hospital. Each OIG Analyst will organize several Lean Teams, helping them to elect their leaders and follow on with the building of wall charts(from the 1980s). Now a 60 in. flat screen TV with a modified spreadsheet will serve the same purpose. The Wall Screen allows each Lean Team member to view the entirety of their functional work flows and provide input to improving the function's processes. When the Wall Screen is completed the result is placed into actual use in the hospital's function and after testing a thumb drive of the screen is shared with all VA Hospital's OIG analysts and their Lean Teams. The documented wall screen is not the final method but can be updated by any Lean Team and the improvement be shared with other Lean Teams.
The second part of the OIG training will be in the work measurement of each of the processes that are a part of the function and necessary in building the wall Screen.
A third part of the OIG training will be in the collection of the measured data into a database representing the total hours for the function. As the functions develop their work hours for all the members of the Lean Teams the Departmental database will be collected into what I call a bottoms-up manpower budget. This will be used to determine right-sizing of the function based on patient backlog. From this the OIG Analysts will be schooled in the scheduling needed to meet patient backlogs. We now have the data to manage the Federal Government for the very first time in history.
Critics will argue that this will lead to making VA hospitals employees work harder. But what we have done is simply removed the wait times for employees waiting on other employees, allowing employees to work smarter rather than harder. Working smarter allows for Continuous Improvement in the Lean Teams function. With 90% of VA personnel meeting once a week in Lean Teams Continuous Improvement can result in thousands of what appear to be small fixes such as the: removing red tape or Improvements in patient care to major cost reductions.
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