Brian Tate Asmussen

Why I Love Jesus But Hate Religion - A Catholic Response

2012-01-14T11:53:00.000-06:00

One Patient at a Time

2012-01-12T21:41:00.000-06:00

Leadership

2012-01-11T21:56:00.002-06:00

“LEADERSHIP is the art of accomplishing more than the science of MANAGEMENT says is possible."
- Colin Powell

Pictures from Brian

2011-11-17T00:44:00.001-06:00

Click here to view these pictures larger

Puppy time!

2011-11-13T23:18:00.001-06:00

We are enjoying Miss Ellie Grace a lot. Potty training is hard but she is learning a lot and I'm sure she'll have in down in a few weeks.

Taylor Swift Concert

2011-10-14T00:31:00.001-05:00

Here's To the Crazy Ones - Think Different - Steve Jobs Tribute

2011-10-09T12:43:00.000-05:00

Steve Jobs - Say YES to Life!

2011-10-09T02:05:00.002-05:00

Her name is Joanne Schiebel. In 1954, she was a young unmarried college student who discovered that she was pregnant. In the 1950s, her options were limited. She could have had an abortion – but the procedure was both dangerous and illegal. She could have gotten married, but she wasn’t ready and didn’t want to interrupt her education. Joanne opted, instead, to give birth to the baby and put it up for adoption.

And so it was that in 1955, a California couple named Paul and Clara adopted a baby boy, born out of wedlock, that they named Steven.

This adopted baby grew into a man that changed the world. We celebrate his life and his accomplishments and wish him the best in the afterlife. The baby's name is Steve Jobs.

If you are thankful for the life of Steve Jobs; if you are thankful for the contributions he has made to the world and your life then today...thank his mother Joanne Schiebel for choosing life.

Steve Jobs 1955-2011

2011-10-06T21:07:00.003-05:00

The Big Idea: How to Solve the Cost Crisis in Health Care - Harvard Business Review

2011-09-12T22:24:00.000-05:00

The Big Idea: How to Solve the Cost Crisis in Health Care - Harvard Business Review:

'via Blog this'

Life Expectancy

2011-09-01T11:48:00.000-05:00

“On the basis of current life expectancy, it is possible that an individual over the age of 50 today could be cared for by a physician who is not yet born.”
– Jack Cochran, MD, Executive Director, The Permanente Federation

Official Gmail Blog: Using Gmail, Calendar and Docs without an Internet...

2011-08-31T13:36:00.000-05:00

I really like the new user interface even better than the normal Gmail user interface!

Official Gmail Blog: Using Gmail, Calendar and Docs without an Internet...: Posted by Benoît de Boursetty, Product Manager (Cross-posted on the Google Enterprise Blog ) The great thing about web apps is that you...

They will now

2011-07-20T21:54:00.000-05:00

They will now:

A lovely story from a friend:

A teacher was in school with young children, and they had just begun a drawing session.

'What do you plan to draw?' she asked a little girl, who was about to start in with her crayons.

'God,' was the reply.

'Oh, that's hard because nobody knows what God looks like,' offered the teacher.

'They will now,' said the girl.

10 Myths About Introverts

2011-07-10T23:33:00.001-05:00

http://owlcityblog.com/2011/06/27/10-myths-about-introverts/

This was written on Adam Young’s (the guy from Owl City) website. It made me think of my wife and made me understand her even that much more.

10 Myths About Introverts

On June 27th, 2011 by Adam Young

I recently stumbled across a blog written by Carl King about the phenomenon known as the introverted human being and it struck a major chord with me. After each bullet, I felt like standing up and shouting “YESSSSSSSSS!” at the top of my lungs because these points (made by author Marti Laney, Psy.D) are total home runs. As an extreme introvert, this is like sweet manna from heaven.

I was lucky enough to discover a book called, The Introvert Advantage (How To Thrive in an Extrovert World), by Marti Laney, Psy.D. I feel like someone has written an encyclopedia entry on a rare race of people to which I belong. Not only has it explained many of my eccentricities, it helps me to redefine my entire life in a new and positive context.

Sure, anyone who knows me would say, “Duh! Why did it take you so long to realize you’re an Introvert?” It’s not that simple. The problem is that labeling someone as an Introvert is a very shallow assessment, full of common misconceptions. It’s more complex than that. (Since Carl King is talking about it, it has to be.)

A section of Laney’s book maps out the human brain and explains how neuro-transmitters follow different dominant paths in the nervous systems of Introverts and Extroverts. If the science behind the book is correct, it turns out that Introverts are people who are over-sensitive to Dopamine, so too much external stimulation overdoses and exhausts them. Conversely, Extroverts can’t get enough Dopamine, and they require Adrenaline for their brains to create it. Extroverts also have a shorter pathway and less blood-flow to the brain. The messages of an Extrovert’s nervous system mostly bypass the Broca’s area in the frontal lobe, which is where a large portion of contemplation takes place.

Unfortunately, according to the book, only about 25% of people are Introverts. There are even fewer that are as extreme as I am. This leads to a lot of misunderstandings, since society doesn’t have very much experience with my people. (I love being able to say that.)

So here are a few common misconceptions about Introverts (I put this list together myself, some of them are things I actually believed):

Myth #1 – Introverts don’t like to talk.

This is not true. Introverts just don’t talk unless they have something to say. They hate small talk. Get an introvert talking about something they are interested in, and they won’t shut up for days.

Myth #2 – Introverts are shy.

Shyness has nothing to do with being an Introvert. Introverts are not necessarily afraid of people. What they need is a reason to interact. They don’t interact for the sake of interacting. If you want to talk to an Introvert, just start talking. Don’t worry about being polite.

Myth #3 – Introverts are rude.

Introverts often don’t see a reason for beating around the bush with social pleasantries. They want everyone to just be real and honest. Unfortunately, this is not acceptable in most settings, so Introverts can feel a lot of pressure to fit in, which they find exhausting.

Myth #4 – Introverts don’t like people.

On the contrary, Introverts intensely value the few friends they have. They can count their close friends on one hand. If you are lucky enough for an introvert to consider you a friend, you probably have a loyal ally for life. Once you have earned their respect as being a person of substance, you’re in.

Myth #5 – Introverts don’t like to go out in public.

Nonsense. Introverts just don’t like to go out in public FOR AS LONG. They also like to avoid the complications that are involved in public activities. They take in data and experiences very quickly, and as a result, don’t need to be there for long to “get it.” They’re ready to go home, recharge, and process it all. In fact, recharging is absolutely crucial for Introverts.

Myth #6 – Introverts always want to be alone.

Introverts are perfectly comfortable with their own thoughts. They think a lot. They daydream. They like to have problems to work on, puzzles to solve. But they can also get incredibly lonely if they don’t have anyone to share their discoveries with. They crave an authentic and sincere connection with ONE PERSON at a time.

Myth #7 – Introverts are weird.

Introverts are often individualists. They don’t follow the crowd. They’d prefer to be valued for their novel ways of living. They think for themselves and because of that, they often challenge the norm. They don’t make most decisions based on what is popular or trendy.

Myth #8 – Introverts are aloof nerds.

Introverts are people who primarily look inward, paying close attention to their thoughts and emotions. It’s not that they are incapable of paying attention to what is going on around them, it’s just that their inner world is much more stimulating and rewarding to them.

Myth #9 – Introverts don’t know how to relax and have fun.

Introverts typically relax at home or in nature, not in busy public places. Introverts are not thrill seekers and adrenaline junkies. If there is too much talking and noise going on, they shut down. Their brains are too sensitive to the neurotransmitter called Dopamine. Introverts and Extroverts have different dominant neuro-pathways. Just look it up.

Myth #10 – Introverts can fix themselves and become Extroverts.

A world without Introverts would be a world with few scientists, musicians, artists, poets, filmmakers, doctors, mathematicians, writers, and philosophers. That being said, there are still plenty of techniques an Extrovert can learn in order to interact with Introverts. (Yes, I reversed these two terms on purpose to show you how biased our society is.) Introverts cannot “fix themselves” and deserve respect for their natural temperament and contributions to the human race. In fact, one study (Silverman, 1986) showed that the percentage of Introverts increases with IQ.

It can be terribly destructive for an Introvert to deny themselves in order to get along in an Extrovert-Dominant World. Like other minorities, Introverts can end up hating themselves and others because of the differences. If you think you are an Introvert, I recommend you research the topic and seek out other Introverts to compare notes. The burden is not entirely on Introverts to try and become “normal.” Extroverts need to recognize and respect us, and we also need to respect ourselves.

-Carl

YouTube - "I will wait for you" by Official P4CM Poet JANETTE...IKZ

2011-04-19T22:08:00.000-05:00

Wachter's World : Are Academic Medical Centers Toast in a Post-Healthcare Reform World?

2011-04-04T21:55:00.000-05:00

Wachter's World : Are Academic Medical Centers Toast in a Post-Healthcare Reform World?

Outstanding article by Dr. Wachter from UCSF. Here is my response to his post.

Dr. Wachter,

Great post and well worth the read. In my opinion – I feel that AMC may actually be one of the best places for an ACO to exist. The reason I say this is that AMC many actually have the means to institute a fully integrated EHR. Many community health systems are either unwilling or unable to fully implement an EHR across the continuum of care – i.e. the PCPs office doesn’t provide notes to the specialist and all the labs, imaging, and other tests live on a paper report in the specialist’s office and never make it back to the PCPs office. AMCs at times are truly able to implement an integrated EHR that can cross the continuum of care from outpatient to inpatient as well as follow the patient on an ongoing basis.

Having worked at UCSF, I know the fully integrated solution is still coming in the future, but I know Epic and have used it in other AMCs with great success. I know the EHR journey is going to be a long one for UCSF, but I know it will be fruitful in the long run and will help to position UCSF as an ACO.

I also agree that UCSF will have to continue to work in the PCP shortage or lack of community integration in order to fully meet the requirements as an ACO, but in time this too will be solved. There are so many great minds at UCSF and with collaboration they too will solve this overwhelming conundrum.

Planned Parenthood's Bunnies

2011-02-28T19:52:00.000-06:00

He was Injured–Blue Cross Trigon Commercial

2011-01-11T20:54:00.001-06:00

Video #2

Snickers Commercial: Road Trip

2011-01-05T19:42:00.000-06:00

San Francisco Fog

2010-10-24T14:21:00.001-05:00

I just saw this video on one of the blogs I normally read. It made me miss San Francisco – I always enjoyed the fog of the city and enjoyed seeing it roll in and blanket the city.

Hello to all my San Francisco friends!

The Unseen Sea from Simon Christen on Vimeo.

Backin up

2010-10-22T18:08:00.002-05:00

Now the funny one

Inspiration

2010-10-19T22:22:00.001-05:00

Yes to LIFE!

2010-10-04T21:16:00.000-05:00

Gianna Jessen from LMF CAM on Vimeo.

Tenth Avenue North and Matt Maher Rocked

2010-09-26T12:19:00.001-05:00

Tenth Ave and Matt ROCKED last night!

Catholics Come Home.org

2010-08-29T20:15:00.000-05:00

Catholics Come Home.org

2010-08-14T23:33:00.000-05:00

SWAGGER WAGON

2010-08-14T23:15:00.000-05:00

"Alive Again" In Space!

2010-05-27T22:30:00.001-05:00

This is just cool!…

Matt's latest album Alive Again is currently on board the Atlantis space shuttle. Check out the video below of the crew waking up to "Alive Again" as well as an excerpt of a recent press release. -Goose

Alive Again

is currently orbiting aboard space shuttle Atlantis, servicing its final scheduled journey after almost a quarter-century of missions. Atlantis launched from Kennedy Space Center on May 14, 2010, and will spend 12 days in orbit and 7 days docked to the International Space Station where astronauts will deliver a Russian research module, along with other equipment and replacement parts.
Maher’s music has become a staple carry-on item for NASA astronaut, Mike Good, who has officially selected Maher’s song “Alive Again” as one of his “wake-up songs” -- not only reviving Good from an outer space slumber but the rest of the STS-132 and International Space Station crew as well.
Astronaut Good relayed a message of inspiration after a recent wake up call from NASA headquarters, “Good morning Houston! It’s great to wake up here in space again. We’re looking forward to another beautiful day docked at the International Space Station. I thank God for this opportunity to view the glory of His creation from this perspective -- and thanks to Matt Maher for that song, ‘Alive Again.’”
This marks the third year in a row that Maher’s music has visited the cosmos. In June 2008 and 2009 Matt’s previous album Empty & Beautiful (4/8/08) found its way onto shuttle Discovery for NASA Mission STS-124 with astronaut Ron Garan and aboard Atlantis STS-125 with Mike Good.
“I had the pleasure of meeting Mission Specialist, Mike Good when I was in Houston last year thanks to a friend of mine; seeing the NASA facility and hearing about the work that everyone there does was amazing, especially since, as a child, I always aspired to be an astronaut!” says Maher. “Music intersects with people's lives and inspires something unique from every person, so really, it's such an honor that he would choose one of my songs to start his day. Having my song played in space is one thing, but in context with what he says reminds me of what a great Man of God Mike is. It is such an honor to have my music start anyone's day.”

Currently listening:
Alive Again
By Matt Maher
Release date: 2009-09-22

Adventures in Traveling to TX

2010-04-26T16:06:00.001-05:00

Well, Cristi and I have officially made it to Dallas, TX from San Francisco, CA. Let me just say that this trip was an adventure, but a good trip. The movers arrived on Monday and left early Tuesday morning for our cross country adventure.

Day 1 – It rained off and on all the way to Las Vegas. The California land was nice and green and the orchards, fruits, and veggies were all around us. We made it to Nevada on Tuesday afternoon/evening and spent a night in Las Vegas. Of course Cristi played a few games… or maybe I went to bed and she played until 1AM :)

Day 2 – We left Vegas with plans to make to to Albuquerque, NM, however the weather had other plans for us. We made it across the Hoover Dam and took a few pictures.

However when we arrived in Flagstaff, AZ we met a nice winter storm and I40 closed for a 3.5 hour wait. You can only imagine Cristi and I waiting in our car for 3.5 hours in the middle of an interstate parking lot… not my idea of fun. Cristi read and I took a 30 minute power nap.

We ended up making it to Gallup, NM instead of Albuquerque, NM. The 3.5 hour standstill put a wrinkle in our travel plans for day 2, but over all things went well. Sorry there is no New Mexico boarder sign – we never saw a nice one to take a picture.

Day 3 – We woke up to a light dusting of snow in Gallup, NM and drove all the way to Lubbock, TX. As you can see, Cristi was happy to arrive in the Lone Star State.

A day in the Internet

2010-04-26T15:39:00.001-05:00

I read this on a friend’s blog and I thought I would share it as well.

Earth Day 2010

2010-04-22T01:13:00.001-05:00

A Time for Everything – Goodbye San Francisco

2010-04-19T00:33:00.002-05:00

Well, here we are…moving day. The movers and the moving truck will be here in the morning to pack all of our belongings into a truck and ship everything to Dallas, TX. It doesn’t feel like it is real at this moment, but I know the day is finally here.

I’m not 100% sure that I’m ready to leave San Francisco, and I’m not sure I was ready to leave UCSF, but the decisions are made. I’m excited and also nervous to see what this next phase in our lives will bring. I feel that God’s hand has been upon us through all of our decisions, and He will continue to bless our steps as we transition back to Texas.

I’m glad that my wife will be with me and we will make this transition back to the Lone Star State together.

Ecclesiastes 3:1-8

A Time for Everything

¹ There is a time for everything,
and a season for every activity under heaven:

² a time to be born and a time to die,
a time to plant and a time to uproot,

³ a time to kill and a time to heal,
a time to tear down and a time to build,

⁴ a time to weep and a time to laugh,
a time to mourn and a time to dance,

⁵ a time to scatter stones and a time to gather them,
a time to embrace and a time to refrain,

⁶ a time to search and a time to give up,
a time to keep and a time to throw away,

⁷ a time to tear and a time to mend,
a time to be silent and a time to speak,

⁸ a time to love and a time to hate,
a time for war and a time for peace.

Renee Byer - TEDxTokyo

2010-04-19T00:10:00.001-05:00

A picture is worth a thousand words…

Adora Svitak: What adults can learn from kids

2010-04-07T16:31:00.001-05:00

Jesus Christ has risen today, Alleluia!

2010-04-05T01:35:00.001-05:00

Cristi and I had the blessing of going to St. Dominic’s Catholic Church last night for the Easter Vigil mass. What a beautiful celebration of our risen Lord!

Cristi and I helped out this year with the RCIA program, so this event comes even more to life when we are able to celebrate the RCIA candidates reception into the church and our faith. We truly had a great group this year and ended up getting pretty close to many of the people in our small group.

Overall the night was a blessing and beautiful celebration! In a classic Lora Asmussen way, “Happy Resurrection Day!”

One in a million

2010-04-03T12:36:00.003-05:00

Nice blog wright up today by Seth Godin, titled "One in a Million". I enjoyed it so much, I thought I would share it here.

One in a million. By Seth Godin

The chances of a high school student eventually becoming first violin for the Boston Philharmonic: one in a million.

The chances of a high school student eventually playing basketball in the NBA? About the same.

In fact, the chances of someone growing up and getting a job precisely like yours, whatever it is, are similarly slim. (Head of development at an ad agency, director of admissions for a great college... you get the idea). Every good gig is a long shot, but in the end, a lot of talented people get good gigs. The odds of being happy and productive and well compensated aren't one in a million at all, because there are many good gigs down the road. The odds are only slim if you pick precisely one job.

Here's the lesson: the ardent or insane pursuit of a particular goal is a good idea if the steps you take along the way also prep you for other outcomes, each almost as good (or better). If pushing through the Dip and bending the market to your will and shipping on time and doing important and scary work are all things you need to develop along the way, then it doesn't really matter so much if you don't make the goal you set out to reach.

On the other hand, if you live a life of privation and spend serious time and money on a dead end path with only one outcome, you've described a path likely to leave you broken and bitter. Does spending your teenage years (and your twenties) in a room practicing the violin teach you anything about being a violin teacher or a concert promoter or some other job associated with music? If your happiness depends on your draft pick or a single audition, that's giving way too much power to someone else.

Cardinal Levada to NY Times: Reconsider 'attack mode' against Pope Benedict

2010-03-31T11:54:00.002-05:00

Catholic San Francisco

Excellent response from Cardinal Levada

Napa Valley

2010-03-25T22:10:00.001-05:00

Cristi and I are moving back to TX, so we’ve already starting to do everything “one more time” that we enjoy about the bay area. This is a picture of us last weekend at V. Sattui, our favorite winery in Napa Valley.

Healthcare Reform Provisions Kick in Over 10 Years

2010-03-23T17:54:00.001-05:00

by Janice Simmons, for HealthLeaders Media, March 23, 2010 - http://www.healthleadersmedia.com/print/LED-248377/Healthcare-Reform-Provisions-Kick-in-Over-10-Years

Many of the provisions included in the healthcare reform legislation approved Sunday—and the bill that adds fixes to that measure that was sent to the Senate—would take place not immediately, but along a 10-year timeline through 2020. Here's a glimpse of how that timeline rolls out:

2010

Adults with pre-existing conditions who have been uninsured for at least six months can enroll in a temporary high risk health insurance pool and receive subsidized premiums--beginning three months after the bill's passage. (The pools expire when exchanges are implemented in 2014.)
All health insurance plans are to offer dependent coverage for children through age 26; insurers are prohibited from denying coverage to children because of pre existing health problems.
Insurance companies can no longer put lifetime dollar limits on coverage and cancel policies--except in cases of fraud.
Tax credits will be provided to help small businesses with 25 employees or fewer to get and keep coverage for these employees.
The Medicare "doughnut hole," in which beneficiaries had to pay full cost of their prescription drugs, begins narrowing by providing a $250 rebate this year to those in the gap, which starts this year after they have spent $2,830. The doughnut hole fully closes by 2020.
Indoor tanning has a 10% sales tax.

2011

For Medicare beneficiaries reaching the Medicare doughnut hole, prescription coverage will be available with a 50% discount on brand name drugs.
A 10% Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
Medicare Advantage plans would begin to have their payments frozen—and then lowered in 2012. The plans would have to spend at least 85 cents out of every dollar on medical costs, while leaving 15 cents for plan operations, including overhead and salaries. Reductions would be phased in over the next three to seven years.
A voluntary long term care insurance program would be made available to provide a modest cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. Benefits would start five years after people begin paying a fee for coverage.
Funding for community health centers would be increased to provide care for many low income and uninsured people.
Employers would be required to report the value of healthcare benefits on employees' W 2 tax statements.
Pharmaceutical manufacturers will have a $2.3 billion annual fee that will increase over time.

2012

Nonprofit insurance co ops would be created to compete with commercial insurers. Hospitals, physicians, and payers would be encouraged to band together in "accountable care organizations."
Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35%—up from the current 1.45%. A new tax of 3.8% on unearned income, such as dividends and interest, is also added.
Medical expense contributions to tax sheltered flexible spending accounts (FSAs) are limited to $2,500 a year—indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7.5% to 10% of income. People age 65 or older can still deduct medical expenses above 7.5% of income through 2016.
Medicare device makers would have a 2.3% sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.

2014

New state health insurance exchanges would be created. Income based tax credits will be available for many consumers in the exchanges. The sliding scale credits phase out for households that are four times above the federal poverty level (about $88,000 for a family of four).
Medicaid would be expanded to cover low income individuals up to 133% of the federal poverty level—about $28,300 for a family of four.
Insurers would be prohibited from denying coverage to people with pre existing conditions, or charge higher rates to those with poor or chronic health conditions. Premiums (with limitations) can only vary by age, place of residence, family size, and tobacco use.
Insurers will be required to cover maternity care as they do other medical procedures
All legal residents would be required to have health insurance—except in cases of financial hardship—or pay a fine to the IRS. The individual penalty starts at $95 each in 2014—rising to $695 in 2016. Family penalties are capped at $2,250; penalties will be indexed for inflation after 2016.
Employers with more than 50 workers would be penalized if any of their workers get coverage through the exchange and receive a tax credit. The penalty is $2,000 times the total number of workers employed at the company. However, employers get to deduct the first 30 workers.

2018

A tax would be imposed on employer sponsored health insurance worth more than $10,200 for individual coverage, and $27,500 for a family plan. The tax is 40% of the value of the plan above the thresholds, indexed for inflation.

2020

Doughnut hole coverage gap in Medicare prescription benefit is phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

Phillip Toledano - Days with My Father

2010-03-15T23:00:00.000-05:00

Phillip Toledano - Days with My Father

What a great website!

Quick Trip to Las Vegas

2010-02-21T03:12:00.003-06:00

After our trip to San Diego for a conference, we hopped on a flight to Las Vegas to meet the Sanchez parents for a quick weekend trip.

We had a blast in Vegas!

My first time to win some real money in Vegas… Press Your Luck at NYNY!

Cristi and Blackjack… need I say more?

We had a friend staying at the Encore… Nice hotel.

Cristi taming a dragon at Aria

In front of the fountains at Aria.

These sculptures behind us are made of ice… very cool art at “Crystals” (the mall) at City Center.

Cristi and I picked up a little Chinese girl for Chinese New Year :)

Happy Chinese New Year!

Oranges are a symbol of gold for Chinese New Year… you learn something new all the time.

San Diego Trip

2010-02-20T15:33:00.002-06:00

Cristi and I headed down to San Diego last weekend for the AANS Coding Conference. Of course we had a little bit of fun while working as well. Cristi took the trolley around while I was in the conference on Friday afternoon. That night we went down to the gas lamp district for a nice dinner. Here are a few pictures from our trip:

Trolley Car Cristi took to Target :)

View from our room… See the helicopters.

Dinner on the street in the Gas Lamp District

Some random guy leaned against the glass… we couldn’t help but take a picture :)

Us in the lobby of the Manchester Grand Hyatt

Walking the shops behind our hotel.

A few pictures from Christmas :)

2010-02-20T15:25:00.002-06:00

Email and Facebook – Hacked!

2010-02-15T13:18:00.002-06:00

Cristi and I are in Las Vegas meeting her parents for the weekend. Somehow (I can’t figure out how) my GMail, Facebook, and AIM accounts were hacked last night. Part of this is my fault for having the same password for all three accounts.

So, word to the wise… don’t make your email and Facebook account password the same!

Happy 1st Birthday Rudy

2010-02-10T19:11:00.001-06:00

Happy 1st Birthday Mr. Raegan “Rudy” Asmussen :)

Convent Life on Oprah

2010-02-10T01:12:00.001-06:00

Oprah did a great job displaying convent life for the Dominican Sisters today on her show. I was very impressed by the way Oprah gave the sisters a nice representation and the sisters rocked! I love the sisters’ faith and how great they displayed religious life.

Here is a clip from today’s show. Take a look if you have a few minutes :)

Tim Tebow Prolife Super Bowl Commercial

2010-02-08T01:08:00.001-06:00

Chick flick… Dear John

2010-02-07T14:27:00.001-06:00

So I have to admit that I do like a good chick flick from time to time. Maria, Cristi, and I went to see Dear John last night at the Regal Cinema at Jack London Square. This movie is based on a book written by Nicholas Sparks.

This film reminded me of the long distance journey Cristi and I took to get to this point. I’m really glad that our journey ended with love… you’ll have to see if the movie ends in the same way.

Plot on IMDb:

While John is on leave in his hometown, he finds Savannah, a college student visiting the town. Although love was unexpected, it doesn't mean they didn't find it. With the knowledge of John having to leave for the army, their love still lives, until his re-signs on due to the 9/11 attack. Troubles invade and their love put on hold. One cannot bear it anymore; can the other?

Sherlock Holmes

2010-01-22T21:59:00.002-06:00

Cristi, Maria, Danielle and I all went to see Sherlock Holmes last Sunday night. Being state employees (and a teacher), we had the luxury of having off on Monday for MLK day so we spent Sunday night out with some great Thai food and a movie.

I have to say that I really enjoyed this film. While there are some dark moments in the film, overall, I really enjoyed the film. I really liked the cinematography, music, story, and acting. The film really had great whit about it as well.

As I'm sure you are already aware Robert Downey, Jr. won a Golden Globe award for his role as Sherlock Holmes and his sick-kick Watson, was played Jude Law.

I give this film two thumbs up and recommend people see it in the theatre!

100lbs Down Today!

2010-01-16T13:14:00.001-06:00

Today marks a major mile stone in my weight loss journey. Today I’ve officially lost 100lbs!

I haven’t blogged about my weight loss journey over the past year. More than anything, I think I was afraid this was going to be one more failure in my weight loss journey, but I’m proud to say that while this journey has been difficult it has also been great.

On May 22, 2009, I had laparoscopic Roux-en-Y gastric bypass surgery at UCSF Medical Center. In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum). In the words on Dr. Campos, “your stomach went from the size of a football to the size of a golf ball.”

More than anything, I’m happy I made the decision to have gastric bypass surgery. I’m also happy that it has been eight months of success!

Bound 4 Life – Houston, Now Is the Time

2010-01-14T17:47:00.001-06:00

Fun at the Park

2010-01-03T14:33:00.001-06:00

We had a blast with Daniel and the Sanchez Family. First, we went to feed the geese (ganzos) and then we to play at the playground. Here are a few pictures from our trip!

Daniel started out by eating the bread instead of feeding it to the birds. He got it down and had fun feeding the geese.

We had a blast at the park too. I think going down the slide with Aunt Cristi was his favorite!

Kolbe and Rudy in the bath

2010-01-01T23:36:00.002-06:00

These two kiddos are just too cute! I couldn’t help but post the cutest cheesy smile! Mark and Laura are blessed to have to very cute kids, Kolbe and Raegan (aka Rudy).

Christmas Texas Style

2010-01-01T23:33:00.001-06:00

Great shot of a nicely mounted deer at Louie Louie’s Piano Bar in Lubbock!

Pope Attached at Christmas Mass 2009

2009-12-28T12:46:00.001-06:00

I know I’m a little bit late, but I just heard the news about Pope Benedict getting attacked as he processed out of the Christmas Day Mass!

Here is a video that someone captured from the mass:

Maui Honeymoon!

2009-12-22T20:18:00.001-06:00

I know I’m a few months late in posting this, but I thought now is a better time than ever considering I actually have the time to do so!

Cristi and I had an amazing time in Maui, Hawaii for our honeymoon! The weather was great and we had plenty of time to rest and relax after the wedding. Cristi really deserved some R&R from all her hard work at the wedding!

Here are a few pictures from our trip.

Ka’anapali Beach

Nice Beach

Burnt on the first day:)

Watching the sunset

Black Rock – right in front of the Sheraton Hotel

Dinner from my boss Liz!

Luau Night

Our own luau back at the room :)

Road to Hana

Parasailing over the ocean

Guns Up!

A Christmas Story – Retooned!

2009-12-21T19:32:00.001-06:00

Avatar

2009-12-20T01:42:00.001-06:00

Avatar was an excellent film we watched with friends Maria and Danielle on Friday night. We watched it on a 3D IMAX theatre screen. And I have to say the special effects are excellent and a must see on 3D IMAX!

Plot from IMDB:

In the future, Jake, a paraplegic war veteran, is brought to another planet, Pandora, which is inhabited by the Na'vi, a humanoid race with their own language and culture. Those from Earth find themselves at odds with each other and the local culture. Written by Giorgio_C

When his brother is killed in battle, paraplegic Marine Jake Sully decides to take his place in a mission on the distant world of Pandora. There he learns of greedy corporate figurehead Parker Selfridge's intentions of driving off the native humanoid "Na'vi" in order to mine for the precious material scattered throughout their rich woodland. In exchange for the spinal surgery that will fix his legs, Jake gathers intel for the cooperating military unit spearheaded by gung-ho Colonel Quaritch, while simultaneously attempting to infiltrate the Na'vi people with the use of an "avatar" identity. While Jake begins to bond with the native tribe and quickly falls in love with the beautiful alien Neytiri, the restless Colonel moves forward with his ruthless extermination tactics, forcing the soldier to take a stand - and fight back in an epic battle for the fate of Pandora. Written by The Massie Twins

Brian Asmussen, MBA

2009-12-17T23:33:00.001-06:00

So it is official, I’m going to start my MBA in the Spring. The issue now is should I go to the University of Dallas (UD) or University of San Francisco (USF).

Option 1: The University of Dallas is a private Catholic university located in Irving, TX. I would work on this program through their distance learning program and it normally takes between 2-3 years to complete this program.

Option 2: The University of San Francisco is one of the only 28 Jesuit Catholic colleges in the country and the oldest university in San Francisco. I would participate in the MBA for Executives. This program is accelerated and rigorous, while designed to be accessible and manageable for students who are currently holding demanding jobs. The program starting in January is a 16-month program and I would graduate in the Spring of 2011.

I have to be honest… my heart is set on going to USF. I really enjoyed their cohort setting when I visited the classroom this past fall. And believe me if you can make Macroeconomics and Accounting fun then you have a good program. Only time will tell, but I hope to have a final decision within the next week or so.

I’ll try to keep the blog updated often – If I have time :)

Ticket From Hell!

2009-12-17T23:09:00.001-06:00

So, on the Monday before Thanksgiving I was headed to an interview for the MBA program at University of San Francisco (USF). I’m driving about 2 miles from UCSF Mission Bay to USF.

A motorcycle cop pulls up next to me at a light and as soon as the light turns green he pulls me over. He said that my TX inspection has expired that is why he is pulling me over.

He proceeded to write me not one but THREE tickets: 1) For having two active license - TX and CA, 2) Expired inspection and 3) No California registration. So, I’m thinking great I’m going to have to pay some major fines and get my car registered in California. But no, my friend, Mr. San Francisco Bike Cop Hero decided that I needed to have my car IMPOUNDED because I’ve been in the state for a year and never had my car registered!

Needless to say I was pissed! My car registration was good in TX and I simply assumed that I would get it registered in CA as soon as mine expired, but no I should have done that within 20 days of making California my new residence.

Mr. San Francisco Bike Cop Hero hailed me a cab and I made it to my interview at USF with about one to two minutes to spare. I had a great story to tell the guy who checked me in… he was just surprised that I made it to the interview before my scheduled time.

After the interview I spent the rest of the day (about two to three hours) at the California DMV getting both Cristi’s and my car registered.

This whole ordeal cost me more than $1,000. So a word to the wise – register your car in California within 20 days of making it your home state! Arnold needs his money… this state is BROKE!

Wedding Little Ones

2009-12-13T22:32:00.001-06:00

Mr. Kolbe at the Wedding… He was the official ring bearer for Cristi and I.

Me, Kolbe, and My Brother (AKA Best Man)

Mr. Daniel was having fun learning how to walk. He’s running around now :)

Aug 1, 2009 Our Wedding Day

2009-12-13T18:07:00.001-06:00

New Casa

2009-12-13T17:15:00.000-06:00

So, I know it has been a very long time since I’ve blogged and a ton has been going on over the past few months… but I thought I would write to tell everyone that Cristi and I moved this weekend! We are living in the same apartment complex, but are in a one bedroom (it is actually considered at 1+) now instead of a two bedroom.

Cristi and I worked our tails off this weekend, but all the hard work has paid off because we are officially moved in and we should be saving a ton of money over the next year.

I hope to start blogging again over the next few weeks. I have so much to write about given God continues to bless both Cristi and I on a daily basis!

Adjusting My Lens

2009-08-18T01:05:00.002-05:00

I thought this was a great quick read in the Harvard Business Blog by Elizabeth Edersheim.

Last week I had the opportunity to participate in the Student Leadership Summit, the inaugural event of the Frances Hesselbein Global Academy for Student Leadership and Civic Engagement, at the University of Pittsburgh. The academy’s mission is to inspire, develop, and reward accomplished student leaders to meet the challenges of tomorrow. We spent four days engaged inintense learning, discussion, and fun with 44 leaders of tomorrow—4 of whom are my mentees. The summit began with “The Wizard of Oz of Leadership” and took these up-and-coming leaders through love, a lion, learning, innovation, tennis-racket propellers, inspiration, communication, respect, inclusion, a scarecrow, values, service, a courageous MIT engineer, passion, ethics, understanding cultures, a tin man, a gigantic light bulb, listening, the color line, confronting challenges, growing talent, creating opportunities, living, loving, and leading.[1] They came away understanding that—like the scarecrow, tin man, and cowardly lion—they already have the courage, heart, and mind to be leaders; they just need to see that it is all there inside them. The summit was fantastic. I learned so much about the difference in perspective that young leaders bring to the table, and walked away with a new sense of hopefulness. Some observations:

1. The leaders of tomorrow emphasize collaboration in problem-solving, seeking ways to share what they have and meet the needs of the many rather than commanding scarce resources to benefit the few. The members of the crucible generation, as Warren Bennis calls them, really do have a more collaborative and less competitive orientation then we ever did. The differences came through every day as we watched them work. The most telling moment was the Ugli Orange Exercise: In essence, two competing pharmaceutical companies want the 4,000 Ugli Oranges right now. One company needs them to fight a new and deadly prenatal disease, the other to resolve a deadly gas leak. Participants are divided into teams of four, two representing each company. The speaker who presented this exercise has been using it for 20+ years. For 20 minutes the two companies typically argue over whose needs are more important and arrive at no solution or action plan. At the summit, all 11 teams rapidly discovered that one company needed the juice and the other the rind, and worked out a viable plan for moving forward. Some went so far as to plant the seeds for the next year’s crop! This has never happened before. In 1994 no team found a solution. At another group last year, out of 14 teams, 2 found solutions. This year at the summit, every team tried to figure out how everyone could be satisfied rather than how to win a fight. “What part of the orange do you need?” was the first question asked by one of my mentees. The question belies a collaborative mindset that asks different questions and seeks fundamentally different types of answers.

2. Despite perceived progress, the color line, with all its ramifications, is still an active force limiting the participation and potential of millions in our society. In another exercise, everyone in the room answered a survey featuring questions about isolation in everyday situations and scored their answers. One of the questions was “Can I swear, or dress in secondhand clothes, or not answer letters without having people attribute those choices to the bad morals, the poverty, or the illiteracy of my race?” At the end of the exercise, we lined up in order of our scores. The predominance of black faces among those feeling most isolated was shocking. It really brought home to me how far we still have to go toward achieving an inclusive society – even here, among the nation’s most engaged, highest-achieving students. The recent arrest of Henry Louis Gates, Jr., in Cambridge has once again brought this concern into the headlines. The presence of the Obamas in the White House – although inspiring and empowering for many – has not even begun to resolve the issue of how we diminish the defining quality of race in American society, how we bring people of color to the table as full participants. One of the leaders of the future spoke about how many people asked her if they could touch or feel her hair. There has been progress, but no magic; much more must be done.

3. The power of a fresh, independent perspective cannot be underestimated. On our third day, each group of four went to a not-for-profit organization in Pittsburgh to help address an issue facing the organization. Their reports back to the group were astounding. My group went to help the Ladies Hospital Aid Society (LHAS) think through how to revitalize their donor base. My team’s first question about achieving that goal was, What is the constraint? They felt that one significant constraint might be the name of the organization. This created a lively discussion with the president and two board members. Finally one board member said that when she has to tell people what LHAS stands for, she often bites her tongue. It is not a name she is proud of, but she had assumed that, as the historical identity of the organization, the name could not be changed. A young man on my team was quick to challenge this boundary condition, pointing out that the organization’s name had originally been the Hebrew Ladies Hospital Aid Society and could potentially be changed again. I was reminded of why McKinsey hires very smart people with little or no business experience—because their lack of preconceptions enables them to push the envelope and cast a wider net in seeking solutions to problems. My team discussed the need for diversity in the images of the organization and on its website, pushing LHAS to redefine its image to draw in more potential donors. Now the board is engaged in reading the Harvard Business School case about the Girl Scouts. The boldness the students showed in their recommendations was surprising, as was the rare opportunity for senior executives to listen to the leaders of tomorrow and discuss solutions with them.

4. The older generation has a significant contribution to make—in mentoring. Jim Collins, the dinner speaker on the final day of the summit, talked about how each of us needs a personal board of directors. That is particularly true for the crucible generation, even though its members scored higher on every academic test than we did and have been developed and programmed to succeed throughout their young lives. They are emotionally young. They have grown up with more supervision than we had, and less freedom to experiment. They are operating in a very uncertain world, where the norm is relentless challenge and unclear expectations. After working hard practicing and performing all their lives, these young people are now faced with the task of deciding how to change the world and making those sweeping changes happen. They do need mentors and people to think with—people who believe in them. When I came home, the first thing I did was call two young people I have worked with recently; I listened to their thoughts and encouraged their ambitions. I hope to be in touch with each of my mentees for a long time to come. Each of them is a fantastic person with a tremendous amount to teach me. To quote Peter Drucker, “Knowledge work requires continuous learning on the part of the knowledge worker, but equally continuous teaching on the part of the knowledge worker.”

5. The leaders of tomorrow define success in terms of making a difference by serving others. Our final exercise was for each leader of the future to define a mountain they want to move, the barriers to moving it, and a plan for how they will get started. To a person, their goals are geared to making this a better world (rather than individual enrichment or achievement) and are all about service. For example, Michael, a graduate student in pharmacy, wants everyone to have available comprehensive information about regulated and unregulated drugs and foods that impact their bodies. He doesn’t want to be a pharmacist – he wants to help people improve their health. Alyssa, an aspiring orthodontist, wants to serve children who might not otherwise be served and help them feel better about themselves. Celeste, a student of Sport Science, wants to help other people accomplish things they never dreamed they could have. Minh, an aspiring ophthalmologist, wants to break down walls and be available to patients where and how they need their doctors. Although it is possible that this youthful idealism will devolve into relentless self-interest, as happened with so many of the baby boomers, the strong emphasis on practical service to others makes me hopeful.

6. Including and respecting young leaders is an essential step to helping them grow and develop. Including people in the group while acknowledging each one’s unique contributions and needs is an enormous part of leadership development—and that is the unique genius of Frances Hesselbein. Frances Hesselbein graciously introduces people to each other so they can make connections, broaden their view of the world, adjust their lens, and grow as leaders. She introduced Tamara Woodbury—a colleague from the Girl Scouts of America whose interest in leadership and organization development was pushing her toward business school—to Peter Drucker, who insisted that business school would be a colossal waste of her time and offered her a different perspective on social enterprises. As a result, Tamara came to change her focus and redirect her impact. As Jim Collins says, “If you are a plant, Frances is the ultimate ultraviolet light—she helps each of us see things differently. For me, the opportunity to talk with military leaders about leadership was a new and eye-opening experience. I learned about President Clinton’s courage in inviting and addressing contrary opinions, about the thinking behind his decision to send troops to Bosnia when only 36 percent of Americans approved of it, because it was the morally right thing to do for millions of innocents. And then when General Randy Fulhart offered to give me some feedback on my writing, a wide smile went across my face…that hasn’t left.

This summit adjusted all of our lenses. Thank you, Frances.

Free Will

2009-07-27T10:35:00.000-05:00

While praying in mass today it came to me how much of a blessing it is to have free will. How amazing is it!

Preview Wedding in 8 DAYS!

2009-07-24T15:47:00.002-05:00

So this is a little preview for our wedding entrance next week - yes our wedding is in 8 DAYS! Cristi wanted to do this, but was worried that we might get excommunicated from the Catholic Church.

PS - Thanks Vogel for the video I stole from your blog!

Remembering Apollo 11

2009-07-20T00:41:00.002-05:00

Great pictures from the Boston Globe - Remembering Apollo 11

How to Become a Saint

2009-07-14T16:44:00.001-05:00

I really like step 1! Maybe someday I'll be a saint too. I have to complete step 1 :)

How to Go to Confession :)

2009-07-14T16:42:00.000-05:00

Love

2009-07-12T01:33:00.000-05:00

I love this one - Future Mrs. Asmussen

Goodbye Lucky

2009-07-08T01:27:00.000-05:00

I aint playin wit chew!

2009-07-01T22:35:00.001-05:00

Please beware the language in this video is bad, but I can't stop laughing. Reminds me of parts of San Francisco :)

CMS Physician Fee Schedule Changes

2009-07-01T21:58:00.001-05:00

CMS put forth a new proposal (1385-P) suggesting to elimate Consultation codes effective CY2010.

Proposal to Eliminate Consultation CPT Codes:

Beginning January 1, 2010, due to continuing confusion around consultation services and inconsistencies in reporting, CMS is proposing to budget neutrally eliminate the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes) by increasing the work RVUs for new and established office visits, increasing the work RVUs for initial hospital and initial nursing facility visits, and incorporating the increased use of these visits into the PE and malpractice RVU calculations. CMS is soliciting comments on the proposal, described more fully above in the attached document, to eliminate payment for all consultation services codes under the PFS and to allow all physicians to bill, in lieu of a consultation service code, an initial hospital care visit or initial nursing facility care visit for their first visit during a patient’s admission to the hospital or nursing facility. Additionally, CMS is soliciting comments on the proposal to create HCPCS G-codes to identify the telehealth delivery of initial inpatient consultations.

Bird's Nest

2009-06-13T21:09:00.001-05:00

Have you ever wondered how a bird starts a nest? I was just thinking that yesterday when I saw a bird carrying one small twig in its beak back to the nest. Imagine starting with one twig and then building it one twig at a time. How does s/he get the first twig to stay in place? I dunno, just something weird that went through my mind yesterday after work.

"These are Hardcore Nuns"

2009-06-06T10:03:00.001-05:00

Do You Know Him?

2009-06-04T21:46:00.001-05:00

The Presentation that Tanked

2009-05-18T00:43:00.003-05:00

I really liked this post on "The Presentation that Tanked" by the HBR because we've all left a meeting and thought what the hell just happened??
Whether we are updating a group of stakeholders or simply running a staff meeting it is important to feel out a group and flex to the needs of the chair, board, or group. We can plan as much as we would like however, we can never fully prepare ourselves for every single response, circumstance, or reaction. It is best to play off the reactions of all those involved in the meeting and make changes on the fly.
* * *
It's 9:36, and Jerome is still talking.
The chairman's advice from last week is ringing in your ears: "Tyler," he'd said, "Make sure you leave time at the end for questions. The board members always have questions, but your predecessor never left enough time for them to ask. And whatever you do, don't run over. They're a busy bunch, and they hate being kept late."
You surreptitiously glance at your watch, again. 9:38. The hour seems to be flying by. You try to make eye contact with Jerome — you make a discreet "wrap it up" gesture.
He seems to be looking everywhere but at you.
At this rate, you're not even sure Katie and Gus will get to talk. You glance across the table at them, their carefully prepared notecards stacked neatly on the polished mahogany. Not only will it make you look bad to skip them, they'll be irate with you as well.
You notice the chairman shifting restlessly in his chair. It is now 9:40.
You clear your throat. Jerome drones on.
"Erm," you begin, "Jerome?"
He ignores you.
"I'm sorry to cut you off Jerome," you interject, "But we've got to move on —"
"Tyler!" he interrupts you, but he's smiling. "I just need a few more minutes, thanks." He continues going through the financials as if you hadn't spoken. It is now 9:43. Gus and Katie had told you they needed 10 minutes. If they started speaking now, that would leave 7 minutes for questions. You suspect that the 15 members of the board will not be satisfied with that amount of time, but at this point, it will have to do.
"I'm sorry Jerome," you say, standing up and trying to convey and aura of firm confidence. "We've got to move on if Katie and Gus are going to speak. Gus? Katie? Update us on the deal with Votto."
"Actually, Tyler" interjects the chairman, "I think we'd rather just get a memo about Votto. We don't need to surface that here." You sit back down, feeling wrong-footed.
"Now, Jerome, " the chairman continues, forgetting about you, "I have a few questions about next quarter's estimated shortfalls..."
Well, this is awkward, you think. It was the worst of both worlds — Katie and Gus had a) been embarrassed in front of the entire board b) spent time preparing a presentation that would now go un-given, and c) now faced the additional work of preparing a memo. You feel undermined by the chairman. And you're irate at Jerome for screwing up your carefully laid-out presentation schedule.
The board members pepper Jerome with questions — as Katie and Gus stew silently across the table. Finally, at 10 am sharp, the meeting concludes with the usual pleasantries and you all file out of the room. As you walk with Katie, Gus, and Jerome along the corridor, however, Jerome turns to you.
"A quick word, Tyler?"
He ducks into an empty conference room, motioning you to follow. Well, this is convenient — I can let him have it now, and get it out of the way. But as you open your mouth to speak, he cuts you off.
"Look, Tyler, I really don't appreciate being thrown under the bus like that. You might have been in charge of planning these presentations now, but you're not my boss. The financials are always the most important part of any meeting with the board. You didn't allow nearly enough time for me to get through them. You made us both look like idiots, and frankly, I don't appreciate it."
He wheels and stalks off, leaving you in the room, alone.

Now what do you do?

More Americans “Pro-Life” Than “Pro-Choice” for First Time

2009-05-15T11:03:00.003-05:00

May 15, 2009
More Americans “Pro-Life” Than “Pro-Choice” for First Time
Also, fewer think abortion should be legal “under any circumstances”
by Lydia Saad at Gallup

Happy Mother's Day

2009-05-10T21:10:00.003-05:00

Happy Mother's Day to all the mom's of the world!

I spent the day with one of the coolest moms I know :) Travis, Melisa, Hayden, and I spent most of the day hangin out Bay Area style. We went out to eat lunch at Outback (I can't help but sing, "Let's go Outback tonight" each time I think Outback) and hit an afternoon movie.

What beautiful weather God blessed us with today. I think it was His way of saying, "thank you for saying YES to LIFE Moms!"

Let's Talk Health Care

2009-05-07T04:08:00.001-05:00

I thought this was an excellent post by Harvard Pilgrim HeealthCare's CEO, Charlie Baker.

Back in December, 2008, the folks at McKinsey - one of the world’s most well known consulting firms - wrote an interesting article on health care reform in the U.S. What’s striking about it now as we all watch the debate unfold in Washington, DC is how different McKinsey’s approach is to the one being taken in our nation’s capital. McKinsey focused on three things - personal behavior, cost and quality transparency, and administrative simplification. The Washington debate is focused mostly on whether or not to create a government run health insurance plan, individual and small group health insurance market reforms, Medicaid and/or Medicare expansions, how much deficit spending is too much, and administrative simplification.

People in DC would argue that doing anything about personal behavior is virtually impossible, so why bother, but McKinsey’s case on this one is pretty compelling. In fact, McKinsey argues that the whole “40% of individual health care expenses occur in the last year of life” is no longer true - primarily due to the rise in costs associated with managing chronic conditions. Quote - “…our findings suggest that the management of chronic disease outside of acute-care environments accounts for at least 20 percent of total U.S. health care spending, perhaps more. That level of expenditure, compounded over decades in many cases, dwarfs the cost of end-of-life care…” They indicate that end-of-life health care spending - on average - for people who pass away between the ages of 65 and 95 represents less than 10% of the total amount of money they spend on health care during their lifetimes.

McKinsey references obesity as a specific example. The incidence of clinically defined obesity has doubled in the U.S. since 1980 - to roughly 34% of the adult population. Clinically obese patients spend almost twice as much as someone with a normal body mass index on health care - every single year. Put another way, if we were as obese today as we were in 1980, we’d spend $60 billion less on health care. McKinsey says ignoring the impact personal behavior - and here, I’m mostly referencing diet and exercise - has on the rising cost of health care is a huge missed opportunity, and their data points make a compelling case.

Second, McKinsey points out that the same service provided by two different providers in the same geographic area with the same patient and the same outcome can vary in cost by as much as 40%, and no one knows it. “In no other industry are service attributes and prices so opaque.” No kidding. Some of us having been banging this drum for years, and we are still in the crawl stage in terms of making this sort of information publicly available. And while I’ve always thought of that as a way to rationalize provider prices, McKinsey thinks it could also rationalize insurance plan design and re-frame the health care conversation generally. They note that without publicly available information on price and performance, the move from delivery and insurance models that are based on acute episodes of injury or illness to ones that are based on promoting healthy behaviors and managing chronic conditions will take forever to occur.

Third, McKinsey discusses the price of administrative complexity - and while Washington does seem interested in taking this one on, some of McKinsey’s observations about what drives complexity require a more nuanced approach than the ones currently under discussion. For example, McKinsey notes that regulation drives complexity, that providers and payors each own a piece of the complexity around claims processing and payment, and that the government as payor has contributed significantly to this conundrum as well. Are there opportunities here? Yup, but it’s not as obvious as it seems. Remember, when someone talks about standardizing processes and rules, they usually standardizing everyone else to the way they do business.

I wonder if the whole diet/exercise question - or the transparency issue - will find their way into the health care reform discussion. My guess is the answer will be “no.” They are too beside the point for a discussion that’s primarily about financing and paying for services rendered. That’s too bad. McKinsey’s piece makes it pretty clear that reducing the rate of growth in health care spending and improving care quality is about a lot more than whether or not we have a government run plan for the non-Medicare/Medicaid population.

Notre Dame Response Video

2009-05-04T23:54:00.001-05:00

3 Ways to Get Through Your To-Do List Faster

2009-05-04T15:18:00.000-05:00

Self-discipline is hard. Try these three things to make your work more efficient every day.

Get three things done before noon. Statistics show that the team ahead at half-time is more likely to win the game. Try to enjoy your lunch knowing that you achieved at least three things in the morning.
Sequence for speed. Break projects into parts. Take on longer pieces at the beginning and make sure each subsequent part is shorter. If you leave the longest parts for last, you are more likely to run out of steam before the end of the day.
Tackle similar tasks at the same time. The mind thrives on repetition. You can build momentum by taking on similar projects at the same time

From Harvard Business

High Plains Snifter

2009-04-30T01:16:00.001-05:00

After 118 years without a liquor store inside their city’s limits, Lubbockites are on the verge of voting with their thirst.

You've gotta love Lubbock after reading this in Texas Monthly.

Benjamin Zander: Classical music with shining eyes

2009-04-13T23:45:00.002-05:00

Amazing! TED does some great work!

About this talk
Benjamin Zander has two infectious passions: classical music, and helping us all realize our untapped love for it -- and by extension, our untapped love for all new possibilities, new experiences, new connections.

About Benjamin Zander
A leading interpreter of Mahler and Beethoven, Benjamin Zander is known for his charisma and unyielding energy -- and for his brilliant pre-concert talks. Full bio and more links

Happy Easter!

2009-04-13T01:10:00.000-05:00

Jesus Christ has risen!

Hospital, health thyself!

2009-04-04T12:50:00.001-05:00

Visit msnbc.com for Breaking News, World News, and News about the Economy

Infinite Growth in a Finite World

2009-04-02T01:57:00.001-05:00

Nice read by John Halamka

We're all aware of the Bernie Madoff Ponzi scheme. He used money from new investors to pay unreasonably high, consistent rates of return to his old investors.

Two recent articles by Thomas L. Friedman, The Inflection Is Near? and Mother Nature's Dow ask if we are engaged in a global Ponzi scheme of accelerating consumption and growth.

Most for-profit companies I've worked with as an advisor or Board member measure their success in quarter per quarter growth percentages.

In the economy of a bygone era, local businesses were considered successful when they made a high quality product, maintained the livelihood of a few employees, and built relationships with customers. There was a focus on service to the community rather than endless growth in value for shareholders.

Just as Bernie Madoff promised double digit returns, the US economy experienced rapid growth (likely unsustainable) via credit cards, speculation, and mortgaging our children's future.

If our resources are finite - we have a limited amount of fresh water, a fixed set of raw materials, and a cap to the population that can be sustained in the environment - infinite growth is not possible.

I believe that the era of "growth is good" is coming to an end. It is my hope that the era of quality, employee retention, customer satisfaction, and sustainability will replace it.

Call me old fashioned, but does it make sense for hedge fund managers, venture capitalists, and option traders to make such high returns without really contributing to society? Do they create new ideas, innovative products, or value added services? Or are they no better than sophisticated speculators in a global Ponzi scheme? The vast sums of money they make come from somewhere and we're all paying the price now for their creation of derivative investments that were based on the notion that home prices and businesses would have infinite growth in a finite world.

As I approach 50, my view of the world and my own needs have changed significantly. In my 20's I measured success by the amount of stuff I owned, the size of my house, and the speed of my car. Now I measure my success by the amount of stuff I do not have, the smallness of my house, and the carbon footprint of my car.

If we all endeavor to focus on the quality of life, the sustainability of our environment, and the future of our children rather than endless growth, the world will be a better place.

CEO Communication Follow Up

2009-03-19T00:30:00.001-05:00

Here's a message I sent out to the staff last night. It is a follow-up from town meetings and the previous budget message.

Dear BIDMC,

It has been a very busy couple of weeks, with thousands of you attending town meetings and sending suggestions to me personally or on our chat page. As promised, here’s my analysis of the options we have considered and suggestions for going forward. This is going to be a long message, so grab a cup of coffee while you read it. I apologize if I don’t address each and every idea that has been suggested, but I am pretty sure I will cover the major ones. At the end of this e-mail, I will tell you how you can best provide input into the next stage of this process.

First, though, an important summary. Your participation in this process and your advice to me has succeeded in accomplishing two very important things: First, we have reduced the number of necessary layoffs dramatically, from over 600 to about 150. This is a major victory and will mean a lot to more than 450 families who would otherwise lose their income from BIDMC. Second, we will do this at the same time we provide earnings protection to our 900 lowest wage workers. As you will see, this does come at a higher cost to the rest of us, but you have all made clear to me that this is consistent with our community's values and expectations. Thank you in advance for your generosity of spirit.

The Situation
Unlike the years leading up to 2002, when most of the hospital’s problems were self-inflicted, we are finally seeing the effect of the general economic downturn on our hospital. As you know, these problems are not ours alone. Our sister hospitals in Boston and across the country, as well as institutions and companies all over America, are facing similar situations. BIDMC has had seven years of extraordinary growth: Our revenue has grown from about $800 million to $1.4 billion and our staffing has grown by over 2000 employees since 2002. But the brakes must now be applied.

The main problem we face is a likely budget imbalance in FY2009 because of reductions in state funding, a slowdown in research spending, and because the number of people we have on staff is not proportionate to our expected level of patient volumes. After at least two years of volume growth that exceeded the regional average, it has slowed down considerably. Some of this is due to the economy, with people deferring medical care. Some portion is due to the fact that the state no longer permits diversions from emergency rooms. In the past, we benefited from diversions in other hospitals, but that has now diminished.

The problem for FY2010 will be more of the same, but it is also compounded by a likely requirement that we will have to make a large cash contribution to the pension plan, and also because we continue to project lower than adequate reimbursements from Medicaid and Medicare. For example, President Obama has proposed a reduction in Medicare payments to hospitals and doctors as part of the “down-payment” on expanded access to health care.

We do not want the hospital to end either of the next two years with an operating loss. Therefore, we believe it is prudent to aim for cost reductions of about $20 million in the remaining six months of FY2009 and at least an additional $20 million in FY2010. My focus in this note will be on FY2009, but many of the steps we take now will also be helpful going forward.

Savings Across the Medical Center
While it is possible to reduce expenses other than personnel, e.g., energy and supplies, these reductions would not be significant enough to eliminate the need to look at personnel-related expenses. We have already taken some major steps to save funds in our research budget. The largest single item is that we will be decreasing the amount of research space that we are renting. But that change will not have an impact until FY2010. The major step we have taken this year was our decision not to fill many positions throughout the hospital. During the last several months, at least 100 vacant positions have not been filled, blunting the previous growth rate in staff.

The personnel budget, including benefits, is about $545 million per year. A $20 million savings is thus approximately 4% of this amount. If we were to accomplish this in layoffs alone, we would have to eliminate over 300 jobs. (This is based on an average cost of $80,000 per employee. This number may surprise you, but it is a “fully-loaded” figure, including all benefits, taxes, and the like. Also, this has to be offset by the amount of severance pay for those people laid off.) With 6,200 full-time equivalent employees currently on staff, this would be nearly 5% of the current staff.

But that is on an annual basis: To achieve the same savings in the remaining six months of the fiscal year, we would have to double the number of people laid off, or over 600.

Our task, it seems to me, and the one with which you have been so helpful in your comments, has been to come up with alternatives that dramatically reduce this number of layoffs and get us close to these total dollar figures. With the strong support I have felt from many of you, I also am trying to shield our 900 lowest paid workers – transporters, food service people, housekeepers and others – from impacts on them and their families. As we have discussed at our town meetings, this will mean a bit more sacrifice from the rest of us, but I sensed a clear commitment to doing that.

Here are my suggestions to meet the likely budget shortfalls. I have outlined here my initial proposal of steps, along with their impact they would have on the budget. It doesn't look to me, at this point, like a menu of options is workable – financially or logistically. In other words, I had hoped to give you some individual options to choose from, but, as you will see, all of the items mentioned below would be necessary.

1) Temporarily discontinue the employer match to the 401(k) plan and the contribution to the executives' 403(b) plan. We currently provide up to a 2% match to the 401(k) plan. The savings from suspending these two types of contributions amounts to $3.5 million for the remainder of FY2009. We would expect to reinstitute these payments in FY2011.

2) Withhold the 3% annual salary increase for those people who would receive it on April 1 and thereafter, exempting people in Grade 4 and below, as well as our residents (physicians-in-training). This freeze on raises would stay in effect through FY2010. The savings from this will be $2.4 million in FY2009.

3) Re-set the salaries for managers and directors to their level before the 3% salary increase received on January 1, 2009. This will save $540,000 in the remainder of FY2009.

4) We had reserved $3 million in the budget for market adjustments in certain highly competitive job classifications. We will choose not to use those funds, saving that money in FY2009.

5) Suspend earned time accruals for five weeks of payroll. This means people will not accrue 3 to 4 days of earned time between April 1 and the second week of May. Then, accruals will start again at the regular rates. This will save $2.8 million in FY2009.

6) Eliminate the ability of people to cash-out their surplus earned time days. Those days would remain in each person’s “bank” for short-term disability purposes, but could no longer be received as cash until an employee leaves BIDMC. This will save $1.0 million in FY2009. (Note: Unlike the other proposals listed here, this one goes into effect immediately.)

7) Continue to reduce payroll by attrition, leaving the vast majority of open positions unfilled, saving $1.25 million in FY2009.

8) Eliminate the employee barbecue this year, economize on other events, and eliminate most hospital reimbursements for cell phones and Blackberries (more on this below), for a savings of about $100,000.

9) On top of this, we will save $1.4 million in the voluntary pay reductions taken by the senior VPs, the VPs, our Chief Operating Officer, and me.

Taken together, these actions would save about $16 million in FY2009, eliminating the need for about 450 layoffs. This is a major step in the right direction! Unfortunately, it does not get us all the way there, and we would still be about 150 positions overstaffed for FY2009. How would we deal with this?

Layoffs and Department Responsibilities
Our first guide to reducing our staff will be based on structure and performance. What do I mean by structure? Many of you have pointed out that there are too many management layers in some cases, and reducing these would be consistent with “flattening” the organization and responding to some of your concerns.

There are also a few departments that are clearly overstaffed relative to the amount of work that needs to be done and will likely be done during this recession. Those departments will be given an overall budget reduction target, and the vice president in charge will have to come up with a plan to meet that target. This might result in some layoffs or it might result in other operational changes or reallocations of staff or managers.

It is clearly our intent to look first at managers and staff who have consistently substandard performance. We will look at performance reviews, your comments on the employee survey, progressive discipline records and other performance factors in making these decisions. We will not make them lightly, but we want to retain employees who work hard and come in on time; managers who have great people and management skills; and employees throughout the organization who make important contributions to patient care.

Finally, we are exploring incentives for early retirement, so that people could voluntarily choose to leave. We are thinking about a plan, say, for people 62 and older, who would be able to leave with their full severance payment but also with an opportunity to continue health insurance coverage at employee rates through age 65. More details will come on that in a few days.

Will This Be Enough?
All of this would likely close the gap for FY2009, but we have to understand that there would be some uncertainty about that for FY2009, and there is still more uncertainty for FY2010. But I would want to defer action beyond this and see how things work out for us and the national and state economies. Only if still needed after these steps would we return to the idea of other layoffs. I expect we would review that early in the summer, and of course, will keep you all informed as we go along.

Your Other Suggestions
Let me address some of the other ideas and suggestion you have brought up. Although they do not amount to a lot of dollars, they have symbolic importance, and we should probably be considering them anyway, in terms of the efficiency of our hospital.

Many of you have offered to voluntarily give up prior earned time and/or make charitable donations to the hospital. We will certainly make that possible and will send out information on how to do it. To the extent that people contribute in this way in the next few weeks, we will be able to see the dollar value of that and apply it against payroll reductions.

I have not adopted suggestions made about furloughs (unpaid leaves of absence); eliminating tuition reimbursement; and eliminating the pay differential for holidays. The problem with furloughs is that we generally have to backfill vacancies, often with overtime pay, so the savings are not that great. Also, there is a large administrative burden associated with this measure. I am loathe to eliminate tuition reimbursement because I do not want to abandon our goal of providing professional advancement for people. In addition to the personal value of these payments, they are important for the long-term viability of our workforce. Finally, holiday differentials in pay are needed to give people an incentive to work on holidays.

There are several hundred people on staff whose cell phone service and/or Blackberry service is reimbursed. Except in special circumstances, I have trouble justifying that. Some people who need to have quick and complete information on technical problems should be reimbursed for these services. But for the vast majority of people, a cell phone is something they would likely have anyway and a Blackberry is handy, but not a necessity of the job. Accordingly, we will do a complete review of who is being reimbursed for these services and will discontinue that reimbursement if we find that it is not necessary. I am guessing that this will save $100,000 for a full year.

Many of you have asked that we cancel the employee barbecue this year. I think that social events for our employees are important for our overall sense of community, but the $50,000 for this occasion is very hard to justify this year, and so we will cancel it. You have also suggested that we economize on other events, like the nursing awards, years-of-service recognition, and so on. We will do so, but we will not cancel them. It is good and important to recognize people for special service.

Many of you have suggested a reduction in catering and meals at meetings in the hospital. In my last e-mail to you, I suggested that this did not appeal to me. Meetings are often scheduled during the times that people would otherwise be having lunch or breakfast, and it seems to me to be appropriate to feed people in these settings. Nonetheless, I will defer to your comments and will say that the hospital will no longer pay for meals for staff people at meetings. Light snacks and drinks, however, will be permitted. I cannot estimate what the savings will be from this measure. (An exception: The meals prohibition would not apply to residents' educational sessions.)

Some of you have asked me to cancel our partnership with the Red Sox. I cannot because it is a contractual obligation, but I would not in any event. This is an important part of our marketing and community presence. The Red Sox are the strongest brand in the region, and our affiliation with them leads to multiple benefits for the hospital. Our name is seen and heard by 2 million fans per year at Fenway Park and millions more on radio and television during the games. We could never afford to buy that kind of visibility with traditional advertising. Our first aid crews provide medical care to thousands of patients each year. We are also involved in important community activities, like the Red Cross Blood Drive and the Scholars Program, with the Red Sox. When the Red Sox sought an "official hospital" six years ago, every hospital in Boston wanted the partnership, and they still do. I was very proud that they chose us, and I still am. In any event, as mentioned, this is a contractual obligation.

There have been other suggestions regarding staffing of the PACUs and other clinical areas. We will continue to review those. There have been suggestions with regard to energy conservation and recycling. We already have strong programs in those areas. For example, as a result of energy efficiency steps, our energy use is the same now as it was when we had 2000 fewer people working here several years ago. Nonetheless, we will continue to pursue enhancements in these areas, but I cannot quantify savings that I can count on at this time. Ditto for other operational improvements, like changes in laundry collection practices.

Now, for your reactions to this list of more concrete options: We have set up a new chat room called Budget Forum 2. See the BIDMC SPIRIT site or the link under “announcements” on our general portal, and each of the major proposals has its own "chapter." Please offer your thoughts there until 5 p.m. on Thursday, March 19. (The original Budget Brainstorm chat room will remain up for observation, but it will no longer be possible to post comments there.) It was great to see the overwhelmingly positive and heartening feedback on our first forum. While there was a small number of commenters who engaged in meanness and sarcasm, we are not going to let that interfere with our goal to give everyone here a voice. I'll ask again: Please use this forum in the way intended, i.e., to comment on these ideas in a polite fashion. (In this next round, we will delete comments that are inconsistent with our values and the purpose of the forum.)

And, of course, feel free to write me directly as well by return e-mail.

I will issue another e-mail within a week with my final decisions and more details on these matters.

Thank you for your patience and involvement as we work through all of these issues. Our commitment to excellent and compassionate patient care and superb research and teaching will continue unabated, and we will come through all this fine.

Sincerely,

Paul

Paul F. Levy
President and CEO
BIDMC

To: POTUS. From: M. Healthcare.

2009-03-19T00:05:00.000-05:00

Dear POTUS (President of the United States):

My name is M. Healthcare. You are holding a "Summit" to discuss me and my illnesses but I will not be there. You have only invited my parts: legislators; economics experts [look where they have gotten us!]; drug companies; hospitals; doctors and nurses. Systems thinking emphasizes the need to consider a system as a whole not separated into neat little separate packets. Your summit without me is like treating the liver when the whole body is sick and no one knows why.

With respect sir, as my healer the summit is guilty of malpractice. You are claiming to fix (heal or cure) me and that requires practicing evidence-based medicine. The good doctor must first establish the diagnosis - the cause(s) of my illness - and then direct treatment at those causes. Treating symptoms only palliates - it makes the patient feel better, temporarily.

As I am not party to the discussion about me, I can only judge from what I read in the media. It appears as though the meeting of my "parts" is already planning to treat one of my symptoms (millions lacking health insurance) without even identifying the cause of that symptom. Proper treatment requires therapy aimed at the why. Otherwise, you produce a fix that fails.

Even if you could somehow give health insurance to everyone, this would neither stop nor even slow down the upward cost spiral. How does throwing more money at me make healthcare cost less?

As my doctor, you need to know the causes of my symptom known as out-of-control-costs. The most obvious is confusion ("micro-economic disconnection") between my parts: the one who consumes is disconnected from the one that pays. Next there is the bloat: I have a huge bureaucratic machine in my belly that gobbles up food and does...nothing, except take up space. Also, I am bloated by millions of pages of rules that hamstring any attempt at efficiency. I am cross-eyed. I look at the wrong things: watching the outcomes I don't want and not paying any attention to the things I should watch. Finally, there is my paranoia (really! they are out to get me) which makes me behave defensively and that too raises costs.

Your summit about fixing me discusses none of these causes. It focuses only on treating one symptom: financing. Even if you could magically give everyone health insurance, and ignoring the cost to the next generation, would that solve the following problems: lack of nurses and doctors; medical errors and avoidable deaths; a failed medical malpractice system; and an increasingly unhealthy population? The clear answer is no!

I also noticed that your stimulus package includes all sorts of money given to my parts, like electronic medical records; beefing up HIPAA; and money for research, particularly cost effectiveness studies. While some may be good ideas taken alone, the result will not help me. This is more piecemeal work that never cures the patient: like putting cream on a rash but not treating the infection causing the rash.

ARRA (2009) stands for American Recovery and Reinvestment Act: an effort to bring us out of the present financial recession/depression. This effort has nothing to do with healing a sick me. Yet 20% of the Act and billions of dollars are for me. Why?

Finally, I notice that you look at me funny, as though I am a bother, a painful cost item, instead of what I am. I - M. Healthcare - am maintenance and restoration of critical infrastructure. The primary asset you have Mr. POTUS is my part called people. They create all the productivity of our nation. Their health should be viewed as an investment for the future, not a burden in the present.

I am sick and you are my doctor. To heal me, you need to practice good medicine: identify all the reasons why I am sick and treat them based on evidence, not logic, personal opinion or popularity polls. That will mean a totally new me, not just a change in one of my parts.

Thank you for your time and consideration.
Respectfully,
M. Healthcare

MLK

2009-03-10T05:42:00.000-05:00

"Not everybody can be famous but everybody can be great because greatness is determined by service. You don't have to have a college degree to serve. You don't have to make your subject and your verb agree to serve. You don't have to know about Plato and Aristotle to serve. You don't have to know Einstein's theory of relativity to serve. You don't have to know the second theory of thermodynamics and physics to serve. You only need a heart full of grace and a soul generated by love."
- Martin Luther King Jr.

Mother Teresa

2009-03-10T04:26:00.001-05:00

"We are called upon not to be successful, but to be faithful."

Man's Best Friend

2009-03-09T00:43:00.002-05:00

Texas Rocks

2009-03-08T05:00:00.002-05:00

TEXAS ROCKS post from Zak. I can’t help it that I love this state so much. Its born in me…I know pride is a sin, but the Bible never talks about Texas pride being a sin.
Here is what Jeff Foxworthy has to say about folks from Texas…and I’ve found it all to be true.
· If someone in a Lowe’s store offers you assistance and they don’t work there, you may live in Texas.
· If you’ve worn shorts and a parka at the same time, you may live in Texas.
· If you’ve had a lengthy telephone conversation with someone who dialed a wrong number, you may live in Texas.
· If ‘Vacation’ means going anywhere south of Dallas for the weekend, you may live in Texas.
· If you measure distance in hours, you may live in Texas.
· If you know several people who have hit a deer more than once, you may live in Texas.
· If you install security lights on your house and garage, but leave both unlocked, you may live in Texas.
· If you carry jumper cables in your car and your wife knows how to use them, you may live in Texas.
· If the speed limit on the highway is 55 mph — you’re going 80 and everybody’s passing you, you may live in Texas.
· If you find 60 degrees ‘a little chilly,’ you may live in Texas.

CEO Communication

2009-03-08T04:39:00.003-05:00

As I read Paul Levy's post from yesterday I am struck by what a candid and honest CEO BIDMC truly has leading their organization. Here is a copy of the communication he sent out to his entire faculty and staff of approximately 9,000 people:
Dear BIDMC,

I wrote you last fall about the state of the economy and measures that we were taking at BIDMC to deal with those general trends. In particular, I said:

"We plan to watch the numbers very, very carefully. Our CFO, Steve Fischer, will bring a monthly dashboard of revenue and cost variances to our Operations Council so that the Vice Presidents can solve problems early and aggressively when they appear. We will have the same discussion monthly with the Chiefs of Service. If we aren't hitting targets for revenue and expenses, we will act quickly to correct the situation. In line with our policy of transparency in so many areas, we will keep you up to date, as well, so that all people working here will know how things are going.

"You have probably read about layoffs in other hospitals in Massachusetts. A number of hospitals already find themselves in worse shape than us, and they have responded by reducing the number of staff. You have probably noticed that this is also true for many other types of businesses in the region. As of now, we do not think we will be forced to do that, and we will do our best to avoid that result. Many of us lived through the dark days of 2002, when I eliminated a number of jobs, and no one wants to repeat that experience."

Well, as you can see from general trends in the economy and by watching the actions of other hospitals, the situation has gotten worse. For BIDMC, our hoped-for 2% FY09 operating margin (about $18 million) has disappeared. The state has reduced Medicaid payments by over $7 million, our major insurer is paying us less than we had hoped, and research funding has also fallen short by several million dollars. In addition, patient volumes are substantially lower than budgeted as people in the community defer or forego medical visits and treatments.

Right now, at best, we can break even for the year if patient volumes return to budgeted levels. However, if they stay at current levels, we will face an operating loss of up to $20 million. This is the contingency for which we must prepare, or else we will have insufficient funds to invest in the buildings, plant, and equipment needed.

We have taken steps to date to reduce expenditures. For example, many of you have probably noticed that we have slowed down hiring dramatically, examining each and every vacancy before refilling positions.

Now, sadly, we have to crank up the expense reduction. We began the year with a level of staffing that assumed a larger number of patients. With the reduction in patient volume and with a fairly dramatic reduction in length-of-stay for those patients who do come here, we are overstaffed. We need to make some hard decisions by April 1, as we are already halfway through the fiscal year, to start reversing the downward trend. We also need to do so well in advance of FY2010, which promises to be an even more difficult year. To be prudent about financial planning for this year, we aim to generate savings of at least $20 million for the rest of the fiscal year.

Part of the solution to this problem will be to lay off people. I'm not sure how many yet, and I am hoping you can help me figure out how to minimize the number by using more creative and less disruptive ways to solve the problem. I am going to hold some town meetings in the next several days to get your thoughts about alternative concepts. I will lay out some ideas here, so you can be thinking about them. You can write back now, or you can tell me in person later. Perhaps you will want to discuss them with your colleagues. Perhaps you have better ideas to suggest. We'll soon set up an electronic chat room, too, to permit people to share their thoughts more broadly with the community.

Our focus has to be on reduction of personnel costs, our major operating expense. Here are some ideas to start the discussion: Eliminate the 3% pay raise for people who would ordinarily receive it starting April 1. (To compensate, in the future, new raises could start with the people who have anniversary dates of April 1 and after.). Reduce future earned time accruals by one or two days per year. Forfeit one or two days of past accruals of earned time. Permit certain floors or units to avoid layoffs by voluntarily taking pay cuts equivalent to the dollars that would be saved by the layoffs in that floor or unit. Ask people to take furloughs, unpaid leaves of absence for several days.

But the bottom line is the bottom line. If you don't like these ideas, please help us come up with others.

The senior managers of the hospital have recognized their personal responsibility to help with this problem. The senior vice presidents, vice presidents, and chief operating officer have been asked to take voluntary 5% pay reductions, and I have eliminated all of their bonuses for 2009, a total potential pay reduction of 15% to 25%. I am personally taking a 10% salary reduction and will forego my bonus opportunity for this year, a total potential pay reduction of 30%.

For the next step in answering your questions and receiving your ideas, I have scheduled three town hall sessions for tomorrow, Friday, March 6 -- at 8am in the Sherman lecture hall, noon in the Leventhal conference Room, and 4pm in the Sherman lecture hall. If you can't make it, don't worry. We will hold other sessions in the coming weeks, on campus and also at Renaissance, 109 Brookline, and Lexington, Chelsea, and Bowdoin Street.

Those who were here in the late 1990's and early 2000's know that we have the tenacity and creativity to pull through hard times. This recession is different in scope and shape from that period, and it will present us with new challenges. If it is any solace to you, we are far from alone. Here's a report with excerpts from the LA Times:

Two new analyses show that the "economic decline is continuing to ravage the nation's hospitals, with half of them operating in the red, and many planning service and staffing cuts." The Times explained that "hospitals are ailing because of a number of problems hitting in close succession." The problems include "investment incomes" plummeting, while more people "put off elective procedures and insurers" tighten "their grip on the length of hospital stays they cover." According to the new data, "an unprecedented 50 percent of the nation's hospitals appear to be losing money." The bottom 25 percent of hospitals "posted margins below minus seven percent, or seven percent worse than the break-even point, while the top performers' margins exceeded 4.5 percent. Even operators of the most robust hospitals are bracing for another difficult year as the effects of layoffs and employer cuts in health-insurance benefits take hold." A second study found that "44 percent of hospitals have seen declines in surgeries, with hip procedures showing the steepest drop-off at 45 percent." This has caused "47 percent of the hospitals surveyed expect to make staff cuts, and 69 percent plan to cancel or delay equipment purchases."

I am confident that we will apply our usual spirit of collaboration and teamwork to this current set of problems. I look forward to your suggestions and thoughts.

Sincerely,

Paul

25 Things I Hate About Facebook - Funny

2009-03-06T03:11:00.000-06:00

Sleep Walking Dog - Good laugh

2009-03-01T23:57:00.001-06:00

Slow Walker - Funny :)

2009-02-27T20:35:00.001-06:00

Right to Say "No" Going Away

2009-02-27T20:17:00.002-06:00

Well it looks as though President Obama is starting to roll back some of the advances we received in the protection of life. More from the Washington Post.

'Difficult' patients can test doctors' patience

2009-02-24T14:02:00.001-06:00

By Rita Rubin, USA TODAY
Remember the Seinfeld episode where word got around that Elaine was a difficult patient? That scenario might not be so far-fetched. For 30 years, studies consistently have found that doctors call one out of every five or six patient encounters "difficult."
The latest, in today's Archives of Internal Medicine, found that primary-care doctors who felt they had a high number of "difficult" patient encounters were younger and more likely to be women.
Researchers surveyed 449 general internists and family practitioners at 118 U.S. clinics, asking them to estimate how often they encountered patients with any of eight attributes ascribed to the most difficult.
A patient insisting on an unnecessary drug was the most frequently cited challenge, cited by more than a third of respondents.
About one in six respondents said they frequently saw patients who appeared to be dissatisfied with their care. One in seven said patients frequently had unrealistic expectations. "Difficult" patients also ignore medical advice, complain persistently, insist on unnecessary tests and do not express appropriate respect.
Women made up half of doctors who reported the most difficult encounters, but only 27% of those who cited the fewest.
Doctors reporting more difficult patients were also more likely to report burnout. It's not clear whether such encounters contributed to burnout or burnout made doctors less tolerant, says lead author Perry An, a general internist at Newton-Wellesley Hospital in Newton, Mass.
The average age of doctors reporting the most difficulties was 41, vs. 46 for those reporting the least. Perhaps, An speculates, doctors cope better as they become more experienced.
Why might women be more likely to have difficult patient encounters? Erin Krebs, a researcher at the Indianapolis Veterans Administration Medical Center, says women might attract patients who demand lots of attention. "Patients who have more psychosocial concerns may perceive a woman doctor as being more understanding," says Krebs, who wasn't part of An's study.
Krebs and An agree that the doctor-patient relationship goes both ways. Patients can help by coming prepared, they say.
"Understand upfront what the time constraints are," An says. And, says Krebs, raise the most pressing issues first so that you don't run out of time.

12 Year Old Speach on Abortion

2009-02-18T21:41:00.002-06:00