OnDemand Release

At PowerHealth OnDemand, customer success is our #1 priority. Our goal is to deliver optimal value in each of our software releases for our customers and their teams. We are excited to introduce next release.

What’s coming?

Our engineering and design teams have been up late creating a new and improved user experience.
Easy User Navigation: All users from Administrators to Power Users/Analysts to infrequent users from departments will have access to OnDemand’s newly designed and intuitive and organized user interface.
Mobile Access: This release will feature a new way to stay attached to critical OnDemand information answers using a desktop, laptop, iPad or other tablets. Now users from analysts to department management to executives will be able to more easily view summary level answers through our new OnDemand Watchlist Key Performance Indicators, new Dashboards, Charts, and Analysis Grids. Mobile devices that are “touch-compatible” will now have their OnDemand Answers at their fingertips.

Expanded OnDemand Analytic Reporting

Based upon our OnDemand Community recommendations, we’ve continued to enhance and expand our product line to meet user needs. High level enhancements include updates to the following:

Financial Performance Analytics now includes areas such as:

1. GL Budget/Variance by organization and individual department, with integration to items such as Labor and Materials Management
2. GL Department Summary
3. GL PowerGrid for Ad hoc Reporting
4. Interactive Income Statement to view and manage all department details

Clinical Operations Performance Analytics have been expanded and organized to enable users to better visualize and manage bottlenecks to patient throughput in areas from “Door to Discharge”. OnDemand now includes analytics reporting to manage critical areas such as Patient Census, Volumes, OR throughput, and Emergency Department , LABS, and Radiology throughput.

Quality Performance Analytics have also been enhanced to enable users to view summary and detailed level answers related to better manage quality outcomes by procedure, readmissions by any variable, ICD performance, patient satisfaction, and more.

OnDemand Support Center: We have revamped our Help & Support system to better accommodate our users from Administrators to Power to Casual users. More to come on this soon!

Custom Reports to help drive decisions. Users who need additional help generating Answers will find a new OnDemand Reporting Service available to their organization. Users will have easy access to submitting a form our PowerHealth team when they require unique or complex reports that require our services.

Lean Management System – All OnDemand subscribers now have access to our newly released Lean management solution called Kaizen OnDemand. This system is tailored to help your organization better manage Lean initiatives through an easy to access online system for ANY and ALL staff members. Contact us today to find out more!

OnDemand Go-Live specifics

• The scheduled time for the OnDemand upgrade will occur on Monday, July 22nd and order to minimize user downtime, the upgrade will occur on a weekend night before our scheduled go-live.
• There will be a brief upgrade window when we will perform this service. During the upgrade window, users will receive a message stating that the service is momentarily unavailable. Once the service is available, organizations will be on the OnDemand 5.0 release.


We are providing four 30-minute training sessions to educate OnDemand users on the new release features/enhancements. Please refer to your “5.0 release email” for a schedule of trainings.


B.I. a focal point for hospital systems taking part in HFMA’s “Value Journey”

FREEPORT, ME – Participation in a national hospital project has shown one small Maine hospital the importance of business intelligence tools.

The 65-bed Franklin Memorial Hospital, a member of Franklin Community Health Network (FCHN), is taking part in Value Journey, a project organized by the Healthcare Financial Management Association (HFMA). The project sets out to identify common challenges that all healthcare providers are facing as they adapt to a value-based business model, such as the fragmentation of care delivery, as well as common capabilities, strategies and tactics that will help them make the change. Thirty-five hospital systems across the country are taking part.

Franklin Memorial has chosen to focus on one facet of the Value Journey project – using business intelligence tools to drive clinical and financial improvement at the hospital said Wayne Bennett, the chief financial officer of FCHN, during a one-day workshop sponsored by the Maine chapter of HFMA.

The hospital began by focusing on a combination of two issues: data warehousing and data integration technologies and desktop query, reporting and analysis tools for self-service access to information, said Bennett.

“Putting the two together – data warehousing and desktop query – allows us to really understand this,” said Bennett. “Relationships of data drive the business intelligence, and you can stop working off of anecdotal information and focus on straight facts. Really, data intelligence is an evolution.”

The evolution of business intelligence maturity, explained Bennett, begins with production reporting, moves to spreadmarts and then eventually moves towards data marts and data warehouses, where data is pooled and reports are run off of a common database, rather than separated databases from each department of the hospital.

“We are at the data warehousing period of the evolution, where we are not only working off of one database, but we are also delivering business intelligence dashboards of information and putting more energy on analyzing information, rather than gathering information,” said Bennett.

Bennett explained that the hospital partnered with PowerHealth Solutions, which specializes in hospital data systems for patient costing and billing, to work on getting their hospital data out of specific systems in the organization and into one data warehouse.

The evolution does not stop at data warehousing though, explained Bennett. From data warehousing, organizations can then make the leap to enterprise data warehousing, where “people begin studying the data and working on improving costs and solving problems,” he said.

From here, organizations then move towards the “ultimate evolution” period of analytic services where every smaller system is driven by an analytic database, he said.

“Wherever your organization is along this evolution spectrum, the good news is you can always try to move to the next level,” he said. “The key is to keep going rather than try to perfect everything at once.”

Massachusetts Hospital Tansformation Through Technology

Growth Strategies | September 27, 2012 | CFO.com | David Rosenbaum

Why is a finance director involved in what seems to be operational minutia? Because operations drives finance.

But all hospitals share the same problem: an aging population.

“With an older population,” says Josh Gray, managing director of the financial leadership council of The Advisory Board Company, a health care and educational consultancy, “you get a higher proportion of medical as opposed to surgical care. Older people have fewer surgeries, and medical care is reimbursed more poorly than surgery. This places incredible pressure on hospital margins while costs are increasing.” (And they are. According to a recent New York Timesinvestigation, Medicare reimbursements to hospitals were $1 billion more in 2010 than five years earlier.)

Hospital margins are already grocery-store thin. At 2%, Jordan Hospital’s is relatively robust, with a total 2011 surplus of a little over $4 million on net patient service revenues of $194 million. But Jordan Hospital is part of the Jordan Health System, which also includes 50-doctor Jordan Physician Associates, Cranberry Hospice, and a wellness center. As a whole, the Jordan Health System’s margin was under .5%, and its surplus was $900,000.

And as hospital revenue streams shift from fee-for-service to what the Advisory Board’s Executive Director Zachery Stillerman calls “risk-based services,” CFOs must develop “different business processes and tracking mechanisms.” It is, says Stillerman, “a huge challenge.”

Beyond Fee-for-service
Instead of insurers paying providers on a transactional, fee-for-service basis, under the ACA their payments increasingly will be based on the care of individuals, a process-based system.

Jordan, for example, became one of 27 national Medicare Accountable Care Organization in April 2012. That means, says Robbins, “we have contracts with a handful of insurers to manage the care of buckets of patients. We have a budget for these patients. For example, we have a contract with Tufts Health Care for the hospital care of 800 enrolled Medicare beneficiaries. Tufts comes up with a budget for their care. We have to manage within that budget.”

Under the terms of the new Medicare Shared Savings Plan, if Jordan spends less on the Medicare-eligible recipients in its ACO (determined by a defined base year, with the additional requirement to report on 30 patient quality indicators that will be used to determine future improvements), it keeps a percentage of the savings. For the first three years, if the hospital exceeds the base year level, it will continue to be reimbursed at traditional Medicare rates. After that, it will be “at risk,” as future reimbursements, says Robbins, “will be contingent upon the achievement of improved patient quality outcomes as compared to the base year.”

In order to reduce that risk, Robbins needs to know “what services are being offered to patients, what’s being used to excess, where physicians are operating out of bounds of reasonable utilization rates.” That is, she needs to get operational.

To do that, she needs the cooperation of Jordan’s physicians, and a single view of the truth, a single view of the patient.

Transformation through Technology
To help get that single view (or something approaching it), in 2010 Robbins implemented PowerHealth OnDemand’s new business intelligence product. PowerHealth OnDemand is a software-as-a-service analytics and business performance system, deployed at Jordan Hospital since 2007, that allows hospitals to pull information from their legacy systems and slice and dice it – no easy task.

“The health-care information system world is made up of many different modules,” says PowerHealth OnDemand chief executive officer Paul Evans. “There are distinct silos, and bringing it into one source is a huge problem. Furthermore, hospitals have to combine third-party systems – clinical, physician management, insurance systems – with revenues and costs and electronic medical records” to get a single view of the patient.

Once that single view is achieved, it can help hospital finance executives figure out profitability and margins. “Let’s take orthopedics,” Evans says. “Having a view of what the costs are for implants in each procedure, plus the labor (nurses, physicians, and staff), allows you to know how much money you’re making or losing on a knee transplant and whether that’s a business you should be investing in.”


Readmission penalties to hit two-thirds of hospitals

September 10, 2012 Firece Healthcare | By Karen Cheung-Larivee

Two-thirds of hospitals will see penalties in the coming weeks for higher-than-average readmissions, according to the Medicare Payment Advisory Commission (MedPAC).

Starting Oct. 1, hospitals will face up to a 1 percent penalty in 2013 for readmissions related to acute myocardial infarction, heart failure and pneumonia. In 2014, the penalty will go up to 2 percent and up to 3 percent in 2015, with four more conditions added to the list.

Sixty-seven percent of hospitals will face a penalty, averaging $125,000. A third (33 percent) will have no penalty, for instance, because they do not have enough cases. In aggregate, penalties will equal 0.24 percent of all inpatient payments in 2013.

The commission, which recommended the program in 2008, met Friday to discuss refining the hospital readmissions reduction program. Although it continues to support hospitals curbing readmissions, MedPAC called out some concerns with the program in the long-term.

As the American Hospital Association has noted before, some readmissions are not preventable and other readmissions are planned. MedPAC suggested shifting all-condition measures and including exceptions for planned and unrelated readmissions.

Another concern is that readmission penalties may not account for socio-economic factors. Hospitals that have the largest share of low-income patients are 2.7 times as likely to have high readmission rates, Kaiser Health News previously reported.

MedPAC also expressed concerns about the math related to the penalties in the long run. For instance, the penalty amount increases as the industry presumably reduces readmissions. Therefore, MedPAC sees a fixed penalty multiplier or using all-condition readmissions as possible solutions.

Using all-condition readmissions also could help solve random variations in hospitals with a small number of cases in distinguishing true improvement performance.

MedPAC said it is, indeed, feasible for hospitals to cut down on readmissions by identifying at-risk populations, reducing hospital complications and improving communication with providers outside the hospital. Hospitals also can improve care transitions by providing patient education and self-management tools, scheduling follow-up visits and reconciling medication before discharge, and calling or visiting patients after discharge.

Meditech Connect Sitdown with PowerHealth OnDemand CEO

Posted by MEDITECH Connect on September 10, 2012 at 11:00pm: We recently sat down with the Paul Evans, CEO of PowerHealth OnDemand, to talk about performance management data, Obamacare and how it all relates to your MEDITECH hospital…

Q: So Paul, tell us a little bit about your background with MEDITECH, how many MEDITECH hospitals you currently serve and why you decided to start PowerHealth OnDemand?
Our relationship with MEDITECH naturally evolved. While we don’t have any staff that have ever been on with MEDITECH, we have formed a deep understanding of how the HIS works within the hospital community. PowerHealth OnDemand serves 600 hospital sites globally and 40+ sites in North America are MEDITECH users.
Our experience with MEDITECH clients is they are proven to be rich in data, but “information poor” in being able to retrieve and logically organize information into simple intuitive solution-based views. Additionally, it became apparent as we worked with more and more MEDITECH sites that hospital staff had a fundamental need to gain access to all the robust data from not only MEDITECH but from all the other systems hospitals implemented over the course of time. That’s what we do

Q: How does PowerHealth OnDemand help clients through the future of Healthcare Reform now that the legislation has passed?
Running a hospital certainly won’t get any easier due to the increased management pressures caused by the new age of Healthcare Reform. Trusted access to performance-based details is key to the success. Cost management is critical and is at the core of survival of all hospitals. In addition, some of our sites have adopted or are moving to an ACO model whereby they must have an integrated solution to both their MEDITECH HIS and 3rd party data sources such as physician and claims data. Administration will need to have consistent visibility into the care continuum for patient populations and managing the financial side related to “Bundled Payments”. Access to trusted data and information to make educated decisions for both strategic and operational is paramount in this model.
Our PowerHealth OnDemand clients are preparing themselves for the storm ahead. They have routine access to detailed costs down to the patient and physician level – from one single system source. The OnDemand Business Performance engine enables MEDITECH sites with a much easier and flexible way to deploy and manage cost accounting, as a service, in order to produce the trusted and accurate results. Our solutions directly support strategic areas for finance and business management. Intervention leading to best practices happens when visibility into strategy is combined with clinical operations such as managing patient throughput, profitability, and labor & materials in major areas such as the OR, ED, Radiology, and other key departments. Quality intervention happens with visibility into performance at the patient and physician level to better our system of patient care. Benchmarking against peers also enables for better management decisions. This is complex stuff, but our clients are grateful that they found PowerHealth to satisfy their performance management needs.

Q: To put it bluntly, why should a MEDITECH hospital care about what you guys do? What problems do your products solve that are not as easy to tackle with the base EHR package?
MEDITECH hospitals are interested in PowerHealth OnDemand for 2 major reasons:
1) Because hospitals committed to surviving and thriving require trusted performance data and information in order to run their business and operations while providing visibility into their quality of care. We provide the quantifiable insights into what service lines and physicians make or lose a hospital profits and, importantly, why that is.
2) Because integrating over 34+ disparate MEDITECH modules and combining them with 3rd party data sources to provide logical insight to executives, department management, and analysts is typically not a core competency within healthcare organizations. PowerHealth OnDemand aggregates all these disparate, but highly valuable, data sources, provides real time access to customized view-points with an implementation time frame within 45 days.
At PowerHealth, we are not an EHR vendor. We are a systems integrator at our core that happens to have a proprietary performance management platform to enable users with access to logical and actionable insight to their performance management needs.

Q: You mentioned reporting in 6.0 which has been a common struggle among members who are upgrading. Can you talk in a little more detail on how you’ve helped hospitals transition all of their reports to their new 6.0 release?
We learn quite a bit from our clients – everyday. One of our clients that recently went through the MEDITECH 6.o upgrade stated that “OnDemand makes upgrades seamless or “Future-proof” to their HIS (both MEDITECH and Non-MEDITECH sites).
This means that our clients can rely on the PowerHealth OnDemand Platform because we securely house all the data integration and reporting logic. Proof to this became apparent when one of our key clients was in dire need of reestablishing access to critical data reporting that drives their operations starting with ED, OR, and Radiology.
The client had over 6,000 NPR’s that provided static, but valuable outputs. We were able to establish connection to each MEDITECH 6.0 module and integrate the data to produce our standard Ready-Access to dynamic analytics and self-service reporting environment for all the departments and physicians. This only took a matter of a couple days due to the fact that we had already established HIS module access from their Finance Team already using our Cost Accounting Module.

Q: We spend so much time talking about 6.0 these days that sometimes we forget how many Magic and Client Server hospitals that are still out there. For those that are not looking to change their systems in the near future, how have you been able to enhance MEDITECH hospital systems on older releases?
Regardless of MEDITECH version, PowerHealth OnDemand provides the same seamless access to all the data captured at the HIS level. We simply enhance MEDITECH (any version) by providing the single source system and logic for actually utilizing all the information in meaningful business decision-making aspects. Without a solution like PowerHealth OnDemand the data is just that, data, and not useful information provided in real time…

Q: So it sounds like you’ve got a variety of different users who utilize your products from the business office to the ER..
PowerHealth OnDemand promotes users at all Service Lines, Executive Level sand Decision Maker Levels. Usually, Finance and Quality are the first to adopt it, but usage quickly spreads to all departments. Our economic model is one where pricing is based on total number of Hospital Beds vs. Users so it makes it easier to get Hospitals to share the solutions tool with all of their applicable staff. We have found that this methodology is the only way our clients are going to get process improvement changes to be adopted. Peer benchmarking by physicians coupled with publicizing it is a great way to get change for the better.

Q: So here’s the million dollar question: How well does your product integrate with MEDITECH. Is data consistently updated accurately and consistently?
Our Cloud-based system integrates seamlessly with MEDITECH source systems, DR’s and combines the data with other source systems to provide users with an enterprise view of their data in an organized manner. We do this in a very tried and tested, and proprietary, method. We are then enabling best practices in their operational and strategic decisions through our benchmarking processes.
Are there checks in place to ensure that everything ties out to the host system?
We have a patent-pending process of data extraction, validation, auditing, and loading that enables administrators and users with on demand access that ties to the host system(s).
When it comes to checking out new vendors, the last thing a user wants is to try to make a process more efficient and end up with more work..!
Great comment and as I tell all our clients and new prospects, “You’ve invested millions in to your core systems – now let us provide you with accurate and trusted answers to your most critical performance needs!” Our solution was designed specifically so that users can not only access data and information in an organized way, but so they can “trust” their decisions through our proprietary business performance engine.

Q: To that end, what does your product support system look like?
We are a leading cloud based performance management company with roughly 60 people and growing. Our support model is essentially enabled 24/7 through our support team being global, and is primarily conducted through our PowerAssist tracking and management solution for support. Our mission is to treat our clients like gold. We only hire people that share this same vision.

Q: If there’s an issue that involves MEDITECH, how does a product support handle resolution with the customer?
Our Client Support team has automation built into the data integration and validation process that tracks IT source issues. Any such issue is tracked back to the source extract (MEDITECH in this case) to provide system administrators with timely alerts to help streamline the process and resolve the issue.

Q: Last but not least, if you were to pick one thing MEDITECH is doing spot on and another that you think they could work on, what would they be?
Spot On: MEDITECH hospitals appear to have a loyal following. Their systems appear to work well with users on the clinical end to trap detailed information.
Spot Off: At their core, MEDITECH is great at trapping clinical and detailed patient information. They are not a data integration and performance management company, just like many of the HIS vendors. That is a missing component and deeply required by all healthcare organizations striving to stay alive. At PowerHealth OnDemand, we are a Cloud-based performance management company that happens to bridge desperate data with multiple systems so that organizations can survive, thrive, and prepare to change in the future. Wisely.

PowerHealth OnDemand Announces Significant Financial and Operational Performance Improvement for Jordan Hospital

Denver, Colo. (August 23, 2012): PowerHealth OnDemand, a global leader in providing Cloud-based business performance management and cost accounting solutions for hospitals and healthcare organizations, is pleased to announce its market leading solution has enabled Jordan Hospital to achieve considerable results.  According to Gail Robbins, Jordan Hospital’s Administrative Director of Financial Planning, “ If you can’t access or accurately measure your financial and clinical operations data, you can’t improve your business and quality of patient care.   PowerHealth OnDemand is our trusted source for data and information that enables our users with near real time results.  The solution  supports our financial and clinical operations decisions in the OR and ED, including our LEAN performance improvement initiative.”   

PowerHealth OnDemand focuses on uniquely solving the information gap for trusted financial, operational, and quality performance needs of community hospitals, which comprise 73% of the North American hospital market. – source: Community Hospital 100.  Jordan Hospital is a 155 bed; full service community hospital located in Plymouth, MA and is a provider member of Jordan Community ACO. The hospital annually services approximately 11,000 patient admissions, over 300,000 outpatient visits, 6000 surgeries, 52,000 ED visits, and 650 deliveries.

“Helping community hospitals, like Jordan Hospital, deeply understand their business, operations, and the overall quality of their healthcare delivery is what we do better than any other technology provider in the category,” said Paul Evans, CEO of PowerHealth OnDemand.  “It is gratifying to know we are enabling Jordan Hospital with trusted data and information to support their strategic and operational decisions. We are also honored to have them as an integral part of the PowerHealth Community, and look forward to further enabling the leadership team to realize great results, well into the future.”

Jordan initially invested in PowerHealth in 2007 to streamline their cost accounting and enterprise reporting.  The solution recently proved to be vital in providing seamless access to trusted financial information through a major HIS conversion.  During 2011, Jordan tapped PowerHealth OnDemand to support Jordan’s strategic LEAN Performance Improvement activities.  Automated, dynamic reports and dashboards have been created for use in measuring, reporting and analyzing operational performance in the Emergency Department and OR.  Using PowerHealth, Jordan Hospital directors and analysts can also now easily access their OnDemand Interactive Income Statements for departmental budgeting performance, has clear visibility to all related business planning and financial data, and has the ability to dynamically drill down analysis by entity, by division, by department and/or by expense account.  Most importantly, all of Jordan Hospital’s data is available from single source. Additionally, Jordan has a trusted insight into:

  • Complete cost of care at patient and physician level
  • Service line management
  • Flexible reporting (by location, DRG, physician, patient type, etc)
  • Detailed GL reporting and analysis including budget variance by department
  • Labor and materials management
  • Over 64 key performance measures to support LEAN performance improvement
  • Operating Room performance management linked to surgeon, block times, materials, and labor scheduling
  • Capital purchase decisions (ROI)

“Our hospital is focused on continually improving overall quality, cost efficiency and patient satisfaction. That requires real-time information so our team can manage to goals on a timely basis,” said Gail Robbins. “PowerHealth OnDemand is a fantastic partner for us. They have demonstrated that their solution can help us to improve our hospital’s efficiency.  PHOD offers a combination of standard as well as custom reporting that has been invaluable to us.   Their responsiveness to our needs has been key to our successful partnership. At the end of the day, the technology has proven to be a key asset in helping our hospital understand how to best use its resources and manage through the next phases of Healthcare Reform.”


About PowerHealth OnDemand:

Founded in 2004, PowerHealth OnDemand empowers hospital and healthcare organizations with actionable insights and trusted intelligence to increase the performance, value and quality of their healthcare delivery. PowerHealth OnDemand has over 600 client executions across the globe. The company’s unprecedented Cloud-based integration with Healthcare Information System data and its award-winning cost accounting solution delivers accurate, timely and proven intelligence for hospital executives & department heads to achieve profitability in the new margin reality.  PowerHealth OnDemand has proven to be the most cost effective solutions for any organization and features our unique advantage that requires No Software, No Hardware, and No Long Term Contracts.  The company’s clients are recognizing a breakthrough to their hospital’s performance visibility, resulting in a minimum savings of $1800 per patient below their peers. 

The solution enables hospitals and healthcare organizations to achieve:

  • Optimized cost & revenue management across service lines & departments
  • Readiness for ACO and value-based purchasing initiatives
  • Management success towards major reductions to Medicare & Medicaid reimbursement
  • Platform for managing physician profitability and quality of care
  • Immediate Visibility to OR management and Emergency Department patient throughput
  • Organizational alignment with consistent metrics across department
  • Competitive advantage in the delivery of quality patient care


For more information: www.powerhealth.com

Leaders brace for October readmission penalties

August 20, 2012 | By Alicia Caramenico from Fierce Healthcare

The Centers for Medicare & Medicaid Services will recoup about $280 million in payments from more than 2,200 hospitals beginning in October–a number that has the attention of hospital executives, Kaiser Health News reports.

“I’m not sure penalties alone are going to move the needle, but they have raised awareness and moved many hospitals to action,” Eric Coleman, M.D., a national expert on readmissions at the University of Colorado School of Medicine, told KHN in a previous article.

For instance, a 0.66 percent penalty has prompted Delaware’s St. Francis Hospital to explore ways to improve handoffs and discharge to home care and skilled nursing facilities, KHN noted. “[H]aving these penalties over our head does kind of make a difference,” St. Francis Vice President for patient-care services and Chief Nursing Officer Coy Smith told WHYY.

Meanwhile, Wisconsin Hospital Association Chief Quality Officer Kelly Court attributed coordination among hospitals, community doctors, home care agencies and nursing homes with helping about 70 percent of the state’s hospitals escape the new penalty, according to Wisconsin Public Radio.

However, some hospital leaders in the Philadelphia area are voicing their opposition to penalizing hospitals for excess readmissions. “[Medicare] needs to remember that people are not cars,” Curt Schroder, head of the Delaware Valley Healthcare Council, told WHYY. “They seem to be treating hospitals like auto repair shops.”

Similarly, execs of two hospitals that have dodged the new penalty maintain a hospital’s readmission rate is not necessarily the best way to measure care.

According to David J. Shulkin, M.D., head of Morristown Medical Center in New Jersey, a  hospital’s readmission rate is only one “piece of a larger puzzle,” while Dr. Thomas MacKenzie, head of quality for Denver Health, said reimbursement rates can’t be viewed in a vacuum, FierceHealthcare previously reported.

Restaurant chains have managed to combine quality/cost control, and innovation. Can health care?

It was Saturday night, and I was at the local Cheesecake Factory with my two teen-age daughters and three of their friends. You may know the chain: a hundred and sixty restaurants with a catalogue-like menu that, when I did a count, listed three hundred and eight dinner items (including the forty-nine on the “Skinnylicious” menu), plus a hundred and twenty-four choices of beverage. It’s a linen-napkin-and-tablecloth sort of place, but with something for everyone. There’s wine and wasabi-crusted ahi tuna, but there’s also buffalo wings and Bud Light. The kids ordered mostly comfort food—pot stickers, mini crab cakes, teriyaki chicken, Hawaiian pizza, pasta carbonara. I got a beet salad with goat cheese, white-bean hummus and warm flatbread, and the miso salmon.

The place is huge, but it’s invariably packed, and you can see why. The typical entrée is under fifteen dollars. The décor is fancy, in an accessible, Disney-cruise-ship sort of way: faux Egyptian columns, earth-tone murals, vaulted ceilings. The waiters are efficient and friendly. They wear all white (crisp white oxford shirt, pants, apron, sneakers) and try to make you feel as if it were a special night out. As for the food—can I say this without losing forever my chance of getting a reservation at Per Se?—it was delicious.

The chain serves more than eighty million people per year. I pictured semi-frozen bags of beet salad shipped from Mexico, buckets of precooked pasta and production-line hummus, fish from a box. And yet nothing smacked of mass production. My beets were crisp and fresh, the hummus creamy, the salmon like butter in my mouth. No doubt everything we ordered was sweeter, fattier, and bigger than it had to be. But the Cheesecake Factory knows its customers. The whole table was happy (with the possible exception of Ethan, aged sixteen, who picked the onions out of his Hawaiian pizza).

I wondered how they pulled it off. I asked one of the Cheesecake Factory line cooks how much of the food was premade. He told me that everything’s pretty much made from scratch—except the cheesecake, which actually is from a cheesecake factory, in Calabasas, California.

I’d come from the hospital that day. In medicine, too, we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality. Unlike the Cheesecake Factory, we haven’t figured out how. Our costs are soaring, the service is typically mediocre, and the quality is unreliable. Every clinician has his or her own way of doing things, and the rates of failure and complication (not to mention the costs) for a given service routinely vary by a factor of two or three, even within the same hospital.

It’s easy to mock places like the Cheesecake Factory—restaurants that have brought chain production to complicated sit-down meals. But the “casual dining sector,” as it is known, plays a central role in the ecosystem of eating, providing three-course, fork-and-knife restaurant meals that most people across the country couldn’t previously find or afford. The ideas start out in élite, upscale restaurants in major cities. You could think of them as research restaurants, akin to research hospitals. Some of their enthusiasms—miso salmon, Chianti-braised short ribs, flourless chocolate espresso cake—spread to other high-end restaurants. Then the casual-dining chains reëngineer them for affordable delivery to millions. Does health care need something like this?

Big chains thrive because they provide goods and services of greater variety, better quality, and lower cost than would otherwise be available. Size is the key. It gives them buying power, lets them centralize common functions, and allows them to adopt and diffuse innovations faster than they could if they were a bunch of small, independent operations. Such advantages have made Walmart the most successful retailer on earth. Pizza Hut alone runs one in eight pizza restaurants in the country. The Cheesecake Factory’s major competitor, Darden, owns Olive Garden, LongHorn Steakhouse, Red Lobster, and the Capital Grille; it has more than two thousand restaurants across the country and employs more than a hundred and eighty thousand people. We can bristle at the idea of chains and mass production, with their homogeneity, predictability, and constant genuflection to the value-for-money god. Then you spend a bad night in a “quaint” “one of a kind” bed-and-breakfast that turns out to have a manic, halitoxic innkeeper who can’t keep the hot water running, and it’s right back to the Hyatt.

Medicine, though, had held out against the trend. Physicians were always predominantly self-employed, working alone or in small private-practice groups. American hospitals tended to be community-based. But that’s changing. Hospitals and clinics have been forming into large conglomerates. And physicians—facing escalating demands to lower costs, adopt expensive information technology, and account for performance—have been flocking to join them. According to the Bureau of Labor Statistics, only a quarter of doctors are self-employed—an extraordinary turnabout from a decade ago, when a majority were independent. They’ve decided to become employees, and health systems have become chains.

I’m no exception. I am an employee of an academic, nonprofit health system called Partners HealthCare, which owns the Brigham and Women’s Hospital and the Massachusetts General Hospital, along with seven other hospitals, and is affiliated with dozens of clinics around eastern Massachusetts. Partners has sixty thousand employees, including six thousand doctors. Our competitors include CareGroup, a system of five regional hospitals, and a new for-profit chain called the Steward Health Care System.


Hospitals not ready for ACOs’ financial risks

From Fierce Healthcare August 17, 2012 | By Ron Shinkman

More than 2 million Medicare beneficiaries now are enrolled in accountable care organizations, and their ranks continue to grow, according to a new survey by the Commonwealth Fund. However, Kaiser Health News reported that many hospitals may not yet be ready to assume the financial risks of an ACO operation.

According to the report, 2.4 million Medicare enrollees are involved in some form of ACO. Altogether, there were 221 ACOs in 45 states as of May. Of those, 148 are Medicare-oriented, with the rest serving private sector patients.

The Commonwealth Fund surveyed nearly 1,700 hospitals nationwide on ACOs, with 213 identifying themselves as participants. According to its data, 54 percent of hospitals in ACOs are in metropolitan areas, compared to 9 percent in small cities and 7 percent in rural areas. Sixty-four percent are aligned with a multi-hospital system.

Just over 54 percent of respondents say they are engaged in some form of capitated model, with the numbers almost evenly divided between those ACO participants who accept global capitation with full risk and partial capitation with some risk. Another 52 percent say they are engaged in a simple shared savings model, where savings are split among participants but there is no risk if expenditure forecasts are exceeded.

“We’re really still at the very beginning of the adoption curve of the ACO model,” lead author Anne-Marie Audet, M.D., told Kaiser Health News. “The challenge is that hospitals are still not ready to assume financial risk.”

Audet noted that few ACOs are using systems that predicted which patients would need the most services due to their poor health, which further compounded their financial risks, according to Kaiser Health News.


PowerHealth OnDemand Announces Dynamic Client Results & Platform Upgrades

Denver, Colo. (June 27, 2012) PowerHealth OnDemand the world’s leading provider of business performance management and analytics solutions for hospitals and healthcare organizations, is pleased to announce upgrades and multiple new customer testimonials for its industry leading operational-insight & cloud-based solution, PowerHealth OnDemand 4.4. By subscribing to PowerHealth OnDemand, Hospital executive management, directors, and administrators are able to dynamically increase business efficiencies by gaining near real time access to critical operational data.

PowerHealth OnDemand focuses on the pressing needs of the nation’s community hospitals, which make up 73% of the hospitals throughout North America, and are typically working on much smaller margins than enterprise hospitals – Community Hospital 100. PowerHealth OnDemand clients are recognizing a breakthrough to their hospital’s performance visibility resulting in a minimum savings of $1800 per patient below their peers.

Implementing PowerHealth OnDemand empowers hospital and healthcare organizations with actual insights and trusted business intelligence to increase the performance, profitability, and quality of their patient experience. The solution serves up all relevant granular operational and financial performance data, from physician to patient to service lines in real-time, into one dynamically customized visibility tool. PowerHealth OnDemand’s performance management solution accurately measures:

  • Cost & profitability across service lines
  • Detailed activity at the patient, physician & DRG level
  • Budget variance across all departments and accounts
  • Clinical operations and patient throughput for OR, ED, Radiology, etc.
  • Labor & materials utilization
  • Physician utilization linked to quality outcomes

PowerHealth OnDemand has over 600 client implementations across the globe.

“By using PowerHealth OnDemand, we have trusted access to critical data and information in one central location that puts it in the hands of staff that are closer to patient care and can better access answers. Our end users are more familiar with and can analyze our critical information more accurately. IT doesn’t know how data is structured or used, so it often takes several back and forth tries before we actually get the data we need. With PowerHealth OnDemand, we have immediate access to one version of the truth and can now easily review Dashboards to Details that enable us to answer our own questions” said Wayne Bennett, CFO of Franklin Memorial Hospital, former CFO at Mercy (Portland, ME)/ Central Maine (Lewiston, ME) and three-time PowerHealth OnDemand client.

Implementation is simple.  Access to data and information begins in 7-10 business days and doesn’t require any internal IT resources. The PowerHealth OnDemand 4.4 Product Upgrade includes:

  • Executive Dashboard information now available on all browser-based devices both from inside and outside the hospital network
  • Updated automated report distribution that will free-up your staff’s time to focus on their core responsibilities
  • Daily census reporting that allows for actionable information related to staff flexing and labor management
  • Dynamic interactive financial reporting for real-time visibility into budget variances by department including labor and materials  

“At PowerHealth OnDemand, we are transforming the healthcare industry by enabling healthcare providers to move away from the expense and overhead associated with farming critical data, and move toward  harvesting trusted data and information so that they can best understand and support their business and operations,” said Paul Evans, PowerHealth OnDemand CEO. “With our PowerHealth OnDemand V4.4 upgrade, we are pleased to extend the most accurate and easy-to-implement business performance management solution to the healthcare community.”


PowerHealth’s solution is amazing! It has eliminated the “frustration factor" in gaining access to accurate data and information. Now we can respond to our hospitals' executive staff, department, and service line managers faster than ever before to directly address the organizations challenges and needs.

Sr. Dir. Financial Planning, Jordan Hospital

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