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The End Of Community Hospitals?

Are the days numbered for Salem Community Hospital and other community hospitals around the country? Yesterday, a local story happened that made me think of this. The announcement was made that the Akron General Health System was being purchased by a joint venture of Cleveland Clinic and Community Health Systems (CHS). CHS is a Tennessee-based hospital operator who also owns three other hospitals in the Northeastern Ohio area where I live.

Six months ago, Akron City Hospital along with the rest of the Summa Health System announced that they were joining Catholic Health Partners (CHP), the largest hospital system in Ohio.  CHP owns a hospital in the Youngstown, Ohio market, close to where I live.

There are two hospitals in Columbiana County: Salem Community Hospital and East Liverpool City Hospital. As of this second, these two hospitals are still independently owned and operated, but for how long? 

I am by no means a hospital policy expert. But, it's not hard to see that across country, smaller hospitals are either being bought or joining larger hospital systems. This has already played out in Ohio's larger cities of Cleveland, Toledo, and Columbus. 

Salem Community Hospital (SCH) is in the midst of building a new patient tower with 87 private rooms. SCH also boasts the area's only 3T open MRI unit between Cleveland and Pittsburgh. On the negative side, SCH recently announced the resignation of their CEO, but states that current leadership is still committed to the future. Will all that be enough to sustain hospital independence, or is aligning with a larger hospital system (like Cleveland Clinic, CHS, CHP, or even University of Pittsburgh Medical Center) inevitable at some point?

"Why one-third of hospitals will close by 2020," is an essay from the KevinMD website. They close the piece by saying, "What hospitals are about to enter is the place Americans cherish: the open competitive market. We know what happens in this environment. There are winners and losers."

Not so fast says Becker's Hospital Review in an article entitled, "Hometown Healthcare Isn't Dead: Why (Most) Smart Community Hospitals Can Still Thrive." The hidden strengths of community hospitals, according to the article, include nimbleness to adapt to change and the ability to achieve higher quality, greater patient engagement, and lower cost - easier than the larger hospitals.

What will be the ultimate fate of Salem Community Hospital and others like it? Some say that the hospital industry will be like the airline industry where there will be a few large players nationally and the small companies will merge or fail.

I think the community hospital model will be similar to the banking industry. There will always be that locally owned community bank that the community gets behind and supports because it is neighbors helping neighbors. The only way small community hospitals will survive is if the community finds value in it and will continue to support the hospital, not only in its hospital services, but also with word of mouth and positive community reputation. Without that, you might as well pick who you're going to merge with, or close up the hospital altogether...

Six Physicians To Follow On Social Media

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Thanks to my friend Bunny Ellerin (pictured above) for including me on a blog post for the ZocDoc blog entitled, "Six Physicians To Follow On Social Media." Bunny is the Senior Vice President at a company called InTouch Solutions and she is also Co-founder of NYC Health Business Leaders. I was given the opportunity to speak to the NYC group last year in this you tube speech called, "Physicians Must Be On Social Media." Here is what she said about me in the article...

This early adopter has gone from being Doctor Anonymous to being... Dr. Mike Sevilla. In between, he used Family Medicine Rocks as his home base, where he tirelessly advocated for his specialty - and primary care in general. Recently, he took a break from social media to regroup (many of us were sad), but came back stronger than ever (which made us happy).
Dr. Sevilla uses every form of social media: blog, podcasts, YouTube, Facebook, Twitter, Vine, Instagram - name it, he'll try it. Wherever he is, he's one to follow for his honest, funny, human musings about family medicine and life in general. 

Thanks to Bunny for these very kind words. We met in person a few years ago at the Mayo Clinic Social Media Summit and have kept in touch (pun intended, hehe) ever since then. I've said this before, but the best things about social media, at least for me, are the people that I've met and the places that I have been. I'm a lucky guy, let me tell ya.

For people who like lists, here are more that I'm on... 

For those new to the site, welcome and I hope you take a look around. I also encourage you to check out the podcast as well as following me on twitter, Facebook, youtube, and linked-in. Enjoy! 

 

Lyme Disease: 300,000 Yearly

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Lyme Disease (photo credit) is something that a lot of people have heard about, but not really understood. The Centers of Disease Control and Prevention just released a new estimate of 300,000 cases a year - which is 10 times more common than previously reported (AP story).

Every day in my office, my patients ask me about the possible sign and symptoms of Lyme Disease (WebMD). The first symptom is typically an expanding red rash. This rash is accompanied by flu like symptoms including:

  • Fatigue (the most common symptom)
  • Headache and stiff neck
  • Fever (which may be high in children, but this is rare)
  • Muscle and joint pain

If not properly diagnosed and treated, there are many complications that can happen as outlined in the WebMD article. Even though not 100%, there is blood testing that can be done after a visit and an examination by your physician. 

This is a mysterious disease that sometimes goes undiagnosed. I encourage you to check out the links above and read about this illness more. And, of course, if any questions, I encourage you to schedule a visit with your physician.

FDA Defines "Gluten-Free"

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More and more of my patients are asking me and telling me that they are following a "gluten free" diet. What many people do not realize is that this is more than a fad diet of the moment. This is the recommended diet of people with the clinical diagnosis of Celiac Disease.

What I did not know is that the term "Gluten-Free" really has not been defined officially, and manufacturers can call about anything they want "gluten free" to take advantage of the popular health craze. 

Earlier this month the US FDA (Food and Drug Administration), defined "Gluten-Free" as the following:

  • Food that does not contain any ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains
  • Food that does not contain an ingredient derived from these grains and that has not been processed to remove gluten
  • Food that does not contain any ingredient derived from these grains and that has been processed to remove, gluten, if it results in the food containing 20 or more parts per million gluten

I gotta be honest. I read that three times, and I still don't know what it means. This is what government double speak is like. How do I really know if the food is "gluten-free" or not? How would you instruct people and patients on this?

The fad diet thing for "gluten-free" will fade in a few months until the next popular diet comes along. I guess I'm kind of reassured that there is at least some definition to "gluten-free" and that my patients with a true diagnosis of celiac disease can have some faith that this label will be a proper one for them.

 

Hope Disqualifies Olympian

Apparently, hope is a performance enhancing drug that disqualifies athletes. Victoria Arlen (pictured above) is a US athlete who is the defending gold medal champion for the 100m freestyle at the 2012 Paralympic Games. 

This week, Victoria was disqualified because the International Paralymic Committee has questions whether her disability is "permanent." Seven years ago, she woke up from a coma and could not move her legs. She is paralyzed from the waist down and is also wheelchair bound.

After she won four medals and set a world record last year, there was a review of her medical records. It was deemed that there was still "hope" that her disability is not permanent - and this drew the ban from this year's competition. 

Doesn't every athlete (whether it be olympian or paralympian) have hope to recover from illness, injury, and disability? Plain and simple, she was unfairly penalized for being too good. Before he went nuts, Oscar Pistorius was questioned whether technology (meaning his bionic legs) was an unfair advantage during his paralympic dominance.

What kind of precedent does Victoria's disqualification send through the paralympic world? Don't disabled athletes have enough of a challenge? Will these athletes now be discouraged from participating at the highest levels when they have to compete against other athletes and the International Paralympic Committee? This ruling is definitely not in the spirit of The Olympic Games.

Is There A Physician #IDcrisis

There will be a twitter chat at 2pm Eastern Time on Friday, August 16, using the hashtag #IDcrisis and twitter account @BermanInstitute. This is from Johns Hopkins and they have taken up the idea of social media professionalism with physicians. Of course, this is not a new concept, but I find it interesting how academic medicine is approaching it. For background information on the chat, check out this link.

There have been some guidelines released, particularly from the ACP & FSMB, stating that "maintaining separate personal and professional identities in web postings may help to avoid blurring boundaries in interactions with patients and colleagues."

My social media colleague Dr. Katz posted the above tweet and I agree with him. People have told me for a long time to have separate twitter accounts for my personal stuff and professional stuff. How do I respond?

I tell people I'm a proud Family Doc in small town America. Personal and professional identities are constantly clashing whether it be at the hospital, at my office, at the grocery store, at the gas station - everywhere. Dealing with your personal and professional life is a daily reality, especially for a small town physician. 

I don't separate my personal from my professional comments in real life. Why should I do that in my online life? And, to be honest, I don't have the time to manage more than one twitter account and more than one facebook account. If people don't like it, then they are more than welcome to unfollow me or defriend me. What you see is what you get whether in real life or on the internet. 

So, I won't be able to participate in the #IDcrisis chat on Friday, basically because I will be seeing patients in my office. But, I'll be monitoring the chat and I will be interested in what those academic docs from Johns Hopkins and other places will have to say about this "crisis" they are talking about. If for anything else, I encourage medical students and other trainees to pay attention to the chat as it will be valuable information as you try to figure out professionalism in a social media world... 

2014: The Year Of The Family Physician

Thanks again to my guest Ronald L Fong, MD, MPH from the University of California Davis talking about his idea of "2014 will be the Year of The Family Physician" and why people like Time Magazine should recognize The Family Physician as the 2014 Person of the Year.

Did you know that on May 28 of this year, the city of Sacramento, California signed a resolution designating 2014 at the Year Of The Family Physician. In addition, to help with marketing the idea, they have a great twitter account and bumper stickers for people.

At the end of our interview, Dr. Ron acknowledges that this is a "pie in the sky" idea, but why not be an Advocate for Family Medicine with this idea in mind. He's hesitant to direct people what to do, but I think that this is a great opportunity to talk to our patients and to our communities about why Family Medicine and Primary Care are essential to fix our broken health care system. 

At the end of the episode, I shared a short segment from Show Number One of my podcast way back to August 30, 2007. Yes, this is the six year anniversary of the podcast. But, don't worry, I am not quitting or taking any more social media breaks for this anniversary. It was fun to edit together this first show to share with all of you. 

You can listen to the show in the players above. You can also download the episode here and listen anytime. You can listen anytime to episodes on demand on iTunes or on RSS. I also encourage you to check out my accounts on twitter, facebook, an linked-in. Enjoy!

Podcast Preview Episode 313

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 "2014 will be The Year Of The Family Physician," says Ronald L Fong, MD, MPH who is the Director of the Family Medicine Residency Network at the University of California Davis. He has written a series of essays at the Family Medicine Revolution website.

To have a galvanizing effort, we need to take to the streets of cyberspace and educate the editors ofTime that the family physician is the right choice for Person of Year in 2014.
Go forth, take a stand and stand out.  Arise and lift those who are in need.  Do it for your patients, neighbors and for the future.  I believe it is our moment to shine as family physicians.  Do not let it pass you by.  Write your legacy from the inkwell of sweat.  Our voices should be hoarse from staying on message and our fingers calloused from typing and texting.

Hope you can join me for the live podcast today at Noon Eastern Time (9am Pacific Time) for the Mike Sevilla Radio Program Episode 313. If you're on a mobile device (like smartphone or tablet), you can click this link to listen live. Don't worry if you cannot catch live, you'll have the opportunity to download and listen to the show later. Hope you can join us later! 

 

Sanjay Gupta Inhales

Dr. Sanjay Gupta made a "shocking" announcement this week leading up to his CNN special this weekend. He wrote an essay called, "Why I Changed My Mind On Weed." Four years ago, he wrote an article for Time Magazine entitled, "Why I Would Vote No On Pot."

What's different now? He smoked marijuana (really). He looked at the medical research, especially for chronic pain and cancer patients. And, he declared that all of us have been "systematically misled" on marijuana. Really? Have we been?

Media analysis of this announcement includes articles entitled, "Sanjay Gupta Rejects Everything Sanjay Gupta Once Said About Marijuana," and "Is CNN's Sanjay Gupta Right About Weed." The Atlantic Wire article does a nice job of tracing his evolving position over the past few years. 

It is not news that a physician supports medical marijuana. I also agree with some of the research on THC use for cancer and chronic pain patients. However, if you read his essay carefully, he says nothing about recreational use of marijuana.

What will be news is the "anytime, anywhere, any condition" marijuana supporters will use this announcement to advance their recreational marijuana position. Will Dr. Gupta go along with this, too? Wait a few years. He may change his mind again for a future CNN special...