Category Archives: Healthcare

What Sets Correctional Medicine Apart

Correctional medicine staff provide medically necessary care to some of America’s nearly 2 million incarcerated people. This non-traditional health care environment has unique challenges that teach important lessons

The Patients Don’t Leave, So You Improve Communication Skills  
In traditional health care environments, patients and providers fire each other. Firings can happen for a number of reasons.  Maybe the patient disagrees with the provider’s recommendations.  Or perhaps the patient violated a care plan, and the provider announces that the patient needs to seek care elsewhere.  Regardless of the reason, patients in the outside world can often find new providers. In correctional medicine, patients are not free to seek care elsewhere.
Patients and providers will continue to disagree.  In correctional medicine settings, both parties need to find a way to move past it.  Providers will need to maintain boundaries while providing medically necessary care.  These are difficult conversations with a variety of factors to consider.  Yet these discussions will teach (and solidify) valuable de-escalation skills.

All the Patients Know Each Other, So You Practice Fairness  
In traditional health care environments, patients do not know each other.  There is no opportunity for patients to discuss their clinical experiences.  In correctional medicine, all patients share the same providers.  Given that, there is a much greater opportunity for patients to discuss their clinical experiences with each other.  Any provider that is perceived as doing a favor for one patient will be asked to do the same for others.  Correctional medicine providers need to ensure that they are treating all of their patients similarly.
Providers in correctional medicine have the chance to provide medical care to their patients without considering the person’s financial status (or their ability to pay.)  The opportunity to provide fair care is unique to correctional medicine because providers in traditional health care environments consider the impact and the importance of insurance payments dramatically.

Your Patients Are Always Around, So You Can Witness Daily Life and Disease Progression
A fascinating part of medicine is watching a patient’s daily life, and how their disease progresses. Often, health care providers in traditional settings only get to see snapshots of the patient’s progression.  So they mark the changes between today and the patient’s last appointment.  Although providers can surmise about what the patient experienced between appointments—they don’t know for sure.
Correctional medicine providers do not have to surmise.  Instead they get to witness aspects of their patients in daily life.  A few providers note that the correctional medicine environment gives them much more exposure to witness disease progression than they did in traditional settings.

Working in correctional medicine has a unique set of challenges and learning opportunities.  Correctional medicine may not be the right fit for everybody.

Correctional Facility Nursing. Minority Nurse, 7 February 2016, Accessed February 9, 2017.
Correctional medicine. Wikipedia, 2 June 2016, Accessed February 7, 2017.
Giang, Vivian. Jailhouse Doctor Shares What It’s Like To Care For The Most Dangerous People In the World. Business Insider, 20 March 2013, Accessed January 31, 2017.
Keller, Jeffrey. Correctional Medicine is Different: Our Patients Don’t Go Home!, Accessed February 7, 2017.
Keller, Jeffrey.  Correctional Medicine: The Principles of Fairness.,  Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: All Clinical Encounters are Discussed in the Dorm., Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: We Can’t Fire Our Patients-and They Can’t Fire Us!, Accessed February 7, 2017.

How To Respond To 2 Common Patient Fears

While it may not be visible, nervous patients walk into healthcare organizations every day.  Although each patient is unique, most share two common fears. First, they fear that they won’t be listened to.  Second, they fear that their care will be too expensive.  Here are some ideas about how to respond to these two widespread patient fears.   Community Health Doctor
No one will listen to me
There are two popular views of doctors.  Some patients consider doctors as trusted partners in their medical care.  Others feel like the doctors will judge them.  Regardless of a person’s specific beliefs, patients and providers can work collaboratively to ensure that the appointment goes smoothly.
Steps For Patients: Prior to the appointment, write down your concerns.  Practice explaining these concerns in the simplest way possible. When patients complete these steps, they often feel more confident—and prepared—during the appointment.
Steps For Providers: During the appointment, remember that everyone communicates differently. Ask questions and listen to answers. Summarize what the patient said, and repeat it back to them.  When possible, allow the patient to finish answering before asking another question.
I won’t be able to afford it
High medical bills are a barrier to care for many people.  Finances impact each patient differently, and clinics should have a variety of resources to help.
Steps For Patients:  If possible, enroll in health insurance.  Once enrolled, read plan documents carefully.  Learn what your insurance policy includes and excludes.  Note any additional requirements (like prior authorization) to ensure coverage. Often, patients with active health insurance have an easier time establishing care with providers.
If unable to enroll in health insurance, you should begin researching.  Ask your providers if they offer financial assistance programs or discounts for cash payments.  If the clinic does not offer it, consider calling other local healthcare organizations to ask the same question.  Healthcare social workers also may be able to connect you with community resources to further assist you.
Steps For Providers:  Clinics should always be transparent about their financial policies and resources.  Offer copies of these policies to patients.  Train staff to explain the organizational billing system in an understandable manner. Implement tools that estimate the costs of office visits or medical procedures.  When possible, offer alternatives to the recommended treatment plan—particularly when there are concerns about if the patient’s insurance will cover it.

Should My Clinic Have A Social Media Account?

In today’s world, it seems that everyone is on social media.  The potential audience is gigantic, and many organizations consider joining social media as a way to expand their reach.  Unfortunately, many do not realize that simply creating an account isn’t enough.
Instead, social media requires commitment. People are more likely to “follow” pages that have consistent posts with helpful information.  In your organization, someone will need to regularly manage and post to the account.  If the organization’s social media page looks incomplete or abandoned, visitors will move on.  Before committing to a clinic social media account, take time to identify the desired goals are.

How do your current patients find information?

Ultimately, you want to be active in spots where your patients are.  If your target patient population does not use social media to find their information, it may not be the right primary channel to invest in.  Instead, social media efforts could come secondary to other marketing efforts.

Who will follow your social media account?

Answer this question with as many specific as possible.  Healthcare organizations usually target their social media content either to patients or caregivers. It’s possible to have a successful social media account that targets patients or caregivers.  An internal medicine clinic may target patients directly.  A geriatric medicine clinic may target its social media content to appeal to the patient’s family, instead of directly to the patient.

How will this account benefit your practice?

Connecting with current and potential patients should always be the primary goal of clinic outreach efforts.  Social media could be the best channel to help accomplish that. Write down your specific goals for social media.  Are these realistic?  Do these make sense? Before creating an account, you should ensure that your organization is comfortable with the potential return on investment.

How will this account benefit your (potential and current) patients?

When done strategically, social media accounts have incredible power to connect and share information.  Describe what information your organization would share on its social media account.  Write down a list of subjects that you’d cover.  List how frequently your organization would post.

For people, businesses, and healthcare organizations, social media is a powerful tool that hold the promise of expanded reach and influence among target audiences.  Yet social media accounts take time and energy to maintain.  If you’re struggling to answer the questions listed above, it may be a sign to postpone creating an account.

5 Questions about the American Healthcare System

Healthcare reform is a contentious issue in American politics.  While a few presidents—Lyndon Johnson, Bill Clinton, and Barack Obama—have signed laws that changed the American healthcare landscape, the system is still imperfect.  With the new Trump administration, the future of healthcare policy remains unclear.  Some of the changes (i.e. Medicare and the Affordable Care Act) may be in jeopardy.Picture-1000words(442x400)

Below are answers to some important questions about the American healthcare system.  In order to play a part in the continuing conversation about healthcare reform, it’s important to understand the current status of the American healthcare system.

Question: What makes the American healthcare system different than other healthcare systems?
Answer: The American healthcare systems offers a lot of choice for potential insurance coverage, private plans, and public plans including Medicare, Medicaid, Veterans benefits, and the Children’s Health Insurance Program.  Despite all of those choices, America is the only wealthy country without universal coverage.   Additionally, the American healthcare system has higher usage of expensive medical technologies—like MRI machines.

Question: Where does the American healthcare system rank on the list of world healthcare systems?
Answer: The World Health Organization’s 2000 report ranks the American healthcare system as 37th in the world—behind every other wealthy country.

Question: How much does the United States spend on healthcare every year?
Answer: In 2013, the United States spent approximately $9,000 per resident (or 17.1% of the gross domestic product) on healthcare costs.  France spent the second highest amount of money on healthcare, approximately $4,300 per resident and 11.6% of its GDP.  With the lowest healthcare spending levels, the United Kingdom spent 8.8% of its GDP or approximately $3,300 per resident.

Question:  Doesn’t higher spending means that Americans get better healthcare?
Answer:  Not necessarily.  The American healthcare systems provides quality care that is similar to the care provided by other wealthy countries.

Question: If the care is comparable, what are the higher costs for?
Answer:  There isn’t one answer to this question.  There are a range of contributing factors including: widespread use of expensive medical technology, the fee for service model, and higher volumes of patients.

Healthcare policy continues to be a contentious issue in American politics.  Citizens, experts, and politicians have spent decades debating what changes will reform the system.  Yet this is not simply an issue for the politicians.  Stay informed about the discussion surrounding healthcare reform.  These changes will eventually impact the lives (and futures) of many Americans.

Baribault, Maryann and Casey Cloyd. Health Care Systems: Three International Comparisons. EDGE: Ethics of Development in a Global Environment, 26 July 1999, Accessed January 22, 2017.
Comparing International Health Care Systems. PBS News Hour, 26 October 2009, Accessed January 22, 2017.
Murray, Christoper J.L., D Phil, and Julio Frank. Ranking 37th—Measuring the Performance of the U.S, Health Care System. The New England Journal of Medicine, 14 January 2010, Accessed January 22, 2017.
The U.S. Health Care System: An International Perspective. Fact Sheet 2016. DPE. Department for Professional Employees. AFL-CIO,, Accessed January 22, 2017.
U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries.  The Commonwealth Fund, Accessed January 22, 2017.
World Health Organization’s Ranking of the World’s Health Systems. The Patient Factor: Your Voice in the Health Care Equation, Accessed January 22, 2017.

4 Reasons Why You Should Share Financial Goals with Staff

There are two sides to the American healthcare system: financial and patient care. While most staff recognize the existence of both, few are aware of their organizations financial goals.  In almost all offices, there are at least two people—the clinic manager and the medical director—who know the organization’s patient-care and financial goals. Smart healthcare leaders share financial information with their clinic staff.  Failing to share this information is a mistake.FL83630

After all, it’s difficult to expect a clinic team to collectively work to accomplish goals when they aren’t aware of them.  Here are responses to some common objections to sharing financial goals with clinic staff.

Objection: What are financial goals?

Response:  Financial goals are the targets that your clinic is reaching toward. Is it a decrease in the no show rate?  Is it an increase in payments from providers?  The specifics vary between organizations.  Summarizing information on financial goals should be easy.  If it cannot be described in a few sentences, continue simplifying until it can.

Objection:  My staff don’t need to know about the organization’s financial goals.

Response:  Many medical directors assume that their staff are uninterested in the larger goals of the organization. That’s not true. Since staff receive paychecks, they already have a vested interest in the financial success of the organization.

Objection:  It doesn’t benefit the organization to share the financial goals.

Response: When managers don’t share information on goals, they actively prevent their staff from assisting.  Since goals cannot always be easily achieved, smart managers recruit their staff to help reach them. Staff suggestions won’t always work.  Frequently, a staff member offers a solution that the managers hadn’t considered.

Objection:  Our first priority is patient care.

Response: Perfect.  Healthcare organizations should focus on providing high-quality patient care first.  The two goals are not mutually exclusive.  Staff can provide high-quality patient care and also be aware of the financial goals of the organization.

Finances and patient care make up the two sides to the American healthcare system. One cannot exist without the other.  Staff realize this, yet many managers still fail to share financial goal information with staff.  Reaching goals takes concentrated effort.  Smart healthcare leaders will share this information with staff to ensure that there is as much brainpower as possible working to achieve goals. Managers who fail to share the information intentionally limit their chances of success.

What Sets Correctional Medicine Apart?

Staff working in correctional medicine provide health care to almost 2 million Americans who are currently incarcerated in jails, prisons, and detention centers. There are differences between correctional and traditional medicine environments.

Different Environment
Correctional medicine has rules to protect the safety and privacy. For example, staff need to routinely assess what items they leave out in an unattended exam room. As a safety precaution, certain items should never be left unattended. There may also be restrictions on items (like cell phones) that can be brought into the care environment. On a broader scale, staff may be asked to limit their sharing personal experiences with patients. These restrictions are meant to help maintain a safe health care environment. Despite the restrictions, workers in correctional medicine benefit from its unique environment.

Staff in traditional health care settings spend a chunk of time worrying about health insurances, contracts, and billing. Different doctors accept separate insurances. Some patients who lack (or have undesirable) insurances are barred from seeking care at certain offices. In correctional medicine, staff do not worry about billing or insurances. Instead, providers in correctional medicine are bound to provide medically necessary care to their entire patient population.

Better Follow-Up Care and Routine Screenings
In traditional health care environments, patients go home. In correctional medicine environments, patients do not leave. The patients are always nearby, which simplifies follow up care. Additionally, many correctional medical facilities have higher percentages of compliance with recommended screenings than their traditional medicine counterparts. Again, this is because the patient population is always nearby.

Treating Chronic and Acute Conditions
Similar to the larger population, patients have chronic medical conditions that need care. While some medications can be given to the patient. Guards or correctional medicine staff need to distribute other prescriptions. Due to the close living quarters, acute infections (if not caught quickly) can spread throughout the entire population. If an infection spreads, providers often work with epidemiologists to determine cause and next steps. Due to changing needs, most correctional medicine providers are generalists who can quickly respond to a patient’s needs.

Partnership with Other Staff
Security guards help maintain a safe environment. Sometimes guards provide extra support when a provider needs help with an escalated patient. Often, security guards recognize and report unusual appearance or behavior to correctional medicine providers. This early recognition helps providers to begin early treatment—if necessary.


Correctional medicine has different restrictions and freedoms than traditional health care environments. While the work is challenging, it is worth considering for those health care staff who want the opportunity to stop worrying about insurance and treat their patients.

Correctional Facility Nursing. Minority Nurse, 7 February 2016, Accessed February 9, 2017.
Correctional medicine. Wikipedia, 2 June 2016, Accessed February 7, 2017.
Giang, Vivian. Jailhouse Doctor Shares What It’s Like To Care For The Most Dangerous People In the World. Business Insider, 20 March 2013, Accessed January 31, 2017.
Keller, Jeffrey. Correctional Medicine is Different: Our Patients Don’t Go Home!, Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine: The Principles of Fairness., Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: All Clinical Encounters are Discussed in the Dorm., Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: We Can’t Fire Our Patients-and They Can’t Fire Us!, Accessed February 7, 2017.

Healthcare Systems Around the World

There are no easy answers in the debate about reforming the American health care system.  Any proposed solution needs provide better patient care and affordability than the current system does.  With a population of 324 million, finding these solutions is difficult.  Over the years, health care reform has come in different pieces of legislation. For President Johnson, it was the creation of the Medicare and Medicaid programs. Under President Clinton’s administration, HIPAA strengthened protections for patients.  In 2010, President Obama signed the Affordable Care Act that took steps to curb rising costs while expanding coverage to twenty million people.  With a new presidential administration, the debate about the future of the American healthcare system continues.  Given that, it is important for all Americans to understand different options for health care delivery systems.

American Health Care System—or the Fee-For-Service Model  

All health care services have fees associated with them.  When possible, those fees are first charged to the patient’s health insurance company.  After the insurance company processes and pays their part of the claim, the patient is responsible for the remaining balance.  If a patient lacks insurance, the entire bill goes to the patient. Every year, almost 2 million people declare bankruptcy due to medical costs.

The American government provides a variety of different insurance systems that provide different coverage levels to distinct groups of people, ranging from veterans to the elderly to children.  Yet, people are still stunned that the United States is the only wealthy country that doesn’t provide universal health coverage.

A National Health Service

In the United Kingdom, the government provides health care like all other public services (i.e. emergency responders and trash collection.)  Taxes pay for the government to operate medical facilities and pay doctors. Privately owned clinics and independent medical providers are allowed, but face restrictions.

National Health Insurance Plans—also called Single Payer System

In Canada, patients seek care from private sector doctors.  Their bills are paid by a government fund that everyone pays into.  Single payer systems have a strong negotiating position, and often pay lower prices for pharmaceuticals and services.

Since any solution needs to work better than the current system, debates about the American health care system will continue long into the future.  As Americans, it is important to remain educated about the options available.  Each health care delivery system faces a unique combination of strengths and weaknesses.  Ultimately, it will be up to the American people to decide how to shape the system as we move into the future.

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8 Steps to a Successful Referral Process

Every day outpatient clinics write and receive dozens of referrals. Staff will spend a significant amount of time processing these referrals and contacting patients.  A simplified system that considers organizational requirements and technological limitations can save staff hours and ensure quicker processing turnaround.  Here are 8 steps to take to craft a successful referral process for your clinic.

More than 100 openings for admin staff!

Step 1: Organizations often have referral standards that clinics are expected to meet.  These standards should be easily accessible.  If you can’t find them, ask your clinic manager. As leaders in the organization, they should know the standards or where to find them. .

Step 2: All systems have technological limitations.  Identify what is realistic with your current resources. Does your clinic receive referrals electronically, via fax, or via mail?  After the referral is entered, are physical files kept?  Or is the information uploaded into an electronic medical record?

Step 3: Consider how referrals flow through your clinic. Are there any bottlenecks in the current process?  Talk with other clinics to ask about their referral process and any associated challenges.

Step 4: Ask the employees who currently work with referrals for their feedback on the current system.  These employees can identify challenges and potential solutions that will assist you in creating a new system. .

Step 5: Reflect on what you’ve learned, and draft a new process.  Instead of delegating it to another staff member, try the new system out for yourself.  If that’s not possible, sit with a trusted staff member while they try it out.  Collectively work to identify and solve any immediate challenges. When ready, share with the rest of the staff.

Step 6: In many organizations, clinical and non-clinical staff both handle referrals.  Ask for feedback from each staff member.  Adjust accordingly.

Step 7:  Begin entering referrals and contacting patients using the new system. .

Step 8: Remain open to criticism.  All systems will require periodic tweaks to make sure they remain relevant and helpful. Recognize that many electronic medical records systems track turnaround times between receipt of referral, processing, and contacting the patient. If this information is available, use it to determine if you’re meeting the desired goals.
Referrals play an important part of the American healthcare system.  Creating a system that works for your clinic while also meeting organizational standards is challenging and possible. Use these 8 steps to identify standards and limitations, and then craft a successful referral processing system. Commit to continuous improvement of the system to ensure that patients are being contacted as quickly as possible.

8 Common Questions about Medicare

Medicare is another popular health coverage provider.  As most Americans already know, Medicare is a federal program that provides insurance coverage to adults ages 65 and older.  There’s so much more to the program than can be summarized in one sentence.   The article below answers some common questions that people have about Medicare.

  1. What is it? Medicare is a federal insurance program that covers adults ages 65 and older, people with certain disabilities, and people with End-Stage Renal Disease.
  2. When did it start? After its 1965 passage, Medicare began on July 1, 1966.  On that date, all adults ages 65 and older were automatically covered under Medicare Part A.   The voluntary Medicare Part B program started at the same time.
  3. Why are there so many letters? In the past 50 years, Medicare has morphed into a four part program.  The letters represent the different parts of the program.
  4. Medicare Part A: Offered since 1966, Medicare Part A provides insurance that covers medically necessary hospital visits and skilled nursing home stays.
  5. Medicare Part B: Also offered since 1966, Medicare Part B provides health insurance that covers medically necessary doctor’s visits and many other services.  Enrollees pay a monthly premium for this coverage.
  6. Medicare Part C (a.k.a. Medicare+Choice, or Medicare Advantage): These plans began after the passing of the Tax Equity and Fiscal Responsibility Act of 1982.  The plans were created as a partnership between private insurance companies and the federal government.  Enrollees in these plans pay their premiums to private insurance companies who contract with the federal government to provide Medicare coverage.
  7. Medicare Part D: Part D began with Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  Effective in 2006, it provides prescription drug coverage to those enrolled in Medicare.   Participants can get prescription drug coverage by signing up for a Prescription Drug Plan as an add-on to original Medicare.  Some participants may choose to get prescription drug coverage through their Medicare Advantage Plan.
  8. How many people use it? As of 2015, over 55.5 million Americans are enrolled in Medicare which is almost equal to the 2013 population of the Northeastern states.  (In 2013, approximately 55.9 million people lived in Massachusetts, Connecticut, New Hampshire, Maine Rhode Island, Vermont, New York, Pennsylvania, and New Jersey.

In its 50 years of existence, Medicare has provided medically necessary health insurance coverage to adults ages 65 and older and certain populations with disabilities.  With the addition of Parts C & D, Medicare has expanded its reach to assist eligible participants to provide more health coverage.  As a federally run program, Medicare is susceptible to political will.  It will be interesting to see where the program is after the next 50 years.

Kaiser Family Foundation. “Medicare Beneficiaries.” (
Kaiser Family Foundation. “Medicare Timeline.” March 24, 2015. ( “How to get Prescription Drug Coverage.” ( “Medicare Advantage Plans.” ( “What’s Medicare?” ( “What Medicare Covers.” ( “What Does Medicare Cover?” 2016. (
McGuire, T.G., Newhouse, J,  & Sinaiko, A. “An Economic History of Medicare Part C.” US National Library of Medicine. National Institutes of Health. June 2011. (
Wikipedia. “List of states and territories by population.” July 6, 2016. (


MultiCare Making Big Changes in the Lives of Children with Special Needs

This year, the Children’s Therapy Unit (“CTU”) in Puyallup, WA, which is part of the MultiCare Health System, is celebrating 50 years of helping infants, children and teens with special needs. The program serves children from birth to age 18 and saw 2,500 patients last year.

Lisa Yates, who began as a therapy student at what was then Good Samaritan Hospital (later part of MultiCare) and started the program in 1966, says the CTU has always operated under a basic philosophy for each child it treats: “What are the strengths, what are the weaknesses? That takes you where you need to go. You either build up the areas of weakness or you find ways around them.”

Yates came to the hospital as a student intern in the adult rehabilitation unit. At the time, there were no facilities for children at Good Samaritan. Societal attitudes and treatment of people with special needs were still in a period that many regard as the dark ages. School districts across the nation didn’t allow children with disabilities to attend school. They were sent to institutions which provided room and board, but not education, to those housed there.

“It was assumed that a lot of the kids — if they had a physical disability — were also cognitively impaired, which, of course, is not true,” Yates said.

Two such children were referred to the hospital just after Yates began. The only facilities available to them was the middle of the adult gym, not an ideal place for kids, especially those who needed special attention. Yates found a private place where the two kids could work, and after some successes, referrals increased. The fledgling program began to grow.

Today the CTU is housed in a 16-year-old, nautical-themed building on the Good Samaritan campus. It is home to a playground, basketball court, computer lab, classrooms for professionals and parents, and a pool shaped like a shell which is used for therapy.

About 10 percent of the patients at the CTU are the children of servicemen and women, many of whom are posted at Joint Base Lewis-McChord. Roughly 60 percent of the patients at the CTU receive Medicaid. Patients served have a variety of issues, including cerebal palsy, autism, and Down Syndrome. The majority of children at the CTU are in occupational therapy to learn the skills of daily life. Speech therapy, followed by physical therapy, are the next most popular programs. While they all have unique issues to address, they generally share one goal: to live an independent life.

“I don’t want to be dependent on everyone else for the rest of my life,” said Kristie Gronberg, an 18-year-old who recently aged out of the CTU. “I have things I’d like to do, and I’d like to do them by myself.”

MultiCare continues to grow and has openings for healthcare professionals who are passionate about their work. See their current openings here.