20 People Who Make Healthcare Better - 2009

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Volunteer Drivers, Pilots Deliver Access to Care
"It is almost like you are being thrown in the lion's den because you don't know where to go." —Kathy Broussard

Kathy Broussard is no stranger to volunteer work. In 1998, Broussard started volunteering her time as a pilot for the Air Care Alliance, a nonprofit organization whose members use their aircraft to transport patients to and from medical appointments. It was through that work she met Eva Tovar, a cancer patient whom she frequently transported to medical appointments. One day in 2001, Broussard was disheartened to learn that Tovar was not going to her scheduled appointment because she could not afford the cab fare to and from the airport—roughly $47 each way. "I said 'Eva, I'll see you tomorrow. That is where I am based and then I'll just drive you down—I live about 36 miles from MD Anderson.'"

During the car ride, Broussard realized Tovar was not alone and that many patients were in similar situations. "Eva knew other patients who weren't going to come in because the 12- and 14-hour car drive was killing them. Once they got here, the traffic stressed them out and they said the hotels were too expensive and they didn't see how they could go on financially," says Broussard, adding that she just never put two and two together. "There was a disconnect," she says, explaining that after she took patients to the aviation terminal, in her mind, they just "vaporized and reappeared at the medical facility."

That realization is what led Broussard to form the Houston Ground Angels and Pilots, a nonprofit organization that provides the ill with air and ground transport to medical facilities free of charge. It relies on a network of volunteers who not only volunteer their time but the vehicles and fuel to transport patients. "It is not about me," says Broussard. "It is about the volunteers."

Broussard started the program by reaching out to fellow pilots and placing an ad in the paper looking for volunteers to drive patients from airports to various medical facilities. She received 200 phone calls initially. "I didn't know what I was doing," Broussard admits. There are 15 satellite airports in the Houston area, she explains, so she began working with pilots to gauge their interest in the program and willingness to coordinate with ground transportation. Then she recruited drivers who could pick up patients on commercial flights and transport them to the medical facilities.

At the time, Broussard was still working 12-hour shifts as a processor operator for Shell Oil in Deer Park. She managed the program in her free time. "I kept a spiral notebook with a list of names of ground angels, other pilots and airports, and patients would call and say they were coming in. Sometimes I was in the spiral notebook all day and didn't get any rest," she says.

Much to Broussard's delight, the spiral notebook has been retired. It has been replaced by an automated scheduling system. Broussard also has a director of operations and Kathy Cardiff volunteers as a mission coordinator to help manage all of the patient requests for transport. Still, she's amazed at the growth of the organization, which received its 501c3 tax designation in 2005. "I never would have thought we'd have a Web site," she says.

Today, the Houston Ground Angels and Pilots has more than 200 drivers and more than 50 volunteer pilots. Most of the Ground Angels pick up patients from large commercial carriers. The organization expects to complete more than 1,500 missions this year, up from 550 missions in 2006.

Its growth has been generated mostly by patient word of mouth. "We are growing by leaps and bounds and at such a great rate that it is taxing our leadership to do this on a volunteer basis," says Bror A. (Pete) Peterson, president and director of, who also acts as air mission coordinator. "There is going to come a time where we will need to pay somebody," agrees Broussard.

Tovar lost her battle with cancer in 2003, but the growth of the organization she helped inspire no doubt stems from the fact that it is about more than saving patient's cab fare. It helps remove the stress of travel—coordinating airplanes, cab rides, directions, and cost—so that patients (many of whom are being treated for cancer) can focus their energies on getting well. "Think of all the patients who come in on commercial airlines and they are at the mercy of the airport," Broussard says. "It is almost like you are being thrown in the lion's den because you don't know where to go."

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Carrie Vaughan is senior technology editor for HealthLeaders Media. She may be contacted at cvaughan@healthleadersmedia.com.

Myth busting CEO says it's easy being green
"We have to think a little longer than the next quarter and we have to take some leadership,"—Jeffrey E. Thompson, MD.

For many hospitals, the idea of "going green" might involve installing energy efficient light bulbs and phasing out the Styrofoam to-go boxes in the cafeteria. It's a school of thought that patronizes eco-friendly policies as a source of good PR and occasional modest savings for modest initiatives, but that deems major green projects as untenable because of their considerable up-front costs and a too-long wait for return on investment.

"That is the stereotype that I'm trying to break, that this costs an endless amount of money and the returns are 20 years from now," says Jeffrey E. Thompson, MD, president and CEO of Gundersen Lutheran Health System, in La Crosse, WI. "The truth is there are a number of things you can do to shorten the payback period and make a positive impact on your bottom line."

If Gundersen Lutheran is not the greenest hospital system in the world, it is not for lack of trying. By 2014, Thompson wants the health system to have zero carbon footprint, and he's entered joint investment deals with biogas and wind energy companies, and tapped into the expertise of nearby technical colleges, and even a brewery, to reach his goal. By 2016, Thompson hopes to have paid off most—if not all—of the approximately $20 million invested in green projects.

Thompson's missionary zeal is not based solely on the bottom line. He says the savings that eco-friendly hospitals realized on reduced expenditures for energy can instead be spent on healthcare and other community services.

"The financial reward is that we will be able to not only improve the health of our region by having less of a carbon footprint, and inspire other organizations in our region to do the same thing, but also lower the cost of healthcare," Thompson says.

"In five or seven years we are going to have our energy program paid for and we are then going to be able to reduce the overall spend on the delivery of healthcare by $5 million or $6 million. We believe it is good for the health of the community, it is good for the finances of the organization, and it fulfills part of our responsibility as a community leader to say here is a way forward that ultimately is going to be good financially and good for the health of the community."

Thompson says hospitals and health systems, no matter their size, can see instant savings and ROI simply by conducting an energy audit of their physical plant and then developing an energy saving strategy.

"With our energy audit and some retro-commissioning activity, we will spend $2 million on our organization over two years," he says. "You can say that is competing with other capital, but we will save $1 million a year from the results of that audit and those retro-commissioning activities. That is a two-year payback. Who has guaranteed two-year paybacks on capital improvements?"

"You aren't going to make millions of dollars by recycling plastic or changing from Styrofoam to using china. But with the energy program you can develop a long-term financially viable program," he says.

Thompson says the high upfront costs for installing wind and biogas power generating equipment can be minimized by finding for-profit partners who will invest in the projects.

"We are a not-for-profit organization. We can't take the tax credits. We can't do the depreciation. But you can partner with someone who puts in more capital to begin with but who gets back those benefits in disproportionate share," he says. "There are other partnerships where for-profit entities can take tax credits and depreciation and green credits and give us a disproportionate share of the energy for our capital expenditure. Therefore, our payback period for that expenditure becomes shorter."

The healthcare sector has lagged behind much of the rest of the economy when it comes to adopting eco-friendly policies. That needs to change, Thompson says, but the only way that can happen is when healthcare leaders embrace the movement. "We have to think a little longer than the next quarter and we have to take some leadership," Thompson says. "And if we start thinking about the health of our communities, we are going to improve the health of the region broadly by burning less coal. That is our job as a not-for-profit healthcare organization."

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John Commins is a senior editor for HealthLeaders Media. He may be contacted at jcommins@healthleadersmedia.com.

Former Health Insurance Insider Takes on the Industry
"[There is] abundant evidence of the lengths that insurance companies go to to preserve profits at the expense of consumers, whether through rescissions, or purging small businesses from their rolls, or denying coverage for needed care." —Wendell Potter

After former health insurance executive Wendell Potter condemned his one-time employers in his June 24 testimony before the Senate Commerce, Science, and Transportation Committee, he became a media darling during the summer's great debate over healthcare reform.

The former public relations executive at Cigna Corp. and Humana Inc. warned lawmakers that the health insurance industry was on another "charm offensive" with the media and the public—saying all the right things about backing meaningful reform—while simultaneously hiring backroom lobbyists to kneecap any component of healthcare reform they deemed detrimental to their bottom line.

Potter told the committee he saw the same effective tactics in 1993, when the health insurance industry was saying the same nice things about the healthcare reforms proposed by President Bill Clinton while planning its demise.

"Today we are hearing industry executives saying the same things and making the same assurances," Potter told the committee. "This time, though, the industry is bigger, richer, and stronger, and it has a much tighter grip on our healthcare system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers."

Potter, now a senior fellow at the Madison, WI-based Center for Media and Democracy, says he didn't intend to turn on the industry that paid him well for 20 years. That changed, though, when he went to a county fair in rural Virginia and saw people queued up for free healthcare exams. "That was an eye opener for me. I realized pretty quickly that a lot of those people had insurance but they still couldn't afford to get care and pay their premiums on time every month," Potter tells HealthLeaders Media.

"The kinds of plans the insurance industry is moving more and more people into have those features, such as high deductibles, that many people, even if they have insurance, realize they can't reimbursed, they can't get coverage for going to the doctor or giving routine care in many cases."

"It became abundantly clear to me that the practices of the insurance industry in particular have forced more and more Americans in to the ranks of the uninsured and more and more and more into the ranks of the underinsured. That is exactly what they want to do and will do unless we have some very meaningful reform with effective regulation and enforcement of those regulations."

In the months since his Senate testimony, Potter has been featured on NPR, CNN, PBS, BBC World Service, prominent print media and the blogosphere, where some have likened him to Jeffrey Wigand, the former Brown & Williamson executive who became an outspoken critic of the tobacco industry and the subject of the movie "The Insider." Potter says Big Tobacco and the health insurance industry have a lot in common.

"One of the reasons why I decided to speak out against the industry is because of the often devious public relations tactics that the industry engages in to try to mislead people and work through shills and front groups that actually disseminate false information, borrowing from some of the same tactics that were used by the tobacco industry," he says. "Also, I know from polling that has been done by the industry, how it compares in terms of its reputation compared to other industries. It is just slightly above the tobacco industry."

Even if the health insurance industry thwarts the latest healthcare reforms, Potter believes that that negative public perception can't be reversed. "There is a growing awareness that the insurance industry doesn't play fair, and abundant evidence of the lengths that insurance companies go to to preserve profits at the expense of consumers, whether through rescissions, or purging small businesses from their rolls, or denying coverage for needed care," he says.

"The industry is now dominated by very large for-profit companies that are beholden to Wall Street. Their No. 1 mission is to enhance shareholder value," he says. "That has changed things considerably over the years to the detriment of average Americans."

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John Commins is a senior editor for HealthLeaders Media. He may be contacted at jcommins@healthleadersmedia.com.

Surgical hospitalist pioneer advocates ER reforms
"Patients who have cancer, I strongly feel, should be prioritized to get to the operating room sooner than patients who merely have cosmetic conditions or relatively elective conditions."—John Maa, MD, FACS

At age 21, he entered Harvard Medical School. At 23, he enlisted in the United States Army National Guard and served as a trauma surgeon and captain of the medical corps for nearly a decade. At 34, he invented a safer central venous catheter, for which he currently holds the patent. And earlier this year, he helped deliver a baby in the elevator of the University of California, San Francisco (UCSF) Medical Center.

This modern-day Renaissance man is John Maa, MD, FACS. Maa has a business card stacked with the many titles he holds at UCSF: assistant professor in general surgery, associate director surgery clerkship, and assistant chair on the Department of Surgery's Quality Improvement Program. To boot, Maa is also on the board of directors of the American Heart Association. Today, Maa teaches, operates, and speaks on healthcare about how to fix emergency care in America. (Exclusive audio interview with John Maa, MD.)

Influence and importance of surgery
"[Growing up,] I thought all doctors were surgeons. I was actually quite surprised to learn that there were doctors that did not operate," Maa says. Having grown up on television shows, such as M*A*S*H and Marcus Welby, M.D., and the strong influence of his microbiologist mother, Maa saw the role of surgeon as a hero and became the first physician in his family.

Serving the underserved
During his time in residency at UCSF, Maa visited various medical sites. He encountered indigent patients, often minority populations and undocumented immigrants in San Francisco and San Mateo, CA. It was then that Maa witnessed firsthand the discrepancy of care between the haves and have-nots in America.

"It was very striking to see the differences in the resources available between each of the UCSF sites. I always remembered how variable the quality of care was and how difficult it was to practice at San Francisco General Hospital because it is a county medical facility that served the uninsured," Maa says.

Fixing emergency care in America
Currently, Maa juggles multiple positions, splitting his time in the OR and at the podium. Among his duties of operating, teaching, writing, and occasionally rubbing elbows with congressional members, Maa's true passion is spreading the word on how the nation can better deliver care to all Americans.

The U.S. not only suffers from a national shortage of surgeons, but embraces a counter-intuitive reimbursement system that rewards elective surgeries over emergent ones, according to Maa. Unlike other countries that utilize universal healthcare, Maa explains, the U.S. prioritizes types of surgeries very differently.

"Our emphasis in the United States is on the elective patient," Maa said. "I think that we have to weigh where society's needs are the greatest. And actually, the needs of these patients are greatest in the emergency population—the patient who is critically injured in trauma who has been shot or who has suffered a penetrating stab injury, patients who have active bleeding—those patients whose traumatic injuries have the highest need," he said.

"Patients who have cancer, I strongly feel, should be prioritized to get to the operating room sooner than patients who merely have cosmetic conditions or relatively elective conditions," he said.

The birth of the surgical hospitalist
Faced with the widespread problem of surgeon shortages, long ED wait times, and insufficient patient care, Maa took action and helped spearhead the UCSF surgical hospitalist model as the first in the nation.

Armed with three full-time staff surgeons, Maa and the other surgical hospitalists dedicated themselves to staying on call continuously. Impressively, Maa help cut the average wait time for a consult down to 20 minutes. That meant that a patient who would normally have waited 16 hours before an operation now only waited 10. Not only did the surgical hospitalist program improve patient wait time, it also became profitable. UCSF's Department of Surgery increased revenue by nearly 200% in its first year from billable consults and about 600% in its second year.

Physician advocate
But it isn't enough for Maa to improve emergency care at UCSF alone; he advocates for the healthcare professional voice in health policy everywhere. When Maa talks about the emergency care crisis, he speaks of values that perhaps stem from his Army days, using words like "honor" and "courage" in his medical mission.

"Our elected officials, economists, and many of the other people who are one level removed from the frontlines of clinical medicine, are the ones who are the most influential nationally in the debate about health reform," Maa says, injecting the bedside perspective into the national healthcare discussion.

Maa further explains, "Surgeons should recognize that being on the frontlines—what they do every day, what they see through their interactions with patients—they are ideally positioned to suggest ways to reform healthcare. I think doctors, nurses, all healthcare professionals should recognize their unique opportunities to assist in the creation of a better future for healthcare in America."

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Karen M. Cheung is associate editor at HCPro, contributing writer for HealthLeaders Media, and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.

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