Saturday, January 30, 2010

Two for a Saturday morning

It's 4 degrees out and here are two songs on my playlist.  The first is just plain fun and the second is from a band worth watching.

Friday, January 29, 2010

The AG’s Report (i.e., Stating the Obvious)

The Massachusetts AG has released a preliminary report indicating:
Massachusetts insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care, according to a preliminary report by Attorney General Martha Coakley. It points to the market clout of the best-paid providers as a main driver of the state’s spiraling health care costs.
The yearlong investigation, set to be released today, found no evidence that the higher pay was a reward for better quality work or for treating sicker patients. In fact, eight of the 10 best-paid hospitals in one insurer’s network were community hospitals, which tend to have less complicated cases than teaching hospitals and do not bear the extra cost of training future physicians.
This is from a piece by the Boston Globe (click here for the full story).  Readers of this blog may remember this post about one of the community hospitals that has struggled partially due to low reimbursement rates, despite competitive quality and clinical outcomes performance.

Let’s face it, we cut the amount of regulation in this industry years ago assuming that free market forces would help reduce costs… and now that some have made good decisions and executed properly based on the rules we all set up, it’s not exactly surprising that those systems have used their resulting market clout to drive up their reimbursement rates.

According to the Globe:
Dr. JudyAnn Bigby, secretary of Health and Human Services, said switching to global payments could help control price increases if it is done right. One option is to have an oversight authority set parameters for the prices paid to providers.
We’ve been there, done that.  Remember the Massachusetts Rate Setting Commission?  Public policy (like public opinion) tends to swing from side to side and it’s not surprising that some are calling for a return to a greater degree of governmental oversight and regulation.

Ideally, in Massachusetts, we need the benefits of large, coordinated systems of care because those systems will better manage across the full spectrum of health needs of large populations and be able to make critical investments in supporting clinical workflows and information systems. 

But we need more than one system able to accomplish that.

Otherwise, the free market approach fails.

Health Reform? Tell us Mr. President…


Analysts are debating about the success or failure of the President’s State of the Union address and depending on who’s talking, it was either depressing or inspiring.  He was snide and arrogant or humble and introspective.  Whatever.

I listened to the first half in my car and watched the second, mostly to hear about health reform.  Given the truly stunning turn of events of the past few weeks, I was searching for clues on whether this President would rally… or retreat.

First, I was fairly stunned that there was no mention of what has arguably been this Administration’s top domestic priority until about halfway through the speech.  In addition to asking members of Congress on “both sides of the aisle” to reconsider what’s been proposed thus far, he essentially suggested that the main problem he’s faced in pushing this initiative has been a public relations one.  “The longer it was debated, the more skeptical people became… I take my share of the blame for not explaining it more clearly to the American People.”  So, the problem was twofold: first, all of us didn't completely understand it and second, the delays (which Mr. Obama often warned could sink the process) didn’t help.

Personally, I don’t buy the argument that the delay hurt.  Rushing legislation of this magnitude and impact through is bad policy… and politics.  I do agree that the President and House and Senate leaders spent so much time back on their heels defending the proposals that they stopped articulating the good they contained.  BNET and others have reported that the more people understood health reform, the more they liked it.  Missives about full government takeovers and ours becoming more like inferior European health systems were always highly exaggerated and politicized.

I was hoping to hear a greater degree of acknowledgement that the Administration had learned some lessons along the way.  And that they would adapt and press on.  Instead, the heavy (and appropriate) focus on jobs and the economy could indicate that Mr. Obama is ready to move on.  If that’s not what he intended, he may have signaled to a weary Congress that this is no longer his hot button and, thus, they could increasingly see health reform as a hot potato instead.

Health reform and the State of the Union address.  I’m thinking about babies and bathwater…

Thursday, January 28, 2010

Blackberry Photo

I know. Shouldn't take pics while driving... but I've never seen a sun this bright and blinding before. 

Ginny, if you're reading this... I pulled the car over and stopped first.

Uploaded by

The Governor’s budget and home care

From the Massachusetts Home Care Alliance:

Governor Deval Patrick released his version of the state's FY2011 budget today, the first of many budget iterations that we will see over the coming months.

In what Senate President Therese Murray called the state's worst budget year, the Governor cut nearly $800 million and proposed lifting the sales tax ban on soda and candy in order to raise $51.7 million for public health services.

Home care, however, largely avoided harm as the "MassHealth Senior Care" and "MassHealth Fee for Service" were increased. In the state's ASAP program, home care case management and Enhanced Community Options remained level funded.

We will post more on the Governor's budget proposal on our website,, along with advocacy messages, and further updates as they become available.

Thank you,
James Fuccione
Director of Legislative & Public Affiars
HCA of Massachusetts

Wednesday, January 27, 2010

The next big thing?


MP3 players weren’t selling.  Enter the iPod.

The smartphone wars were raging along with no one clearly winning.  Enter the iPhone.

Tablet and slate computers have been humming about at a ho hum pace.  Enter the iPad.

It’s a gigantic iPhone minus voice calls.  Minus a pesky cellphone contract and plus a real physical keyboard you can pop on when at your desk.  But being at your desk is not where the iPad is intended to shine.  It shines in your hands, on your lap and while you’re moving about your life.

Cool?  Being able to browse the web and read your emails on a lightweight device with 10 hours of battery life.  Being able to wirelessly buy books and read them on the fly (Kindle what?).  Being able to run serious applications (word processing, presentations, etc.) and a bazillion other existing iPhone apps on a small device that you can easily pop into your bag or briefcase.

Uncool?  Do we need one more device?  We have smartphones, laptops, e-readers, netbooks, etc.  Will this one replace many of them or just end up being one more AC adapter and monthly fee (the 3G wireless is $30 per month) to go along with all the rest? readers will know I’ve been interested in the manner in which Apple has reinvented itself and shaken the industry through the design and delivery of truly breakthrough products.  See post here.  The big question is: will this thing sell and, more importantly, will it become THE must have gadget for millions worldwide.  I think so.  Why?

  • Pretty low cost, relatively speaking.  Starts at $500.
  • Can replace the netbook/notebook computer for many, many applications.
  • No cellphone contract.
  • Many people will give up their iPhones and Blackberries, choosing instead the simplicity and convenience of smaller, traditional phones and welcoming more usable on-screen and physical keyboards and larger, more readable screens.
  • Amazon has sold a lot of Kindles and Barnes & Noble has sold a lot of Nooks.  The e-reader generation is here and once those e-readers get a look at this thing, it will be hard going back to a single purpose, monochrome, kludgy device again.
  • Those bazillion apps will work on this.  Right away.
  • Ease of purchasing content: everybody has and knows how to use iTunes to buy music and videos.  Now books can be purchased in the same place and in the same manner.  Nice.
  • Apple design.  In short: it’s winning.
  • It’s a platform.  Big companies and aspiring teenagers everywhere are all conspiring to write new programs for this device.  That means they’re all not writing for other devices and other platforms.  The strong get stronger.

Innovation.  Ease of use.  Coolness factor. 

You may not even want one.  But someday, you’ll own one.

Tuesday, January 26, 2010

Even more HDR

This time with a bit more post-processing (contrast, saturation, sharpness tweaked).  Too much?

First HDR Images

Several days ago, I posted about HDR photography.  I've now had a chance to experiment with the technique and here are my first examples.  Nothing special... still learning.

Is health reform really dead?

In some circles, we’re hearing that, in the wake of the stunning Massachusetts special election last week, health reform (aka Obamacare) is officially dead.  Obamacare may be struggling, but health reform is far, far from over.  Four main reasons:
  1. Many states have put local reform, including needed payment reform, initiatives on hold, pending the outcome of the national debate.  Those efforts, including here in Massachusetts, may pick up where they left off now that the future of a national program is in question.
  2. Parliamentary acrobatics are still possible as persistent Reps and Senators, along with a President who may adopt an I-know-what’s-best-and-let’s-not-overreact-to-what-happened-in-Massachusetts approach as opposed to an I’ve-learned-and-grown-and-will-now-adapt approach, may still try to salvage a blockbuster deal.
  3. Republicans and Democrats may decide it’s in the best interests of the country to proceed, albeit more systematically and incrementally and in a bipartisan manner.

    … and here’s the most important one of all…
  4. The health care provider industry, already moving down a path toward creating accountable care organizations and medical homes, embracing pay-for-performance programs and contending with data that suggest major gaps in the continuum of care and impending shortages of primary care physicians, are moving in this direction anyways.  Many of the benefits (excluding insurance reform) of the House and Senate bills are already inherent in the initiatives of some of the most innovative players in the market.  With the bright light of the national debate possibly dimming, the quiet laboratories that exist in local markets will begin to kick up their activity level.
Reform isn’t dead.  It’s still coming…

Monday, January 25, 2010

Contact Governor Patrick

From an email sent to all VNAB employees and Board members:
Our friends from the Home Care Alliance of Massachusetts have asked us to contact Governor Patrick’s office.  Please see this message from them below… and please consider doing so.  If you click on the link below, you’ll be taken to a very slick site where you can send a generic email (or personalized one) directly to the Governor.  Let him know that home care is part of the solution through reducing hospitalizations, preventing unnecessary emergency room visits, enhancing clinical outcomes and improving the quality of lives for citizens of the Commonwealth.  We’re going to be in a difficult budgeting season in Massachusetts and hearing from the home care community will make a difference!
Thank you,
From the Home Care Alliance of MA:
Contact the Governor!
It’s that time of year and a new message is posted on the Alliance website’s advocacy page.  The Governor and his staff are constructing their version of the budget, which will set the tone for budget deliberations for the legislature going forward.  Please take ONE MINUTE to visit the Alliance website to contact the Governor and ask that he preserve home and community-based services.  With a recent report from the Senate Ways & Means Chair revealing the state budget is down $1 billion from last year and will likely need to shed $1 billion more next fiscal year, it is vital that we begin our advocacy strong.

Car buying and a few hours with Mike

Mike sells cars and I had a chance to meet him and learn from him this past Saturday morning.  Mike was born in Russia and possesses the exaggerated but authentically pure accent I grew up watching actors fake on television.  As I was speaking with Mike, it dawned on me that Russian may be the easiest accent to credibly fake and get away with.

I learned three interesting things from him.

First, Mike just completed his Masters at Babson College in International Finance.  When he decided to pursue that degree, his logic was that an ability to speak multiple languages, coupled with some experience working in global markets and an advanced degree would align him well with a future moving toward an increasingly global business arena.  But it’s the economy thing now, and so Mike is selling cars.

Second, Mike told me all about the inner workings of the car business.  How cars and sold and how salespeople are compensated.  As I listened, I couldn’t help but think that I’m glad I don’t sell cars.  Obviously, salespeople are motivated and incentivized to sell a car with the highest possible mark-up intact.  It’s good for the manufacturer, good for the dealer, good for the salesperson.  But Mike isn’t wired that way.  He put the invoice price on the table and gave me “the bottom line that they will let me to sell this for”… in that heavy Russian voice.  Because I had done my homework (, I knew he was  being honest.  Mike may be highly trained in global finance, but I wonder if he’s properly wired for selling cars.

And here’s the most interesting thing of all.  Because I’m trading a car in, Mike asked me up front how many miles are on it.  A few hours later, we walked out to the car together and he looked at the odometer.  He congratulated and thanked me for giving him an honest number earlier.  Mike said many people, most people even, mention the mileage on their trade-ins and estimate low.  Sometimes really, really low.  Mike assumes that’s because people figure they will get more for their used cars if they understate the mileage.  He wonders if people forget that the dealership will eventually verify the actual mileage.  According to Mike, the people who give accurate estimates are always the nicest people to work with and who usually walk home with the best deals (including thrown in accessories, free service visits, etc.).  The people who intentionally misestimate, Mike believes, “pay for it in the end.”

Mike can’t wait to get a job more in line with his aspirations.  He’s working hard to put his MBA to good use and to move on from this temporary gig.  As I departed, Mike mentioned that his numbers are low and margins too thin.  He’s not sure he’s going to make it selling cars… and I was happy to have made his acquaintance.

Blackberry Blogging

This is a test of Blackberry blogging via the cellspin service ( I have a work issued Blackberry and being able to blog from it would be nice, such as this past weekend when I lost access to my iPhone.

Friday, January 22, 2010

There’s a new face of…

buckner coakley

If you’re from Massachusetts, you understand this already.

Today, a colleague, Janice, mentioned these names together in the same sentence and I thought it was brilliant.  If you watched Game 6, then you know that the Sox had basically already lost it by the time the ball went through his legs down the first base line.  So, so many things had gone wrong already… but his face became The Face of that particular loss.

Twenty four years later, another stunning loss.  And by the time Tuesday night rolled around, so, so many things had gone wrong already… but her face has become The Face of it all.

History, for many years, was not kind to Bill Buckner.  But time and two Series victories have had a way of making most of us reconsider.  Martha Coakley, who has served well in many ways, will likely receive public clemency also.  But it will probably take some time.


Thursday, January 21, 2010

The Skyline Cage

Passing by quickly on my way to the T in the Pru Mall.

- Posted using BlogPress from my iPhone

Location:Dartmouth St,Boston,United States

Wednesday, January 20, 2010


I would just like to know how he came up with this in the first place.  And why?

Why Scott Brown is good for the Democrats

Conventional wisdom holds that anything that moves a President toward the center is a good thing.  After President Clinton's own mid-term election results sent him a message, it changed how he governed and, many argue, made him more effective.  It seems that America loves the opposite of whatever we have at the moment... and Scott Brown is the opposite of what we have at the moment.

But here's another theory.  House and Senate Democratic leaders have been working overtime to support their president by advancing reform packages with critical differences between them, numerous open questions regarding implementation details, and some seriously nagging concerns about overall affordability.  Sensing that there's a general public that also wants health reform has made President Obama's pedal-to-the-medal tactics much more tolerable for congress.  I suspect that Democratic senators and representatives have been conflicted over wanting to secure a stunning and historic victory for their leader while also worrying about all the open issues and how the public would ultimately feel about it upon passage.

And now they have a poster child for the defeat of the President's headline agenda item.  A scape goat.  Imagine being a member of Congress up for re-election this year.  Now, to the more liberal constituencies, he or she can say that but for the unexpected results of the Massachusetts special election, they would have gotten it done.  Those darn Republicans.  And to more conservative voters, the campaign can suggest a more conciliatory tone.  This has already begun with President Obama saying today that: "The people of Massachusetts spoke."  He is recommending that the Senate resume debate after the new senator has been seated.  Perhaps more importantly, he said he's slowing the process of debate and that "nothing should be rammed through".

Ultimately, if we go at a slower pace and come up with a package that Republicans and Democrats can agree upon, we're all better off.  I remember the Massachusetts reform process and the culminating signing event at Faneuil Hall where then Governor Romney, then Senator Kennedy, and the then Massachusetts House and Senate leaders (where has everyone gone?) sat together and shared the spotlight.  The question is, is this even possible in the national arena?  The election of Scott Brown probably means that nothing will be "rammed through", thus preventing the subsequent political blood bath.

Last night a tidal wave hit the beach in Massachusetts.  It's likely that it will prevent a tsunami from hitting the rest of the country in the coming year, however.
Photo by Ed Spadoni.  For more of his work, click here.

Amazing sky

Just had to grab it with my iPhone.

- Posted using BlogPress from my iPhone

Tuesday, January 19, 2010

“Avatar” again

After seeing Avatar, I wrote a post essentially saying that the visual spectacle was predictable and ultimately left me a bit flat.  But because a few members of my family hadn’t yet seen the movie, I found myself sitting in the theater at Patriot’s Place in Foxboro once again, this time wearing 3D glasses.  I was sure that the addition of 3D into the mix would again leave me feeling exhausted (maybe even more so this time) by all the visual popcorn and again, somewhat underwhelmed by all the other things that you look for in film.

But that’s not the case.  This time I found myself more drawn to the subtleties in the story line (there are some, but not many), less annoyed by the clichéd references to the United States in the early 21st century, and not completely absorbed by the three dimensional rendering of planet Pandora and all its vegetative and zoological cinematic candy corn.

It was the acting.  Yes, I know… much of this movie was produced on computers, but the acting was top notch.  I was especially impressed by Zoe Saldana who took on the role of Neytiri (pictured above).  Zoe was mad, really mad, happy, scary, powerful, vulnerable and when the protagonist starts to fall for her, we do too.  So how does Hollywood give us movies made against blue screens with computer generated characters, yet provide for the full range of emotions and interpretation by a human cast?  This piece provides some clues.

Avatar is the future of movies.  I’m sure of it.  But only after seeing it twice.

Monday, January 18, 2010

Remembering Martin Luther King

It was ten years ago.  I had been at Dimock Community Health Center in Roxbury, Massachusetts for less than a year… having joined the organization largely due to the charisma of then CEO, Jackie Jenkins-Scott, as well as the compelling nature of the organization’s mission and history.  My intentions seemed right to me from the start, but I’ll never forget my first meeting with a group of HIV/AIDS activists and case workers.  One woman, who hadn’t made eye contact with me during my entire presentation, came to life when I asked whether there were any questions after my smart PowerPoint production.  Her question was simple… and piercing: “Yeah, what do you and your two hundred dollar fountain pen know about me?”  I had a lot to learn.  And it turns out that she had a lot to teach me.  But that’s a post for another day.

Just before Christmas, Jackie asked me if I would deliver the keynote address at the annual Martin Luther King breakfast at the health center.  The entire workforce would be there, as well as many board members and community guests.  Though to that point I had given many speeches to many audiences, this one stopped me squarely in my tracks.  MeSeriously, me?  I was overwhelmed by the prospect of delivering a speech on a subject, a person, I did not know.  I was overpowered by the clear fact that I, the one of the two hundred dollar fountain pen fame, would be speaking to an audience who, in many cases, had been personally inspired by and whose lives had been altered by this Martin Luther King.  What could I possibly say to them?

Jackie, I’m sure, sensed all this in me.  So she nudged and guided me to the task.  When I left her office, she had her yes.

Within hours, I stood at the nearest Barnes & Noble and thumbed through the numerous books on the man.  And there are numerous books on the man… with different points of view and all coming from varying, sometimes contrasting angles.  The greatness of Martin Luther King, a hero for black Americans everywhere, confounded me as I tried to choose the right angle and the right perspective… and precisely the right book.  Bewildered, I reached into the pile and grabbed one.

And I read it.  I read about his growing up in Georgia, the Baptist roots, Morehouse College, moving to Boston.  I read about a Civil Rights movement I had previously studied in history books full of brief, obligatory and two dimensional accounts of Birmingham and Selma and Washington, DC in 1963.  But this time through it, I understood it.  This time, I saw a man who was motivated not only by justice, but driven by the Christian ideals of service and caring for the very least among us.  Two dimensional Martin Luther King started to become three dimensional.  And so I bought a few more books.

I was drawn to his lingering, inner conflict, his being driven by a cause he felt he needed to pursue… while wanting what many of us want: peace and tranquility, a family, a simple life.  But despite threats against him, he continued in his mission, which he described to some as his ministry.  His unyielding support of non-violent activism, shaped by a visit to India in 1959, became his trademark approach, even when some of his closest friends and advisors began to grow weary of it.

I remember hearing the U2 song, “Pride (In the Name of Love)” and knowing it was about King, but never fully understanding the particular angle they pursued.  Love.  In the Name of Love.  What exactly did Love have to do with it? 

And there it was.  There was the speech.  It became a speech about love.  About humility.  About true greatness.  About the inspiration of Martin Luther King, not only for black Americans, but for all Americans.  For all Americans motivated by a desire for change and a profound willingness to see the good in everyone… even adversaries. 

The very least among us.

King once said: “Anyone can be great, because anyone can serve.” 

And here was his true greatness.

It was a speech about love.


This has nothing to do with the endless stream of radio spots for tomorrow's Massachusetts special election.

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Sunday, January 17, 2010


I was in a large and mysterious mansion all weekend, full of intriguing passageways such as this one. Glad I at least had the camera in my phone, though I often wished for the optical quality of something better.

- Posted using BlogPress from my iPhone

Saturday, January 16, 2010

A few days by the sea

Taking a few days over the weekend to get away. To disconnect completely from the world of perpetual connectedness. I'm cut off.

Other than my iPhone.

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Friday, January 15, 2010

On the importance of successful reinvention

Yesterday, Pat Kelleher, Executive Director of the Massachusetts Home Care Alliance, mentioned that the home care industry sits at an interesting intersection.  In some ways, it has traditionally been just another vendor in the chain of health care services available to referring providers and patients.  In some ways, it holds a critical key in an evolving industry where pay for performance, keeping people out of the hospital and more successfully treating populations across the entire continuum of care needs will be even more highly valued (and, theoretically, compensated).

The more successful organizations will transition from the vendor model to the partnership model.  Pat suggests that this will require reinvention.

During our meeting, I mentioned that traditional wedding photographers are struggling with this very issue as well.  When I was married in the 1980s, our photographer handed us a big book full of big photos and we were happy.  We also received a few photos which adorn our walls all these years later.  Photographers took the photos, printed them, and moved on.

With the digital age in full swing, we now have SLR cameras fully capable of capturing high definition video with stereo audio.  For years, still photographers considered this to be marketing gimmickry and useless engineering wizardry.  But, now that the YouTube generation is getting married, the most successful photographers are integrating video, audio, documentary-style interviews with guests, transitions and other effects, and the output is no longer that big book.  It’s a blue ray disk or a usb drive.

Successful photographers today have embraced the new media and technologies and understand that their clients’ expectations have dramatically shifted in the past several years.  Photographers who have not adapted are bemoaning these changes and, increasingly, seeking other lines of work.

There are, I think, obvious lessons here for our industry.

Thursday, January 14, 2010

To share and to share freely…

I’ve been admiring photographer/artist Trey Ratcliff’s work recently – see previous post.  This morning, driving to work, I had an opportunity to hear an interview with him and it was truly inspiring on many levels.  If you’re interested in hearing the interview, click here.

What most struck me, however, was Trey’s comments regarding the distribution of the content he creates.  He freely posts images on Flickr and his own site,  On his site, if you hover your mouse over each image, you are offered the option of sharing the photo, which can include sending a link via Twitter, Facebook, IM, Yahoo and email.  And here’s the amazing part: if you right click each image, you can save a copy onto your desktop.  It’s enough to make most (traditional) photographers shudder.

First, here are some examples of his work:

4261537620_5deba3570f_b 4250355834_d5b1541ba3_b 4258823236_e2a17e164b_bIn the interview, Trey was asked why he so freely shared his work with the world.  His response was that we live in a new world where 95% of the general population will never be inclined to pay for a photograph and will only want to access it when free.  4.9% will be willing to pay for it and 0.1% percent will blatantly steal it.  That 0.1% is the “cost of doing business”, per Trey, and simply “something you just learn to get over.”

By distributing his content freely, he has been able to become a household name (in those particular circles) and build a tremendous amount of “Google trust”.  When people go looking for this kind of art, Trey’s name pops up.  Given that kind of name recognition and internet traffic, Trey has been able to successfully promote a popular book title and other paid for content (books, tutorials, workshops, etc.).  Had he been protective of his content, trying to be adequately paid for all of his work from the start, he maintains that he’d never have found the success he now enjoys.  This success includes numerous awards and publications. 

If you saw the recent “Julie and Julia” film, you witnessed an example of how an aspiring author rose out of obscurity by consistently placing content out onto the internet for free.  If you didn’t see the film, here’s the synopsis: Nice job by Amy Adams, stunning job by Meryl Streep (you swear you are looking at Julia Child), Julie Powell impulsively starts a blog about cooking (click here to see the real deal), we watch Julia Child hit it big, Julie experiences marital problems due to obsessive-cooking-wife-and-unsupportive-husband syndrome, marital bliss follows, as does the book deal, movie deal, and happy-ever-after… the end.

Many authors and artists clamor over protecting their intellectual and creative property and copyright lawyers are busier than ever, but for Trey and Julie, putting everything out there for all to see and take proved to be their tickets to success.  (Oh yeah, they have real talent too.)

Which is all just a long winded response to a comment posted here several days ago from Anonymous who wondered how I could feel so comfortable posting as I do at

More to say soon on this entire concept of blogging.  Jury is still out, but I’m finding myself increasingly surprised by the response. 

Seeing the world in HDR

High Dynamic Range photography.  Per the Wikipedia entry: “HDR is a set of techniques that allow a greater dynamic range of luminances between the lightest and darkest areas of an image than standard digital imaging techniques or photographic methods. This wider dynamic range allows HDR images to more accurately represent the wide range of intensity levels found in real scenes, ranging from direct sunlight to faint starlight.”

Click here for a link to an exceptional HDR artist’s (Trey Ratcliff) website for examples.

HDR is not everyone’s cup of tea.  Some feel as though it represents the worst example of over-saturating and computer processing an image to the point of rendering it too "painterly” and unrealistic.  But, when done well, HDR seeks to more accurately match the dynamic range that the human eye can see and which digital capture technologies cannot.  Check out Trey’s site and let me know what you think.

More on Trey in the next post.


Better without the truck?

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Tuesday, January 12, 2010

P4P Home Health Compare

It’s our report card and in a health care environment increasingly report card oriented, how we do on it is important.  The whole concept of P4P (pay for performance) has been embraced by larger payers and the national health reform movement has soundly endorsed the concept.

Fazzi Associates compiles data for the Visiting Nurse Association of Boston as well as other Medicare participating home health agencies across the country and every month, on 12 key measures, we’re compared to the Massachusetts, US and top tier (upper 20%) US performers.  These measures include scores on items such as: percentage of patients who get better at walking or moving around (higher is better) and percentage of patients who had to be admitted to the hospital (lower is better).

I’m happy to report that the VNA of Boston consistently ranks among the very best home health agencies in the United States.  Please note that:

  • On 11 of the 12 scores, VNAB outperformed the industry average in Massachusetts and on the twelfth, it was a virtual tie.
  • On 11 of the 12 scores, VNAB scored better than the average of all US home health providers and again, on the twelfth it was even.
  • What about the top performing providers in the country?  The agencies who stand in the top 20% of all home health providers in the United States?  I’m happy to report that the VNAB performs at a comparable level or better on 9 of them and within a few percentage points of the remaining 3.

We are dedicated to maintaining and improving the quality of our service and maintaining high levels of satisfaction.

There are a number of choices that referring providers and families have when it comes to home care services.  In Massachusetts, we have one of the very best in the country right here: the Visiting Nurse Association of Boston.

For more information, please click here.

Today's iPhone blip

A church in Braintree, Massachusetts. To say the colors caught my attention as I drove by would be an understatement...

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Monday, January 11, 2010

Blipping goes all iPhone

I posted previously (see here) that I had started blipping (daily photo blogging) and now, after 10 days at it, I've decided to make it exclusively an iPhone endeavor.  Scanning the entries on, I see that I'm not alone.

Why?  The Blipfoto free app for the iPhone is excellent and taking pictures on the iPhone is easy and fun.  If you're going to try to record one respectable photo per day, being able to do so from the iPhone is the only practical way to go, especially if you're busy.

Follow my blips here.

Despite economic downturn, health care looks good


According to a piece that ran in yesterday’s Boston Globe:

“Health care has remained one of the few bright spots in an otherwise dismal US job market, and demand for health care workers is expected to continue to grow as the nation’s population ages. Across the country, nearly half of the 30 fastest-growing occupations through 2018 are in health care, according the US Bureau of Labor Statistics.”

The entire piece can be found here.

The VNA of Boston’s own DeAnne Mignault and her patient Ann Boyle are featured in the photo.

Walking through the lobby at Tufts Medical Center…


Staying put

I had been seriously mulling a shift from Blogger (Google’s blogging engine) to Wordpress (widely considered one of, if not the, best blogging site).  The reason?  The inexplicable lack of integration between Google’s Blogger site and Google Analytics – the site that allows you to track statistics associated with your blog.  As traffic has been building here, I’ve been able to understand roughly where the volume has been coming from based on the Blogger Dashboard, but Google Analytics provides a great deal more information (for example, if people find via a search engine, exactly which words are they using in their search?). 

It has required some technical gymnastics trying to insert html code into certain input boxes in the layout mode of Blogger and, frankly, it’s been frustrating.  In Wordpress, just the mere act of using their site gives you the stats you need to manage it.  Strange that Google is so far behind.

A Saturday morning conversation with this person did the trick, however.  Gymnastics completed and so I will discontinue the laborious task of porting content to a new blogging engine.

Here’s where I’ll remain.  For now…

Sunday, January 10, 2010

Best scene from the best play...

Amazing performances.  Fantastic writing.  Moving storyline.

My favorite play... and a pivotal scene.

Sun sets...

... on the most disappointing Patriots season yet. OK, not as disappointing as 2007, but disappointing nevertheless.

Lots of talent + key injuries + no heart = an early exit.

Took this photo from my iPhone just minutes ago.

- Posted using BlogPress from my iPhone

Saturday, January 9, 2010

A mini-break

Taking a small break away from posting as I port VNA CEO to a new hosting service.  This will take a few days...

I'll have more to say about it (and other things) soon.

Thanks for checking in and for the messages.  I'm fine.

Thursday, January 7, 2010

The 2010 version of COGITO, ERGO SUM

My colleague, Jeff, this morning jokingly stated that “I blog, I tweet, I blip.”  He also noted that this might make a great t-shirt (heads up out there entrepreneurs!).

The 2010 version of “cogito, ergo sum” (“I think, therefore I am”) has got to be “I blog, I tweet, I blip”.

Wednesday, January 6, 2010

The Perfect and the Good… aka “Read Your Blog"!”

You’ve heard the phrase: “Don’t make the perfect the enemy of the good” or its many derivatives?  For some reason, this has become a much uttered, nearly cliché saying of late… the idea being that you should not allow the pursuit of perfection to prevent you from getting something, anything, reasonably worthwhile done. 

I tend to agree as long as you don’t bend and break your core values.  I believe that taking the time or expending the energy to make something that much better is often just not worth it in terms of a materially improving outcomes; the earlier in life you learn how to weigh up the pros and cons of something, the better off you are as we all spend a great deal of time considering tradeoffs and making decisions within murky shades of gray.  I remember many years ago when churning over a difficult decision, my mother stated: “well, if it was easy, they would train a monkey to do it.”  Such is life in the professional world.  If it was easy to be a pharmacist, computers would be deployed instead.  If it was easy to be a doctor, you could seek lesser trained (and lower cost and more accessible) paraprofessionals instead.  And if you could easily pick which issues to support as a  US Senator or Rep, then they would train a monkey to do it instead.

As readers here will know, I support the passage of a comprehensive health care reform bill.  Providing coverage for the presently un- and underinsured population is the right thing to do (oh, and it’s the cost effective thing to do too).  Moving toward payment reform is good.  Instituting needed insurance reform is good.  Shifting payments for providers to quality-based methodologies is good.  All good.

And so last night at a gathering with friends, an unexpected and heated debate emerged regarding the current health reform debate.  When asked point blank whether I support THIS reform package, I hesitated.  Then, I said “no”.  My friend, sensing triumph, exclaimed: “Read Your Blog!”… clearly suggesting that I’ve been a big supporter here.

I’ve been thinking about this all day.  It’s not as though we have ONE UNIFIED package to assess at this point as that’s what the House and Senate are working on creating… and there are critical differences between the two versions.  But there’s enough in common that we can pretty easily determine where the one final package will probably end up.  As I’ve stated here before, the debate has been long on insurance reform and short on any other kind of reform.  Furthermore, it has emphasized improving coverage and deemphasized how we’re ultimately going to pay for it all in the short-term, i.e., before the longer-term financial benefits begin to accrue.  Similarly, estimates of morbidity and mortality don’t consider the fact that we’re all going to live longer, and need more services, than prior generations.  And so, it’s flawed.  In some ways, significantly so.  It’s not perfect… far from it and I was thinking of these things when the no welled up within me.

So, do we go back to the drawing board?  Do we crumple up the paper the two bills are written on and toss them into the wastebasket in the corner of our office and then start all over?  Do we make the perfect the enemy of the good?

I don’t think so.

And so, I respectfully reverse my barroom position of last evening and state that I do support the passage of the reform bill.  But, I have a caveat: If the final bill does come together and strays too far in a direction I don’t support, I’d like to have an opportunity to reverse myself… again

Interested in your comments.  Thanks.

Tuesday, January 5, 2010

A disproportionate share…

Yesterday’s Boston Globe contained an opinion piece regarding the ongoing struggle of some of our Massachusetts hospitals to be adequately compensated for the care they provide to “publicly insured” patients.  These hospitals, embroiled in a legal battle with the Commonwealth over just reimbursements for their “disproportionate share” of such patients, have joined forces to raise awareness and to press forward with their goal of increasing payments.

Not too long ago, I worked for one of these hospitals: Quincy Medical Center.  QMC is the local health care resource for a large and mostly working class community that is located just ten miles from some of the most prestigious medical institutions in the United States.  During my time there, I frequently heard cries from some quarters that “there are too many hospitals in Massachusetts” and that “only the strong survive”… and so… “we should just let QMC close”.  While I was there, the hospital was engaged in a much publicized separation from long time partner, Boston Medical Center, which was itself engaged in much publicized turmoil sparked by reduced reimbursements for it’s own disproportionate share of said patients.

The public policy implications surrounding Quincy Medical Center’s future role in the health care environment raise many good and important questions.  Questions such as:

  • For the large elderly population in Quincy, will longer (perhaps much longer, given traffic on the x-way) ambulance rides into Boston or further south make for better health care?
  • For the growing Asian population in Quincy, will scattering medical care services to multiple locations versus localizing that care nearby in an institution that has invested in enhancing its ability to serve Asian populations (e.g., offering ready translation services) make for improved medical care?
  • Will sending patients to higher cost (and for many services, comparable quality) in town hospitals make the most sense economically?
  • Will area emergency departments, typically already quite crowded, be able to handle the 40,000 visits that currently are served in QMC’s ED?

Hospitals such as Quincy Medical Center should be supported and payments for all health care services they provide need to be fair.

I blip. Do you?

Someday, I’d like to come up with something that spawns a new vocabulary, a new language.  OK, I’d settle for coming up with a new word, a verb even.  For example, the twitter people can lay claim to “tweeting” and we know who came up with “I’ll facebook you.”  How about being “googled” as we all have been or “do you have a kleenex?”

Well, the folks at are at this very game as they attempt to coin the verb “blip”.  To blip means to take a photograph and then to post it to a blog the same day you took it.  There’s something inherently important and immediate about snapping a shot and then posting it on the self same day.  Now, If you took an Ansel Adams-quality photograph of the Half Dome in Yosemite National Park but lost your internet service that day and couldn’t post immediately, you’d have a decent picture, but certainly no blip.

Somehow, the act of trying to capture one good photo per day (I’ve attempted it – see here) helps you to become a better photographer.  The idea is that you begin to notice simple, ordinary things around you in new and different ways.  You begin to develop your creative eye.

But, it takes a commitment.  I’m going to give blipping a try.  I created a new daily photo journal, entitled “still looking” and here’s the link.  I’m not claiming any artistic merit here, just that I’ll try to do this every day.  Every single day.  The process is greatly facilitated by the fact that blipfoto has released a free iPhone app that allows you to do all of this (including taking the picture) from your iPhone.  Convenient.

The internet world is suddenly buzzing about blipfoto… and so I’ll give it a shot.

Will this make me a better photographer?  Who knows.  But I will be able to say: “I blip.  Do you?”

Man, that’s going to get annoying…

Monday, January 4, 2010

"Avatar" - innovative, fresh, creative... and strangely familiar

Spoiler alert.  Though I'm not going to give away any plot details, read no further if you like walking into a movie theater knowing as little about the story as possible.

I saw Avatar on New Year's Day at the plush Patriot's Place movie theater.  I anticipated a great James Cameron adventure, having enjoyed Titanic, the Terminator movies and Aliens.  Those movies were genuinely unique, fresh... even though the ultimate outcome of Titanic was expected (ship sinks) and story lines and settings of the best Terminator movie (#2) and Aliens were already set by their predecessor films.  The romance in Titanic was, to me, interesting and there was suspense inherent in the story of Rose's conflict, even though we surely knew that there was an iceberg in her future.  And we suspected that Sigourney Weaver was going to come face-to-face with aliens, but we didn't know for sure whether or how she would survive another horror-filled encounter.  And the twists and turns in the second Terminator movie were pure bliss.

In Avatar, Cameron has created his most lush and unexpected world yet.  Pandora.  A place where all manner of life is connected, including its many nasty and scary creatures as well as the beautiful, glowing plant life.  When the protagonist is left stranded in Pandora's jungle for the first time, it's tense.  But the sparkling and glistening all around him are captivating.  And so, seeing this, I settled in for a two hour and forty minute ride into the unexpected.  I was completely ready for Mr. Cameron to do it to me one more time.

The story line, which I won't go into here, involved the inevitable conflict between Pandora's inhabitants and the visiting and scavenging earthlings.  Pretty early on, we come to like the locals and grow increasingly irritated by our own kind.  We identify with the blue people and understand that the main protagonist, who stands before both worlds, will have a difficult decision to make at some coming point.

And here is the main problem.  Actually, it's one of the two main problems with the film.  First, though the action sequences are thrilling and the animators deserve the Academy Award they will most assuredly be nominated to receive, there's a predictability that runs through the build up and then right through to the conclusion.  Every single time I sensed where the story was going to end up, I was right.  Every single time.

The second problem?  You've seen it all before.  Han Solo flying back to save the day in the Millennium Falcon... it's in there.  Tarzan rallying the creatures to come to his aid... yup.  A romance between two from warring factions, a la Romeo and Juliet, John Smith and Pocahontas (and a thousand other stories)... check.  Sigourney Weaver fighting the bad guy in a big robot suit... got it (OK, Cameron is borrowing from Cameron).  I could go on.

Bottom line: I enjoyed Avatar and recommend it, especially on the big screen.  I just wish I hadn't seen most of it before.

Friday, January 1, 2010

Happy New Year!

Thank you for the comments about the new masthead photo.

To the person who asked about location, it was taken at Bird Park in Walpole, Massachusetts.  And to the person who asked whether I'm going to change this photo each season, the answer is "probably yes."

Wishing all of you a very happy, healthy 2010!