This is just fun to read and think about. Crowdsource funding, using Twitter for help solving technical problems, open-source volunteer effort to revive a derelict satellite. 

Rebooting ISEE-3: Space for All –


Faced with the challenge of a very expensive Medicaid program, New York chose to dramatically reform it. A key element of the reform is moving Medicaid long-term care patients, including nursing home patients, into managed care plans, including managed long-term care plans (MLTC).

A key elements of the new policy is that MLTCs need not have a contractual relationship with every nursing home. While they need not negotiate prices during the transition period, nursing homes and plans may negotiate prices

Now the managed care plans are faced with the challenge of dealing with nursing homes on a much larger scale than in the past. 

A health plan representative asked whether we could create a visual, interactive dashboard that combined Medicaid price data with quality indicators. We did.

The dashboard, includes:

  • CMS Nursing Home Compare Star Ratings, Overall, Staffing and Survey
  • Staffing levels for several types of staff (RN, LPN, Aides, Physical Therapy, etc.)
  • Staff, influenza vaccination percentages
  • Fines imposed, both number and level
  • Medicaid rates for operating costs and capital
  • Location
  • Number of beds
  • Vacancy rates and average number of vacant beds

The dashboard is highly visual and highly interactive. Users may filter (in or out) by quality rating, Medicaid rates, region, county and sub-county geographic areas. Users may also test the effects of discounts and value-based pricing.


 SNF MLTC Tool 1 2014 04 15 0926

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A colleague and friend, knowing of my history flying large Air Force transports internationally, and who’s intensely curious about the fate of Malaysia Flight 370, has sent me a string of emails, most with the subject line: “does this make any sense?”

My first response, and one which is still correct was this:

“It is a capital mistake to theorize before one has data.”

Sherlock Holmes
… and me


I did observe to my friend that the world is a big place, but that I was still confident that eventually 370 would be found. I also observed that aviation technology is dramatically better, and the amount of data generated from routine operations dramatically greater than when I was flying internationally. That was a few decades ago, which depending on your perspective was a long time ago or practically yesterday. But to me, the changes have been both fast and great.

Other than that, I’ve refrained from comment, except at home (my wife is a very patient person). Well, it’s time to come out of my corner and make public some of my own observations. Here’s the first, which is on the news coverage.

The TV news coverage has been a decidedly mixed bag. I’ve been generally impressed with the guests on several shows, who have accident investigation experience. They’ve been informative, while being appropriately cautious and not overrunning the evidence. Anecdotally, the ones I’ve watched have rarely, if ever, made absolute statements. Instead they tend to express themselves in terms of possibilities and probabilities.

In contrast, the reporters and hosts overdramatize and express themselves in absolutes far too often (once is probably too often.) Here’s Lt. Col. Robert Bateman’s apt criticism of CNN: “CNN Malaysia Flight Coverage – On CNN’s Reckless Malaysia Flight 370 Coverage – Esquire

And here’s Nick Martin at TPM pointing out Don Lemon’s (CNN Anchor) questioning a guest about whether the flight may be missing due to a supernatural event or might have been sucked into a black hole. Really? I couldn’t bear to link to CNN on that one. That’s pathetic.

But it’s not just CNN. An ABC affiliate  used a modified version of the graphic for the fictional TV show, Lost, to push its coverage of Flight 370. That’s crass.

And, of course, we already have a broad array of conspiracy theorists, even including Rupert Murdock (really) asserting on Twitter, with neither hesitation nor uncertainty, the the loss is the result of anti-Chinese jihadists. And that’s nutty.

And then, there are those who are already pushing fixes such as eliminating the ability of the pilot to turn transponders off. (That’s not TV coverage, but an op-ed by Gregg Easterbrook in the New York Times). More thoughtful than some of the other coverage and commentary, but not an impressive idea in my book, And more importantly given how little we know at this point, way too early.

Without getting super specialized, if you want one reliable observer/journalist, who knows something about aviation, then try James Fallows at the Atlantic Magazine

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Here are some terrific examples of measuring and visualizing without interfering with existing patterns or operations and without spending much time – and I suspect – without spending any money.

Though I’m bicycle-biased, I’m not a transportation policy guy or an urban planner. Yet I’ve always admired those who figure out how to measure any system’s functioning indirectly, from something that’s already in that system and without additional system cost. In that respect, these are really good.

In traffic and street planning, a “neckdown,” (new word to me) is a physical constriction of the road space to quiet traffic and/or to increase space for pedestrians, bicycles or other uses (sidewalk cafes?). I presume this can be accomplished by reducing space that’s actually used by motor vehicles or more subtly, just cutting off the space that cars and trucks don’t use anyway. Even if it’s not physically used, restricting it visually will likely also restrict it psychologically.

As it turns out a “sneckdown” is a temporary neckdown, one created by snowfall. Just look at and record the less traveled street space after a snowstorm to see where cars and trucks don’t drive.

Here’s a New York City example from Streetsblog NYC Sneckdowns: Taking the World by Storm.

The snow is almost like nature’s tracing paper,” Streetfilms’ Clarence Eckerson told the BBC. “It’s free. You don’t have to do a crazy expensive traffic calming study. It provides a visual cue into how people behave.

The folks at In This Old City in Philadelphia, did some very nice examples at What Snow Tells Us About Creating Better Public Spaces.

All they did was take photos of where traffic had not passed after a snowstorm. The Philadelphia examples just added a bit of visual highlighting to the pictures.

Clever, clever, clever.


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And here’s a really nice summary by Liz Farmer of why the cost of ignorance is rising in local government finance: Financial Illiteracy: One of Government’s Biggest and Least Discussed Problems.

Yes, it’s more eat your fruits and vegetables stuff but …

  • Don’t be surprised, as some have been even when their actions are legal, when your bond rating is trashed. Rating standards are getting tougher.
  • The regulatory climate is more stringent as a result of Dodd-Frank.

I’ve been reeling for years from a conversation I had with an experienced, and otherwise smart, county legislator who told me:

Oh, I never read the County Budget. I don’t have time for that. That’s what staff are for.

When I pressed him, he said he never even read the Executive Summary, which was only 5-10 pages. And the legislative “staff” he relied on had no financial expertise. Still doesn’t.

The legislator in question has moved on and is now a member of the NYS Assembly, where at least there’s a Ways & Means staff and some legislators who do their homework.

The more time passes since the end of the Recession, the more people have become complacent. That’s a trap and a dangerous one.

Wake up folks.

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From the Center on Budget and Policy Priorities, Budgeting for the Future: Fiscal Planning Tools Can Show the Way (PDF), by Elizabeth C McNichol, Vincent Palacios, and Nicholas Johnson.

Ten tools:

  1. Multi-Year Forecasts of Revenues and Spending
  2. Fiscal Notes with Multi-Year Projections
  3. Current Services Baselines
  4. Independent Consensus Revenue Forecasts
  5. Independent Legislative Fiscal Agencies
  6. Independent Review of Pension Assumptions and Methods
  7. Well Designed Rainy Day Funds
  8. Oversight of Tax Expenditures
  9. Prudent Rules for Pension funding and Debt Levels
  10. Budget Status Reports

This is eat your fruits and vegetables stuff. And it’s not like others haven’t done similar lists. But it’s always worth repeating.

And perhaps especially now.

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Detroit Medical Center has made a concerted effort to re-structure their discharge process, even to the point of re-naming it. This is worth a read.

“Now the word we use is transition, a much more refined process, to get our patients back into their community,” says Suzanne White, MD, the eight-hospital system’s executive vice president and chief medical officer.

“The readmission problem is really just a symptom of a very broken system and, in our region, of a very poor support system. … It’s never just one reason for a readmission but a variety of causes that require everything to be thrown at efforts to prevent them.”

There’s a lot at stake for DMC, a hospital system with more than 1,800 licensed beds and where, at most of its hospitals, the number of uninsured and Medicaid and Medicare patients is about 50%.

But with a lot of hard work, DMC is seeing improvement. Readmission rates in January 2012 were as high as 25%, and several DMC hospitals received significant financial penalties. But in January 2013, readmission rates were down to 20%, and down to 15% as of August 2013.

“We have a very difficult demographic to deal with,” White says of the metropolitan Detroit area her hospitals serve. Health literacy is poor and educational levels are lower than in many other urban areas.

Here’s a killer relationship discovered during their analytical process:

A review involving 4,000 admitted patients at three DMC hospitals in 2010 has revealed what White calls a “dramatic, very tight” correlation between all-cause readmissions and one simple thing: the timing of the first physician appointment after the patient left the hospital.

“We discovered that the rate of 30-day readmissions correlated perfectly with the number of days between the patient transitioning out of the hospital and when they saw their primary care physician,” she says.

If the patient saw the doctor between day one and day four after hospitalization, the chance of readmission would be less than 6%. If the appointment was on the 6th to the 10th day after hospitalization, chance of readmission was between 6% and 13%. And for visits with the doctor on day 25, the chance went up to 29%. “The readmission rate increased by 1% for every additional day between discharge and the first physician visit,” she says. (Emphasis added.)

Good stuff.

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That’s my Girl!

by John W Rodat on November 5, 2013

Halloween postscript.

On her own initiative, granddaughter, age 9, surveyed her Halloween loot.

Then she categorized it by size and counted the pieces (total 63).

I’m so proud.

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John Kelly of USA Today and Emily Le Coz of the Jackson (Miss) Clarion-Ledger on USA Today have done an exemplary job of using the latest in data visualization technology to display and enable interactive exploration of nursing home problems.

Take a look here! Note the interactivity. Be sure to look at each of the tabs across the top. Your comments will be especially welcome.

Note that Kelly and Le Coz used Federal data that’s already public. This is a strong reminder of the value of government’s “making the public’s data public.” It doesn’t have to be fancy; it just has to be openly available in a simple, workable form.

Side note: notice of this work came to me yesterday not through a health care source, but through Tableau Software’s “Viz of the Day.” We’re using the same technology to explore government finances and operations and health care issues.

Kudos to Kelly, Le Coz, USA Today and the Clarion-Ledger!

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