Healthcare Reform, Key Initiatives – Timing and Implications | healthcare

Healthcare Reform OverviewThe Patient Protection and Affordable Care Act will have a profound effect on healthcare providers, including reductions in reimbursement to hospitals and physicians; focus on value based purchasing – higher quality and lower costs; financial incentives and penalties tied to clinical quality outcomes and a transition away from fee-for-service payment to bundled payments and Accountable Care Organizations (ACOs).Healthcare Providers: Recommended ResponsesHealthcare organizations developing plans to respond to reform initiatives must create a path for the organization that:
Aligns the board, executive staff, medical staff, and clinical staff
Implements measurement, monitoring and benchmarking systems for costs and quality
Streamlines processes to enhance clinical outcomes and reduce costs
Integrates information technology, including electronic health record technology, with clinical and administrative processes to support care management across all settings
Focuses on improving clinical performance through evidence based medicineIt will be critical for organizations to get a clear understanding of their strengths and weaknesses relative to each reform initiative.Thriving under reform initiatives will require organizations to evaluate the entirety of their business, optimizing operations in all areas to enhance net revenues and reduce labor, supply, drugs and other costs. The goal should be to achieve or beat ‘best’ quartile performance.Hospitals must continue to improve quality while increasing cost effectiveness.Hospitals should undertake an in-depth evaluation of what service lines are crucial for their success – and which lines might be scaled back or divested based on funding limitations.Healthcare reform will forever alter the landscape of medical care in the U.S.Hospitals will have to align medical staff to address quality of care and comprehensive performance improvement under healthcare reform measures.An organization’s ability to collaborate with physicians to redesign clinical processes, minimize unnecessary services, lower readmission rates, and reduce hospital acquired conditions will be critical to their success under reform.Hospitals now not only need margins to meet their missions, they need margins to meet the demands of reform.Short-term and long-term savings from critical performance improvements will help position organizations to succeed under reform and beyond.While many of the ramifications of healthcare reform and its effect on hospitals remain to be seen, one thing is certain: there will be less money in the system to go around.

The Geelong Botanic Gardens | gardening

Scattered around rural Victoria are some very interesting Botanic Gardens. One of these hidden treasures is the new Geelong Botanic Contemporary Gardens situated at the rural gateway to Western Victoria. The concept of a drought tolerant garden was created by Chris Dance and was implemented by John Arnott. It is stunning, exciting and truly modern. It is 21st century gardening at the cutting edge.The new contemporary site is in front of the 19th century gardens and is positioned on the side of the hill overlooking the Corio Bay. There is a strong connection to the port of Geelong, with bow like structures reach out into the waterhole and they remind you of the front of a ship.This new modern garden is absolutely fabulous and inspiring. John Arnott explained that it is full of ideas that we can apply our own gardens. The Geelong Gardens are special, they reflect two different centuries and they do it well. Many times you see the modern and tradition jarring each other but here at Geelong the two marry superbly because the design has created a contrast between the two era’s and there is transition point rather than a transition zone. It is black and white you are either in the 21st century or the 19th century.Gardening in Australia in the 21st century is changing. No longer do we have the resources to create the green oasis style gardens of the 19th century. The 21st century gardens at Geelong reflect this. The Geelong area has a below average rainfall and has been suffering drought for over 7 years. The idea of the contemporary gardens is to capture people’s imagination and prompt an intellectual conversation about the challenges of today. The 21st garden is not comfortable and tranquil. It is challenges our idea of what a garden is. It is showing casing how to use attractive drought tolerant plants from around the world as well as Australian ones and create a sustainable garden.There are 3 themes for the new gardens:-
Low water requirement
Use of indigenous plants
Use of plants from arid regions of the worldSustainability is the philosophy this contemporary garden is based on. We no longer can afford to waste water on high water users. Over the last 10-15 years, there has been a huge shift in environment practices and principles in urban horticulture. The new garden reflects our shift from moderating the microclimate to suite the plant, to choosing plants that are suited to the environment conditions. Picking the right plant for the right spot. The bed of Agave’s is perfectly position to tolerate the summer sun and catch any run off that may occur.One of the difficulties for the designer was to make sense of the Bunya-bunya pines Araucaria bidwillii (that date back from the Gondwana period) is apart of the 19th century garden. Gondwana was the great southern continent that contained Africa, Australia, South America, Antarctica and New Zealand. Eventually the continent broke up but we still have some remnant plant material. A clever solution was found by surrounding the Bunya-bunya pines with plants from that period. Walking around this area you will notice plants such as Spear lily Doryanthes palmeri and the Lustre leaf holly Ilex latifolia.Another problem was how to make the garden relevant to the visitors of the gardens. It was decided to divide the garden into two:- North/South. The north section contains the indigenous species that is subtle and beautiful and the south the cacti collection that is big and bold. By using these two types of design, everyone can find something to relate too and enjoy.The preparation of the site was simple. John explained that they worked with the existing soil heavy clay soil that is nightmarish. It cracks in the summer and is boggy in the winter. The only area that was modified was the cacti bed where drainage was significantly improved. Because of the soil conditions the choice of plant material was severely limited. There was no compost or animal manures added as many arid plants like low nutrient soils. Mulch is a wonderful aid in reducing evaporation but it can soak up moisture preventing it from percolating into the topsoil. So only a thin layer <40cm of Eucalyptus mulch was used. As part of the aesthetic design white pebbles were also used.It is interesting to note that a water system was installed but has only been used about 10 times over the last 3 years. To establish the plants they were watered at the time of planting and the twice a week for 6 weeks. Once an active root system was established, watering was stopped. The garden survives on rain-water and the tough adaptations of the plants. Lessons were learnt from the species that died, not to replant them.The design of this garden is formal and predictable. It is an open design where you can see everything. And as the design was not about the landscape but about plants, two detractions are that there are no surprises and it doesn't give the general public many ideas how to create shade that is very important in a hot climate like Australia. Many of the species those could be used to create shade for example Plum pine (i>Podocarpus elatus or Myrtle Beech Nothofagus cunninghamii.The garden also has its pretties, plants that provide colour and interest throughout the year. There is an interesting collection of salvia’s from the America’s and other plants from such as the Blue bush sage Salvia urica, Sprawling blue bell Wahlenbergia gracilis and Chocolate lily Arthropodium strictum. Many of the trees and shrub provide flowers and interesting foliage such as Coastal yucca Yucca aloifolia and Wine/jelly palm Butia capitata.This garden explodes the 1970s myth that when natives are planted that you can forget them. They need just as much TLC (tender loving care) as any other plant. The 21st garden at Geelong is managed just as intensely as the 19th century garden. It is treated like the traditional herbaceous border or short-lived perennials. It is managed like this so as to keep it aesthetically pleasing.This new 21st century garden is challenging. It is not about the design or the hard landscapes. Instead the focus is on the plants! Choosing the right plant for the right spot and using species that create interest and intrigue from not only in Australia but also all around the world. The aim of the garden is to excite and inspire you and to show case to the home gardener what potential these plants have. It is not intended you go home and copy it exactly, but to give you ideas so you can use them to suit your garden and save water.


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