In the area of high school football I became aware of the value of coaching when our local football team challenged for the high school state championship in the 90's. Mark Speckman, the coach without hands, directed this team to glory with marginal talent. Many games started in the same fashion. The first half would be a very close contest. The opposing team tried its magic. Even with teams exchanging tapes of the previous games, the reality of actually playing a game the first half was pretty unpredictable. The line is fresh, the team usually has figured out a defense for the team. Much of the time in the first half the team works against its own tendencies. In high school ball the reality is that a successful outcome is more of a function of the players correctly identifying the defense and accurately execution of their plays. The coaching staff works to put the players in places where their natural tendencies will enhance the execution sequence. In the years that our local team won the state title, Mark Merced High's head coach designed a smoke screen back offense that made it hard to confirm which back had the football as there was a great deal of horizontal movement right behind the line. The fullback could have the ball or not as they passed right in front of the quarterback. This was seldom done the high school football basically because the "fly" offense is so hard to make happen fast enough to complete the illusion. The blocking ahead of the offense has to be impeccable as well. The back has to hit the hole without a question in his heart. Mark is now working in the pro ranks, for the Montreal Allouettes of the Canadian Football League as their back coach.It was fun to pick him out on the sidelines this summer as I was flipping channels.
A similar move was done at the University of Nevada when the 49er quarterback Colin Kaeperneck led their team. They called it the pistol. The added wrinkle to the fly is a very effective short pass available in this formation. When Colin was playing for the Turlock Pitman High School team, he tore the local Merced High school teams to shreds.
The Forty Niners also have a similar rhythm in their games in comparison to the Merced High State competition teams. The Forty Niners have to be winning or close to winning for a typical blowout to occur in the 2nd half. The difference is the same. Excellent coaching with less than stellar performers can result in an amazing performance. The difference is coaching. Changes are made in the 2nd half that allow for the Forty Niners to dictate the rhythm of the game. Match ups are made. The commentators have mentioned that the offenses have a decided advantage in the modern game. It still takes superlative coaching to see and take advantage of the execution of the game plan in the 2nd half.
Coaching was the highlight of the recently completed America's Cup sailing catermaran series. The team was down to its last loss, but a cleverly positioned time out allowed the Oracle USA boat to chang the way the cup was played. Suddenly the Oracle team representing the home USA cup holder figured out by coaching how to tack (move against the win) while staying on their little wedges in the foam. On the last race a tack was not completed as well as could have been done and boat almost skidded into disaster. The boat made it screaming at almost 30 miles an hour while headed up against the wind. They and recovered to pound the lead into the New Zealand boat which raced much better in lighter air. The last races which all had to be won to keep the cup were ferocious wind days. The team that figured out the tide advantage in the end (The USA Oracle Boat) won in decisive fashion. Coaching and understanding the tides in San Francisco Bay in September was vitally important for this boat to continually win from behind. And did it ever win!
By the way, the coverage and commentary for this sporting event was extraordinary. For the first time tech brought the TV viewer closer to the race than ever before. The graphics on the screen allowed the viewer to see the relative speed of each of the boats as well as the turning radius and boundaries in each of the races. It is still amazes me that 70 ton racing cats with 14 story sails could survive on the bay let alone race.
Hats off the coaches of the games.. they figure it out so that the stars can look good.
: ) Pat
Discrepancy in local medical costs can cause sticker shock
Procedures at St. Mary's can be twice as high as Community Hospital, but context is key
St. Mary’s Hospital and Community Hospital in Grand Junction are barely a three-minute drive from each other, but the two are far apart when it comes to what they charge patients.Medical costs at St. Mary’s are almost always more expensive than those over at Community, and in some cases twice as high, according to a federal database on hospital costs.
While the two hospitals, and others in the region, are still cheaper than most parts of the state, St. Mary’s costs were higher in 18 of 19 diagnoses in what hospitals charge Medicaid and Medicare patients, according to a federal database maintained by the Centers for Medicare and Medicaid Services.
Dan Prinster, St. Mary’s vice president of business development, acknowledged those numbers as accurate, but said a true comparison of the two hospitals isn’t that simple.
“If you have a patient who has additional complications, they’re going to come here before they go there (to Community),” he said. “We’re at a different level as a facility. We offer many more services that they don’t.”
While patients may get comparable care at both facilities for certain procedures and treatments, the two hospitals really can’t be compared because there is a limited list of conditions the two facilities have in common that they treat, Prinster said.
St. Mary’s has services and staff that Community doesn’t, so its expenses are naturally higher, he said.
Furthermore, Community has made a conscious effort to keep its charges low, a philosophy that eventually will hurt them, Prinster said.
“I know from having looked at charge data that Community has made the decision over several years that they’re not going to raise rates in certain areas,” he said. “Our board has made the decision over the years that given cost increases for medical equipment, for pharmaceuticals, for staff and other things, is that we have to — from a fiduciary standpoint — ... adjust our rates on an annual basis. That accounts for some of the price differences.”
Chris Thomas, president and chief executive officer at Community, agreed that the two hospitals are different when it comes to the services they offer, but he said Prinster doesn’t have a clue what drives his charges.
He said St. Mary’s costs are higher simply because it can get away with charging more.
“A big part of this is, when little Community Hospital sits down with the insurance companies and says, ‘Boy, I’d like to get paid more,’ the insurance companies say, ‘Yeah, Chris. No thanks,’ and I say, ‘Okay,’” Thomas said. “But when St. Mary’s, who has 85 percent of the market share, goes in and says, ‘I’d like to get paid this,’ they get it. I’m limited in most of my (insurance) contracts to not be able to increase my charges more than 6 percent a year. St. Mary’s doesn’t have those kind of restrictions.”
As a result, the difference in costs continues to widen, he said.
According to the Medicare cost database, St. Mary’s charges more than $46,000, for example, to treat a blood infection such as septicemia, but Community Hospital charges only about $21,000 to treat that same illness.
Dr. Donald Nicolay, chief medical officer at Community, said the only thing that is different in the treatment of that infection between the two hospitals is what patients would be charged.
Prinster, however, said cost considerations don’t stop there. When complications develop while treating such life-threatening conditions as septicemia, patients prefer to be at a hospital that has more services, and can more quickly deal with unexpected situations.
Oftentimes, Community Hospital patients end up being transferred to St. Mary’s because it doesn’t have the wherewithal to treat those who develop complications, he said.
Prinster points out that when there are no complications, the cost between St. Mary’s and Community is nearly identical.
Indeed, the database bears that out, showing St. Mary’s cost to be $27,158, and Community’s charge at $27,058. Charges for that condition, without complications, at Delta and Montrose are even cheaper, at $17,303 and $14,954, respectively.
Still, the Colorado Center on Law & Policy, a left-leaning group that advocates for affordable health care and responsible government spending that has studied hospital charges, says there seems to be no rhyme or reason as to why costs for the same procedures vary so widely across the state.
In a recent study of those charges, the center found that hospital costs can range from 43 percent higher than the statewide median to 57 percent lower.
Community Hospital, Delta County Memorial Hospital and Montrose Memorial Hospital were among the bottom five charging the least of all major hospitals in the state, with Montrose and Delta coming in second and third to last, respectively.
St. Mary’s, however, ranked closer to the middle, at about 19 percent below the state average.
With the exception of Denver Health, which charges about as much as St. Mary’s, all other Denver-area hospitals listed charges that were, on average, 25 percent higher than the state median, with some as high as 43 percent over that baseline.
Prinster said that’s why it’s better to compare St. Mary’s with hospitals located elsewhere in the state, such as Fort Collins, Boulder or Pueblo.
When compared to those facilities, St. Mary’s costs are more often than not much lower, and that’s by design.
“What we don’t want to do is force people to go to Denver to get cheaper care,” he said. “Every year when we do that (cost) analysis, we look at how our rates compare to similar hospitals, and on average we’re 10 to 15 percent below them. So, with our rate increases, we’re still below them. What’s fascinating is, we raise our rates, and they do, too, and some of them raise them even more.”
Both St. Mary’s and Community are in the midst of major construction projects to expand their facilities.
St. Mary’s, which opened its new $276 million 12-story building in 2010, is spending another $40 million to complete construction on the four top floors, two of which will become the new home to its rehab and surgical units.
Meanwhile, Community is building a whole new hospital and medical office building for about $73 million.
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HOSPITAL COSTS
Here’s a list of 41 charges of common ailments treated at regional hospitals, according to data from the Centers for Medicare and Medicaid Services.
Blood infection with a major complication:
• Community Hospital: $20,910.46
• St. Mary’s Hospital: $46,268.97
• Montrose Memorial Hospital: $24,270.38
Fluid accumulation in the lungs and respiratory failure:
• Community Hospital: $18,812.58
• St. Mary’s Hospital: $39,572.48
Chronic obstructive pulmonary disease with a major complication:
• Delta County Memorial Hospital: $20,283.08
• Community Hospital: $17,501.39
• St. Mary’s Hospital: $28,461.46
• Montrose Memorial Hospital: $14,539.19
Pneumonia and lung inflammation with a major complication:
• Delta County Memorial Hospital: $24,681.69
• Community Hospital: $24,361.82
• St. Mary’s Hospital: $34,133.83
• Montrose Memorial Hospital: $17,892.29
Heart failure and shock with a major complication:
• Community Hospital: $14,361.91
• St. Mary’s Hospital: $28,228.12
Major small and large bowel procedures with complication:
• Community Hospital: $36,950.88
• St. Mary’s Hospital: $49,988.05
Chronic obstructive pulmonary disease with a complication:
• Delta County Memorial Hospital: $16,416.65
• Community Hospital: $16,959.93
• St. Mary’s Hospital: $23,603.48
• Montrose Memorial Hospital: $14,115.83
Chronic obstructive pulmonary disease without complications:
• Delta County Memorial Hospital: $11,723.56
• Community Hospital: $15,416.09
• St. Mary’s Hospital: $16,533.21
• Montrose Memorial Hospital:$9,141.40
Pneumonia and lung inflammation with a complication:
• Delta County Memorial Hospital: $17,302.14
• Community Hospital: $17,223.78
• St. Mary’s Hospital: $23,314
• Montrose Memorial Hospital: $11,244.70
Pneumonia and lung inflammation without a complication:
• Delta County Memorial Hospital: $9,809.72
• Community Hospital: $12,720.14
• St. Mary’s Hospital: $18,100.51
• Montrose Memorial Hospital: $9,680.86
Heart failure and shock with a complication:
• Delta County Memorial Hospital: $10,830.43
• Community Hospital: $16,268
• St. Mary’s Hospital: $22,092.77
• Montrose Memorial Hospital: $12,705.17
Stroke or bleeding within the skull with a complication:
• Community Hospital: $19,931.47
• St. Mary’s Hospital: $24,025.42
• Montrose Memorial Hospital: $12,592
Blood infection without a major complication:
• Delta County Memorial Hospital: $17,303.91
• Community Hospital: $27,058
• St. Mary’s Hospital: $27,158.90
• Montrose Memorial Hospital: $14,954.40
Inflammation of the esophagus, gastrointestinal tract or other major digestive disorders without major complications:
• Delta County Memorial Hospital: $10,339.65
• Community Hospital: $13,953.12
• St. Mary’s Hospital: $16,699.77
• Montrose Memorial Hospital: $8,590.93
Skin or connective tissue inflammation:
• Delta County Memorial Hospital: $8,544.95
• Community Hospital: $11,641.08
• St. Mary’s Hospital: $21,005.58
• Montrose Memorial Hospital: $11,164.12
Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without major complications:
• Delta County Memorial Hospital: $8,597.86
• Community Hospital: $11,695.88
• St. Mary’s Hospital: $13,354.75
• Montrose Memorial Hospital: $11,812.36
Hip and femur procedures not including major joint replacement with complications:
• Community Hospital: $28,152.73
• St. Mary’s Hospital: $36,832.12
• Montrose Memorial Hospital: $27,593.74
Major joint replacement or reattachment of lower limb without major complications:
• Delta County Memorial Hospital: $31,814.80
• Community Hospital: $37,524.77
• St. Mary’s Hospital: $34,378.06
• Montrose Memorial Hospital: $31,441.26
Kidney and urinary tract infections without major complications:
• Delta County Memorial Hospital: $10,958.25
• Community Hospital: $10,073.53
• St. Mary’s Hospital: $14,433.41
• Montrose Memorial Hospital: $11,141.69
Heart pacemaker with a complication:
• Montrose Memorial Hospital: $34,939
• St. Mary’s Hospital: $64,094.60
Stroke or bleeding within the skull without a complication:
• Delta County Memorial Hospital: $12,147.29
• St. Mary’s Hospital: $22,598.36
• Montrose Memorial Hospital: $9,385.70
Short term loss of blood flow to the nervous system:
• Delta County Memorial Hospital: $8,854.87
• St. Mary’s Hospital: $16,546.46
Seizures without a major complication:
• St. Mary’s Hospital: $19,283.85
• Montrose Memorial Hospital: $7,573
Blockage of an artery of the lung without a major complication:
• Delta County Memorial Hospital: $14,768.68
• St. Mary’s Hospital: $23,736.04
• Montrose Memorial Hospital: $13,054.44
Permanent heart pacemaker:
• St. Mary’s Hospital: $64,094.60
• Montrose Memorial Hospital: $34,939
Perc cardiovascular procedure with a drug eluting stent without a major complication:
• St. Mary’s Hospital: $45,519.17
• Montrose Memorial Hospital: $34,859.20
Perc cardiovascular procedure with a non-drug eluting stent without a major complication:
• St. Mary’s Hospital: $45,493.55
• Montrose Memorial Hospital:$34,072.92
Heart failure and shock without a complication:
• Delta County Memorial Hospital: $7,911.91
• St. Mary’s Hospital: $15,955.39
• Montrose Memorial Hospital: $7,594.50
Heart arrhythmia and conduction disorders with a complication:
• Delta County Memorial Hospital: $13,749.77
• St. Mary’s Hospital: $23,247.50
• Montrose Memorial Hospital:$13,753.24
Heart arrhythmia and conduction disorders without a complication:
• Delta County Memorial Hospital: $6,109.94
• St. Mary’s Hospital: $11,970.62
• Montrose Memorial Hospital: $8,613.79
Fainting and collapse:
• Delta County Memorial Hospital: $7,344
• St. Mary’s Hospital: $16,640.82
Chest pain:
• Delta County Memorial Hospital: $5,345.43
• St. Mary’s Hospital: $12,033.37
• Montrose Memorial Hospital: $7,877.40
Major small and large bowel procedures with major complication:
• Delta County Memorial Hospital: $69,319.75
• St. Mary’s Hospital: $105,751.25
Gastrointestinal hemorrhage with complication:
• St. Mary’s Hospital: $20,359.18
• Montrose Memorial Hospital: $13,632.23
Gastrointestinal hemorrhage without complication:
• Delta County Memorial Hospital: $13,628.12
• St. Mary’s Hospital: $14,011.36
Gastrointestinal obstruction with complication:
• Delta County Memorial Hospital: $16,624.83
• St. Mary’s Hospital: $21,347.64
Gastrointestinal obstruction without complication:
• Delta County Memorial Hospital: $9,029.35
• St. Mary’s Hospital: $12,163.70
Minimally invasive removal of the gall bladder without complications:
• St. Mary’s Hospital: $25,684.89
• Montrose Memorial Hospital: $19,444.82
Fractures of the hip and pelvis without complications:
\• Delta County Memorial Hospital: $13,324.25
• St. Mary’s Hospital: $14,299.92
Medical back problems without major complication:
• Delta County Memorial Hospital: $10,025.12
• St. Mary’s Hospital: $18,586.62
Signs and symptoms without complications without major complication:
• St. Mary’s Hospital: $19,006.70
• Montrose Memorial Hospital: $7,925.31