Wednesday, December 21, 2011

Ouch! That Hurts!

"TRIAGE Nurses sort emergency room patients according to the urgency of their condition, and            Blackbaud sees no reason hospital fund-raisers, for instance, shouldn’t behave similarly.."

That end  note appeared in a story by Ron Lieber in last Saturday's New York Times.The gist is that "Blackbaud helps hospital fund-raisers sniff out your net worth at the same time the doctors are evaluating your chest pain" and  they “take advantage of the captive audience by sending hospital admissions lists to the development office for a wealth screening within hours of when the patients are admitted. 


 As Lieber  points out this  not  illegal. There is a  lot  in the public domain. But there is a  lot not in the public domain and, one hopes, your health records, the reason you're  in the hospital, your illness and so on are among the items one cannot find  on a search engine - or through improper communication between a medical staff member and the development office. In my opinion the very fact that someone has been admitted to the hospital deserves a cloak of confidentiality. Why is  your face lift or my prostate any of the development office's business?

The federal government's Office for Civil Rights enforces the HIPAA Privacy Rule, which is supposed to protect the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. 

We live  in a time in which friendship has been commoditized (Facebook etc.), trivialized (Twitter ) and privacy subjugated to smart phone content and "wealth engines." There's  not a lot left to steal.Which doesn't mean that we shouldn't try to redeem what's left.

Having been a consultant to many hospitals and health care systems I know the question of proper and ethical behavior with regard to patients' privacy is always of concern.The hospital grapevine functions more efficiently than the development office in most places so stuff  gets around.

I  know Blackbaud and their senior people. It is a remarkable company whose services I always recommend to clients with the simple remark that "they are the industry standard." There is  no doubt that their people are ethically committed to good corporate citizenship. For that reason I asked them to respond to this blog beofre I  posted it. Here's what, Marc Chardon, their CEO, wrote:

    "We agree that that the development office should not know a patient’s condition or other medical information -- that should be off limits. We and our customers support this by being active members of associations like AHP, AFP, and APRA, and following their codes of ethics.  First any information is scrubbed via HIPAA, and then whatever can be communicated legally is subject to one or more codes of ethics.

    "Information passing through this scrubbing can be used to identify potential donors, which are a growing source for healthcare funding. With insurance reimbursements declining, government funding decreasing, and patients without coverage increasing, hospitals rely more and more on fundraising to provide the standard of healthcare we all value.  

   "Sensitive fundraising practice can bring patients to welcome the opportunity to ‘pay it forward’ because they value the services that have been funded by previous donors"

A patient's right to privacy and confidentiality should always trump any institution's perception that there is  no privacy. 

 Only prospects.

Tuesday, October 18, 2011


With the poverty rate at 15% in the world's richest nation and with private philanthropy this year (at best) flat this sign on the door of a New York City East Village soup station says it all.

The delivery of basic services to the most vulnerable has always been an uneasy and highly unbalanced partnership between public money and private charity. The majority provider has always been the public side. The idea that private charity can replace government is a long discredited notion that nonetheless has gained new currency (so to speak) in this presidential election cycle.

Republicans and Democrats alike are falling all over themselves in arguing that less government is more and that government is the root of evil. As Occupy Wall Street underscores, government is not the problem except in the sense that Obama inherited eight years of increasing laissez faire among government regulators. The unhappy result is known to all.

Now comes Howard Schultz founder and CEO of Starbucks who has had the simple and possibly loopy idea that with the support of its millions of customers the chain can act as a middleman for delivering micro-loans to American small business. Schultz is very much among the 1% against whom OWS rails, But he demonstrates that not everyone is driven solely by self interest. That this scheme will drive up Starbucks' sales (that fell off during the worst of the recession) is quite unlikely and, call me silly, not his motivation. It is just possible that he is sincere. I am a Starbucks guy, always have been. (Road warriors know to look for a Starbucks as very often it is the only place to buy a New York Times - and enjoy a good if not sublime cuppa).

That one of the country's great banks could have come up with this seems to me obvious. Other than finding new ways to gouge customers in the new ideas department the banks are closed. Until further notice.

Tuesday, October 11, 2011


On Sunday October 9th we walked down to Zucotti Park, 2 blocks north of Wall Street, and the Occupy Wall Street locus.This movement is catching on not because it's an alternative to the Tea Party but because, far more fundamentally, this country is a mess, our political institutions are a mess, the president's leadership is - to say the least - wanting; a growing number of people, especially young people, see their lives in turmoil and without a lot of good options for the future. That heady brew, not tea, is what the growing protests are all about.

To blame this all on Wall Street is of course a bit simplistic and I know better. But the sad fact is that they got us into this mess and they are still running the economy. Because he was inexperienced Obama did not thoroughly clean house and the unfortunate result of having a Geithner rather than say a Krugman as treasury secretary has, in my view, really worsened the situation.

Peacefully raging against "the interests" is absolutely right on and clearly I am not alone. What's left of the Left is out there. But it's more than Birkenstocks and guitars: the Democrats finally woke up and to the extent they can would like to co-opt the occupation. Organized labor, sidelined for years, has come aboard. Even Ron Paul, that nerdy dyspeptic, was represented by a noisy claque.

The paradox is this: I spend my professional life helping our clients extract from corporations and foundations (whose portfolios are made up of those same companies)as much as they can in charitable gifts. Unfortunately the exchange is far from even. The vast harm that's been done by corporate and individual greed unchecked and lack of any effective brake on the piggery is far greater than the modest sprinkling of money called "corporate philanthropy."

Wall Street may be laughing all the way to the bank. But metaphorically at least it has to cross Zucotti Park to get there. The coming New York winter will inevitably end the Occupation. Until then I"ll stop by occasionally for a reality check.