Paul Levy reports medical department chiefs at the hospital have started a Physicians Support BIDMC Fund and that, to date, senior docs have agreed to forego more than $350,000 in salaries as the hospital tries to cut a projected budget deficit.

Paul Levy at Beth Israel Deaconess posts the e-mail he sent to hospital staff last night on the hospital's budget: The hospital will likely lay off 150 people, but that's compared to the 600 originally planned - and the 900 lowest-paid workers will not be laid off.

Other money saving steps: Executives will lose the 3% raises they got on Jan. 1, employees will temporarily stop accruing "earned" vacation time, the hospital will not fill most positions as they become vacant through attrition, an annual staff barbecue is cancelled and the hospital will no longer subsidize most employees with BlackBerries or pay for meals at staff meetings. Also, top hospital management, including Levy, are taking pay cuts.

Levy also explains why the hospital won't be canceling its contract with the Red Sox - partly because it has a contract and partly because the deal is an excellent marketing tool.

One interesting reason the hospital will bring in less money than originally budgeted: A new state law forbidding hospitals to send away emergency patients means Beth Israel is now seeing fewer ER patients, because BI was where many of these "diverted" patients ended up.

Paul Levy reports on a "town meeting" for Beth Israel staffers to try to come up with ways to cut costs without laying off workers:

... As expected, the response from the staff has been spectacular. People have a terrific sense of community and are quite willing to make sacrifices for the good of their fellow workers. (And, as you can see in the picture above, people are maintaining a good sense of humor, too.) I'm going to post some of their comments for you below so you can get a sense of the sentiment.

Beyond the general feeling, I was very, very pleased when I asked people if they agreed with my predisposition to protect our lower wage earners (e.g., transporters, housekeepers, food service people) from measures we take, even if it means that other people have to give up more of their salary and benefits. The response was overwhelmingly positive. ...

Beth Israel Deaconess CEO Paul Levy explains why: Basically, the shrinking economy is now affecting even hospitals.

Beth Israel Deaconess CEO Paul Levy, who has long publicly chronicled Beth Israel Deaconess's efforts to reduce infections among patients with tubes going right into the chests for medications, reports on the reaction when he called on other area hospitals, insurers and doctors to develop a formal program to fight these often fatal ailments: Complete silence.

... [Y]esterday, a world expert in this field, whose wisdom and advice I treasure, told me that he has come to accept gradual progress in quality and safety improvement, citing the kind of training doctors get, which does not emphasize these areas. That such a person has become content with gradual changes in the status quo is an indication of what it must be like to beat your head against this wall of recalcitrance for several decades.

My advantage, being without medical training and having had but a short tenure in this field, is that I retain a sense of outrage. Our collective failure to approach this problem using well established methods of process improvement -- including publication of current performance results -- represents a moral and ethical lapse by the clinical and administrative leadership of the medical establishment in this city. Why? Simply put, a profession that takes an oath to do no harm is, by inaction or incomplete action, doing harm. We are causing people to die who should not die. What would we call that if we saw it happening in other sectors of society?

Beth Israel Deaconess CEO Paul Levy wants your suggestions on how to improve life in the ICU for patients and families.

Chaka Khan? When you click there, look at his headline and tell me Levy didn't get down in the '80s with Chaka Khan.

Paul Levy, CEO at Partners HealthCare frenemy Beth Israel Deaconess, reports he dismissed complaints from friends at Norwood Hospital about the MGH/Brigham clinic under construction in Foxboro - until this past Friday, when he gave a speech at a meeting at neighboring Gillette Stadium and was stunned to see how huge the thing is:

... [T]he two facilities are merely 8.5 miles apart, making them indistinguishable to many patients in terms of transportation access. Since insurance companies pay community doctors in the Partners system substantially more than those in the Caritas Christi system, it will be easier to recruit physicians to offer services in Foxboro than in Norwood. Does this difference in reimbursement rates reflect a documented difference in the quality of care between the community-based doctors in the two systems? No.

Now, let's acknowledge that MGH and the Brigham are powerful brands. To the extent patients are influenced by that reputation or other factors to migrate to the PHS facility from Norwood Hospital, the overall health care bill for the state will rise for no documented additional value to those patients or society. ...

Beth Israel Deaconess Medical Center Paul Levy praises Tufts Medical Center for its "gutsy move" in trying to get more money from Blue Cross/Blue Shield, discusses how his hospital is also trying to negotiate a new contract with the insurer, one that gets Beth Israel more money in exchange for a "capitated" payment system in which Blue Cross pays a set amount per patient regardless of how long his or her stay is:

... One key issue is that such a plan transfers a portion of the insurance risk of health care to the providers and away from the insurance company. Some element of this risk-sharing is probably essential to align incentives between the providers and the insurer, but the specific design and implementation plan is important, lest the hospital and doctors find themselves with a major revenue loss at the end of any given year. After all, providers do not have the kind of financial reserves that insurance companies have. ...

The Boston Business Journal reports on a man who has lost his chance at suing his doctors at Beth Israel for malpractice because his lawyer failed SIX TIMES to file legal documents on time.

Oh, if only Neil Chayet were still around to come up with a suitable pun for this story.

Paul Levy at Beth Israel Deaconess discusses the full-page ad Brigham and Women's and Mass. General took out in the Globe today to tell us how wonderful they are (no doubt out of a sense of bursting pride, not because of a Globe Spotlight article on how they are using their muscle to boost their reimbursement rates).