The concept of practice variation raised its ugly head again this weekend in the northern California news media. And buried in the stories are several themes for our ages. But the conclusion is, the power of individual health systems and very small numbers of physicians to change patterns–and the cost–of care are enormous.

First the stories. Both about health care but also both revealing the future of investigative reporting. The BayCitizen is a non-profit blog about the San Francisco metro, created as response to the local papers cutting their reporting. It also provides stories to the NY Times–I’m unaware about how much of its revenue comes from the Times, but it’s part of  the Times’ entry into non-NY competition with retreating local papers.

For this story on heart program readmission picked up on an older UCSF press release and showed how UCSF used a $500K+ donation from the Gordon & Betty Moore Foundation (that’s the Moore of Intel & Moore’s law fame) to create a very sensible program that gave in-home support to newly discharged elderly cardiac patients. It cut readmission rates by 30%. The BayCitizen though will upset Gary Schwitzer as it did not include the actual numbers but the UCSF press release does, and yes this is a relative not an absolute cut. Here’s the key graf

Over the past 11 months, only 16 percent, on average, of the hospital’s heart failure patients were readmitted within a month of discharge, down from 23 percent in 2006. That’s well below the national 30-day readmission rate of 25 percent. The average readmission rate was 11.6 percent during the first four months of 2011.

So UCSF was about average and got much better and seems to be getting better still–but there’s quite a way to go. But it is an indication that at least one AMC is capable of moving the ball in the right direction. Of course UCSF is a leader in the pro-Dartmouth “use resources sensibly” camp, and we may or may not see the “keep em alive at all costs” folks at UCLA follow suit.

Meanwhile up in rural northern California it looks like the same Dartmouth data set is about to bring a series of visits from the FBI. You may recall the trials and tribulations of Tenet and Drs Chae Hyun Moon and Fidel Realyvasquez at Redding Medical Center–who ended up settling for more than $450m while incredibly not facing criminal charges for unnecessary surgery and Medicare fraud. It seems that basically the same thing is happening again.

What’s interesting is that back in 2002 when the Tenet Redding story was blowing up, it was a qui tam suit from another physician and a patient that revealed the mess. In 2011 the San Francisco Chronicle reported that basically the same thing is going on in Clearlake, another backwater in rural northern California best known for putting on concerts by has-been 70s rock stars. A small hospital with three cardiologists has been using angioplasty and stents at five times the state average. But it wasn’t the Chronicle or a QuiTam suit that exposed the goings on Adventist Health-owned St. Helena Hospital–it was a combination of an academic–Stanford’s Lauren Baker–and the California Health Care Foundation-funded Center for Health Reporting, that tracked down what was happening using the Medicare Data via the Dartmouth Atlas. And the exposure is now producing a furious rearguard action from the hospital, using the “our patients are sicker” line. Good luck guys. Oh, and unlike in the Tenet case, some prosecutors are now going after “unnecessary stenting” with criminal charges such as this possible 35 year sentence on the way for one Maryland cardiologist.

But the big picture is this. Stenting and other debatable procedures are coming under the microscope. And Foundations and academics broadly favorable to the Dartmouth view are going to be playing a bigger role in both exposing the hidden activities of the health care system–a la Clearlake–while other Foundations are going to help promote new ways of care coordination, as at UCSF. And the nature of the new media means that transparency into how health care is delivered will continue to increase. Finally what we’re realizing is in medicine the actions of a limited number of professionals–whether promoting a new system or overusing stents–are highly influential. So we can expect more regulation and interference in individual medical decisions in the future.

(FD-I know Lauren Baker though haven’t worked with him & the CHCF funds some of Health 2.0′s conference activities, although I had no contact with them about this story)

Share on Twitter

1 Response for “Hearts on Fire: a Tale of Two Californias”

  1. Eric Tremont says:

    Keep in mind that the heart failure readmission rates cited by the NY Times are not risk-adjusted. UCSF”s readmission rate might look better than average if it was risk-adjusted.

Leave a Reply

THCB BLOGGERS

FROM THE VAULT

The Power of Small Why Doctors Shouldn't Be Healers Big Data in Healthcare. Good or Evil? Depends on the Dollars. California's Proposition 46 Narrow Networking
MASTHEAD STUFF

MATTHEW HOLT
Founder & Publisher

JOHN IRVINE
Executive Editor

JONATHAN HALVORSON
Editor

JOE FLOWER
Contributing Editor

MICHAEL MILLENSON
Contributing Editor

ALEX EPSTEIN
Director of Digital Media

MICHELLE NOTEBOOM Business Development

MUNIA MITRA, MD
Clinical Medicine

Vikram Khanna
Editor-At-Large, Wellness

THCB FROM A-Z

FOLLOW US ON TWITTER
@THCBStaff

WHERE IN THE WORLD WE ARE

The Health Care Blog (THCB) is based in San Francisco. We were founded in 2004 by Matthew Holt and John Irvine.

MEDIA REQUESTS

Interview Requests + Bookings. We like to talk. E-mail us.

BLOGGING
Yes. We're looking for bloggers. Send us your posts.

STORY TIPS
Breaking health care story? Drop us an e-mail.

CROSSPOSTS

We frequently accept crossposts from smaller blogs and major U.S. and International publications. You'll need syndication rights. Email a link to your submission.

WHAT WE'RE LOOKING FOR

Op-eds. Crossposts. Columns. Great ideas for improving the health care system. Pitches for healthcare-focused startups and business.Write ups of original research. Reviews of new healthcare products and startups. Data-driven analysis of health care trends. Policy proposals. E-mail us a copy of your piece in the body of your email or as a Google Doc. No phone calls please!

THCB PRESS

Healthcare focused e-books and videos for distribution via THCB and other channels like Amazon and Smashwords. Want to get involved? Send us a note telling us what you have in mind. Proposals should be no more than one page in length.

HEALTH SYSTEM $#@!!!
If you've healthcare professional or consumer and have had a recent experience with the U.S. health care system, either for good or bad, that you want the world to know about, tell us about it. Have a good health care story you think we should know about? Send story ideas and tips to editor@thehealthcareblog.com.

REPRINTS Questions on reprints, permissions and syndication to ad_sales@thehealthcareblog.com.

WHAT WE COVER

HEALTHCARE, GENERAL

Affordable Care Act
Business of Health Care
National health policy
Life on the front lines
Practice management
Hospital managment
Health plans
Prevention
Specialty practice
Oncology
Cardiology
Geriatrics
ENT
Emergency Medicine
Radiology
Nursing
Quality, Costs
Residency
Research
Medical education
Med School
CMS
CDC
HHS
FDA
Public Health
Wellness

HIT TOPICS
Apple
Analytics
athenahealth
Electronic medical records
EPIC
Design
Accountable care organizations
Meaningful use
Interoperability
Online Communities
Open Source
Privacy
Usability
Samsung
Social media
Tips and Tricks
Wearables
Workflow
Exchanges

EVENTS

TedMed
HIMSS South x South West
Health 2.0
WHCC
AHIP
AHIMA
Log in - Powered by WordPress.