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flying cadeuciiIf another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the Root Cause Analysts might mount their horses, the Six Sigma Black Belts will sky dive and the Safety Champions will tunnel their way clandestinely to rendezvous at the sentinel place.

What might be their unique insights? What will be their prescriptions?

One never knows what pearls one will encounter from ‘after-the-fact’ risk managers. I can imagine Caesar consulting a Sybil as he was being stabbed by Brutus. “Obviously Jules you should have shared Cleo with Brutus.” Thanks Sybil. Perhaps you should have told him that last night.

Nevertheless, permit me to conjecture.

First, they might say that the hospital ‘lacks a culture of safety which resonates with the values and aspirations of the American people.’

That’s always a safe analysis when the Ebola virus has just been mistaken for a coronavirus. It’s sufficiently nebulous to never be wrong. The premise supports the conclusion. How do we know the hospital lacks culture of safety? ‘Cos, they is missing Ebola, innit,’ as Ali G might not have said.

They would be careful in blaming the electronic health record (EHR), because it represents one of the citadels of Toyotafication of Healthcare. But they would remind us of the obvious ‘EHRs don’t go to medical school, doctors do.’ A truism which shares the phenotype with the favorite of the pro-gun lobby ‘guns don’t kill, people kill.’

Continue reading “Six Sigma vs Ebola”

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flying cadeuciiCrowdsourcing is engaging a lot of news organizations today. While some journalists are nervous about crowdsourcing — “Yikes, we’d rather talk than listen, and what if they tell us something we don’t want to hear? Or something that we know isn’t true?” — we here at clearhealthcosts.com love crowdsourcing. We find, as journalists, that our communities are smart, energized, truthful and engaged, and happy to join hands in thinking, reporting and helping us make something that’s bigger than the sum of its parts. We learn great things by listening, so … now we’re going to to an experiment crowdsourcing coverage for our blog.

Our current project crowdsourcing health care prices in California, with KQED public radio in San Francisco and KPCC/Southern California public radio in Los Angeles, has been a great success, as was our previous project with WNYC public radio, and we’re looking forward to launching similar projects with other partners. Continue reading “It Cost What? Crowdsourcing Costs In An Evolving Healthcare System”

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Screen Shot 2014-10-12 at 6.49.00 PMA friend of mine has been living well with lung cancer for five years — working, running several miles a day, traveling, doing good stuff with his family, and generally enjoying the pleasures of everyday life. He knows the cancer will eventually kill him, but has been making the most of every remaining minute.

Then, a month ago, things suddenly turned dramatically south. Severe shortness of breath, constant coughing, sleeplessness, fatigue, loss of interest, anxiety. My friend figured the jig was finally up — that he was going terminal. We all felt sad in the face of this inevitability. In our different ways, we began the painful process of saying goodbye.

Then things seemed to get even worse. I accompanied my friend to visit his lung doctor — an amiable and thorough man who spent lots of time with us, took a good history, and did many tests.

Continue reading “How Not to Talk to Someone Dying of Cancer”

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California-HealthCare-FoundationI am excited to announce that the California Health Care Foundation (CHCF) has just published a report, authored by me, about the state of healthcare Accelerators in the U.S. and around the world. For those of you who don’t know CHCF, it is a very large not-for-profit endowment that has a mission to improve the quality, cost and efficiency of healthcare delivered to the underserved populations of California. In so doing, they also provide a very valuable educational service to the overall healthcare community and fund the creation of reports like this one about Accelerators.

The new report, entitled Survival of the Fittest: Healthcare Accelerators Evolve Towards Specialization is available for download HERE.

This report is intended to update the report that CHCF released two years ago entitled “Greenhouse Effect: How Accelerators are Seeding Digital Health Innovation” about the then emerging field of healthcare Accelerators.   I would have to say that two years later in 2014, these programs have definitely emerged.

Continue reading “Healthcare Accelerators Evolve Towards Specialization”

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new adrian gropper

The essence of controlling Ebola is surveillance. To accept surveillance, the population must trust the system responsible for surveillance. That simple fact is as true in Liberia as it is in the US. The problem is that health care surveillance has been privatized and interoperability is at the mercy of commerce.

Today I listened to the JASON Task Force meeting. The two hours were dedicated to a review of their report to be presented next week at a joint HIT Committee Meeting.

The draft report is well worth reading. Today’s discussion was almost exclusively on Recommendations 1 and 6. I can paraphrase the main theme of the discussion as “Interoperability moves at the speed of commerce and the commercial interests are not in any particular hurry – what can we do about it?”

Health information technology in the US is all about commerce. In a market that is wasting $1 Trillion per year in unwarranted and overpriced services, interoperability and transparency are a risk. Public health does not pay the bills for EHR vendors or their hospital customers.

Continue reading “Ebola Offers a Teachable Moment For Health Information Technology”

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Risa preferred headshotFor the past several months the Robert Wood Johnson Foundation has been promoting a particular vision– of a Culture of Health in America, where everyone  has the opportunity to live the healthiest life possible, no matter their income, or where they live, or work, or play.

With  that vision in mind, geriatrician Dr. Leslie Kernisan asks an important question in her Oct 7 Health Care Blog post, “Why #CultureofHealth Doesn’t Work For Me.”  She writes: “Is promoting a Culture of Health the same as promoting a Culture of Care? As a front-line clinician, they feel very different to me.”

For physicians treating the chronically ill and patients facing the end of life, good health might seem like a pipe dream. Kernisan and some of her commenters even wonder if the phrase “Culture of Health” could be misconstrued as “blaming the victim.”

Continue reading “Let’s Make Sure “Health” Encompasses “Care””

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Open to students of any level, the conference is the largest pre-medical and pre-health professions gathering at an undergraduate institution, and is the only event of its kind, supporting URM students (underrepresented in medicine, as defined by the AAMC) interested in a career in medicine. More than 8,500 pre-medical and pre-health students from California and beyond will attend alongside deans of admissions from top medical, dental, public health, pharmacy and nursing schools.

The American Resident Project is hosting a panel at the UC Davis Pre-Medical & Pre-Health Professionals National Conference this coming Saturday, Octoer 11th. The panel will feature The American Resident Project Writing Fellows Dr. Marisa CamilonDr. Craig Chen and Dr. Elaine Khoong who will discuss what it’s really like to be a medical resident and will be moderated by WellPoint Chief Medical Officer and conference keynote speaker Dr. Sam Nussbaum.

http://www.americanresidentproject.com/

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ACOs

One of the big questions since the inception of the Medicare Shared Savings Program has been whether the model would only work in regions with extremely high baseline costs.  Farzad’s state-level analysis of earlier MSSP results suggested that ACOs in higher-cost areas were more likely to receive shared savings. It’s one of the questions that Bob Kocher and Farzad received in the wake of the op-ed on Rio Grande Valley Health Providers last week.

So we decided to dig into the data.

We’re still waiting for CMS to make baseline costs for ACOs – and the local areas they serve – public. But in the meantime, we linked each ACO to a Hospital Referral Region using the main ACO address provided by CMS – and took a look at the region’s per capita Medicare costs as a predictor of ACO success.

Continue reading “Why ACO Savings Aren’t About Location.”

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Screen Shot 2014-10-08 at 8.26.56 AMThe role of the United States’ antitrust laws are to ensure competition, not to prescribe or favor any particular organizational structure.  Yet recent Federal Trade Commission (“FTC”) enforcement actions in the health care provider merger arena have done just that – dictated that if provider groups want to integrate, they can only do so through contractual means, not by merging their businesses.  Everyone accepts the proposition that health care integration is essential to improving health care and bending the cost curve.  Yet often the FTC has been a roadblock to provider consolidation arguing that any efficiencies can be achieved through separate contracting.[1]  But this regulatory second guessing is inconsistent with sound health care and competition policy.

Health care provider consolidation poses some of the most challenging antitrust issues.  Particularly challenging are efforts by hospitals to acquire or integrate with physician practices.  There is clearly tremendous pressure from both the demand and supply side for greater integration between hospital and physicians.  And arrangements between firms in a vertical relationship are treated solicitously by the antitrust laws, because they are typically procompetitive and efficient.  Where competitive concerns arise from a merger or alliance, the FTC will ask if there are efficiencies from the relationship and, if so, whether there are less restrictive alternatives to achieve the efficiencies.  If there is a less restrictive alternative, the FTC will claim the efficiencies should not be credited.  So for example, if the FTC believes that contractual arrangements between doctors and hospitals can achieve comparable efficiencies, the FTC will reject the merging parties’ claimed efficiencies.

Continue reading “An Open Letter to the FTC on Hospitals and Providers”

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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
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