There is a consensus that measuring performance can be instrumental in improving value in U.S. health care. In particular clinical areas, such as cardiac and intensive care, measurement has been associated with important improvements in providers’ use of evidence-based strategies and patients’ health outcomes over the past two decades. Perhaps most important, measures have altered the culture of health care delivery for the better, with a growing acceptance that clinical practice can and should be objectively assessed.
Nevertheless, as we argue in the full-length version of this paper, substantial shortcomings in the quality of U.S. health care persist. Furthermore, the growth of performance measurement has been accompanied by increasing concerns about the scientific rigor, transparency, and limitations of available measure sets, and how measures should be used to provide proper incentives to improve performance.
The challenge is to recognize current limitations in how measures are used in order to build a much stronger infrastructure to support the goals of increased accountability, more informed patient choice, and quality improvement. In the following paper, we offer seven policy recommendations for achieving the potential of performance measurement.
1. Decisively move from measuring processes to outcomes.
There is growing interest in relying more on outcome measures and less on process measures, since outcome measures better reflect what patients and providers are interested in. Yet establishing valid outcome measures poses substantial challenges—including the need to riskadjust results to account for patients’ baseline health status and risk factors, assure data validity, recognize surveillance bias, and use sufficiently large sample sizes to permit correct inferences about performance.
2. Use quality measures strategically, adopting other quality improvement approaches where measures fall short.
While working to develop a broad set of outcome measures that can be the basis for attaining the goals of public accountability and information for consumer choice, Medicare should ensure that the use of performance measures supports quality improvement efforts to address important deficiencies in how care is provided, not only to Medicare beneficiaries but to all Americans. CMS’ current focus on reducing preventable rehospitalizations within 30 days of discharge represents a timely, strategic use of performance measurement to address an evident problem where there are demonstrated approaches to achieve successful improvement . Read more.
Continue reading “Seven Policy Recommendations for Healthcare’s New Era”
Filed Under: OP-ED, THCB
Tagged: clinicians, Featured Posts, Harlan Krumholz, Hospitals, Measurement, Patient Safety, Patients, Peter Pronovost, Policy, Quality, Robert Berenson, RWJF, Urban Institute
May 31, 2013
A seasoned colleague recently told me that some PowerPoint presentations have no power and make no point.
But sometimes, a picture really is worth a thousand words. Or maybe — in the case of any meaningful discussion of health reform, thanks to its density and complexity — it might be worth 10,000 words. Hence our handy little exhibit.
This picture captures the 10,000 words it would require to explain with technical precision where President Obama’s Affordable Care Act fits relative to all health reform plans. It places “ObamaCare” along an ideologically scaled continuum of all serious reform options developed, debated and discarded or ignored since the 1980s.
They are all here: from the single-payer, centrally controlled models popular with those who detest corporations and the influence of money in medicine — two actual, not imagined “government takeovers of health care” — to two free market, laissez-faire models favored by those who detest regulation and the heavy hand of government in medicine.
Continue reading “Obamacare In Pictures”
Filed Under: OP-ED, THCB
Tagged: Affordable Care Act, Costs, David Goldhill, HillaryCare, Medicare For All, Multi-State Plans, Obamacare, Policy, Single payer
Mar 2, 2013
“Just look at this second sentence!” groaned Samuel Adams. “‘We hold these truths to be self-evident . .’ This flies in the face of ‘evidence-based practice’! We’ll never get funded!”
Another delegate had a different complaint: “This mission statement is way too long!” he wailed. “Mr. Jefferson, no one will ever read this ‘Declaration of Independence’ of yours.”
In the meantime, George Washington had been working up a budget for the revolutionary war (earlier called the innovative war). His initial figures were daunting: $37 million would have to be raised by the collaborative, which would need to be matched by $114 million from the states. And of course, they didn’t have a dime (or rather, a shilling).
But let’s go back to the meeting, where they had just decided to give the collaborative a name: the Continental Congress.
The meeting chair pounded his gavel: “Next on the agenda is Fundraising Prospects. Mr. Hancock, your report?”
John Hancock looked up, startled, but recovered his poise: “We’ve developed a list of foundations to approach. Unfortunately, none of them have giving areas that include democratic revolutions, perhaps because there hasn’t been a democratic revolution before. They also want to know who else is funding it, and how we’re going to continue the funding when their grants run out. And several of them aren’t funding right now because they’re doing something called ‘strategic planning.’ Continue reading “The Founding Fathers Write a Grant Proposal”
Filed Under: THCB, The Business of Health Care
Tagged: donor prospecting, Founding Fathers, Grant writing, Jan Masoaka, Policy, The States
Feb 15, 2013
If you study misdiagnosis you realize how often patients get the wrong diagnosis.
But what do expert doctors think about how often it happens? And what do they think can be done to address it?
We wanted to find out so we partnered with the National Coalition on Healthcare to conduct a landmark, nationwide survey. We surveyed 400 cancer specialists from our Best Doctors database – and the findings were provocative.
The survey, “Exploring Diagnostic Accuracy in Cancer: A Nationwide Survey of 400 Leading Cancer Specialists,” focused on what doctors believe to be the most significant barriers in efforts to accurately diagnose cancers; the types of cancer they believe are most often misdiagnosed; and the tools and improvements they most need to combat misdiagnosis.
One of the most surprising findings was on how often doctors believe misdiagnosis happens. While published studies show that misdiagnosis occurs in about 15-28% of cases, the large majority of doctors we surveyed thought it happens in less than 10% of cases. At the same time, doctors recognized that the root causes of misdiagnosis were very prevalent – fragmented medical information, disparities in experience among pathologists and other factors.
So – how to explain the difference in doctors’ perceptions and the published research? I think it is because there is no systematic feedback loop for doctors letting them know of inaccuracies in their care. If you diagnose someone and they go on to get treatment someplace, and it’s later discovered that a diagnosis wasn’t exactly right, the original doctor may never find out about it. If you don’t hear about it, you can’t be blamed for thinking this problem is rare. It also means you miss out on the opportunity to improve the quality of care that these cases represent.
Another interesting point. Doctors reported that, regardless of how often they thought diagnostic inaccuracies happened, it is a problem that needed more attention from policy-makers. As NCHC President and CEO John Rother observed, “Not enough is being done on the state and federal policy end of things to acknowledge and firmly address this critical issue. Given our current health care climate and challenges, as decision-makers become more aware of the frequency of misdiagnosis and the enormous costs associated with it, they have a sizeable opportunity to make diagnostic accuracy much more of a ‘front and center’ issue in health care.”
Here’s to that promising thought.
Evan Falchuk is Vice Chairman of Best Doctors, Inc., where this post originally appeared. Prior to joining Best Doctors, Inc., in 1999, he was an attorney at the Washington, DC, office of Fried, Frank, Harris, Shriver and Jacobson, where he worked on SEC enforcement cases. This post originally appeared on Best Doctors, Inc.’s See First Blog.
Filed Under: Hospitals, THCB
Tagged: Evan Falchuk, John Rother, Misdiagnosis, National Coalition on Healthcare, Physicians, Policy, Quality
Feb 1, 2013
Today I’m speaking at the ONC annual meeting as part of panel discussing interoperability.
For years, patients, providers and payers have complained that EHRs “do not talk to each other.”
By 2014, I expect this issue to disappear.
Do I expect that every state and territory will have a robust, sustainable healthcare information exchange by 2014? No
Do I expect that every provider will be connected to a Nationwide Health Information Network by 2014? No
Do I expect that a single vendor will create a centrally hosted method to share data by 2014 just as Sabre did for the airline industry in the 1960′s? No
What I expect is that Meaningful Use Stage 2 will provide the technology, policy, and incentives to make interoperability real.
Stage 2 requires that providers demonstrate, in production, the exchange of clinical care summaries for 10% of their patient encounters during the reporting period. The application and infrastructure investment necessary to support 10% is not much different than 100%. The 10% requirement will bring most professionals and hospitals to the tipping point where information exchange will be implemented at scale, rapidly accelerating data liquidity.
Continue reading “Are We Finally Seeing the Dawn of the Golden Age of Interoperability?”
Filed Under: Uncategorized
Tagged: Blue Button initiative, Care coordination, EHR, health information exchange, Interoperability, John Halamka, Meaningful Use Stage 2, ONC, Policy
Dec 12, 2012
We were coding up a storm yesterday (Saturday) at the Health 2.0 Developer Challenge Code-a-thon and that goes on today–you can even stop by the PariSoma Loft to see the live judging at 3pm — with $13,000 in prizes on the line.
But the main act is starting up TODAY with 4 fabulous pre-conferences. Don’t forget these are FREE to anyone registered to attend the main conference and to doctors, patients and employers as appropriate for their sessions. There’s also an Innovation Exchange with the Beacon Communities which has some public availability.
The Pre-Conferences: Patients 2.0 brings together more than 150 patient activists. Doctors 2.0 has several leading physicians on stage and in the audience, and more than 15 demos and active panel discussions. Employers 2.0 has leading employers again on stage and in the audience (Wanna meet Facebook’s head of benefits? -scan the badges!) and more demos than you can shake a stick at–as long as some cool case studies from Pfizer on wellness and Cisco on worksite clinics. Continue reading “Pre-Conferences kick off Health 2.0″
Filed Under: Health 2.0, Matthew Holt
Tagged: e-patients, EHR, Health 2.0, Jane Sarasohn-Kahn, Policy
Sep 25, 2011
If you’re near or in Chicago next Weds (April 27) and you care about health data, applications or innovation, we highly recommend that you get to a Community Forum on the Health Data Initiative. The formal invite & details follow–Matthew Holt
James M. Galloway, MD, Acting HHS Regional Director and Regional Health Administrator, Region V invites you to a community dialogue hosted in Chicago on the Health Data Initiative with Todd Park, HHS Chief Technology Officer. Todd Park joined HHS as Chief Technology Officer in August 2009. In this role, he is responsible for helping HHS leadership harness the power of data, technology, and innovation to improve the health and welfare of the nation.
One of his priority projects, on behalf of Secretary Sebelius, is the Community Health Data Initiative. The Community Health Data Initiative is a public-private collaboration among federal, state, local and private organizations, that aims to make indicators of health available to a broad array of users. Health indicators represent data from populations or groups of individuals that can be used to reflect health trends or differences in health status, cost, quality, and health system performance.
This is an opportunity for public health officials, businesses, academic institutions, providers, hospitals, health plans, and advocates to learn more about the Community Health Data Initiative, in particular, on the use of health and health care data to improve performance. More information on the initiative can be found at http://www.hhs.gov/open/datasets/communityhealthdata.html.
We hope that you can join us in a community dialogue with Todd Park!
When: Wednesday, April 27th from 2 – 4 p.m.
Where: The MidAmerica Club (inside the Aon Building)
200 E. Randolph, 80th Floor
Chicago, IL 60601
Why: You can help improve the health of our nation and the reach of this program in our community.
RSVP: Space is limited. Please RSVP for this free event by Friday, April 22nd to Ms. April Dublin at firstname.lastname@example.org or 312-353-1385
Filed Under: THCB
Tagged: EHR, Health 2.0, HIT, Medicare, Obama administration, Policy, Startups
Apr 18, 2011
To no one rational’s surprise, a study confirms that those few Oregon patients (400 over 10 years) who chose legal physician assisted suicide in case of terminal illness had a better quality of death than those who didn’t. Sadly because those attacking it aren’t rational, this won’t end the debate–but if you’re terminally ill you have better choices in Oregon (and Washington & Switzerland).
Filed Under: micro
Tagged: Policy, Quality
Mar 30, 2011
Catalyst for Payment Reform is a new organization set up by several large employers. The organization’s goal is to pay for health care differently, and make sure that those employers run ahead of any Medicare payment reform coming down the track. Suzanne Delbanco, formerly of Leapfrrog, is now the first Executive Director and Founder of the new organization. Last week I interviewed her about what the organization is going to do, what employers care about, and (despite decades of employers being simple price takers in health care) why this time it’s going to be different.
Keep watching to the very end to see the great view from Suzanne’s office!
Filed Under: Matthew Holt
Tagged: Employers, Policy
Nov 12, 2010
I was absolutely delighted that after several polite “maybe later” responses I was able to recently interview Victor Fuchs, the Henry J. Kaiser Professor Emeritus at Stanford University. Vic is best known as the “Father of Health Economics” and perhaps less well known (but more importantly to me!) the professor who taught the first health economics class that I ever took.
Matthew Holt: Victor, thanks so much for agreeing to come on THCB. I must admit Vic when I joined your class I had no idea about your background and reputation in health economics. So, I was just delighted to figure out that I blundered in right at the top. It’s a real pleasure to have you on the line
Victor Fuchs: I think you’re doing a great job and therefore I’m glad to spend some time with you.
Matthew Holt: Fantastic! You’ve, obviously, been observing and commenting on– and more recently sort of promoting ideas around –health reform for quite a while now, so let’s jump into a couple of things that you’ve published very recently, in fact just these past few weeks.
The first is a paper in The New England Journal of Medicine about a conceptual future for new biomedical innovation and I’d be grateful if you could just explain just a little bit what your general concepts are here. You’ve been working on this for quite a while. In fact, back when I was in your class, you were publishing some stuff with Alan Garber about technology assessment and this is sort of a continuation to that in some ways. So, I’d love to hear your thoughts.
Victor Fuchs: Well, I think there were two key elements here, one of them better understood by a larger audience and one of them I think rather new. Let me do the new one first. The new one is that we are going through what I call the second demographic transition.
The first transition was when every country had high mortality and high fertility and then the mortality especially of young people started to drop, but fertility did not drop right away, so you had a divergence there and in some cases it lasted for a couple of decades and during that time the population soared because there was this discrepancy between mortality and fertility.
You see the high fertility made sense when mortality was high because you wanted to have at least a couple of children survive to adulthood, but when mortality dropped it didn’t sink into people’s consciousness right away, so it took quite a bit of period which the historians and the demographers referred to as the demographic transition, okay. I don’t know if you’re familiar with it or not, but –
Matthew Holt: Yeah, I get the concept and there’s been some stuff written about that in terms of the impact on social security and healthcare.
Victor Fuchs: And some of the third world countries are going through it now, but now the second demographic transition is the one that I talk about in the NEJM piece a little bit. It has the following elements.
First is that a very large and increasingly large percentage of the population cohort lives until age 65, whereas at the beginning of the 20th century only a small percentage lived until 65. Now we’re going to 80% and we’ll eventually approach close to a 100% living till 65.
The second element is that life expectancy at 65 is increasing and it’s increasing at a quite brisk pace in recent decades. You put those two things together and you find out a very large and growing percentage of all the additional years that are lived if you have increasing life expectancy will be lived after 65.
Continue reading “Vic Fuchs Speaks!”
Filed Under: Matthew Holt, Superhealthanomics
Tagged: Dartmouth Atlas, Economics, Policy
Sep 19, 2010