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Hospitals Helping Hospitals Be Better Hospitals

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The moment that an accreditation team shows up unannounced can spike the pulse of even the most seasoned hospital executive. The next several days will amount to one big exam for the safety and quality of care, as surveyors meet with executives, managers and care teams, and watch first-hand as care is delivered. Make the wrong move or give a wrong answer, have them see rust on a ceiling sprinkler, and your hospital may get dinged. Get dinged too many times or have findings of serious patient risks, and your accreditation (and the federal funds attached to that) may be in jeopardy.

This is a useful and essential exercise. It makes sure that hospitals are doing what they’re supposed to. For example, do they have an infection prevention and control plan? Do they conduct fire drills? Do they inspect, test and maintain medical equipment? Do doctors sign their orders and notes?

Regulators have been innovating how they evaluate hospitals to make their reviews more meaningful and impactful for patient safety. Yet, if we truly want to strive for the best possible care, end preventable patient harm and reduce needless costs, meeting regulations alone isn’t nearly enough. Regulations may help identify the “bad apples” and ensure compliance with minimum requirements. Yet these regulations alone have not been enough to transform a health care system that still harms patients too often, improves too slowly, wastes too much and innovates too little. How do we help hospitals to excel?

Join Health 2.0’s Free Webinar To Hear the Potential Impact on Health Tech from Repeal & Replace

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Register for Live Webinar To Hear Experts Discuss The Future of Health Tech

In the last week, the Republican Congress introduced the AHCA. What does this mean for the health tech industry, and how will this impact the growth rate of health technology?

Join Health 2.0’s Indu Subaiya and Matthew Holt as they tackle these questions and more with policy expert Josh Seidman from Avalere Health during the Repeal and Replace: Impact on Health Tech Webinar on March 23, 2017 at 10 AM PST.

Get the latest perspective on what the repeal/replace will mean for startups/entrepreneurs, whether companies will benefit from these changes, and if Medicaid is cut, what does it mean for hospital spending?

Space is limited so register today to secure your spot for the free webinar.

Deepa Mistry is the Operations & Marketing Manager of Health 2.0.

A Doctor’s Dilemma: A Case of Two Right Answers

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Imagine you are a doctor running a clinic in a primarily lower-income neighborhood, where many of your patients are recent immigrants from different parts of the world. You are granted a fixed annual budget of $100,000 through your local public health department, and it is unlikely that you can obtain additional funding later in the year. Traditionally, you have used your entire budget for the past several years, which usually lasts from January until December. This allows you to care for all of the few thousand patients who come to you for treatment throughout the year.

One day in January, a frightened, thin young man appears to the clinic with a folder of medical records. He is accompanied by his aunt, who explains to you that he has recently traveled from El Salvador, where he was diagnosed with a rare type of cancer that, if untreated, will result in his death within 6 months. After further inquiry, you determine that his cancer is treatable, but will require $50,000 of your budget to save his life. What do you do?

Thinking Through the Moral Dilemma

The ethical dilemma in this case is one that physicians and public health practitioners confront often, particularly in very low-resource settings: the care of the individual versus the equitable distribution of resources to the society at large. For this case, treating this single patient means that there will not be enough money to treat all of the other patients who come to the clinic over the course of the year. In economic terms, we might say that his care is not cost-effective because for the same amount invested in supplying the clinic, we could prevent many more deaths or disability adjusted life years (DALYs) for a greater number of patients. However, allowing a patient to die of a treatable condition feels wrong on many levels.

Thinking through this further, we must look closely at our values as a country and a health system: thanks to EMTALA, we ensure that no patient will ever be allowed to die of an emergency condition while in a hospital; thus, we value saving people from imminent, preventable death.

Ayasdi–Big Data changing hospital operations

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One of the more interesting companies playing in the analytics space is Ayasdi. We’ve featured them at Health 2.0 a couple of times, but at HIMSS I got a chance to talk a little more in depth with chief medical officer Francis Campion about exactly how they parse apart huge numbers of data points, usually from EMRs, and then operationalize changes for their clients. The end result is more effective care and lower variability across different facilities, for example changing when drugs are delivered before surgery in order to improve outcomes. And increasingly their clients are doing this over multiple clinical pathways. They’re really on the cutting edge of how data will change care delivery (a tenet of our definition of Health 2.0) so watch the interview to hear and see more!

Trump Friend & Ally: “Donald, Build Universal Healthcare!”

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Opinions are flying. Opinionators with a plan to fix healthcare in America are suddenly as common as waiters with a script in Santa Monica. Few are worth a second glance. They fall into the “that’ll never pass” pile or the “that’ll never work” pile.

So why should we pay any attention to Christopher Ruddy’s idea? Because he’s a prominent conservative, the CEO of Newsmax, and a long-time friend and ally of Trump—and he is advocating for at least a “lite” version of universal coverage.

Insurance Is Not the Problem. It’s Also Not the Solution

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Most everyone is talking about Healthcare lately and I just can’t take it anymore and had to send out a primer, because there is so much bad information being floated.  I don’t like the ACA replacement because the idea is still based on the premise that you can give-away insurance as an entitlement program.  The problem is that you can’t “give-away” insurance, it’s an oxymoron, if there is no skin in the game for the insured they’ll never care.

I’m an insurance guy and Trump voter.  I only point this because I want you to know that my healthcare recommendation is heartfelt and I offer it with no real bias other than offering my experience and expertise on the matter.  My idea is just an independent thought and many Republicans, Libertarians and Democrats would hate it, but I think Trump (the Independent) would love it.  And I feel it’s the only way for Trump to try and “solve” the healthcare problems in the U.S. and keep his commitment that “all” would be covered.

Value-Based Purchasing and “Free Lunch Syndrome”

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Imagine that a drug company released a “study” that claimed to find that if all 75 million Americans with high blood pressure took the drug company’s hypertension drug the nation’s annual medical expenditures would drop by $20 billion. Imagine as well that the “study” failed to take into account the $40 billion cost to patients and insurers of buying all those hypertension drugs. Such a study would be roundly criticized for failing to take into account an essential component of cost – the cost of the intervention that led to lower medical expenditures.

But studies like the hypothetical drug company study appear constantly in the health policy literature. Almost all peer-reviewed papers that examine managed-care interventions – HMOs, ACOs, “medical homes,” “value-based purchasing,” etc – fail to report the cost of the intervention. Instead, they measure only medical costs or medical utilization rates. If they find that costs or utilization rates fell, the vast majority of studies imply or come right out and claim that “costs“ went down. This unethical practice is so widespread and so chronic I propose we give it a name. I propose we call it the “free lunch syndrome.”

Bridget Duffy: Improving the patient experience

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Bridget Duffy, the CMO of communications tech company Vocera & head of its Experience Innovation Network, is a national leader in the patient experience movement. And we all agree there are lots of improvements needed in the experience for both patients and front line clinicians. Anyone following the story about the death of my friend Jess Jacobs last year knows that there are problems a plenty in how patients are treated (pun intended). Bridget talked with me at HIMSS17 about how well we’ve done and how far we have to go.

CBO 24 GOP 0

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If you carve a huge chunk of revenue out of Obamacare and shift more subsidies to the middle class it should not be a surprise that the lower income folks will pay the price

The Congressional Budget Office (CBO) has estimated that 14 million  people would lose coverage in 2018, 21 million in 2020, and 24 million in 2026 if the House Republican plan is allowed to significantly amend the Affordable Health Care Act (Obamacare).

In my last post, I called the House Republican bill “mind boggling” for the negative impact I believe it would have on the number of those uninsured and the viability of the individual insurance market. Guess the CBO agrees with me.

The CBO’s report came after the Brookings Institute estimated 15 million people would lose Medicaid and individual health insurance coverage at the end of ten years under the Republican plan. The arguably more business oriented S&P Global estimated between 6 million and 10 million people would lose coverage between 2020 and 2024.

The Vanishing Hospital: ASCs Follow the Consumer

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Call it what you want, disruption or evolution, but when two of the largest for-profit hospital chains, HCA Healthcare and Tenet Healthcare, and one of the largest insurance intermediary services companies, Optum (part of UnitedHealth Group), invest billions of dollars in capital for building new care settings, everyone should take notice. From freestanding ambulatory surgery centers (ASCs), to urgent care centers, to retail pharmacy-sponsored clinics and employer co-located clinics, the disruption of care delivery is all around us.

How does General Community Hospital compete with Walmart, CVS and Walgreens (retail clinics)? How does it compete with Urgent Care Centers? How will it compete with freestanding ASCs? How does a hospital stop consumers’ desire for savings and convenience? How does it stop physicians’ own desire for convenience and efficiency? This is the disintermediation of hospitals in a very big way! General Community Hospitals can zero base care, but they need to have answers more in line with a consumer retail operation than those of a charity. How many product lines does a focused factory operate?