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QUALITY: Improving health care from within, by Eric Novack

Eric Novack sees hope in the IHI’s 100K lives program which announced impressive results this week, and being Eric, he thinks that there’s a political message in there too. There’ll be more on his show this Sunday.
The Institute for Health Improvement’s ‘100,000 Lives Campaign’ (www.ihi.org) just released the results for the first 18 months:  participation of over 3000 hospitals and an estimated 122,000 lives saved.
 
In a word, astounding.
 
What is more astounding is HOW they did it.  First, the ‘they’ are the organizers of the program and the THOUSANDS OF DOCTORS, PHARMACISTS, AND NURSES who implemented some simple changes in hospitals all over the country.
 
Did they focus on hundreds of best practices and brow-beat institutions into submission?
Did they threaten to not compensate anyone for trying to provide care?
Did they threaten lawsuits?
 
No, No, No.
 
The 100,000 lives campaign focused on 6 simple steps that are essentially universally accepted to be good practices to get the right care, at the right time, in the right place, and to reduce infections along the way.
 
With success breeding more success, more hospitals are continuing to sign up for the programs and looking to expand their involvement in the program further.
 
Most remarkably absent, however, was new federal legislation and government regulation.  May I repeat: no federal bureaucracy was and is required to make improvements to our healthcare system.
 
This, no doubt, is like fingernails on the blackboard for many denizens of The Health Care Blog-osphere.
 
I was fortunate to interview Alexi Nazem, National field coordinator for the IHI’s 100,000 Lives Campaign for my show this weekend.  You definitely want to find time at 3pm west coast time this Sunday to tune in at www.ericnovack.com to hear the whole interview- and to better understand both the IOM ‘To Err is Human’ report and get an insider’s view of patient safety efforts.

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3 replies »

  1. Eric,
    Re “Improving Healthcare From Within,” I agree that IHI is doing a great job. Don Berwick (head of IHI) is right when he says that health care reform will not come about by “someone buying right” (i.e. the consumer can’t lift quality) but through health care professionals pulling together to reduce waste and errors.
    But at this point, they’re badly demoralized.–they need leadership. Just today, a physician in New York told me that the head of nursing at one of the large hosptials here recently confided to him that at this point, she’s “ashamed” to be part of the U.S. health care system.)
    Berwick and IHI are providing leadership– but there is only so much that they can do working with relatively small groups of hospitals.
    The fact that government isn’t involved with IHI’s effort doesn’t prove that govt’s help isn’t needed
    In fact, Berwick himself emphasizes the need for the government (and especially the Centers for Medicare and Medicaid) to take the lead in demanding reform– and funding information technology. In an interivew with GE’s Robert Galvin in Health Affairs (Jan 12,2005), Berwick said:
    ” . . . government is an extraordinarily important player in the American health care scene, and it has inescapable duties with respect to improvement of care, or we’re not going to get improved care. Here’s some of what really counts: Government remains a major purchaser. . . . So as CMS goes and as Medicaid goes, so goes the system. CMS needs to continue to develop to be the best and possible purchaser of care, on behalf of its beneficiaries. To do that through giving more choice to individuals, as I said earlier, is a very weak lead. To do it as an aggregate purchaser, demanding performance, is a very strong lead.
    Berwick continues: “Number two is research. AHRQ [the Agency for Healthcare Research and Quality] does a great job, but with an embarrassingly small budget. We spend less than a fraction of 1 percent of the money on understanding how to configure care systems as we do on providing the pipeline of biotechnology that those care systems supposedly deliver. That’s a misallocation of resources. . . .
    ” So, as we said in the IOM Quality Chasm committee, we need to billionize AHRQ and create an aggressive and well-supported national agenda for public research on better health care systems. That would be really a big win.
    “With respect to the transparency agenda,” Berwick adds, ” much data exists in the hands of government—largely Medicare and also Medicaid—and we should be using the data to improve transparency. I think that government has an essential role in supporting the education of professionals and should be helping to mold that education to create professionals who are better able to help improve care.
    “I have an opinion about the issue that you and I touched on a little bit, which is technical assistance. Where should a hospital or group practice turn for support to improve its work? We can make that a private-sector issue, and you have to find the right consulting firm. But I am biased toward thinking of knowledge about improvement of care as a public good. I like the idea of an agriculture extension service analogue in the government that will help especially small and rural hospitals and physician practices improve their work—as a national investment, not as a consulting gig.
    Berwick concludes “We are beginning to do that with information technology, and it’s crucially important for the work that David Brailer [national health information technology coordinator] has now launched to be heavily supported by government funding.”

  2. J,
    You’re correct to a point, but what you’re forgetting is marketing. Medicaid plans aren’t allowed to market, period, so there are no costs associated with advertising and whatnot, and that could account for a fair chunk of the difference.
    That said, you’re right that there is some admin advantage Medicaid enjoys, since it doesn’t have to submit folks to the underwriting process (you pass the means test, you’re in!), and what’s covered or not covered is laid out pretty clearly. Medicaid plans have finally got religion about maintaining a formulary, too, thank goodness.

  3. Eric, your post about the 3% myth was quite thought provoking, but I think I have an rebuttal to your argument which can be summed up in one word, Medicaid. Correct me if I’m wrong, but I believe that Medicaid’s administrative costs are something like 4-6%. While that is not as good as 3% that still leaves a substantial savings if compared to the 15% to 25% of private insurers. I don’t believe that alone is a good enough reason to switch to single payer, but it does mean that’s one aspect of potential savings if there was a switch.

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