TECH/POLICY/PHYSICIANS:American medical care, or Larry Weed on Speed

(This one is long on links and short on explanation….sorry, but it’s all old ground here on THCB).

Larry Weed was at IHI last week using the same line that he was using in 1998 and was probably using for years before that.

"What’s the point of outcomes data?" Weed wonders. So what if there are four times the rate of prostate surgeries in Salt Lake City as in Denver? "I wouldn’t know whether I should move to Salt Lake so they don’t miss my cancer of the prostate or move to Denver so I wouldn’t have unnecessary surgery."

That statement has been true for a while, but Eliott Fisher et al are basically now showing that care is better in Salt Lake City. As Fisher says in the roundtable in the Health Affairs blog

The increasing fragmentation — almost atomization — of medical care, and a payment system that rewards commercial behavior on the part of physicians that, from all of my work, looks as if it’s on average certainly wasteful and quite often harmful.

The situation is certainly worse in Miami (and the rest of Florida), and it costs a hell of a lot more there. I know that’s true because Brian Klepper says so too! (read down in the article for his quote). And even the pestilent sore-lickers at the NY Times have finally figured it out.

And much of the reason is the inconsistent incentives that, Jeff Goldmsith points out in a recent Health Affairs article, are making the physicians primarily in the Sunbelt leave their compact with the hospitals and open up their own shops/heart hospitals—all of which are turbocharging the natural incentives that FFS gives them to do more anyway. Not that this is exactly hurting all hospitals; some of the biggest of which are having banner years. But while everyone in the business makes hay, there are those who suffer as a consequence.

And we’ve known about this for thirty years and nothing has been done to stop it.

PS. “Larry Weed on Speed” is an Ian Morrison line about the future of the EMR. 25 years later no one is using the Problem Knowledge Coupler. Which is a pity and a problem.

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2 replies »

  1. I, too, attended the IHI event in Florida last week. With 5,000+ attendees and sessions galore, it seems that there is an exploding interest here.
    Dr. Weed is, of course, a luminary and makes good points about pkc. To the point in this blog, it is not about “Salt Lake City vs Denver” for optimizing best care scenario but more of managing the dynamic balance as data becomes available. There are many reasons why the pkc approach is not catching on and it seems to me that logic alone is insufficient to drive this forward.
    I also agree with Eric’s comments – to me that the “trust” in Eric’s “How do I know if I can trust the results?” implies a wholistic level of assurance.
    Matthew, It was good to meet you in person at the Norcal HIMSS and hope your plans to avoid airports till 2007 is working out. Season’s Greetings to you and other readers.

  2. Perhaps if physicians are resistant to using problem/knowledge couplers, patients should use them directly. I see from the PKC Corporation website that an individual can subscribe to all available couplers for $9.99/month or $69.99/year. I am almost compelled to give it a shot. Yet, here is the dilemma. How do I know if I can trust the results? There are so many companies anymore that promote health information, how do I decide which ones are legit? I’m confident that a good decision support program could process my information more efficiently than any human physician. However, I am not confident that I, as a consumer/patient with limited time and technical expertise, could identify which programs are “good.” Of course, at the same time, I don’t really have a system of identifying which of my local physicians are “good.” I guess what I am looking for is a trusted source of rating information for both technological health tools and physicians. However, there is currently too much of a market scramble to be confident in any of the few ratings systems that exist or are in development.