Author Archives

Matthew Holt

Controlling Health Care Costs by Seduction

Mar 13, 2009• 26

By PETER NESBITT

The past failure of insurers and care providers to control medical costs challenges the Obama health care team to redesign health care to provide broader coverage while managing costs. If the past is any guide, they will fail just as certainly as those who went before. The problem is that those working on the new health care plans do not fully understand why existing plans failed over the past 30 years. The panoply of managed care ideas; HMO’s, rationing, pre-approvals, denial of benefits, denial of service, reduction in fees have all failed to reduce medical costs. If we wish to get past these failures, we need to think about seducing those who control the costs.

The phenomenology of health care shows that medical costs are a function of fees and utilization. Fees are what we pay for a medical service. Utilization denotes the variety of services available. Almost all medical services are performed or ordered by physicians. The ever spiraling cost of medical care amply demonstrates that coercive methods used by insurers and managed care proponents against physicians have failed to bring about the desired results.

If physicians cannot be coerced into cooperating, perhaps they can be seduced.

ARRA: A New Era for Health IT, and for CCHIT – Part 1

Mar 12, 2009• 10

By MARK LEAVITT

When President Obama signed the American Recovery and Reinvestment Act (ARRA) into law, health IT
was catapulted into a new era. I believe this is — and forever will be — the biggest milestone in the history of health IT. I’d like to share my perspectives on it, but it will take several blog posts to cover such a big topic. Today, I’ll start with a high level view of the significance of this event, and talk about some of the confusion that has resulted from the injection of so much new money – and with it, some new politics – into the world of health IT. Then I’ll follow up with posts that delve into the details of how I believe CCHIT will need to evolve in this new environment.

I’m personally struck by the parallels to a historical event still vivid in my memory: Project Apollo, President Kennedy’s incredible national goal of achieving manned spaceflight to the moon.

Apollo cost $22B (in 1969 dollars, now worth five times that) and took 8 years to achieve the first moonwalk. NASA, a new government agency, spearheaded the effort, but the technology was developed by private sector contractors.

The New Landscape of the Health Reform Debate

Mar 12, 2009• 28

By Bill Kramer

In the recent publicity about President Obama’s budget and health reform initiative, an important issue
has not received enough attention. Most reporters, analysts, editorial writers and bloggers have focused on the proposed $634 billion reserve fund, the aim for universal coverage, the reduction in Medicare Advantage payments, the tax on families with incomes over $250,000, and other key features. In the view of many Republicans and others opposed to this approach, the proposal looks like just another version of a “tax and spend” strategy to fix our health care system. There is something different, however, and the health reform battle is moving into new terrain.

In the past, advocates of health reform focused on need to provide access to care for the uninsured. This was (and is) a moral issue – “How can the richest nation on earth let millions of people go without access to decent health care?” To provide universal access, however, required a lot more government spending. This set up a conflict, because every reform proposal had a big price tag, and few politicians were willing to support a program that dramatically enlarged the federal deficit. Many advocates believed that expanding coverage was worth it, but it faced very difficult obstacles due to concerns about the rising government debt load.

Is the Healthcare Economy Rightsizing?

Mar 12, 2009• 34

By Brian Klepper and David C. Kibbe

More than at any time in recent memory, powerful forces are buffeting
the health care sector. We are in
the midst of profound upheaval,
driven by market and policy responses to the industry's long-term
excesses.
We can already see evidence that the dysfunction of our traditional
health system is accelerating. It also seems clear that the center
cannot hold indefinitely.

Dog Eat Dog
It is useful to remember that the health care industry's
different stakeholders are adversaries. While they clearly share a
common understanding that a wholesale meltdown is possible, there is
little real motivation for collaboration and no unity. Independent of
role, the industry as a whole has been focused on, and extremely
effective at, securing dollars from purchasers: government, employers
and individuals. But each silo within the industry has been separately
focused on growing its own slice of the health care pie. In every
niche, there are courteous conceits – access, appropriateness, efficiency and value – reserved
for the good manners of public relations. But these are meaningful in
practice only if they do not conflict with the professional's or the
firm's economic performance.

Commentology

Mar 12, 2009

Carla was one of many commenters who wrote in response to insurance broker John Sinibaldi's thoughtful post on the role that he and his colleagues play in the current healthcare system. ("A Broker's Lament: We Brought This On Ourselves.")

"To get anywhere, we are all going to have to go to a 12 step program and admit our problem: "Hi, my name is Carla and I'm a physician, I'm addicted to our current healthcare system and have been completely focused on pushing through as many patients as possible, because that's what pays."

"Hi, I'm an American patient and I'm addicted to our current healthcare system because it fulfills my every whim and doesn't have time to help me do the hard stuff to improve my health."

"Hi, I'm your health insurance company and I'm addicted to our current healthcare system because it enables me to insert myself in the middle and make a nice profit, without really adding much value."

Mr. Sinibadi, thanks for being the first one to stand up at the meeting."

Christopher George had this to say in response to Dr. Albert Waxman's post on the free market's power to create change. "Innovation + Economics: Keys to Successful Healthcare Reform."

"When I was in medical school, CCJ Carpenter, legendary infectious disease giant, used to brow beat the poor interns for ordering so much as an un-necessary serum calcium level for which a good reason could not be articulated.(At the time probably a $10 test.) The exact opposite of today. No test is too unlikely to order. Again, like a broken record, no meaningful reduction in utilization will happen without tort reform. The un-empowered, demoralized professionally castrated doctor is not the one who will make the decision to NOT order something stupid. Instead, he order out of the fear that it might, in retrospect, if it were positive, seem logical to do. These are the tests that are killing the system."

My forecast: a sad conclusion to the health care bubble…

Mar 12, 2009• 12

Brian Klepper and David Kibbe have written a terrific piece on how and why health care is in a handbasket and wondering where it’s going. But as we ex-futurists know, there’s lots of luck required to make a good forecast.

When I met Brian five years ago he told me that the sky would fall within five years, and at the time he was trying to persuade players in the health care system to self-reform. He suggested to them that the alternative would be soon be much worse.

I said, “no no, it'll take longer (10-15 years) and the system players will never self reform”. Instead I thought “reform” would be be done to them by the government when the system hit crisis. My guess was a combination of Medicare with 5 years of baby boomers on board and a middle class with 80 million uninsured would arrive around 2012–15. And then the brown stuff would be hitting the whirly object soon after that when the Chinese wanted their money back.

As it turns out we were both wrong and both right.

Stimulus Modeling and Accountability

Mar 11, 2009• 1

By JOHN HALAMKA

As well all prepare for the work ahead, many in healthcare are
beginning to model the potential payments and design the reporting
systems needed to account for the money spent.

I've promised to share all the Beth Israel work we're doing as it happens, so here's a near real time update. Our CFO, Steve Fischer used the guidance from the American Hospital Association to compute BIDMC's share. You'll see that we are expecting $6.3 million because we anticipate "meaningful use of EHRs" by all our clinicians in 2011.

Health Affairs is all about IT

Mar 10, 2009• 6

By Matthew Holt

Most of the Health care geek squad is in DC as I write, at a press conference conducted by Health Affairs which has an entire issue out today about IT in health care. Here’s the table of contents. And for those of you who don’t have a subscription, well here are four articles for free including those from David Brailer and John Halamka.

As you might guess KP’s HealthConnect is featured prominently with academic articles about the impact of its installation on physicians & the system (office visits down 25%) and patients (they love it).

There’s lots and lots more, including an article that makes stars of nerdy docs Jay Parkinson, Danny Sands and Ted Eytan—if “star” is the right word for this rarefied environment. (Oh, and somehow Bob Coffield got in there too!) My early tweetings on that one (which is the only one I’ve read so far) were captured and blogged by e-Patient Dave. Converting tweets into a blog post and making it make sense may be the new art form. Be warned that despite the words “Facebook & Twitter” in the title, this is about using Health 2.0 tools for patient to physician communication not about the social networking side of Health 2.0. Still I guess there’s room for another article in the next Health Affairs about that.

The Role Speech Technology Can Play in Helping to Streamline the EHR Transition

Mar 10, 2009• 14

By Keith Belton

Early adopters – the approximately 15 percent of
doctors who use an electronic health record (EHR) system successfully –
are hitting a major speed bump ahead of their peers: EHRs can slow physicians
down.

Too much emphasis is being placed on EHR
deployment and not enough on utilization. In the rush to
computerize patient information, per Obama’s five-year goal that all
medical records go digital, it has been assumed that once EHRs are widely
deployed, patient records will automatically be more complete and shareable, administrative
costs will be cut and that universal quality of care will be enhanced. First,
we have to get doctors to meaningfully use the system…

In a study conducted by Fallon Clinic comparing EHR
technology used as is vs. with speech recognition technology (replacing traditional
transcription and keyboard-only control of the EHR), not only did speech
recognition prove to help doctors capture the patient encounter in more detail;
it helped to save $5,000 per doctor per year in transcription costs and generated
additional reimbursement per encounter.

Better Records On Our Cars Than Ourselves?

Mar 9, 2009• 20

By DOUG KLINGER

Did you ever stop to think that many people probably have better service records for their cars than for
their bodies and minds ?

Having spent many years involved with the collection and management of health data to facilitate predictive modeling, early intervention and disease management, it became clear that doctors, hospitals and insurers typically have far more information about our health than we do.

Maybe the time has come for the US healthcare establishment to follow President Obama’s lead and turn its collective attention to rapidly enabling the collection, storage and private and secure exchange of personal health information in a standardized, cost-effective and efficient manner.