Author Archives

Matthew Holt

HIMSS still raising that neutrality question

Mar 3, 2009• 5

By Matthew Holt

And although the fuss about CCHIT’s corporate issues seems to have been more or less settled, there are still some real questions about the inter-relationships between HIMSS, CCHIT and EVRA.

And frankly it doesn’t really help un-muddy the waters when HIMSS comes out with a guide for providers on how to spend all that lovely money that the Feds just tossed your way as though they’re a neutral body.

They call it the HIMSS Online Buyer's Guide. It’s actually a guide to companies that are exhibiting at HIMSS; or for a mere $395 a year you too can buy an ad in it. Now I know it’s a service from a company that runs conferences, publications and consulting. And given that’s something I do too in a much smaller way I have no problem with them doing that.

But given the influence HIMSS peddles on behalf of (mostly big) vendors, and the real concerns over the neutrality of CCHIT, perhaps they could change their terminology to make it a little more transparent about what this “Buyer’s Guide” actually is—a list of advertisers and vendors, not a neutral publication from a organization that only has providers & buyers at heart.

Health care reform : What we can learn from Costco

Mar 2, 2009• 11

By JANE SARASOHN-KAHN

The most telling point about health reform in President Obama's budget is that, "Some researchers
believe that healthcare costs could be reduced by a stunning 30 percent — or about $700 billion a year — without harming quality if we moved as a nation toward the proven and successful practices adopted by the lower-cost areas and hospitals."

That sentence gives us some grist for forecasting some of the elements of health reform — in particular, the last phrase which talks about moving from higher-cost, unproven health practices to lower-cost proven approaches.

In a post earlier this week, I talked about the importance of understanding practice variations, especially those behaviors that lead to increasing costs without improving health outcomes. Under the New England Journal of Medicine paper's scenario, all practitioners would be incentivized to behave as if they practiced in Salem, Oregon and not Miami, Florida.

What will it take to "move" medical practices? We can take a page out of Costco's playbook to answer this one. Three Costco tactics which keep the business resilient will be relevant to this scenario: standardization, deployment of information technology, and tough negotiations with suppliers.

Commentology

Mar 2, 2009• 9

David Longstreet had this to say in response to Andre Blackman's post last week on the the increasing importance of technology in public health. ("Why Technology is No Longer Optional in Public Health."

"the biggest change in software technology is the growing trend of specialization along industry disciplines. The healthcare field is too complex for "generalist" software developers. Those software organizations that specialize in healthcare have productivity and quality rates orders of magnitude higher than generalist firms.

This should not surprise anyone in the healthcare discipline because healthcare has understood the value of specialization for some time now. Unfortunately there are still software firms whose employees work for a bank one week and a hospital the next week…."

Christopher George wrote in reply to Bob Wachter's piece on the implications of comparative effectiveness research. ("Are We Mature Enough to Make Use of Comparative Effectiveness Research?")

"Because the only case which you discuss is one in which supposedly greedy doctors perform ineffective surgery for profit, one might be left with the impression that the principal problem in healthcare is restraining rapacious doctors.

It is well known in certain segments of the medical community that back surgery, and cardiac angioplasty are largely ineffective. It is also well known that regulators with government sponsorship have a limited grasp of statistics and science, and an uncanny tendency to target effective procedures as often as stupid ones. Don't be surprised if you don't like the result once a soviet style Supreme Extra-ordinary Medical Committee makes enforcable decisions about what heathcare is on your treatment menu.

Remember an early target of those who would use government to eliminate medical progress: The CT scan. The assault on the Cat scanner was nearly successful. When you torture the data enough, a CT scanner can seem like a silly thing to use. Why not practice like they did at the dawn of time?"

The President’s Budget

Mar 1, 2009• 51

By MAGGIE MAHAR

Earlier this week, I suggested that the Commonwealth Fund’s recent proposal for healthcare reform underlines just how difficult it will be to build a sustainable, effective, safe healthcare program for all Americans.

President Obama’s budget reinforces the message. His ten-year $634-billion plan for funding healthcare reform depends on “asking the wealthy to pitch in a bit more” (budget director Peter Orszag’s happy phrase), wringing some of the waste out of Medicare and Medicaid (cuts that are needed, but that will not be popular ); and strong-arming drug makers to raise discounts on Medicare drugs from 15 percent to 21 percent. About half of the money will come from changes in government programs, half from tax increases.

Health 2.0 more interesting than porn!

Mar 1, 2009• 5

By Matthew Holt

Last Thursday I gave a talk to a very high powered group, the National Committee on Vital and Health Statistics. My old colleague Matt Quinn is now working for the soon to be very rich Agency for Health Research and Quality (another HHS agency), and he lined up a series of talks for the committee on non-traditional data sources. Non-traditional, by the way, means about anything that isn’t from one of the huge Federal government household surveys (like MEPS) that’s used by HHS to analyze health care spending and consumption. John Halamka, CIO of BIDMC and Chair of HITSP, gave an excellent summary talk about data sources that are being collated and integrated in Massachusetts. It’s available on his blog here. Bear in mind that a LOT of work has already gone into putting various patient data sets together in that part of the country. The most encouraging thing was how relatively easy it was for BIDMC to interface with Google Health and Microsoft HealthVault, and how problem free those interfaces have been.

My talk was about Health 2.0, and given that it was less familiar to the committee I both introduced the concept of social networking and consumer tools, and discussed how it might be integrated into a national data capture strategy to improve quality reporting and hopefully spur improvements in medical care processes. Both talks are available here. You need to go to 4.48.00 or so to catch where I start. John’s talk is after the discussion

The Obama Health care Budget

Feb 28, 2009• 88

By ROBERT LASZEWSKI

Pieces of the health care portion of the Obama budget are leaking out.

Based upon published reports, the Obama “down payment on health care reform” will include:

$634 billion to help pay for health care reform over the next ten years.
$318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.
Charging wealthier seniors more for the Medicare Part D drug benefit—as is done for Medicare Part B now.
Cutting Medicare HMO payments by $175 billion over ten years.
Reducing Medicare hospital payments by $17 billion over ten years by bundling inpatient and outpatient reimbursement to include the 30-days after discharge.
Cutting Medicare hospital payments by $8.4 billion over ten years for re-admissions resulting from substandard care.
Requiring drug makers to increase the rebates on drugs sold to Medicare patients from 15% to 21% saving $19.5 billion over ten years.

Are We Mature Enough to Make Use of Comparative Effectiveness Research?

Feb 27, 2009• 39

By ROBERT WACHTER, MD

Thanks to White House budget director Peter Orszag, a Dartmouth Atlas aficionado, $1.1 billion found its way into the stimulus piñata for “comparative effectiveness” research. Terrific, but – to paraphrase Jack Nicholson – can we handle the truth?

In other words, are we mature enough to use comparative effectiveness data to make tough decisions about what we will and won’t pay for? I worry that we’re not.

First, a bit of background. Our health care system, despite easily being the world’s most expensive, produces (by all objective measures) relatively poor quality care. Work begun 3 decades ago by Dartmouth’s Jack Wennberg and augmented more recently by Elliott Fisher has made a point sound-bitey enough for even legislators to understand: cost and quality vary markedly from region to region, variations that cannot be explained by clinical evidence and do not appear to be related to health care outcomes. In other words, plotting a 2×2 table with costs on one axis and quality on the other, we see a state-by-state Buckshot-o-Gram.

Three key conclusions flow from this “variations research”:

Lots of what we do in health care is costly and ineffective
We must somehow goose the system to move all providers and patients into the high quality, low cost quadrant on that 2×2 table; and
Better evidence about what works would help with such goose-ing.Continue reading…

For the Obama Administration Health Care Reform Will Require Tough Cost Containment

Feb 27, 2009• 26

By ROBERT LASZEWSKI

The President has made a powerful argument— America cannot get its economic house under control without comprehensive health care reform. The cost of existing entitlements – public and private —and any new ones are just too big a ball and chain on our short and long-term economic health.

The
President has also argued that there could be no better time to fix
this mess than now—when it is so critical to get our economic house in
order once and for all.

The President is right on both counts.

As any of us who have studied this issue know, the number of those uninsured in America are not really the problem—they are a symptom of health care costs
run amuck as individuals, employers, and government just can’t afford
to insure everyone. Adding more people to this unaffordable mess
without fixing it first is not an answer—it’s a prescription for even
more fiscal irresponsibility.

Novel Data Sources for Quality Improvement

Feb 27, 2009• 1

By JOHN HALAMKA

This Thursday I gave a presentation to the National Committee on
Vital and Health Statistics (NCVHS) about measuring quality using
“traditional” and emerging, novel sources of healthcare data.

My
definition of traditional data sources that are currently used to
measure quality includes administrative claims data aggregated from
hospital-based claims databses (for example, BIDMC has an Oracle
respository called Casemix), payer-based databases (all have a claims
warehouse to support disease management), physician organizations (Beth
Israel Deaconess Physicians Organization has worked with Heathcare Data Services to create all payer business intelligence tools ) and health data consortia (such as the Massachusetts Health Data Consortium offers de-identified aggregated claims to enable institutional comparisons)”

Commentology

Feb 27, 2009

Helen Darling of the National Business Group on Health wrote in to comment on the thread on Robert Laszewski's post on the realities behind the Obama health plan. ("For the Obama administration health care reform will require cost containment.")

We have known for many years that we have a wasteful health care system full of overuse, misuse and underuse. The system is not getting better and people are less healthy than ever. It is exciting and inspiring that we have political leaders who are willing to fight the tough and thankless battles that they will have to fight to get us on the right track as a nation. While there will be plenty of specifics to make everyone unhappy about one element or another, can't we all pull together to have a much better, more effective and affordable health care system for the good of the country?

In the thread on MEDecision CEO David St. Clair's post over the brewing battle over privacy in Washington "Consumers Need All the Facts in the Privacy Debate" Inchoate but Earnest writes:

"At present "healthcare privacy" is a wraith, a boogeyman, & like most boogeymen, it is foisted upon the innocent by people, by institutions, that would retain power over them. The unknown deserves respect, but rarely fear …"