Author Archives

Matthew Holt

Rating Doctors Like Restaurants, by Bob Wachter

Dec 4, 2007• 19

Robert Wachter is widely regarded as a leading figure in the modern
patient safety
movement. Together with Dr. Lee Goldman, he coined the
term "hospitalist" in an influential 1996 essay in The New England
Journal of Medicine. His most recent book, Understanding Patient
Safety, (McGraw-Hill, 2008) examines the factors that have contributed
to what is often described as "an epidemic" facing American hospitals.
His posts appear semi-regularly on THCB and on his own blog "Wachter’s World."

So Zagat will now be rating doctors, using the methods it perfected helping you find the best sushi in Brooklyn Heights. What’s next, Consumer Reports rating grad schools? Fodor rating auto mechanics?

Whatever you think of Zagat’s cross-dressing, it again demonstrates
the bottomless market for doctor rankings. HealthGrades, the Colorado
company that breathlessly delivers its “200,000 Americans died from
medical errors in 200X!” pronouncements every year (grabbing a bunch of headlines, despite the fact that this report is based on measures that were not intended for this purpose and really aren’t measuring deaths from errors), appears to be doing quite well,
thank you, largely fueled by its doctor ratings. And every metropolis’s
city magazine has its “[Your City’s Name Goes Here]’s Best Doctors”
issue, based almost entirely on peer surveys. Most docs scoff at these
ratings (particularly docs like me who haven’t made their city’s list),
but they clearly move magazines. [I’ll discuss hospital rankings,
especially US News & World Report’s Best Hospitals list, in a future posting.]

POLITICS: Jonathan Cohn confesses on the Obama 15 million problem

Dec 4, 2007• 2

Apparently the 15m uninsured in Obama’s plan are all Jonathan Cohn’s fault. At least the picking up on that number by Hillary and Edwards in the debates, that is.

I’m still struggling with how Obama is correctly to the left of those guys on the only foreign policy that really matters but in a foolish place on health care. Anyone relying on David Cutler for advice on health care must be seriously internally conflicted over what the aim is! After all Cutler seems to be too.

More on that to come later this week; but my explanation is that Obama shares my belief that health reform is impossible in 2009—so why bother?

POLICY: The Proper ASD Policy Begins with Listening to Parents, By John Whitmer

Dec 3, 2007• 3

On November 24, 2007 Senator Clinton announced her "Plan to Help Children and Families Affected by
Autism." While the Senator should be commended for finally paying attention to the
issue in her presidential campaign and while other candidates should take note, her plan isn’t really a plan at all.

The "plan" calls for spending 700 million dollars to primarily fund research "to identify
causes of autism and monitoring its impact across the country. The Combating Autism Act of 2006, which Clinton co-sponsored, appropriates 500 of that 700 million. Therefore, the plan really only calls for an additional 200 million. Meanwhile, not one penny of that original 500 million has been spent. Perhaps the Senator needs
to look first into seeing that her original policy gets implemented.
In fact, Senator Clinton should lead the charge in Congress to fully fund the Individuals with Disabilities Education Act(IDEA); this would go a long way in solving the issue of "encroachment" that
school districts across the nation are facing.

POLICY: What next in the fight against AIDS?

Dec 3, 2007• 2

Susan Blumenthal updates us on World Aids Day which was last Saturday.

PODCAST: Overtreated, Shannon Brownlee explains all

Dec 3, 2007• 14

I am so so far behind getting my transcripts of podcasts up here that it’s not funny. But this was one of the most recent and one of the most fun that I’ve ever done. It was a discussion with Shannon Brownlee. author of Overtreated, of which everyone in America should be forced to read at least the Cliff Notes version. (Warning, it’s long and the two of us had far too much fun talking with each other….)

Matthew Holt: It’s Matthew Holt with the Health Care Blog, and I’m back with yet another podcast. This time I’m talking with Shannon Brownlee. Shannon is a senior fellow at the New America Foundation and, more importantly, has just written a great book called "Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer." Shannon, first of all, thanks for coming on The Health Care Blog. I’m really excited to have you here.

Shannon Brownlee: Oh, I’m delighted to be with you.

Matthew: My feeling about reading this book is that I thought I knew all this stuff. I’m sure in the last 15 years of hanging out in healthcare, I know all the Wennberg stuff, and I’ve known all this and I’ve known all that. I pretty well read all the studies. I’ve got to confess that when I read the first chapter, and you can introduce the first chapter in a little bit, it’s kind of like a homage to Jack Wennberg. You went and hung out at Dartmouth and it’s kind of almost like a folksy introduction to his character.

And I guess I started reading this and going, yeah, but is this is a serious way to treat a health policy issue. So why did you go about starting in that fashion?

Shannon: I started it that way because I found Jack Wennberg to be one of the most interesting people I’ve ever met, and the fact that he kept plugging away at this idea that started, oh gosh, almost 40 years ago, now 40 years ago, that he saw this enormous variation in practice patterns in the state of Vermont, and sort of puzzled over it and puzzled over it and puzzled over it. And then he finally started to say, "Yeah, this is real, there’s a variation in practice patterns. It’s not driven by how sick patients are. It’s driven by what the doctors are doing."

Health Care Reform: What Do Americans Want? (Or Think They Want?)

Nov 30, 2007• 22

By MAGGIE MAHAR

On the surface, it seems that American voters have made their will clear. Poll after poll shows that they are calling for a major overhaul of our health care system. But when you look closer, their responses bristle with contradictions and discrepancies that I think the reform-minded presidential candidates will have to consider when deciding how to approach health care reform.

In a poll reported in Health Affairs at the end of last year, sixty-nine percent of respondents rated the US system as “fair” or “poor.” Yet in the same survey, when asked about their own experience with receiving medical services or with their own physician, 80 percent who had received care in the last year ranked their care as “excellent” or ”good.”

Other polls reveal the same pattern.

According to a survey released by Greenberg Quinlan Rosner in July, voters express doubts about the quality of the American health care system (with 49 percent dissatisfied), while 74 percent were dissatisfied with the cost. Yet, “at another, more personal level,” the pollsters note, “a slightly different picture emerges. Fully eight in ten (82 percent) describe themselves as satisfied with the quality of the health care they receive personally. This number jumps to 90 percent among seniors (64 percent very satisfied), but includes impressive majorities of nearly all groups…”

HEALTH 2.0 UPDATE Dyson, Kibbe join advisory board

Nov 30, 2007

We’re pleased to announce that Esther Dyson of Dyson EDventure Holdings has agreed to serve on the Health 2.0 advisory board. Esther’s tech background is well known and second to none. Esther has been watching, leading and guiding innovation in the technology industry for more than two decades. In 1983, she purchased a small and relatively obscure industry newsletter called the Rosen Electronics Letter, renamed it Release 1.0 and made history with a series of bold forecasts on the impact of the pc and computer networks. Her predications included some of the first warnings that American dominance in R&D might be on the decline and that the American universities might fail to produce adequate numbers of students trained in the sciences. From 1998 to 2000 Esther served as the chairman of ICANN, the Internet Corporation for Assigned Names and Numbers. In 2003, in response to public criticism of ICANN, she played a key role in driving reforms at the organization. Companies where she has served on the board or as an early stage investor include include Flickr, Del.icio.us, Orbitz, Medscape and Medstory, as well as many, many others. We are delighted to welcome Esther and look forward to her contributions.

We also welcome David Kibbe MD MBA. A highly regarded figure in Washington and in healthcare information technology circles, Dr. Kibbe has served as director of the American Academy of Family Physicians’Center for Health Information Technology of the and played a leadership role at a number of companies. David is perhaps best known for his work in the fight to encourage physicians to adopt electronic medical records. He is currently involved with the ASTM CCR standard for health data and information exchange. When not busy with his other projects, David writes for the Health 2.0 Blog, where he has recently contributed posts on Health 2.0 and identity and Computable Data Exchange and Sparse Information Model.

INTL: Market invisible hand forces Canadian death rate numbers public!

Nov 30, 2007• 8

In a valiant effort to stop Canadians storming the borders and leaving their home health care system bereft of their health care dollars, the Canadian government has yielded. It’s made death rate numbers at Canadian hospitals public. The probably futile hope is that Canadian citizens will believe that the competition of transparency will lead to improvements in the current situation in some Canadian hospitals, such as the Scarborough Hospital mentioned in the article, which kills 124 out of every 100 patients admitted.

Now that the Canadian dollar is so strong, buying some 45,000 American Lire to the northern Peso, it’s cheaper for a Canadian to sneak across the border and pay cash for open heart surgery than it is to pay the tax on the Canadian cigarettes that caused the heart disease in the first place.

The combination of renowned treatment from private American hospitals that kill far fewer than 1 in every 1 patient (and sometimes less than that), and the strength of the Northern Peso have now resulted in the desperate situation of empty waiting rooms, and no queues for surgery in America’s northern neighbor.

The collectivist Marxists who run things in Canadian health care from their command center in the bunker of the UBC health care economics department have been horrified at this development. A spokesman who sounded a lot like Morris Barer was (or maybe wasn’t) overheard saying, “it’s our right as Canadian elitists to make the rest of our citizens wait forever for hospital care that will probably kill them if they don’t die waiting in line first. The overwhelming transparency and easily demonstrated quality of the now dirt cheap American health care system is not fair.”

Reports that the WTO was investigating were unconfirmed at time of writing.

Unrepentant free-marketeer Canadian exile David Gratzer was reportedly seen crowing, “See how Adam Smith has kicked those loonies in the ass! The market triumphs again!”

Now can I get a job in the Giuliani administration?

If Grady Fails By Brian Klepper

Nov 29, 2007• 6

In an extraordinary move earlier this week, the politically-appointed Fulton-DeKalb Hospital Authority, the governing body over Atlanta’s Grady Health System, unanimously and voluntary stepped aside, to be replaced by a new non-profit corporation. Projecting a $55 million deficit this year, the hospital had just three weeks of cash on hand. It needs $300 million immediately for sorely needed renovations, and must deal with $63 million in accumulated debt to its biggest creditors, Emory University Medical School and Morehouse School of Medicine. New oversight was the predicate for a hoped-for financial bailout from business, philanthropies and financial institutions.

Other Atlanta hospitals are undoubtedly concerned that Grady will fail, and will probably do everything possible to support a bailout. The last thing they want is for Grady’s patients to come to their facilities. Now would be a good time to rally business leaders and legislators, who nearly always go to fancier hospitals, which of course has been a big part of the problem.

Grady’s turmoil should be recognized as the first small shock of much larger seismic event, long in the making, a concrete sign of America’s relentlessly intensifying health care crisis. The wrath falls on our most vulnerable – those with health problems or with few financial resources – as well as on the institutions and professionals that care for them.

Physicians: Can Computerized Decision Support Get Docs to Toe the Line on Quality? by Robert Wachter

Nov 29, 2007• 7

Robert_wachter_3 Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog “Wachter’s World.”

A humorous and telling story about quality measurement, decision support, and human nature:

I was visiting professor at a very good academic medical center a year or so ago. On these trips, one of the fun things I get to do is meet with the residents. Sometimes they present a clinical case to me, but this day they wanted to talk about healthcare policy. So I thought I’d check out what they knew about the new world of quality measurement and transparency.

“Who admitted a patient with pneumonia last night?” I asked the bleary-eyed, overcaffeinated group of 20 somethings, each looking only slightly older than my kids. Three interns hesitatingly raised their hands.

“If I wanted to figure out whether you provided high quality care,” I continued, “what should I look at?”

“I think we saved this guy’s life,” one beamed. “Yeah, and I had a lady who was confused, hypotensive, and hyperglycemic,” said another, “and we did a really good job taking care of her. She’s much better this morning.”