Category: Uncategorized

Scoring the Surgeon Scorecard

Oct 13, 2015• 4

By MARK W. FRIEDBERG

Mark W Friedberg is a researcher at the RAND Institute and a co-author of the recent RAND analysis of the Surgeon Scorecard. He posted this on THCB in response to Ashish Jha’s post “Misunderstanding ProPublica.”

I don’t disagree at all with the idea that providers should release their own performance data, to the extent that they have it. Free flow of accurate and understandable performance information is inherently good. If the ProPublica Surgeon Scorecard can create pressure for this to happen, fantastic.

But there is no tradeoff between recognizing the serious methodological problems in the Scorecard, improving the Scorecard, and encouraging providers to release their own data. All three can and should be done simultaneously.

Also, for frequenters of this blog, I think it’s important to clarify a few key things about the “RAND critique” (which I authored with individuals from many institutions, all of whom deserve credit for devoting considerable unpaid time to the effort).

1. Nowhere in the critique do we suggest that ProPublica – or anybody else for that matter – abandon efforts to generate and publicize reports that truly reflect provider performance. Far from it. If you look up the authors of our critique, you’ll see that all of us have devoted substantial time and effort to furthering the science and practice of performance measurement and transparency in health care.

Wellness 2.0: Better Health, Better Coverage

Oct 13, 2015• 19

By JIM PURCELL

Just what on earth are businesses thinking? Companies pay too much for poor quality health care coverage. If this were any other business expense, this wouldn’t be tolerated. Yet, expensive, sub-standard healthcare is something U.S. companies roll over and accept. There are many reasons why, all unacceptable.

Fortunately, there’s a path that companies can take now to address healthcare costs: fostering healthier employee lifestyles. This is perhaps the only avenue for immediate action that can lower healthcare costs for both employers and employees while cultivating a healthier, more productive workforce. Your cynical side laughs? Consider this:

“Only private business, not the federal government, can solve America’s epidemic of obesity, chronic disease, and runaway healthcare costs by investing in the health and fitness of their employees,” said Cleveland Clinic CEO Toby Cosgrove in an Affordable Care Act debate panel, a sentiment increasingly echoed inside and outside of healthcare.

Employers must move away from the adversarial, zero sum approach of increasing employees’ share of the cost of coverage to a more partnership-centered model of forging employer/workforce partnerships where both companies and employees support each other’s goals, not just in lowering coverage costs, but by improving health.

Increasing coverage in this day and age? Unheard of! But this is not a pipe dream. If companies are willing to make the investment, on the condition that employees undertake required behavior modifications and achieve positive outcomes, it truly can happen. And though may have heard this before, up to now we’ve not done it right.Continue reading…

Contextual Communication

Oct 13, 2015

An Interview with PatientSafe CEO Joseph Condurso

Oct 13, 2015

By MICHELLE RONAN NOTEBOOM

An interview with Joseph Condurso, president and CEO of PatientSafe Solutions

Michelle Noteboom: Give me a short overview of PatientSafe and your role in the company.

Joseph Condurso: I’m the president and chief executive officer of PatientSafe Solutions. I joined PatientSafe in 2011 with the focus of taking its skills and its core competencies as a mobile applications provider from the bedside to the enterprise to the home, which is my vision and goal for the company.

We provide a platform for creating and delivering an intelligent interactive workflow solution. We express those workflows through bedside applications that can be executed at the point of care by the frontline care team. We have also been building out an expression of those workflows to enable the patient to engage the care team as they discharge from the hospital and go into their home and into their daily life.Continue reading…

Trauma Room Two

Oct 12, 2015

By PHILIP ALLEN GREEN, MD

Sometimes when I am bored, when it is all sore throats and dental pains, when I feel more like I am a social worker and a hand-holder than an emergency medicine physician, I play a game.

I do not look at the chart before I go into a room. I walk in cold. I enter with no idea who is going to be in there or why. In that very first second, before anyone speaks, I try to guess what the story is, who the people in the room are, and why they are in my emergency room.

Here-maybe it would make more sense if I showed you.

I draw back the curtain and step into Trauma Room Two. My eyes scan quickly about, gathering as much information as they can.

There are three people in the room.

For a brief second, I intentionally do not look at the patient lying on the hospital bed, not yet. Two people accompany the patient, a man and a woman. The man sits on a hard plastic chair pushed back against the room’s wall, staring quietly ahead. I start with him. I know if I can just look closely enough, the story is there.

Measuring ROI: Quantifying the Benefits of an HIE

Oct 12, 2015• 1

By INTERSYSTEMS SPONSORED CONTENT

How do you measure the ROI of a health information exchange? For Missouri Health Connection (MHC), the HIE serving Missouri and neighboring states, quantifying that elusive ROI for its participants is now a priority.

If you’re going to the CHIME15 Fall CIO Forum, you can see firsthand the work of our client, Mark Pasquale, President and CEO of MHC.

He has been in the HIE trenches and knows that calculating ROI is critical to winning new participants and physician adoption. After investing government dollars to create infrastructure and services, HIEs must now demonstrate their value to participants. In this regard, MHC is taking a lead. Pasquale developed a spreadsheet calculator, based on metrics for healthcare costs that an HIE can prevent – numbers he drew from published studies.Continue reading…

Payers Join the Healthcare Team

Oct 12, 2015• 1

By ED CHUNG, MD SPONSORED CONTENT

Back when I was in medical training a decade ago, patient rounds were usually conducted by a group of physicians. We’d walk down the ward, visiting patients and scribbling notes as we went. If we were feeling particularly inclusive, we might bring nurses along. But that was as diverse as the care team got. Even the concept of a “care team” was only just starting to take hold on wards where highly complex patients were being cared for.

These days, the picture looks quite different. Now, in addition to doctors and nurses, we have pharmacists, social workers, therapists, nutritionists, and case managers joining us on rounds.Continue reading…

Is ProPublica the Paul Revere of Transparency?

Oct 11, 2015• 24

By SAURABH JHA, MD

Recently, I was speaking with a “less is more” advocate. He used his superior knowledge of statistics – he had an MPH – to debunk randomized controlled trials. We discussed overdiagnosis, overtreatment, and the shakiness of medical sciences.

We spoke about measuring the quality of physicians. I remarked that quality metrics have as much evidence as Garcinia Cambogia – we had just laughed about Dr. Oz. I expected a chuckle. Instead, he became distinctly uncomfortable and, in a solemn tone, lectured me about the Institute of Medicine (IOM) report, “To Err is Human.”

The physician, a bulldog of evidence-based medicine (EBM), had a blind spot. He ripped cardiologists for overusing pacemakers. He believed in the usefulness of the physician quality reporting system. He disdained big pharma for pushing statins. He was a fan of maintenance of certification. He was at once a raging skeptic and a true believer.

My understanding of statistics is modest compared to his. But I am skeptical by nature. I’m skeptical of many things including (not necessarily in this order): statins in 65-year olds, kumbaya, hellfire, England’s soccer team, quality metrics, screening (much to the chagrin of my radiology colleagues), high priests, middle priests, hard drives spontaneously combusting, and futurists. I’d like to believe this is because I’m a dark knight searching for the truth. The reality is that I’m just a cynical git who was raised in an island where it rains without remorse. My skepticism manages to offend a unique human every day.

The Goose and The Elephant

Oct 10, 2015• 2

By BRIAN KLEPPER

America’s drug and biotech industries are no doubt alarmed by the national firestorm that erupted when Turing Pharmaceuticals raised the price 55 times of its 62 year old lifesaving drug, daraprim. They must worry that CEO Martin Shkreli’s tone-deaf reactions to the public’s scorn could precipitate close scrutiny of broader drug industry dynamics. The last thing pharma wants is a vigorous, in-depth national discussion of pricing, value, what we can afford and how other advanced countries handle drug spending. All this could kill the golden goose.

Seeking distance from the furor, PhRMA tweeted that “Turing Pharma does not represent the values of PhRMA’s member companies.” Then BIO, the biotech industry’s association, rescinded Turing’s membership and returned its dues, the equivalent of booting Turing out of the country club.

You can hardly blame them. In the US, pharma has engineered a great sweetheart deal. Once a drug is FDA-approved, the law dictates that Medicare must pay whatever a manufacturer demands, without negotiating, and that pricing sets a reference for the rest of American drug prices. Peter Bach, MD, who leads Memorial Sloan Kettering’s Center for Health Policy and Outcomes, summed up our dilemma earlier this year:

[Drug] companies are taking advantage of a mix of laws that force insurers to include essentially all expensive drugs in their policies, and a philosophy that demands that every new health care product be available to everyone, no matter how little it helps or how much it costs. Anything else and we’re talking death panels.Continue reading…

What the World Might Look Like If We Taught Docs How to Hack Spreadsheets

Oct 10, 2015

By HAYWARD ZWERLING, MD

I am an IT geek physician. I have my an EHR which I created and control.

Today, I wanted to understand my diabetic practice a little more, so I dumped all my HbA1c data out of my EHR and into a spreadsheet where I was able to manipulate the data and learn a few things about my practice.

I learned that:

If my patient had a HbA1c ≥ 8, the likelihood that the HbA1c would be < 8 at the next visit is 68%.

If my patient had a HbA1c ≥ 8, the likelihood the HbA1c would be even higher at the subsequent visit is 29%.

If my patient had a HbA1c ≥ 8, the average change in the HbA1c at the next visit was -0.7.

If my patient had a HbA1c < 8, the likelihood that HbA1c at the subsequent visit would exceed 8% would be 15%.