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What Business Can Learn From Cleveland Clinic: How To Report Quality To The Public
This summer I spent some time exploring how big teaching hospitals publicly report clinical outcomes to the public. For a given set of patients, how many live or die? And with what complications?
Patients can rarely find this information before getting elective surgery, or when deciding to commit to a given institution for a long-term course of treatment.
The problem is that right now there are few short-term incentives for hospitals to be transparent to the public. Patients are used to finding care based on proximity, word-of-mouth, and referrals from trusted physicians. (None of these are bad methods, by the way.)
Meanwhile insurers and public programs rarely pay for better outcomes, so they do not build networks that steer patients to quality. Paternalism pervades the entire system, where insurers and providers alike do not trust patients to shop for the best care.
Thus it is only the most long-term focused institutions that decide to become radically transparent. And there’s one that stands out above the rest: Cleveland Clinic.
The Ohio institution is already known for excellent care, especially in cardiology, for being a “well-oiled machine”, and for being an economic bright spot in the otherwise dreary environs of Cuyahoga County. (Sorry, as Pittsburgher it’s hard for me to say nice things about the Mistake By The Lake.)
But something else Cleveland Clinic should be known for is its public outcomes reporting. Every year since at least 2005 Cleveland Clinic has published Outcomes Books on its Web site. For each clinical category it releases data on mortality, complication rates, and patient satisfaction. It also mails paper copies of these books to specialists around the country as a kind of transparency-marketing. No other hospital system comes close to reporting this level of detail about the quality of its care.
Burnout
It happened again. I was talking to a particularly sick patient recently who related another bad experience with a specialist.
“He came in and started spouting that he was busy saving someone’s life in the ER, and then he didn’t listen to what I had to say,” she told me. ”I know that he’s a good doctor and all, but he was a real jerk!”
This was a specialist that I hold in particular high esteem for his medical skill, so I was a little surprised and told her so.
“I think he holds himself in pretty high esteem, if you ask me,” she replied, still angry.
“Yes,” I agreed, “he probably does. It’s kind of hard to find a doctor who doesn’t.”
She laughed and we went on to figure out her plan.
This encounter made me wonder: was this behavior typical of this physician (something I’ve never heard about from him), or was there something else going on? I thought about the recent study which showed doctors are significantly more likely than people of other professions to suffer from burn-out.
Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both).
This is consistent with other data I’ve seen indicating higher rates of depression, alcoholism, and suicide for physicians compared to the general public. On first glance it would seem that physicians would have lower rates of problems associated with self-esteem, as the medical profession is still held in high esteem by the public, is full of opportunities to “do good” for others, and (in my experience) is one in which people are quick to express their appreciation for simply doing the job as it should be done. Yet this study not only showed burn-out, but a feeling of self-doubt few would associate with my profession.
Building a Medical Practice: Does Government Help or Hinder?
Over 30 years ago, I began a cardiology group practice in St. Petersburg, Florida, Bay Area Heart Center. I invested $30,000––all of my savings at the time, and worked 90-110 hours per week for three years before I hired a partner. Since then the practice has grown to about 50 employees, including twelve physicians. I was taken aback by President Obama’s recent remark, “If you’ve got a business — you didn’t build that. Somebody else made that happen.”
Did I have help building this business? Yes. I have been graced with fine physician-partners, nurses, physician assistants, secretaries, medical assistants, and a remarkably efficient and dedicated administrative staff. But in all due respect, Mr. President, I must disagree with you. I did build my business, and nobody else made it happen. , along every step of the way, the federal government has been more of an impediment to the growth of my business than a facilitator.
From Medicare dictating to me how much I can charge a patient for my services, to OSHA requirements against using lip balm in “patient-care” areas; federal rules, regulations, and bureaucracies have heaped increasing administrative costs on my business without one iota of improvement in patient care. Now with the imminent implementation of “Obama Care” dangling over us, the outlook is even direr.
Demo: Healthline Launches BodyMaps for the iPad
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Health information and education company Healthline Networks launched the BodyMaps iPad application today. BodyMaps, which displays rotatable high-resolution 3D illustrations of human anatomical structures, was created with GE Healthymagination in partnership with Visible Productions. Here you’ll see Senior Director of Product Management at Healthline John Emerson demo the app on his iPad, and CEO West Shell talks about his own recent experience using BodyMaps at his orthopedic surgeon’s office.
Vinod Khosla: Technology Will Replace 80 Percent of Docs
I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.
Not surprising, the most fascinating person, was the keynote speaker, Vinod Khosla, co-founder of Sun Microsystems as well as a partner in a couple venture capital firms.
“Health care is like witchcraft and just based on tradition.”
Entrepreneurs need to develop technology that would stop doctors from practicing like “voodoo doctors” and be more like scientists.
Health care must be more data driven and about wellness, not sick care.
Eighty percent of doctors could be replaced by machines.
Khosla assured the audience that being part of the health care system was a burden and disadvantage. To disrupt health care, entrepreneurs do not need to be part of the system or status quo. He cited the example of CEO Jack Dorsey of Square (a wireless payment system allowing anyone to accept credit cards rather than setup a more costly corporate account with Visa / MasterCard) who reflected in a Wired magazine article that the ability to disrupt the electronic payment system which had stymied others for years was because of the 250 employees at Square, only 5 ever worked in that industry.
Why Lance Armstrong Matters. And Always Will Matter.
Like many of you, I have been reading the various news stories about Lance Armstrong, especially one this past weekend in a major newspaper, which went into great detail about the allegations surrounding Lance Armstrong’s cycling career.
But what I didn’t see in all of that coverage was much mention of the other side of the man, the side that I witnessed up close and personal one Friday in Texas a couple of years ago, the side that has led me to share my thoughts with you today.
I saw something that day that I had never-let me repeat, never-seen before. It was a moment that has forever influenced my opinion of Mr. Armstrong, even as these various charges have swirled about him these past couple of years. And the impression it created was indelible.
I am not here to hash/rehash the incriminations. I am here to stand up and say that no matter what the truth is regarding the allegations, this is a man who has forever changed the cancer landscape for millions of people in this country and around the world.
The Moral Case for Romneycare 2.0
Since 2010, when the Affordability Care Act was signed into law, the American mainstream media has insisted that President Obama’s bill provides the most at-risk Americans, low income families and seniors, with better health care. And that must mean, by any logic, better access to doctors, more access to the modern tools of diagnosis and treatment, and ultimately better health outcomes. That poor Americans benefit greatly from the ACA, and that seniors will be more secure under the president’s law, has seemed so obvious to the left-leaning news outlets that this fact has yet to be critically examined by them.
President Obama’s ACA law purports to provide new health coverage to upwards of 16 million low income Americans by way of Medicaid. We already see in the wake of the Supreme Court decision that many, if not most, states simply cannot be burdened with massive increases in their Medicaid outlays, regardless of the promise of financial support from the federal government (itself a financially unsustainable funding source).
But President Obama’s assertion about new insurance for the poor and all it brings is, in fact, a grand deception. We know that 55 percent of primary care physicians and obstetricians already refuse all or most new Medicaid patients (about four times the percentage that refuse new private insurance patients), and only half of specialist doctors accept most new Medicaid patients. Clearly, granting poor people Medicaid is not equivalent to providing access to doctors.
What Next After Implementation? Challenges For the Informatics Community
I had the opportunity recently to attend this year’s Healthcare Forum, put on by Xerox’s the Breakaway Group, an organization whose mission is to improve healthcare through optimization of the electronic health record (EHR). The forum brought together about 100 leaders from healthcare delivery organizations, academia, and industry. We had the great opportunity to take a break from our daily grind to step back and take a look at the big picture. Clearly much progress has been made, but there is still so much more to do to improve healthcare and its use of information technology.
In my reflection of the event, I had the opportunity to gather some thoughts on what the biomedical and health informatics (BMHI) field must do to contribute to the larger picture going forward. The last few years have been very good for those who work professionally and academically in BMHI, which I have defined as the field that is concerned with the optimal use of information, often aided by the use of technology, to improve individual health, health care, public health, and biomedical research [1]. The Health Information Technology for Economic and Clinical Health Act (HITECH) Act has provided tremendous opportunity to expand the use of informatics systems to improve health.
Much of the focus of the early (2009-present) HITECH era has focused on implementation of electronic health record (EHR) systems. Many healthcare organizations, especially larger ones, have made the transition to electronic systems and collected their meaningful use dollars.Continue reading…
Nationwide Health Information Network Comes of Age
The Nationwide Health Information Network Exchange (NwHIN Exchange, or just Exchange) has been operating as an ONC program since 2007. For the past three years, a rapidly growing community of public and private organizations (Exchange Participants) has been routinely sharing information in production. That community now represents thousands of providers and millions of patients. Healtheway is new a non-profit, public-private partnership that will operationally support the eHealth Exchange (formerly referred to as the NwHIN Exchange).
On August 1, 2012, the Exchange Coordinating Committee appointed three representatives to serve on the Healtheway Board of Directors, including: Michael Matthews (CEO, MedVirginia), Paul Matthews (CTO, OCHIN) and Jan Root (CEO, Utah Health Information Network). These individuals, along with Healtheway’s Interim Executive Director, Mariann Yeager, will serve as the initial board of directors for the non-profit. The remaining Healtheway board seats will be filled by up to nine elected Healtheway members. The company launched its Member Program in August 2012, with elections for the member board seats expected in the Fall 2012.
