Category: Uncategorized

Medicare hospital quality reporting steps up in sophistication

Sep 2, 2008• 2

By Bob Wachter

Robert_wachter
Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important because NPR’s "Talk of the Nation" spent 30 minutes interviewing Don Berwick and me about it — on the day of Hillary’s speech nonetheless!

To listen to the show, click here. Also, here’s an article from USA Today that got the ball rolling, as well as Avery Comarow’s thoughtful blog on these new reports.

Here are a few observations about the new Centers for Medicare & Medicaid Services initiative, some of which I made on the NPR broadcast:

Keep tabs on your digital footprint

Sep 1, 2008

By Susannah Fox

Is it "disordered" behavior to Google your doctor? An article in JAMA suggests that doctors should be on their guard.

The Journal of the American Medical Association recently published an article about how doctors should be aware of how they are portrayed online and consider taking steps to manage their digital identities.

It is an article that, for the most part, could have been written about any profession with its warnings about “slanderous information published about someone with the same name” or “by a vengeful…colleague or ex-lover.” And the advice given is also familiar: create your own Web page to be sure correct information is available about you and use appropriate privacy settings on social network sites.

And if you thought the requirements for Health 2.0 were tough…

Aug 29, 2008

By Matthew Holt

For the Health 2.0 conference we look at lots of great technologies and put the people who make them through the wringer before and after we choose them. But apparently we’re not quite as honorous in our requirements as TechCrunch is for its conference. We also don’t have a major league Hollywood celebrity presenting at Health 2.0.

TechCrunch50 does, and boy is Aston Kuchner pissed!

Voila! Uninsured problem solved by not counting them

Aug 29, 2008• 1

John McCain’s health adviser John Goodman in the Dallas Morning News on solving the problem of the uninsured:

"So I have a
solution. And it will cost not one thin dime," Mr. Goodman said.
"The
next president of the United States should sign an executive order
requiring the Census Bureau to cease and desist from describing any
American – even illegal aliens – as uninsured. Instead, the bureau
should categorize people according to the likely source of payment
should they need care.

"So, there you have it. Voila! Problem solved."

Read Matthew’s comments and a great discussion on Goodman’s quote here.

The mirage of a “nonprofit” health system

Aug 29, 2008• 3

By Don Johnson

Not-for-profit hospital monopolies are helping make health insurance unaffordable for millions of Americans.

In its Thursday edition, The Wall Street Journal profiles the near monopoly that Carilion Health System has in Roanoke, Virg., and how it uses its monopoly power to inflate prices and enrich its executives.

The impact graph:

Carilion’s market clout is manifest in other ways. With eight hospitals, 11,000 employees and $1 billion in assets, the tax-exempt hospital system has become one of the dominant players in the Roanoke Valley’s economy. Its dozens of subsidiaries include businesses ranging from athletic clubs to a venture-capital fund.

The power of nonprofit hospital systems like Carilion over their regional communities has increased in recent years as their incomes have surged. Critics charge this is creating untaxed local health-care monopolies that drive the costs of care higher for patients and businesses.

The Journal also published a story in its Jan. 17, 2005, edition. about how the Federal Trade Commission was trying to stop monopolistic hospital mergers. I commented on it here.

On Jan. 24, 2007, I said health care reform should include breaking up not only health systems, but also medical groups and large regional insurers.

The Journal continues to call not-for-profit, tax-exempt health care providers “nonprofit.” Its stories show that tax-exempt health care providers are not “nonprofit.”

Checklists save money but adopted at glacial pace

Aug 29, 2008

By Charlie Baker

For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care.

In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and infections, along with significant improvements across many care standards for a wide range of surgeries that were done using the tool. And yet the take-up rate on this tool — which is so simple it fits on one single sheet of paper — is very slow to occur.

Balloon Mania: Happy Birthday Health 2.0

Aug 28, 2008• 2

By Scott Shreve

Having been around for the beginning of the Health 2.0 movement, it is good to see the conference continuing into its sophomore year. A lot has and continues to happen regarding the ongoing health care innovations that collectively make up Health 2.0.

An ongoing criticism and source of frustration for me has been the banter of those who continue to regard the entire space as a “farce.” People who demand the “proof”, demand unwarranted standards of outcome/impact prior to experimental implementation, and dismiss the space because current business models have yet to produce multiple exits (although there have been a few notables, including AthenaHealth, Medstory, HealthCentral, etc).

So at the infancy of this movement, all I can share with those doubters is an anecdote from the life of one the most famous tinkerers of all time — Benjamin Franklin (just finishing up his biography). In describing the distinctively French invention and subsequent “hype” associated with hot air balloons:

Stanford Med School rejects industry funding for continuing education

Aug 28, 2008• 4

By Sarah Arnquist

Stanford University’s medical school announced this week new restrictions on educational contributions by drug and medical device companies, which turn out to be among the strictest in the nation.

The rules are an effort to limit industry influence on physician practice. Currently, the continuing education programs tend to follow the market’s needs and not necessarily the best advancements for optimal patient care.

"The school will no longer accept funds from pharmaceutical or device companies that are targeted to specific programs, as industry-directed
funding may compromise the integrity of these education programs for
practicing physicians," a press release states.

SiliconValley.com reported that "Drug and medical-device company
contributions for continuing medical education have surged nationwide
from $302 million in 1998 to $1.2 billion in 2006, according to the
Accreditation Council for Continuing Medical Education. Stanford
officials said about $1.87 million — or 38 percent — of the medical
school’s budget for continuing education came from industry sources in
fiscal 2006-07."

Cost-containment missing piece of Mass. health reform

Aug 28, 2008• 5

By Niko Karvounis

Niko Karvounis tracks the health care system for the Century Foundation. This post first appeared on the HealthBeat blog, one of our favorite health care reads.

The Massachusetts experiment in health care reform is all about expanding access. But it doesn’t try to control costs. This, in a nutshell, is why it’s running into trouble.

The plan didn’t reform health care delivery, just coverage. Granted, in terms of bringing more people in under the tent, it’s been a success: Since the plan went into effect in 2006, 439,000 people have signed up for insurance — a number that represents more than two-thirds of the estimated 600,000 people uninsured in the state two years ago. This surge in coverage has reduced use of emergency rooms for routine care by 37 percent, which has saved the state about $68 million. (Going to the ER for routine care drives up health care costs by creating longer wait times and tying up resources that can be used to help patients who are critically ill).

Health Reform Prospects Fade as Presidential Campaign Enters Homestretch

Aug 27, 2008• 13

By Jeff Goldsmith Ijeff

Jeff Goldsmith is President of Health Futures, Inc, and a professor of public health sciences at the University of Virginia.

As presidential aspirants geared up their issue analyses last fall, health reform ranked as the number one domestic policy item the next President should address in many national public opinion polls. As the campaign season draws to a close, however, health reform has virtually disappeared from the headlines, supplanted by concern about gas prices, home mortgage foreclosures, soaring food costs and, most recently, the "Soviet" invasion of Georgia. Though you will hear campaign rhetoric from both parties at their upcoming conventions, health reform has been demoted to the second tier of campaign issues. Their platforms and campaign pledges on health reform seem increasingly unlikely to decide who is the next president of the United States.

As previously argued in this space, "health reform" really meant doing something about "health costs for my family" to most voters, not reducing inequity in access to coverage. Ninety-three percent of the voting public has health insurance of some kind. It is clear now that voter concern last fall about health reform was really a leading indicator of anxiety about the deteriorating economy and their own household economic insecurity. As Brian Klepper pointed out a few months ago in THCB, the purchasing power in real dollars of the American paycheck moved into negative territory last September, thanks to the rising price of energy, food and the resetting of home mortgages to higher rates. All these problems have worsened materially in the ensuing year