Category: Uncategorized

Evaluating the Quality of Quality Improvement Claims: The Population Health Impact Institute – Brian Klepper

Aug 24, 2007• 2

Thomas Wilson PhD is on a mission that’s important to health care. Tom, a respected epidemiologist particularly well-known in disease management circles, founded the Population Health Impact Institute (PHII), a not-for-profit devoted to establishing clear, objective rules to evaluate claims of financial and clinical improvement associated with health management programs.

In an August 16th press release, PHII announced its intention to develop a new accreditation program that

“will focus on the methods behind the claims. It will be based on the established evaluation principles of transparency and scientific validity successfully used by the PHII since its founding in 2004:

Transparency of metrics,
Equivalence of populations,
Statistical significance of measures,
Plausibility of hypotheses, and
Disclosures of potential conflicts-of-interest.”

This isn’t a lightweight effort. To oversee the development of their "Quality Evaluation Process” (QEP) standards will be developed by a volunteer panel of national experts, and chaired by former URAC President and CEO Garry Carneal, who oversaw the development of 16 new accreditation programs during his tenure with that quality accreditation organization.

PHII also boasts the participation and support of Sean Sullivan, the CEO of the not-for-profit large employer group, The Institute for Health and Productivity Management. Sean has been an extremely balanced and important voice on health care reform. His group argues that it is in employers’ interests to stabilize and improve health care quality and costs, because employees and families with good health care produce are far more productive. The opposite is true as well.

PHII is looking for expert volunteers for its standards panel. Visit the site of this important effort and consider whether you or your organization might have a way to contribute expertise, financial resources or both.

By way of disclosure, I sit on PHII’s Steering Committee.

THCB: Matthew’s back, and many thanks to Brian Klepper

Aug 23, 2007• 1

This is a photo of some of what I’ve been up to while I was away….and to those of you who asked, yes it was as wonderful as we’d hoped, in an "oh so on the beach in Northern California" way.

While I’ve been off getting married my friend Brian Klepper has done an amazing job covering a huge variety of topics with insight and humor. Thanks very much to Brian, and I hope that we can keep him contributing to THCB. (He’s in lots of demand from other blogs and publications, and a great person to have speak to any group). Brian will also be covering the upcoming Health2.0 conference for THCB (as I’ll be a mite busy otherwise).

Finally the team working on Health2.0 has been doing an amazing job while I abandoned them for purely personal (if unavoidable) reasons. So I want to thank Indu, John and Sara for their incredible work. If the conference is half as as successful as our wedding, then it’ll be great!

Health Care Wonk Review Is Up – Brian Klepper

Aug 23, 2007

Every month, some good soul hosts Health Care Wonk Review, an eclectic gathering of posts from around the expert health care blogosphere. This month, its Daniel Goldberg at the Medical Humanities Blog, and he’s assembled a genuinely superb collection of thoughtful essays. One of the underlying themes of THCB, of course, is the vastness and complexity of health care, and those of us really interested in the diversity of health care issues, dynamics and perspectives will find plenty to feast on here. Go on over and work through the ideas on display.

Benign Neglect and the Nursing Shortage – Brian Klepper

Aug 21, 2007• 34

I sit on the Dean’s Advisory Councils of the Colleges of Health at two public universities in Florida. Both Colleges are led by extremely capable PhD nurses, and have a variety of programs that train students to be health professionals, including nurses.

A few months ago, I was startled when one of the Deans mentioned that
her Nursing program had 500 qualified applicants for 132 student slots.
In other words, at a time when the market wants her to gear up, she
turns away 3 qualified applicants for each one she accepts. As it turns
out, it’s a national problem. In 2006, Colleges of Nursing turned away 43,000 qualified applicants.

It’s not news that health care institutions face a critical nursing shortage. An April 2006 AHA report estimated that American hospitals currently need 118,000 RNs to fill vacancies. That number is expected to triple by 2020, to 340,000 vacancies.

HHS Secretary Leavitt’s New Blog – Brian Klepper

Aug 21, 2007• 1

HHS Secretary Mike Leavitt has a new blog.

While its hard to know what information the posts will contain once he settles in, it can only be a good thing for a public official to lay out his thoughts in such an open format. HHS and CMS lie at the heart of much of health care change now, so the establishment of a venue for exchange is extremely progressive and valuable.Kudos to Mr. Leavitt for going down this path. We’ll be reading with interest.

Not Paying For Preventable Errors: A Big Step – Brian Klepper

Aug 20, 2007• 11

Fee-For-Service (FFS) reimbursement has been disastrous for the American health care system because, instead of encouraging the delivery of the RIGHT products and services, it simply encourages MORE, and independent of quality and safety. The system lacks transparency, so we haven’t been able to distinguish appropriateness from inappropriateness. As a result we pay for everything, rewarding excess. The industry has seized on this and cultivated excess as a core value. It’s a big part of why we’re in the fix we’re in today.

But FFS’ other insidious impact is that it has enabled – and I mean this in the clinical sense – doctors and hospitals to engage in behaviors fundamentally counter to their patients’ interests as well as their own. FFS has allowed physicians to remain in small practices where they lacked the scale to invest in information technology tools, group purchasing or offshore medical malpractice arrangements. As a result, care in the little practices that currently dominate the medical landscape is often more expensive and of lower quality than is typical in larger practices.

OMNI: The Oncology Metrics National Index – Brian Klepper

Aug 20, 2007• 6

An innovative Ft. Worth consulting firm comprised of experienced oncology professionals, Oncology Metrics, has linked private oncology practices throughout the country in a collaborative, knowledge-sharing enterprise, called the Oncology Circle. The first round of information brought together 22 practices containing 167 medical oncologists. Combined, the practices treated almost 63,000 patients annually, had $600 million in revenues and spent $375 million on drugs.

In a separate but related effort, Oncology Metrics has established a new national data aggregation effort, The Oncology Metrics National Index (OMNI), which brings together data from practices using electronic medical records (EMRs), mapping the data in each EMR to a standard template. Then those data are aggregated and mined to produce different cancer care-related clinical measures associated with procedures and processes: e.g., the administration of erythropoietin (anemia drugs), hemoglobin (Hgb) testing, and patient staging. A primary goal is to create a data mine that can allow each practice to see how it compares to others, and how they might improve. But a secondary and also very important objective is the development of transparency information that can help rationalize the practices and costs that have dominated oncology.

This is a leading edge project that leverages the data that is newly available through EMRs, and that is indicative of the kind of progress that we can anticipate throughout health care in the next few years. Clearly a company to watch.

Outrageous by Eric Novack

Aug 20, 2007• 4

Outrageous!!

First and foremost—congratulations to Matthew and Amanda on their
wedding!!! Now to the outrage!!!

In Friday’s Boston Globe , health reporter Alice Dembner reports the plight of a 60 year old woman who has to pay twice the amount for health insurance as a 27 year old. “That’s discrimination!!” she says in the article.

Yet MSNBC reports that, “ a typical couple retiring in 2020 will have paid about $100,000 in lifetime Medicare taxes. ‘For that price, this couple is scheduled to receive about $500,000 in lifetime Medicare benefits over and above the premiums it additionally pays in retirement.’

Also, has anyone checked out how much more it costs to get auto insurance
for a 20 year old versus a 60 year old?

Hmmm…

Essential Reading: Laszewski on Rove and Medicare D – Brian Klepper

Aug 17, 2007• 8

All of us who have worked in policy during our careers know the old joke that there are two things you never want to see made: sausage and laws. Never was this more true than with Medicare D.

Earlier this week, Robert Laszewski at Health Care Policy and Marketplace Review wrote an eloquent and succinct piece called "Good Riddance to Karl Rove: How Part D Left An $8 Trillion Debt And Got Them Nothing," a genuinely damning indictment of the cynical use of power. Read Mr. Laszewski’s posts and you quickly get the fact that he is a keen, unbiased, open-minded, analytical observer of the Washington health care scene. His obvious knowledge about the circumstances and his stature lend terrific weight to his words. I’d urge every person who reads this blog to read Mr. Laszewski’s column, and to pass it around to your colleagues.

HEALTH2.0: The People’s choice award

Aug 17, 2007• 9

By now you know that the Health2.0–User Generated Healthcare
Conference organized by Matthew Holt (THCB) and Indu Subaiya (Etude
Scientific) is all set to take place on September 20th in San
Francisco. Among other things, there are four fabulous demo panels on Search, Tools for Consumer health, Providers and Social networks, and Social Media for Patients.

You would not believe how many people want to show their cool tools on these panels. Well it just so happens that we ended up with one spot left on the Social Media for Patients Panel. We already have the wonderful Amy Tenderich (DiabetesMine) to moderate. On the panel are OrganizedWisdom, DailyStrength, MedHelp, PatientslikeMe & SophiasGarden.

So how to choose the remaining panelist from so many great possibilities? Too tough for us to decide, so we’re throwing it over to you. The contenders, listed in no particular order with a line or two of description are below. Please go take a look—don’t worry if these don’t exactly fit your definition of “social media”—we have ways of shoehorning the most interesting sites into our program.