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TECH: Barcoding prevalent almost everywhere! (Just kidding)

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Brian Klepper writes to tell me that in today’s almanac

On this day in 1974, bar codes were first used in supermarket checkout lanes. In a Marsh’s supermarket in Troy, Ohio, the first product to be scanned was a 10-pack of Wrigley’s Juicy Fruit chewing gum. It just happened to be the first thing lifted from the cart. Today, the pack of gum is on display at the Smithsonian National Museum of American History in Washington, D.C.
Of course bar coding is used uniformly in every health care establishment now, so why would the fact that retail’s been using bar-coding for 32 years be on this blog? Oh, hang on a minute….

OFF-TOPIC: Torture day 2006

Today is Torture day 2006. That’s not an invitation for people to do more of it despite what our current Adminstration thinks. instead it’s UN International Day in Support of Victims of Torture. I’ve supported a London Charity called The Medical Foundation for the Care of Victims of Torture for years, and I invite you to check out their web site. Whatever your political views this is an organization that but for the accident of birth we might all need.

 

HOSPITALS/QUALITY: A quiet little speech by Michael Millenson

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Millenson on the lack of real committment to patient safety. Acerbic and fantastic. A few quotes, but as they say in the blogosphere read the whole thing

If there is a quality crisis today, it certainly is not apparent from the actions of major stakeholders….

 

…on the fifth anniversary of the IOM report, the Institute for Healthcare Improvement launched its "Save 100,000 Lives Campaign." It is a wonderful campaign, even if four out of every 10 hospitals don’t participate. What does that say about the will to change?

…Imagine what might happen in the QI world if the head of the IOM publicly criticized by name those 40 percent of hospitals that declined to participate in the IHI safety initiative. Imagine if Congress reacted by holding hearings. Imagine if CMS asked the Joint Commission to investigate whether those hospitals were really as safe as they seemed to think they were. Imagine if there were class-action lawsuits filed. Imagine the impact this unprecedented kind of focused, multi-faceted pressure would have on the "will to change" and the cultural context of quality improvement. If you find this scenario unlikely, it may be because those promoting the quality agenda sometimes seem to display greater concern for those whose behavior they are trying to change than for those whom that behavior is hurting.

POLICY: Universal Health Care in San Francisco…well not exactly

My buddy Laura Locke has a nice article in Time about San Francisco’s Latest Innovation: Universal Health Care. This one’s closer to the George Bush agenda than gay marriage—and I’m pretty sure that we’ll all have accepted gay marriage long before we’ve got to genuine universal health insurance. Essentially it’s about redirecting funds from the City and County back to the city and county health facilities, and making the uninsured pay into a pool. Not a bad start given that a City can’t do much, but it’ll run into trouble, just as I explained a while back when the proposal first came out because it’ll mean small low-wage businesses will have to pay more.

PHARMA/POLICY: Scottish Drug Czar Says Drug War Is Lost, Causes Big To-Do

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Everyone with half a brain knows that the drug “war” is lost and was always unwinnable and that the drug “problem” is only controllable by sensible legalization, regulation and education—as has been done with other addictive drugs like alcohol and tobacco. But it’s pretty rare that someone at the center of the drug “fighting” business—an industry with its mouth firmly attached to the teet of public funding—actually comes out and admits the truth. So when a drug Czar says so, perhaps some of his counterparts should listen.

Pity that it’s the Scottish rather than American drug czar who’s saying just that. But he at least comes from a place that has a real problem (remember Trainspotting) and an even more Calvinist past than we have over here. So there is perhaps some hope in the madness, although not much I’ll admit.

HOSPITALS/POLICY: MY 2 cents on the non-profit conundrum….incentives matter more than labels

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Here’s my follow up to Maggie’s interesting piece and it’s the editorial in FierceHealthcare later today

The non-profit hospital world has been in the news lately, and this week a study of all the studies ever done on the non-profit/for-profit contrast came out in Health Affairs. The story is pretty well known and the study confirmed that non-profit hospitals offer a little more charity care, and have slightly lower costs than for-profits. But then again, there are three factors that make those results a little less than great. First is that location matters and the non-profit category includes a great number of hospitals that are in unfavorable locations, like inner city areas and poor rural counties. Second, the behavior of their for-profit competitors over the years has tended to center on the border between scandalous and criminal. And far too many non-profits have been imitating that behavior, such as New Jersey’s St. Barnabas, which settled with the government for as much as it could afford for apparently over-charging Medicare by over $500m. Third, for-profits have stayed at around 15% of hospital beds for decades and aren’t expanding their market share much. So the main issue is how do hospitals overall behave.

The truth is that whatever the label put on an organization, in an environment where doing more and charging more brings more profit/margin, there will always be institutions and people within them that will fall temptation to taking the easy (and fraudulent) way to more money. Proponents of self-reform may point to the improvements in quality brought about with no financial incentives which were reported by IHI last week, but until we create incentives for organizations to do well by doing the right thing, the label will be largely irrelevant.

QUALITY: Improving health care from within, by Eric Novack

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Eric Novack sees hope in the IHI’s 100K lives program which announced impressive results this week, and being Eric, he thinks that there’s a political message in there too. There’ll be more on his show this Sunday.
The Institute for Health Improvement’s ‘100,000 Lives Campaign’ (www.ihi.org) just released the results for the first 18 months:  participation of over 3000 hospitals and an estimated 122,000 lives saved.
 
In a word, astounding.
 
What is more astounding is HOW they did it.  First, the ‘they’ are the organizers of the program and the THOUSANDS OF DOCTORS, PHARMACISTS, AND NURSES who implemented some simple changes in hospitals all over the country.
 
Did they focus on hundreds of best practices and brow-beat institutions into submission?
Did they threaten to not compensate anyone for trying to provide care?
Did they threaten lawsuits?
 
No, No, No.
 
The 100,000 lives campaign focused on 6 simple steps that are essentially universally accepted to be good practices to get the right care, at the right time, in the right place, and to reduce infections along the way.
 
With success breeding more success, more hospitals are continuing to sign up for the programs and looking to expand their involvement in the program further.
 
Most remarkably absent, however, was new federal legislation and government regulation.  May I repeat: no federal bureaucracy was and is required to make improvements to our healthcare system.
 
This, no doubt, is like fingernails on the blackboard for many denizens of The Health Care Blog-osphere.
 
I was fortunate to interview Alexi Nazem, National field coordinator for the IHI’s 100,000 Lives Campaign for my show this weekend.  You definitely want to find time at 3pm west coast time this Sunday to tune in at www.ericnovack.com to hear the whole interview- and to better understand both the IOM ‘To Err is Human’ report and get an insider’s view of patient safety efforts.

QUALITY: Book reviewer?

There’s an article out called “How We Die in America” which is from a new book called UNPLUGGED: Reclaiming our Right to Die in America, by William Colby.

The publisher is looking for a reviewer, so if you’re interested in reviewing a copy and having your review on THCB let me know by email

PHYSICIANS/POLICY: Brian Klepper on the end of life as we know it, or something like that

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Brian Klepper was recently up at Medscape bemoaning the lack of physician leadership in righting the troubled ship of our health care system, and challenging physicians to do better.

He got lots of feedback, not all of it as negative as you’d think, and he had his own response. All well worth reading.

On the other hand, HSC says that in real terms we’re paying physicians substantially less than in 1995. I suspect that most of that pay "cut" was in the 1990s, and things seem to be picking up again, but — as one reader asked me — there is not that much good data on physician incomes, and in real terms they did very well between 1960 and 1990.

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