I believe I am one the few commentators on the Internet who routinely compares the fields of health and education (see previous posts here and here). The reason: lessons from one field are often applicable to the other.
The parallels are obvious: In both fields (1) we have systematically suppressed normal market forces; (2) the entity that pays the bill is usually separate from the beneficiaries of the spending; (3) providers of the services see the payers, not the beneficiaries, as their real customers and often shape their practice to satisfy the payers’ demands — even if the beneficiaries are made worse off; (4) even though the providers and the payers are in a constant tug-of-war over what is to be paid for and how much, the beneficiaries are almost never part of these discussions; and (5) there is rampant inefficiency on a scale not found in other markets.
Long before there was a Dartmouth Atlas for health care, education researchers found large differences in per pupil spending (more than three to one among large school districts, e.g.) that were unrelated to differences in results. In fact, study after study has found no correlation between education spending and education results. (See Linda Gorman’s summary at Econlog.)
Internationally, the parallels continue. Just as the United States is said to spend more than any other country and produce worse outcomes in health care, the same claim is now made for education.Continue reading…
Ozioma – uses local health data sets to inform media sources, enhancing the relevancy of health related news stories. View the solution
GSAREH – uses geospatial research to inform users of cancer related information in their communities. View the solution
NCI sponsored this challenge to promote the sharing of cancer data between public health entities and communities. Teams were asked to create a web-based or mobile application using datasets from the National Cancer Institute and Division of Cancer Control and Population Sciences (DCCPS). The solution needed to enable communities’ use of population data for cancer prevention and control.
4. A Reinhardt Health Affairs interview with former CMS director Tom Scully who opines that “Medicare is a dumb payer;” and
5. A Reinhardt explanation of how Medicare pays doctors (7,000 physician tasks, each with a price that varies for every city, town and hamlet in the land), along with a challenge to readers to come up with a better way.
Okay. I accept the challenge.
I sometimes wonder if health economists actually understand how other markets work. Let’s try a thought experiment. Suppose you ran a business that purchased lots of wheelchairs and you had the misfortune of paying the way Medicare pays. What do you think would happen?
The minute your presence in the market was generally known — probably before the first wheelchair was even delivered — you would be visited by a rival vendor offering to meet your needs for, say, two-thirds of what you were paying. Then another rival would offer to top that — say, cutting your costs in half… and before long the cost of the wheelchair to you would be a fraction of what it started out to be. This is how normal, sensible people function in typical markets, day in and day out.
If you study previous attempts to reform healthcare delivery through the private sector, there is one common thread. These attempts all failed because of an absence of proper management information systems. We need integrated electronic health records. And not just to improve medical decision making. We need EHR that can be used for management decision making – for contracting, measuring costs, measuring and rewarding quality; I could go on and on. We are trying to solve management problems in a $2 trillion industry using management information systems that would be an embarrassment in nearly any other sector of the economy.
Of course, the industry has been pushing EHR for decades and there are places where EHR is really first rate. Kaiser is a great example but also a special case because of its thorough vertical integration and long history. And even Kaiser has been unable to replicate itself outside of its core markets. The sad fact is that most providers have little incentive to adopt EHR, and even when they do, they have little incentive to be compatible with other providers. Unfortunately, the network externalities benefit purchasers and consumers a lot more than they benefit providers, so don’t expect the compatibility problem to solve itself.
My proposal is simple. Assemble a panel consisting of medical professionals, managers, and insurers. “Lock them in a room” for 72 hours and tell them to choose from among the many fine existing EHR systems. Tell them they can combine the best features of each if they wish. Once we have settled on an EHR system, give every provider one year to adopt it. If they refuse, deny them Medicare and Medicaid payments. Combine the stick with a carrot – subsidies to providers who have limited financial resources. I believe the total one-time subsidies would be less than $50 billion, a drop in the bucket compared with the size of the system.
American Medical News, the award-winning newspaper published by the American Medical Association (AMA), announced today it is offering unrestricted access to its online news archive at amednews.com.
The online news archive dates back to January 2000, with selected earlier content. It represents a rich resource on issues confronting physicians and trends in medicine. Content includes in-depth reporting on the business and regulatory sides of health care, practice management and hot issues in public health and patient care.
“The American Medical Association hopes the accessible online news archive, and digital conveniences offered by American Medical News, will better help readers stay on top of the trends and forces shaping a complex, ever-changing medical environment, said AMA President Cecil B. Wilson, M.D.
In the wake of health care reform, leaders in the industry need a new set of tools to navigate through a health care landscape that has changed forever. In response, the Tuck School of Business at Dartmouth and The Dartmouth Institute for Health Policy and Clinical Practice (TDI) have joined together to create a new and timely Master of Health Care Delivery Science (MHCDS) degree program. Applications are currently being accepted.
Aimed at working managers and professionals in health care organizations with high potential to become change agents in their field, the 18-month MHCDS program will combine a strategic mindset and a scientific approach to current and future health care delivery challenges.
“Reform of the existing health care system has been desperately needed,” said Dr. James N. Weinstein, Director of TDI and recently-named President of the Dartmouth-Hitchcock Clinic. “The challenge for those of us running systems today is to transform our institutions to succeed in this new world by focusing on how to provide high-value, high quality care, while lowering the costs of delivering that care.”
Launched by Dartmouth College President Dr. Jim Yong Kim, the interdisciplinary program will blend TDI’s pioneering research in health care pattern and practice, delivery innovation, and payment models, with the Tuck School’s expertise in strategy and how to effectively create and execute change.
The OptumHealth Culture of Health Institute is hosting a webinar that explores how employers can boost employee participation in wellness programs by adopting marketing strategies used by top consumer retail companies. This event will feature Rohit Kichlu Senior Director Wellness Marketing, OptumHealth and John Waters Director Wellness Consulting, OptumHealth. November 9, 2010, 1 – 2 pm EST. You can register here —
Organization: The Service Employees International Union (SEIU)
Location: Washington, D.C.
The Service Employees International Union (SEIU) is seeking a talented and forward-thinking individual for the position of HCBS Policy Manager. This is a senior-level position within SEIU Healthcare, one of the union’s three operating divisions, and will report to the Home Care Director. The HCBS Policy Manager will have lead-level responsibility for the following:
Providing overall leadership to SEIU’s policy work in the area of home and community based services (HCBS)
Cultivating and maintaining relationships with allied organizations, academic policy experts, government policy-makers and other stakeholders in order to achieve program goals and to drive joint work
Conducting research and policy analysis and developing legislative and regulatory proposals
Developing policy white papers & other written documents for both internal and external audiences
Collaborating with our government affairs staff on lobbying and federal legislative priority-setting
Serving as a resource on long-term care issues for other SEIU staff in DC and in our local union affiliates
The focus of the work is on influencing policy-making at the federal level, though intermittent support of state-level efforts is also part of the job.
Recent trends in radiology imaging portend a dramatic and rapid reduction in this segment of a hospital’s business plan. Even before capitated (or global) payments have come into full play, there has been a large reduction in the number of some types of imaging studies in hospitals.
Our Chief of Radiology summarizes our experience — common to other hospitals as well — and provides some of the reasons.
The biggest hit has been in CT, the modality we are most dependent on for revenue. We are about 10% down in CT cases from last year, due to a combination of patient and physician fears about radiation exposure, more prudent ordering of studies by physicians, leakage out of the medical center, and the introduction of physician incentive programs (to minimize the amount of imaging) by some insurers.
Also, and very surprising, we have not seen an upswing in ultrasound or MRI to match the CT volume drop. We have, however, seen an increase in the number of patients arriving with their scans on CD ROMS having been imaged at other lower priced vendors. We don’t bill for these interpretations even though we are frequently asked to reinterpret the studies for our clinicians, and BIDMC is paying to store these images on our PACS systems.
By the way, this occurred while our overall patient volume increased during the same period.
The result of these trends will be to reduce the number of radiologists working in hospitals, and there will also probably result in a reduction of salaries for this physician specialty.
Paul Levy is the President and CEO of Beth Israel Deaconess Medical Center in Boston. Paul recently became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so. For the past three years he has blogged about his experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.
How will the Senate bill impact health insurance companies and their customers?
Even better, how will it impact a not-for-profit health plan–one with a reputation for being a “good guy” that continually wins the country’s top awards for member services and with historic profits of less than 1% of premium? And, one that is operating in Massachusetts–a market that has already been through much of this?
I will suggest that, in combination, these are three intriguing questions.
That is why I thought that the Harvard Pilgrim’s CEO’s recent post on their website was important. It is short, direct, and to the point. And, from everything I know, it is bang-on.