Rosemarie Day has been a long time health care consultant and operator, most prominently as the COO of the Massachusetts Health Connector–the first real state exchange that was created as part of Romneycare (which with a few twists later became Obamacare!) Following the 2017 Women’s March, Rosemarie decided to write her own book, Marching Towards Coverage. It’s really four books in one. A personal patient & caregiver journal; a history of the slow march towards universal health care; a policy document; and a primer on how to become an activist. All in less than 200 pages! For the November THCB Book Club Jessica DaMassa and Matthew Holt talked with Rosemarie about what we can all do to really get to better health care for everyone.
By VINCE KURAITIS and DEVEN McGRAW
Two years ago we wouldn’t have believed it — the U.S. Congress is considering broad privacy and data protection legislation in 2019. There is some bipartisan support and a strong possibility that legislation will be passed. Two recent articles in The Washington Post and AP News will help you get up to speed.
Federal privacy legislation would have a huge impact on all healthcare stakeholders, including patients. Here’s an overview of the ground we’ll cover in this post:
- Why Now?
- Six Key Issues for Healthcare
- What’s Next?
We are aware of at least 5 proposed Congressional bills and 16 Privacy Frameworks/Principles. These are listed in the Appendix below; please feel free to update these lists in your comments. In this post we’ll focus on providing background and describing issues. In a future post we will compare and contrast specific legislative proposals.
Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.
Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.
Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.
First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.
We need to design a system of health care that optimally meets the country’s needs while also being affordable and socially acceptable. Clinicians should be at the center of this debate if care delivery is to be designed in a way that puts quality of care before financial gain.
This challenge is too important to be left to politicians and policymakers. There is an urgent need for clinicians to step up, lead the debate and design a new future for health care. Placing professional responsibility for health outcomes in the hands of clinicians, rather than bureaucrats or insurance companies with vested interests, must be an ambition for all of us. We need to find the formula that meets the needs of the patients and communities we serve. A sincere collective effort by committed clinicians to design an effective system will lead to a health care system that has a democratic mandate and the appropriate focus on optimizing the outcomes patients and society need.
As clinicians enter the debate, they should keep three things in mind.
Promote the leadership role of clinicians
We need to help politicians and policymakers recognize the role of clinical leaders in shaping a transformed but effective health care system. Clinicians must redefine the debate so that it focuses first and foremost on patients and health outcomes. Cost effective care can and should be a byproduct of optimal care. Accomplishing this will provide a strong common purpose for efforts to address the challenges of designing outcome-based funding structures and improving access to care.
There is a consensus that measuring performance can be instrumental in improving value in U.S. health care. In particular clinical areas, such as cardiac and intensive care, measurement has been associated with important improvements in providers’ use of evidence-based strategies and patients’ health outcomes over the past two decades. Perhaps most important, measures have altered the culture of health care delivery for the better, with a growing acceptance that clinical practice can and should be objectively assessed.
Nevertheless, as we argue in the full-length version of this paper, substantial shortcomings in the quality of U.S. health care persist. Furthermore, the growth of performance measurement has been accompanied by increasing concerns about the scientific rigor, transparency, and limitations of available measure sets, and how measures should be used to provide proper incentives to improve performance.
The challenge is to recognize current limitations in how measures are used in order to build a much stronger infrastructure to support the goals of increased accountability, more informed patient choice, and quality improvement. In the following paper, we offer seven policy recommendations for achieving the potential of performance measurement.
1. Decisively move from measuring processes to outcomes.
There is growing interest in relying more on outcome measures and less on process measures, since outcome measures better reflect what patients and providers are interested in. Yet establishing valid outcome measures poses substantial challenges—including the need to riskadjust results to account for patients’ baseline health status and risk factors, assure data validity, recognize surveillance bias, and use sufficiently large sample sizes to permit correct inferences about performance.
2. Use quality measures strategically, adopting other quality improvement approaches where measures fall short.
While working to develop a broad set of outcome measures that can be the basis for attaining the goals of public accountability and information for consumer choice, Medicare should ensure that the use of performance measures supports quality improvement efforts to address important deficiencies in how care is provided, not only to Medicare beneficiaries but to all Americans. CMS’ current focus on reducing preventable rehospitalizations within 30 days of discharge represents a timely, strategic use of performance measurement to address an evident problem where there are demonstrated approaches to achieve successful improvement . Read more.
A seasoned colleague recently told me that some PowerPoint presentations have no power and make no point.
But sometimes, a picture really is worth a thousand words. Or maybe — in the case of any meaningful discussion of health reform, thanks to its density and complexity — it might be worth 10,000 words. Hence our handy little exhibit.
This picture captures the 10,000 words it would require to explain with technical precision where President Obama’s Affordable Care Act fits relative to all health reform plans. It places “ObamaCare” along an ideologically scaled continuum of all serious reform options developed, debated and discarded or ignored since the 1980s.
They are all here: from the single-payer, centrally controlled models popular with those who detest corporations and the influence of money in medicine — two actual, not imagined “government takeovers of health care” — to two free market, laissez-faire models favored by those who detest regulation and the heavy hand of government in medicine.
Another delegate had a different complaint: “This mission statement is way too long!” he wailed. “Mr. Jefferson, no one will ever read this ‘Declaration of Independence’ of yours.”
In the meantime, George Washington had been working up a budget for the revolutionary war (earlier called the innovative war). His initial figures were daunting: $37 million would have to be raised by the collaborative, which would need to be matched by $114 million from the states. And of course, they didn’t have a dime (or rather, a shilling).
But let’s go back to the meeting, where they had just decided to give the collaborative a name: the Continental Congress.
The meeting chair pounded his gavel: “Next on the agenda is Fundraising Prospects. Mr. Hancock, your report?”
John Hancock looked up, startled, but recovered his poise: “We’ve developed a list of foundations to approach. Unfortunately, none of them have giving areas that include democratic revolutions, perhaps because there hasn’t been a democratic revolution before. They also want to know who else is funding it, and how we’re going to continue the funding when their grants run out. And several of them aren’t funding right now because they’re doing something called ‘strategic planning.’Continue reading…
But what do expert doctors think about how often it happens? And what do they think can be done to address it?
We wanted to find out so we partnered with the National Coalition on Healthcare to conduct a landmark, nationwide survey. We surveyed 400 cancer specialists from our Best Doctors database – and the findings were provocative.
The survey, “Exploring Diagnostic Accuracy in Cancer: A Nationwide Survey of 400 Leading Cancer Specialists,” focused on what doctors believe to be the most significant barriers in efforts to accurately diagnose cancers; the types of cancer they believe are most often misdiagnosed; and the tools and improvements they most need to combat misdiagnosis.
One of the most surprising findings was on how often doctors believe misdiagnosis happens. While published studies show that misdiagnosis occurs in about 15-28% of cases, the large majority of doctors we surveyed thought it happens in less than 10% of cases. At the same time, doctors recognized that the root causes of misdiagnosis were very prevalent – fragmented medical information, disparities in experience among pathologists and other factors.
So – how to explain the difference in doctors’ perceptions and the published research? I think it is because there is no systematic feedback loop for doctors letting them know of inaccuracies in their care. If you diagnose someone and they go on to get treatment someplace, and it’s later discovered that a diagnosis wasn’t exactly right, the original doctor may never find out about it. If you don’t hear about it, you can’t be blamed for thinking this problem is rare. It also means you miss out on the opportunity to improve the quality of care that these cases represent.
Another interesting point. Doctors reported that, regardless of how often they thought diagnostic inaccuracies happened, it is a problem that needed more attention from policy-makers. As NCHC President and CEO John Rother observed, “Not enough is being done on the state and federal policy end of things to acknowledge and firmly address this critical issue. Given our current health care climate and challenges, as decision-makers become more aware of the frequency of misdiagnosis and the enormous costs associated with it, they have a sizeable opportunity to make diagnostic accuracy much more of a ‘front and center’ issue in health care.”
Here’s to that promising thought.
Evan Falchuk is Vice Chairman of Best Doctors, Inc., where this post originally appeared. Prior to joining Best Doctors, Inc., in 1999, he was an attorney at the Washington, DC, office of Fried, Frank, Harris, Shriver and Jacobson, where he worked on SEC enforcement cases. This post originally appeared on Best Doctors, Inc.’s See First Blog.
For years, patients, providers and payers have complained that EHRs “do not talk to each other.”
By 2014, I expect this issue to disappear.
Do I expect that every state and territory will have a robust, sustainable healthcare information exchange by 2014? No
Do I expect that every provider will be connected to a Nationwide Health Information Network by 2014? No
Do I expect that a single vendor will create a centrally hosted method to share data by 2014 just as Sabre did for the airline industry in the 1960’s? No
What I expect is that Meaningful Use Stage 2 will provide the technology, policy, and incentives to make interoperability real.
Stage 2 requires that providers demonstrate, in production, the exchange of clinical care summaries for 10% of their patient encounters during the reporting period. The application and infrastructure investment necessary to support 10% is not much different than 100%. The 10% requirement will bring most professionals and hospitals to the tipping point where information exchange will be implemented at scale, rapidly accelerating data liquidity.
We were coding up a storm yesterday (Saturday) at the Health 2.0 Developer Challenge Code-a-thon and that goes on today–you can even stop by the PariSoma Loft to see the live judging at 3pm — with $13,000 in prizes on the line.
But the main act is starting up TODAY with 4 fabulous pre-conferences. Don’t forget these are FREE to anyone registered to attend the main conference and to doctors, patients and employers as appropriate for their sessions. There’s also an Innovation Exchange with the Beacon Communities which has some public availability.
The Pre-Conferences: Patients 2.0 brings together more than 150 patient activists. Doctors 2.0 has several leading physicians on stage and in the audience, and more than 15 demos and active panel discussions. Employers 2.0 has leading employers again on stage and in the audience (Wanna meet Facebook’s head of benefits? -scan the badges!) and more demos than you can shake a stick at–as long as some cool case studies from Pfizer on wellness and Cisco on worksite clinics.Continue reading…