Medicare’s recent policy of refusing to pay hospitals’ additional costs to treat hospital-acquired infections fails to adequately incentivize prevention and proper treatment of these complications, associated with 99,000 deaths annually. A recent analysis by Peter McNair and colleagues in the journal Health Affairs suggests that, in the entire state of California, only 11 hospitalizations complicated by infection would have received lower reimbursement as a result of the policy if it had been in place in 2006.The Medicare policy focuses on infections that have low mortality, such as catheter-associated urinary tract infections, and infections that affect few people, such as mediastinitis after CABG surgery. This means that the vast majority of severe hospital-acquired infections remain completely unregulated.
To Change Health Care, Change Diabetes.
As we work to change health care in America, we must recognize the need to dramatically change diabetes. Twenty-four million Americans have diabetes at a cost to our nation of an estimated $218 billion for diabetes and pre-diabetes, according to a series of studies recently published in Population Health Management. Imagine the effects diabetes will have on our health and economy in the future if we don’t take action now. The prevalence and economic burden of undiagnosed and pre-diabetes make the case for the importance of policies that promote early diagnosis and prevention. About 25 percent of Americans with diabetes aren’t even aware they have the disease. And, those with undiagnosed diabetes result in $18 billion in health expenses, or $2,864 per person each year, according to one of the studies mentioned above.
Joint Commission Apes Newt, Takes on IHI
Not content with handing out demerits for bad behavior, the Joint Commission has launched an effort to help those who misbehave change their ways.
As detailed in the Wall Street Journal’s Health Blog, the mission of the Joint Commission’s new Center for Transforming Healthcare will be, in the Journal’s words, “to work on new collaborative programs with leading hospitals and health care systems to find a cause of the most deadly breakdowns in patient care, and put a stop to them.”If the name of the new group sounds familiar, you could be confusing it with Newt Gingrich’s Center for Health Transformation. That center was launched by the former House Speaker to tout the benefits of health information technology and a changed reimbursement system and then show how those benefits could work in practice through demonstration projects. Of course, with the advent of the Obama administration, the for-profit center has changed its mission just a tad from Newt-the-Wonk’s, “Paper Kills” to Newt-the-Republican-Attack-Dog’s “Democrats kill.” Visitors to the Center’s site can now find helpful op-eds with titles like “Healthcare Rationing” and “Listen to Barney Frank or listen to America?”
Our President is on the Ropes
Recent pictures of President Obama suggest he is battered and on the ropes. Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.
There is already much oversight at federal and state levels of all insurance programs, yet all of these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work for our country. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.Continue reading…
Separating Fact from Fiction and Health from Health Care
By JAMES S. MARKS, ROBERT WOOD JOHNSON FOUNDATION
In an editorial on Wednesday, The New York Times debunks the often-cited claim that America has the best health care system in the world. For the politicians who routinely use this as a plank in their efforts to stifle reform, the Urban Institute study (disclosure: this study was funded by the Robert Wood Johnson Foundation) is an objective rebuke. The U.S. health care system is not the best – far from it. And Americans, with a life expectancy that still trails many other countries, are not the healthiest people in the world.
Clearly, this country desperately needs health reform. But the study, the editorial, and the entire current discourse around health care neglect an important truth about reform: fixing the health care system alone will not significantly improve Americans’ health.
For example: medical spending consumes 16 percent of the U.S. GDP and is projected to reach a staggering one dollar for every five earned by 2018. And yet, only 10-15 percent of preventable mortality is linked to health care. This and our terribly poor international rankings in length of life are telling signs that our tremendous investment does not do enough to address the factors that make us sick in the first place.
Our current national debate must look beyond health care – the so-called repair shop of our health system – and focus on our health. Fixing health care will require insurance reform, cost containment and sound economic policy. Fixing health will require us to look at our neighborhoods, our schools and our workplaces. From our earliest years of life, these are the places that determine how long and how well we live in America. The recommendations of the Robert Wood Johnson Foundation Commission to Build a Healthier America, which identify pockets of success where programs are making a real difference in people’s health, provide a useful place to start.
In schools, where obesity threatens the current generation of children with sicker and shorter lives than those of their parents, solutions are critically needed. By guaranteeing daily physical activity in schools – which fewer than 3.8 percent of elementary schools provide – and linking federal funds for school meals to their nutritional value, we can reverse the epidemic and help our children grow up healthy.
In our neighborhoods and communities, we must consider the health impact of investments and development to ensure that they help promote physical activity, make healthy foods more readily available and lay a foundation for prosperity. With public-private partnerships, we can bring grocery stores and nutritious food into underserved neighborhoods and help both the stores and the neighborhoods thrive. By incorporating bike lanes, sidewalks and trails into our transportation planning, we can help make the daily lives of Americans more physically active.
All of this amounts to a change in the way we think about health in this country. Health care reform, while critically important, will not avert the crisis of poor health that we’re facing. The Times editorial and Urban Institute study shine an important light on the dubious claim that we have the best health care system in the world, but they don’t go far enough. It’s time that we debunk the larger myth, that Americans are the healthiest people in the world, so all of us – from the halls of Congress to the family dinner table – can start working to improve the health of the country we love.
Dr. James S. Marks, M.D., M.P.H., senior vice president at the Robert Wood Johnson Foundation and director of the Foundation’s Health Group. Dr. Marks oversees all of the Foundation’s work in childhood obesity, public health and vulnerable populations. Prior to RWJF, Dr. Marks was an assistant surgeon general and director of CDC’s National Center for Chronic Disease Prevention and Health Promotion.
Interview: Bob Wachter on reform, safety, primary care and everything
One of the best commentators around on the issues of patient safety, health care quality and basically everything to do with health care organizations is UCSF Professor Bob Wachter. Bob has been in the trenches as one of the leaders in the hospitalist movement, a major driver behind improving patient safety, and has also straddled the worlds of medical practice as a PCP, academia at UCSF, and been publicizing this all to a wider audience–particularly with his 2005 book Internal Bleeding and his more recent book Understanding Patient Safety. Then of course there are his occasional blog posts both on Wachter’s World and here on THCB.
This was a really fun conversation and somehow Bob remains an optimist. Here’s the interview.
E-Health – It All Depends on How It’s Used
By MERRILL GOOZNER
Technology isn’t a quick fix. Just ask General Motors. In the 1980s, the auto giant spent $50 billion to automate and computerize its plants in an effort to compete with Toyota. Today, GM is emerging from bankruptcy while Toyota still leads in producing high quality, fuel-efficient vehicles.
What happened? “The Japanese have a great way of describing the error that General Motors made,” said Thomas Kochan, co-director of the Institute for Work and Employment Research at the Massachusetts Institute of Technology Sloan School of Management. “It’s workers who give wisdom to these machines.”Continue reading…
E-Health – It All Depends on How It’s Used
By MERRILL GOOZNER
Technology isn’t a quick fix. Just ask General Motors. In the 1980s, the auto giant spent $50 billion to automate and computerize its plants in an effort to compete with Toyota. Today, GM is emerging from bankruptcy while Toyota still leads in producing high quality, fuel-efficient vehicles.
What happened? “The Japanese have a great way of describing the error that General Motors made,” said Thomas Kochan, co-director of the Institute for Work and Employment Research at the Massachusetts Institute of Technology Sloan School of Management. “It’s workers who give wisdom to these machines.”
Will the Obama administration’s $20 billion push to flood the nation’s physician offices and hospitals with electronic medical records (EMRs) suffer a similar fate? The July/August cover story in the Washington Monthly by Phillip Longman pointed to one possible stumbling block on the road to widespread diffusion of EMRs – self-interested software firms pushing proprietary systems that can’t talk to each other.
But there may be an even greater danger. The people who actually deliver care will fail to achieve the potential health benefits of having every patient’s EMR at their fingertips.
That was the reality facing Kaiser Permanente’s Colorado medical group in Denver five years ago. The health maintenance organization, touted as an exemplar of quality care, was an early adapter of EMRs. And what those records told local managers when it came to controlling blood pressure — a major goal — was troubling. Despite annual free checkups and prescribing lots of blood pressure pills, only 59 percent of patients had achieved control in follow-up visits. “Putting a blue sticker on a piece of paper that says you have high blood pressure wasn’t working,” said Sean Riley, the medical director of the group.Continue reading…
Op-Ed: The Unintended Consequences of “No Pay for Errors”
Medicare’s policy to withhold payment for “never events” – the first effort to use the payment system to promote patient safety – remains intriguing and controversial. To date, most of the discussion has focused on the policy itself at a macro level (including two articles by yours truly, here and here).
In the past month, experts on two of the adverse events on the “no pay” list – hospital falls and catheter-associated urinary tract infections – have chimed in. Interestingly, while agreeing that the overall policy has upsides and risks, they came to strikingly different conclusions about the wisdom of including their pet peril on the list.
Let’s begin with UTIs. Last month’s Annals of Internal Medicine article by Michigan’s Sanjay Saint and colleagues begins, quite cleverly, with a quote from Ben Franklin: “By failing to prepare, you are preparing to fail.” Turns out that among Franklin’s many inventions was the flexible urinary catheter (so who the hell was Foley?). The piece nicely reviews the “no pay” policy and describes the epidemiology of catheter-associated UTI (CAUTI).Continue reading…
Schwarzenegger replaces most of state nursing board
Gov. Arnold Schwarzenegger replaced most members of the California
Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious
misconduct.
He fired three of six sitting board members – including President
Susanne Phillips – in two-paragraph letters curtly thanking them for
their service. Another member resigned Sunday. Late Monday, the governor's
administration released a list of replacements.
The shake-up came a day after the Los Angeles Times and ProPublica published an investigation finding that it takes the board, which oversees 350,000 licensees, an average
of three years and five months to investigate and close complaints against
nurses.
During that time, nurses accused of wrongdoing are free to
practice – often with spotless records – and move from hospital to
hospital. Potential employers are unaware of the risks, and patients have been
harmed as a result.
