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Tag: Quality

OMNI: The Oncology Metrics National Index – Brian Klepper

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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.

Can We Talk, Frankly? – Brian Klepper

Over at The Doctor Weighs In, Bill Bestermann literally grabs our attention and forces feeds us a highly informative, and, dare I say, USEFUL physiology lesson in If You Want To Get It Up – You’ve Got To Get It Down. The subject is the one topic that men (and the women who care about men) really care about: erections. That’s right. Ever thought that even you (or your male partner), burly, strapping man among men, could be afflicted with erectile dysfunction? Get the skinny on the why, what it means and what to do about it from Dr. B. In the process, you’ll get a glimpse of the Marlboro Man and learn some fascinating background on how Viagra came about.

Consultants to Hospitals: Prepare for Transparency – Brian Klepper

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We must view and treat the community as the "owner" to whom we are fully accountable. Aggregate financial performance data, aggregate productivity performance and aggregate quality and patient satisfaction data belong in the public realm. How else can consumers make a decision to…support us?

— Rich Umbdenstock, President and CEOAmerican Hospital AssociationInterview in Hospitals and Health Networks, 10/18/04

Most health care professionals sincerely believe in performance transparency, especially if it applies to someone else. Three years after the encouragement of Mr. Umbdenstock and similar pronouncements by colleagues throughout the industry, many physicians, health plan executives and hospitals executives remain extremely resistant to public reporting of pricing and performance.

Norton Healthcare in Louisville KY has developed one of the most progressive and forthright quality reporting efforts in the country. On their site, they provide their performance figures on a range of indices, indicating where they fall above or below national benchmarks. (You can just imagine how thrilled their staffs were with this decision to "bare all." ) The home page for their quality section lists six principals that drive their reporting.

   1. We do not decide what to make public based on how it makes us look.

   2. We give equal prominence to good and bad results.

   3. We do not choose which indicators to display.

   4. We are not the indicator owner.

   5. We display results even when we disagree with the indicator definition.

   6. We believe unused data never become valid. 

Norton sets a fine example for hospitals. But now, as demands for transparency become more compelling, the mega-consulting firms, always quick to lead the way and claim credit once a trend has been firmly established, are throwing their hats into the ring as well, hoping to provide guidance for tidy if exorbitant sums.

And so it is not surprising that the consulting firm Grant Thornton, in its spring newsletter Health Care Rx, has a thoughtful, pragmatic article urging hospitals to review and potentially change their pricing, document justifications when necessary, and generally take steps to ensure that they’re prepared as transparency efforts become irresistible. Its a good piece and, for hospital execs, well worth a few minutes time.

Managed Care Redux – by Brian Klepper

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Like democracy, managed care is a great idea. It’s just that its rarely been tried.

Even so, my guess is that its about to re-emerge in a new, improved form, and possibly with some other name. If the signs around us now have any meaning, it will be different than our experience of a couple decades ago, and much truer to the original principles and possibilities that first caught our attention.

Last week the New York Times’ David Leonhardt ran another pop health economics piece, exploring several presidential candidates’ notion that the savings captured by providing better care could fund the uninsured. He explains better care as really being prevention – making sure that patients get services that stave off illness – and better management of the care process once they do get sick. And then, quoting a variety of health care experts, he takes issue with the notion that these approaches actually produce returns-on-investment. The problem, you see, is that while you may save money on the diabetic who avoids hospitalization to get his foot removed, you’re spending money taking care of all those diabetics who wouldn’t ever have had a costly problem.

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QUALITY/POLICY: Sicko, Deloitte and the reason for EBM

The Deloitte Center for Health Care is best known for being headed by Paul Keckley, recently of the Center for Evidence Based Medicine at Vanderbilt, and a minor actor in Michael Moore’s recent spat with CNN. (CNN didn’t come clean that Keckley has consulted for lots of health plans and, horror of horrors, is a Republican).  I personally thought that Moore won that spat pretty convincingly, in that CNN couldn’t spend 12 seconds googling Paul.

The joke is that some of what Paul said was exactly what Moore said. Health care that is free at the point of care is not without cost, as it’s paid for out of general taxation (or some variant of it). Of course, it’s pretty shallow to say Americans don’t like paying tax, but then ignore the fact that they are otherwise (via reduced wages) forced to pay a "private tax" in health costs which massively exceeds that paid in tax to governments in other countries (after all there it adds up to 10% of GDP, here 17%). And I thought Moore was pretty clear in the movie twice (once with Tony Benn in the UK, and once when he went to visit the well-off French couple) that Europeans accepted higher taxes so that they can take care of the poor. Of course they probably don’t realize that in paying higher private taxes they save money overall.

However, the good folks at Deloitte are moving on, led by Paul, to talk more about the problems within the US system, and I suspect that Paul has learned his lesson about letting CNN tape his words without being clear about what their going to do with them and how they’ll represent him.

Instead, Deloitte’s gone to Kansas. Topeka, KS to be precise. Overall Topeka is a mirror of the national average in healthcare delivery data. Their analysis done using Healthgrades’ and other data is that if hospitals in Topeka could just do a little bit better than average they could save over 150 lives a year by just performing a little better–and that in a metro of just under 230,000.

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PODCAST/QUALITY/TECH/HEALTH PLANS: Disease management, technolgy and the future of health care–Gordon Norman tells all

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Gordon Norman is Exec VP and Chief Science Officer at Alere Medical, formerly head of DM at Pacificare and a font of knowledge and opinion about disease management, technology, the role of health plans, and the chances for overall change in the  system. We agree much more than we disagree, but if you have any interest at all in the restructuring of health care, I’m sure that you will enjoy our conversation.

You’ll also enjoy Gordon’s recent talk at Healthcare Unbound–his slides are here

QUALITY/POLICY: Medpundit right on on cancer treatment

I didn’t get around to talking about the cancer treatment article in the NY Times last weekend, but Syd at Medpundit did. And I agree with her—we should be figuring out when to say no, heartbreaking though it is. Although buying a few extra months for a 35 year old mother in my mind is different from doing it for a 93 year old (even if he was President once). Look in the comments for a note from the subject of the NY Times article.

QUALITY/INTERNATIONAL: A great check list and more about EBM

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Humphrey Taylor from Harris mentioned to me earlier this year that one thing Americans don’t realize is how much other health care systems are changing—while ours seems stuck in 1987. One case in major point is the UK where serious changes in terms of more money being spent on health care (a designed increase of nearly 2% of GDP), a reorganization of primary care called Primary Care Trusts, a major investment in IT for healthcare, and a significant change towards paying primary care docs for outcomes have all been going on in the last few years. In fact probably the most Americans realize about this is the scene in Sicko where the British GP discusses his salary (much higher than PCPs get in the US), shows off his fancy car and nice house, and explains that he gets paid more for keeping his patients healthy. All true and all recent phenomena.

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