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Bad Medicine: How The AMA Undermined Primary Care in America – Brian Klepper

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On Tuesday’s Wall Street Journal website, Dr. Benjamin Brewer describes
physicians’ reactions to the 10.1% cut in Medicare physician payments
that will take effect January 1. He argues that the onus will fall,
once again, disproportionately on primary care physicians, who are
already losing the struggle to keep their heads above water.

He is right, of course. There is no question that Medicare must rein in
cost. But the cuts are approximately the same across specialties and
therefore regressive. Insensitive to its distinct role, its lower
revenues and its high operational costs, they hit primary care harder
than they do specialties. Given its already battered status, the cuts’
impact on primary care could translate to real consequences this time.

Continue reading…

If Grady Fails By Brian Klepper

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In an extraordinary move earlier this week, the politically-appointed Fulton-DeKalb Hospital Authority, the governing body over Atlanta’s Grady Health System, unanimously and voluntary stepped aside, to be replaced by a new non-profit corporation. Projecting a $55 million deficit this year, the hospital had just three weeks of cash on hand. It needs $300 million immediately for sorely needed renovations, and must deal with $63 million in accumulated debt to its biggest creditors, Emory University Medical School and Morehouse School of Medicine. New oversight was the predicate for a hoped-for financial bailout from business, philanthropies and financial institutions.

Other Atlanta hospitals are undoubtedly concerned that Grady will fail, and will probably do everything possible to support a bailout. The last thing they want is for Grady’s patients to come to their facilities. Now would be a good time to rally business leaders and legislators, who nearly always go to fancier hospitals, which of course has been a big part of the problem.

Grady’s turmoil should be recognized as the first small shock of much larger seismic event, long in the making, a concrete sign of America’s relentlessly intensifying health care crisis. The wrath falls on our most vulnerable – those with health problems or with few financial resources – as well as on the institutions and professionals that care for them.

Continue reading…

What the Blogs are saying …

Adam Bosworth, describing life post-Google:

"Well, as some seem to know, I’ve left Google. And now that I’ve
left, that old entrepreneurial fever has struck me again and I’m off
working on a startup. Google is a wonderful company and I had a great
time there and had a lot of fun building something I really believe in,
Google Health, which I think has a great potential to change the way
consumers manage their health when it launches. Still, for me, it is
time to start a new company and I’m off and running.

I’ve been dusting off extremely rusty engineering habits and writing
code. Not elegant code to be frank. Just enough to think through my
ideas. Some extremely clear-headed and smart people can work out
everything abstractly in their heads and then just go and implement it.
I’m not one of them. Watching me write code is like watching an
indecisive sculptor work with clay. I shape it. I look. I wince. I
reshape it. I play with it. I wince some more. I ask my friends, nurse
my wounds, and then reshape it yet again. And so on. Constant iterative
development. It takes three tries before it is even close to the way it
should be, best case. I think it is totally worth it. The arguments and
design decisions are just way more concrete and tested."

Continuez

The Download squad on the impending PHR Wars

"This raises an interesting question. Are doctors going to want to sign
up for Microsoft, Google, ZocDoc, and other online services just to
communicate with their patients? It seems more likely that an
individual doctor or medical practice will pick one service and then
stick with it.

For example, if you take your kid to Fluffy
Bunny pediatrics, you’ll find that the doctors are willing to share all
of your child’s medical records with you over Microsoft HealthVault. If
you sign up for Google Health, you’ll have to get old-fashioned paper
records. Because otherwise, Fluffy Bunny doctors would have to spend
time submitting all of their documents to 2 or more different sites,
which would increase their workload, not decrease it. This, of course
would force health consumers to sign up for multiple services if they
want to make sure they have access to the latest information from all
of their doctors, meaning that you’re the one with a disorganized mess,
not your doctor."

Woodstock of the Wonks: The Health Policy Establishment Honors One of its Own – Michael L. Millenson

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Ha25yr
You might call it the Washington Woodstock of the Wonks.

Hundreds of members of the health policy establishment gathered in the nation’s capital last Thursday to celebrate the 25th anniversary of the premier health policy journal, Health Affairs, and honor editor-in-chief John Iglehart on his retirement from the position he’s held since the journal’s founding. How a publication whose first issue is dated Winter, 1981 can celebrate a 25th anniversary on the eve of Winter, 2007 was a question that went unanswered. On the other hand, when’s the last time numbers coming out of Washington actually added up?

Continue reading…

X2HN, Women’s Executive Networking Conference

Want to go to a conference where there’s no chance that you have to meet Matthew? Gale Wilson-Steele (founder of MedSeek & CareSeek and one of my favorite people in healthcare) wrote to THCB about the conference that she co-founded last year. Apparently because men haven’t got X2 but a spare Y instead, they can’t come! Here’s why you should go if you don’t have a dangling Y!

X2HN was founded to accelerate the pace of healthcare improvement by providing the top-level women in all sectors of healthcare a venue for exchanging ideas, knowledge, and resources. Each year we host a space-limited 2-day Xscape where our members are recharged and inspired by learning from each other and experiencing the nation’s best programs and products.

This year we will convene January 30 – February 1, 2008 at the legendary La Valencia Hotel in the heart of La Jolla, California—a village known for its beauty, beaches, and boutiques.

The rejuvenating agenda for this remarkable event includes:

  • An Inspiring Evening with Darlene Price – Darlene, is one of America’s finest executive communications trainers. No wonder she is retained by many of the world’s top corporations. Darlene is President of WellSaid! and has received numerous honors including nine Telly Awards for outstanding corporate communications. Listen to the life-altering tale of her own healthcare experience, as Darlene sets the tone for the 2008 Xscape and focuses our hearts and minds on leading a much needed healthcare revolution—one communication at a time.
  • Pearl Sessions—X2HN-member presentations provide illumination on the numerous, interconnected facets of our healthcare system. In a few moments you will learn how your executive peers use their competencies and connections to drive important healthcare objectives.
  • Life Lesson —"Constructing a Business Plan for Life”—a female executive’s guide to applying business mindedness to the personal pursuit of meaning and happiness.
  • Workshop—Darlene Price will share the secrets to effective executive communication in an interactive training workshop.
  • Trends for 2008—A panel discussion of the top trends in healthcare improvement.

Fire Burns Away the Fog of Ideology: Can Humane Health Care Reform Rise from the Ashes? – Michael Millenson

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THCB welcomes back our solid pal, the erudite Michael Millenson, for whom the sun doesn’t shine if there’s no wisecrack in the wings. Now leading a consulting firm specializing in health care quality projects, Michael is a former Chicago Trib reporter with 3 Pulitzer nominations to his credit. Michael’s groundbreaking 1997 book Demanding Medical Excellence was one of the first to call attention to the problems addressed by the Quality and Safety movements. Enjoy.

As wildfires sweep Southern California, I have been surprised that homeowners in some of the most affluent and staunchly Republican enclaves in the state have not protested the widespread deployment of government workers bearing fire hoses and driving ambulances. The pain of watching one’s life possessions burn to a crisp must almost be matched by the pain of watching tax dollars wasted on a task that private, for-profit firefighters could surely perform more cheaply and more effectively. Yet not even the richest of the fire-torn refugees has expressed regret over government intervention in their rescue.

Continue reading…

Evaluating the Quality of Quality Improvement Claims: The Population Health Impact Institute – Brian Klepper

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Thomas Wilson PhD is on a mission that’s important to health care. Tom, a respected epidemiologist particularly well-known in disease management circles, founded the Population Health Impact Institute (PHII), a not-for-profit devoted to establishing clear, objective rules to evaluate claims of financial and clinical improvement associated with health management programs.

In an August 16th press release, PHII announced its intention to develop a new accreditation program that

“will focus on the methods behind the claims.  It will be based on the established evaluation principles of transparency and scientific validity successfully used by the PHII since its founding in 2004:

  • Transparency of metrics,
  • Equivalence of populations,
  • Statistical significance of measures,
  • Plausibility of hypotheses, and
  • Disclosures of potential conflicts-of-interest.”

This isn’t a lightweight effort. To oversee the development of their "Quality Evaluation Process” (QEP) standards will be developed by a volunteer panel of national experts, and chaired by former URAC President and CEO Garry Carneal, who oversaw the development of 16 new accreditation programs during his tenure with that quality accreditation organization.

PHII also boasts the participation and support of Sean Sullivan, the CEO of the not-for-profit large employer group, The Institute for Health and Productivity Management. Sean has been an extremely balanced and important voice on health care reform. His group argues that it is in employers’ interests to stabilize and improve health care quality and costs, because employees and families with good health care produce are far more productive. The opposite is true as well.

PHII is looking for expert volunteers for its standards panel. Visit the site of this important effort and consider whether you or your organization might have a way to contribute expertise, financial resources or both.

By way of disclosure, I sit on PHII’s Steering Committee.

A Broker Afterthought: An Acknowledgment, An Apology and A Criticism – Brian Klepper

In the comment section of my post on broker compensation, KWeller properly points out that 1) some states regulate broker commissions more stringently than Florida does and 2) I do a disservice to brokers who practice without financial conflict. He is right, and I apologize to anyone whose practice is at odds with my description.

On the other hand, as several other commenters noted, the practices I described are well-known and widespread, and they occur because the brokerage profession does not self-regulate very effectively. (If it makes anybody feel better – it shouldn’t – neither do many other groups of health care professionals.)

So if you’re not one of the broker’s I was referring to, please excuse me then for pointing to the poor behavior of your colleagues. I wouldn’t have tarred you with the same brush if you had held your fellow brokers to a higher standard of practice.

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.

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