Tag: Transparency

W(h)ither thy health benefits?

Oct 13, 2008

By Jane Sarasohn-Kahn

The headlines read that CFOs are having trouble accessing credit.

What will that mean for health benefits?

A survey of American CFOs and comptrollers from Grant Thornton has found that over half of CFOs have seen credit costs increase. 2/3 find credit harder to come-by than in 2007.

One in two CFOs think the U.S. economy will remain the same over the next 6 months.

The No. 1 pricing pressure concern is employee benefits — 55% are most concerned about benefits, including health and pensions.

In the short term — six months out — 23% of employers expect their headcount to decrease.

Jane’s Hot Points: Getting credit flowing is Job 1 for the Treasury Secretary (separate from stock market woes). Even with the possible infusion of cash into the U.S. market (with similar moves by European and G7 banks under consideration), the credit crisis won’t be reversed immediately. CFOs anticipate the pricing pressures plaguing their daily businesses will persist for at least six months.

As health benefit designs return to their drawing boards, we can expect two impacts: (1) some employers forced to drop the health benefit; and (2), further erosion of the benefit, in the form of insureds bearing more costs.

That is, if the employee happens to land in the 77% who will be lucky enough to keep his

A Genius Shines…And, Where the Light Doesn’t, Hospitals Don’t

Sep 25, 2008

By Michael L. Millenson

It doesn’t take a genius to figure out that hospitals could dramatically reduce the hundreds of thousands of deaths and injuries they unintentionally cause patients ever year, but it may take a genius to coax change out of ossified organizations. As for getting hospitals to publicly disclose injuries and deaths the law says they must? That’s another story entirely.

On the good news front, The MacArthur Foundation has just honored Johns Hopkins’ Dr. Peter Pronovost with a “genius award,” the informal moniker for the go-and-do-smart-stuff prize given to MacArthur Fellows.

Pronovost, you may recall, is the critical care physician who came up with the idea of culling lengthy guidelines on error prevention in the ICU into a simple checklist of five precautionary steps. When tested in ICUs throughout Michigan, the result was to “change the culture of [the] institutions in the interest of reducing the risk of medical errors and hospital-acquired infections,” the foundation noted. “Pronovost’s checklist intervention yielded a significant and sizeable decrease in rates of infection and is currently being replicated by hospitals across the U.S. and Europe.”

A long way to go in price and quality transparency

Sep 2, 2008• 4

By Jane Sarasohn-Kahn

Providing price and quality information is viewed as a Holy Grail among health plans and providers, who see transparency as the key for igniting health care consumerism. However, that Grail remains elusive, as issues of tool usefulness and consumer trust cloud the market."A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency," a report from those indefatigable folks at the Center for Studying Health System Change (CSHSC), explains that health plans are ramping up transparency efforts in what is still an early phase of market development and adoption.

Health Systems’ Ferocious Challenges

Jul 22, 2008• 3

By Brian Klepper

Lately, I’ve had interesting discussions with a thoughtful exec. at a
major Western health system about the ferocious challenges facing
hospitals and health systems. Her organization’s internal conversations
at the moment are centered, in part, on what they should do to become
"reform ready," not only for policy changes that could be in the wings,
but more importantly, for emerging market dynamics that will change the
ways hospitals work. She asked me to catalog some of the trends I think
health system managers will have to deal with, along with five
recommendations for action. Here’s some of what I told her.

Hospitals face dramatic financial stresses on a range of fronts.
Over the last 25 years, health systems’ average total margins have
remained reasonably stable at around 5 percent. As you’d expect, some
organizations have performed better, and others worse. About
one-quarter of all US hospitals, many of them safety nets, have
reported negative margins, and continually teeter toward failure.

Now the pressures are ramping up considerably. Perhaps most
profoundly, the balance has eroded between more profitable
privately-covered patients, and patients with public coverage –-
Medicare, Medicaid and other governmental sources –- that may not cover
cost.

A message you hope to never send

Jul 7, 2008• 7

By Paul Levy

First, an email sent out on Thursday morning. My commentary follows.

Dear BIDMC Community,

This week at BIDMC, a patient was harmed when something happened that never should happen: A procedure was performed on the wrong body part. With the support of all our chiefs of service, we are sharing this information with the whole organization because there are lessons here for all of us.

While respecting the confidentiality of both the patient and caregivers, here are the key facts: It was an elective procedure, involving an excellent team of providers. It was a hectic day, as many are. Just beforehand, the physician was distracted by thoughts of how best to approach the case, and the team was busily addressing last-minute details. In the midst of all this, two things happened: First, no one noticed that the wrong side was being prepared for the procedure. Second, the procedure began without performing a "time out," that last-minute check when the whole team confirms "right patient, right procedure, right side." The procedure went ahead. The error was not detected until after the procedure was completed. When it was, our patient safety division was notified immediately, and they in turn took all appropriate steps including investigation, reporting and corrective action. The physician discussed the error with the patient at the first opportunity, and made a full apology. The patient is now recovering at home from the injury, which is not life-threatening.

Consumer Reports on Health: Worse Than Average

Jun 4, 2008• 9

By MICHAEL MILLENSON

Maybe no one at Consumer Reports has a mother.

The first rule of effective consumer information is “tell it to Mom.” That is, explain why something is important in the kind of language you would use when speaking to your mother. Unfortunately, the folks at Consumers Union have now, for the second time, put out purportedly pro-consumer health care information that no one’s mother could love. Their latest offering is at best mildly helpful and at worst seriously misleading. The only explanation I can think of is that the CU folks believe so firmly in their own good intentions that they ignore the impact of what they are actually doing.

Health 2.0 Consciousness Dawns – Even In Jacksonville, FL!

May 15, 2008• 2

by BRIAN KLEPPER

Today, Matthew, Michael Millenson and I are converging at a Robert Wood Johnson Foundation conference on public reporting of health care pricing/performance information in Amelia Island, FL, three short barrier islands north of my home in Atlantic Beach. (Always helpful, Michael suggested to the conference organizers that I should be required to walk or take public transportation, to compensate for the fact that everyone else has to come in by airplane.)

In any case, we decided that we might as well seize the opportunity and hold a short symposium on market-based transformation for the Northeast Florida health care and business communities. Dean Chally of the University of North Florida’s College of Health graciously arranged the space on their beautiful campus, and so we’re set for a 7:30AM, 2 hour conference on Friday May 16th–that’s tomorrow.Michael will talk about public reporting, Matthew will present on the consumer side of H20, and I’ll hit H2O business-to-business analytics, the emerging medical home movement, and some wellness/prevention approaches that are gaining traction. Should be a fun morning. If you’re in the neighborhood, be sure to drop by and join us.

An Open Response To HHS Secretary Mike Leavitt – Brian Klepper and Michael Millenson

Apr 22, 2008• 1

By Brian Klepper and Michael Millenson

A few months ago, the two of us – both long-time advocates for
transparency and accountability – posted separate comments on Secretary
Mike Leavitt’s blog. Brian asked Secretary Leavitt to square his
support of "Chartered Value Exchanges” with the attempt to block
release of physician-specific Medicare claims data to Consumers’
Checkbook, which wants to rate doctors. After a court ruled that the
data should be provided to the group, HHS appealed. Michael urged the
secretary to go beyond supporting Consumers’ Checkbook and use his
“bully pulpit” to promote sophisticated data analysis that could be
used to create national quality comparisons.
Secretary Leavitt graciously asked us to consider and comment on the
department’s proposed "Medicare trigger legislation" calling for the
release of physician performance measures. We are delighted to continue
the conversation.

First, let’s give credit where credit is due. We agree that the proposed legislation is a major step in the right direction.

Knowledge Like Clear, Clean Water: Muir Gray on Health Care’s Progress

Apr 7, 2008• 4

By Brian Klepper

Over the last year or so, I’ve written a lot about how health care
information will become increasingly available to consumers and health care
business, and how this access will drive new decision-support
capabilities that will profoundly change how health care works,
eliminating many of the problems that have placed health care in
crisis. So imagine my delight when a colleague forwarded this quote.

Sir Muir Gray is Chief Knowledge Office of Britain’s National Health Service. His wonderfully clear explanation of how health care knowledge will become guidance – that is, decision-support – makes a compelling case for the transformative power of Health 2.0.Check it out.

The future is something we make, not something we discover. And the
future is easy to make because as William Gibson has said, the future
is here, it’s just not evenly distributed.

The second revolution took place in the latter part of the 20th
Century. It was driven by science, making plastics, airplanes,
televisions and innovation in chemical and mechanical technology in
health care.

We’re in the middle of the third Healthcare revolution. The first was
based on common sense, an empirical revolution; the health of nations
was transformed by making observations and deductions from data and
improving conditions based on those deductions. So now, for example, we
take clean clear water for granted.

Which way to go for health reform? From Birkenstocks to pom-poms

Mar 31, 2008• 1

By Sarah Arnquist

The methods proposed to clean up the health care mess in the United States that leading voices pitched to hundreds of journalists Friday unsurprisingly were as varied as their Birkenstocks and patriotic tie.

David Himmelstein, co-founder of Physicians for a National Health Program and Birkenstock-wearing Harvard Medical School professor of medicine, unrelentingly pushed a single-payer system. "We need a reform that helps the insured as well as the uninsured," he said, adding that the system should "get rid of the insurance companies that provide no added value."

At the other end of the spectrum, Tom Miller, resident fellow at the American Enterprise Institute conservative think tank, wants more tax credits to put consumers in the driver’s seat and deregulation of the individual market.

Between those two ideologies, were Karen Davis, president of The Commonwealth Fund, and Julie Barnes, deputy director of the New America Foundation‘s health policy program.