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JOB POST: Ultimate Super Hero of UI Designers

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HOSPITALS: These things happen By Paul Levy

Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. Paul recently became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so.  For the last year and a half he has blogged about his experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive. Today Paul writes about some of the reasons he decided to publish data on central line infection rates and the (adverse) reaction his decision stirred up among competitors in Boston.

These things happen … I was reminded of this by our Chief of Medicine. In the movie, "It’s a Mad, Mad, Mad, Mad World," Ethel Merman, playing Mrs. Marcus, says:

Now
what kind of an attitude is that, ‘these things happen?’ They only
happen because this whole country is just full of people who, when
these things happen, they just say ‘these things happen,’ and that’s
why they happen! We gotta have control of what happens to us."

I am struck by the relevance of this to running a hospital.

Several
years ago, we had that attitude in our hospital with regard to certain
types of medical outcomes. For example, we were content with our level
of central line infections because we were below the national average.
After all, these things happen. Then our chiefs of medicine and surgery
said, "No, they don’t have to happen. When they happen, people die. We
are going to insist that we achieve zero central line infections." And
then they got to work. As I have noted below, it is not an easy problem
to solve, but it is worth the effort, and you can improve.
One way to encourage organizational improvement is to publicize the results of your program. I have done that below
for our hospital, and I have made the suggestion that others in the
city could do the same. As I noted, I did not make the suggestion for
competitive purposes — after all, I don’t know if our numbers are
better or worse than those of other hospitals — but because public
exposure of all our efforts will drive all of us to do better. Also, it
will build, rather than erode, public confidence in the academic
medical centers in our city.

The
response, as you have seen from the press reports, ranges from simple
recalcitrance to technically sophistic arguments about comparability of
data. Please, does anyone argue that the goal should not be zero? If it
is zero, it does not matter whether the data is measured in cases per
thousand patient-days, cases per thousand catheter-days, or just the
raw number of cases.

We all
keep track of these numbers in some form or another. We could easily
post them in real time voluntarily on a website maintained by the state
or an insurance company, along with our own explanations of how and
what we measure. (And perhaps, over time, we will agree on what single
metric is most useful.)

People can and will understand this. They already spend hours on the Internet
reading medical websites. Why do we give them so little credit? It will
demonstrate to the public that we care about this problem, and will
show our individual progress towards our ultimate goal.

Finally,
it will enhance the reputation and credibility of all of the academic
medical centers, two aspects of our character that will be more and
more under siege because of the broader problems of the health care system.

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POLICY: Massachusetts Health Plan Update By Eric Novack

Those of following along with the attempts to provide comprehensive health insurance under current market conditions in Massachusetts under the ‘Connector’ concept, are aware that former Governor Romney and the legislature was aiming for an average policy to cost $200 per month. Never mind that the average policy up to this point in Massachusetts was over about $420 per month.

Well, Governor Romney is out and the first round of bids came in, averaging $380 per month. Shocking.

So new Governor Patrick and the health commission sent the insurers back to the drawing board to see what round 2 would bring, even considering proposals that might limit or exclude prescription drugs.

Last week, the Governor and the Boston Globe presented a breakthrough.  To read the headlines, you would think that success had been achieved.

But wait, get to paragraph 10. The average plan now is $305 per month.  A significant improvement, to be sure, but hardly what Partners Health Care CEO called being “back in the ballpark”.  The $305 rate is still 50% higher than what was intended, and we really do not know exactly what restrictions are being placed to get the lower rates.  And just wait until the purchasers of the new plans start bumping into the restrictions.

Other criticisms about the plan have been chronicled here and elsewhere before and again.

Prediction: By New Year’s 2008, few will be happy to claim ownership of the Massachusetts Health Plan—other than the appointed bureaucrats and their minions.

POLICY/QUALITY/HOSPITALS: Keynsian reporting trumps Smith-ian invisibilty

Michael Cannon at Cato picks up on David Leonhardt’s NYT article about error/process reporting in hospitals and suggests that there’s no need for regulation, as the market is getting us there already.

Hmm… methinks Michael underestimates what one economist he does approve of suggests identifies as a major problem. People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices” He may think that this has only been going on since 2002 or thereabouts but Codman was trying and failing to get transparency in hospitals in 1910! If we’re going to wait for the industry to really do this by itself to respond to Smith’s invisible hand, then as an economist Michael probably doesn’t have quite such a high regard for once said, in the long run, we are all dead!. Codman certainly has been pushing up daisies for a more than 60 years.

POLICY/QUALITY: Why does Health Care in the USA cost so much? Over-utilization is an important factor by Walter Bradley

Walter Bradley has not only written the shorter piece today, but has sent me a longer piece citing over-utilization as a cause of high health care costs in the US. I’m inclined to agree with him even if Anderson doesn’t. It’s a longer more academic piece and I’ve buried most of it behind the fold.

Introduction

The United States (US) invests a higher proportion of gross domestic product (GDP) on health care than all other developed countries, despite which the US population suffers poorer access, a higher individual financial burden, inefficient care and a higher medical error rate than people in most other developed countries.

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