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Physicians: Can Computerized Decision Support Get Docs to Toe the Line on Quality? by Robert Wachter

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Robert_wachter_3 Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog “Wachter’s World.”

A humorous and telling story about quality measurement, decision support, and human nature:

I was visiting professor at a very good academic medical center a year or so ago. On these trips, one of the fun things I get to do is meet with the residents. Sometimes they present a clinical case to me, but this day they wanted to talk about healthcare policy. So I thought I’d check out what they knew about the new world of quality measurement and transparency.

“Who admitted a patient with pneumonia last night?” I asked the bleary-eyed, overcaffeinated group of 20 somethings, each looking only slightly older than my kids. Three interns hesitatingly raised their hands.

“If I wanted to figure out whether you provided high quality care,” I continued, “what should I look at?”

“I think we saved this guy’s life,” one beamed. “Yeah, and I had a lady who was confused, hypotensive, and hyperglycemic,” said another, “and we did a really good job taking care of her. She’s much better this morning.”

Continue reading…

HEALTH PLANS: Tracing this all back to the vine….

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Eric Schlosser, author of Fast Food Nation, has an op-ed in the NY Times about how Burger King has basically singlehandedly scuppered a meager pay rise for some of the poorest immigrant workers in America. It’s searing stuff and he relates it all back to the owners. Who are they?

Three private equity firms — Bain Capital, the Texas Pacific Group and Goldman Sachs Capital Partners — control most of Burger King’s stock. Last year, the chief executive of Goldman Sachs, Lloyd C. Blankfein, earned the largest annual bonus in Wall Street history, and this year he stands to receive an even larger one. Goldman Sachs has served its investors well lately, avoiding the subprime mortgage meltdown and, according to Business Week, doubling the value of its Burger King investment within three years.Telling Burger King to pay an extra penny for tomatoes and provide a decent wage to migrant workers would hardly bankrupt the company. Indeed, it would cost Burger King only $250,000 a year. At Goldman Sachs, that sort of money shouldn’t be too hard to find. In 2006, the bonuses of the top 12 Goldman Sachs executives exceeded $200 million — more than twice as much money as all of the roughly 10,000 tomato pickers in southern Florida earned that year. Now Mr. Blankfein should find a way to share some of his company’s good fortune with the workers at the bottom of the food chain.

Why is this appearing in a blog about health care? Because the same kind of corporate bad behavior happens here too, and the same type of private equity groups are behind it.

Who’s the worst behaved actor in the list of not exactly angelic characters in American health insurance? THCB regulars know that I’m talking about: Mega Life & Health.

Who owns HealthMarkets, Mega’s parent company? Yup, the biggest and richest private equity group, Blackstone, and Lloyd Blankfein and his colleagues at Goldman Sachs.

I’m delighted that they’re being called out personally in the NY Times, and somewhat frustrated that neither Paul Krugman nor Bob Herbert has taken up a similar cause on the health care side. (Incidentally Mitt Romney owes his huge fortune to Burger King’s owner Bain Capital, but that’s another story).

But it’s time to make these connections and to call out some of the richest people in America on what they’re decisions and the behavior of companies they own is doing to some of those significantly less fortunate than themselves.

Genomics vs. Proteonomics: Accessorizing Your Genes By Scott Shreeve

Scott_shreeve_small_2
I had the occasion this past weekend to be out with my wife doing
some shopping. Apparently, I have
been too busy of late to notice that
my wardrobe had been in some decline. My wife therefore drug me out on
grey Saturday (which follows Black Friday) to hit the local Nordstrom Rack.  I was shamed into trying on jeans formerly priced at over $200 (who pay sthis kind of money for a pair of jeans?), gigolo bling-bling shoes (are pointy toes really appropriate for male shoes?) , and a variety of belts and watches (how does wearing a watch “change” my outfit) required to properly “accessorize” my look. We ultimately settled out on some funky 7 Diamonds and Roar surfer shirts to match the now half priced jeans. More on the shoes later.

The experience of “accessorizing” reminded me of a recent post by Matthew Holt regarding Personal Genome Management.  Matthew reviews some of the recent buzz surrounding 23andMe, highlights longtime player DNA Direct, and then puts out some thoughts as to where the market is and can go over the next several years (there is some interesting banter within the comments section as well). He concludes with this consideration:

“The genetic test market is very small, and the
management services that these companies offer around it are going to
only be a share of the testing market itself. So the fact that Navigenics
has already raised money at a substantial valuation means that some
very astute people are thinking that genetic testing will turn from an occasional activity for a small minority of patients (usually those going into pregnancy with some type of risk factor) into
a consumer norm that most patients will have as part of the standard
testing they get done and that management of that genetic information
will be part of the new flow of consumer and clinician activity.”

Matthew hints at something that I believe most people have failed to
grasp when considering the genetic market. I actually see three
distinct limitations:> Continue this post over at the Health 2.0 Blog ….

TECH: Tell us about your Health 2.0 company

We’re
collecting information about companies in the Health 2.0 space. And
have been for some time. Unfortunately what that usually means is that
really interesting companies email us, then email us again to ask why
we didn’t respond to the last email. The result is too many really
great applications we’d love to hear about getting lost in our
in-boxes.

So we’re trying something else instead.

Tell us about your organization using this form,
and you may end up being mentioned in dispatches, featured at a Health
2.0 Conference, or landing the VC meeting of your dreams.  Well perhaps
not all or in fact any of those …but if you want us to pay attention
to your company, this will get it into a systematic review process
starring our crack staff.  Otherwise you may face the peril of being
lost in the email queue.

Editor’s Note: While the emphasis in the sign up process in the
linked form is very much on start ups and new ventures, we encourage
you to get in touch even if you are working on a small project.

POLICY: Wrong, but wrongly influential

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At the recent PRI meeting, one loony lambasted me for failing to agree with her that all the problems of the US health care system were due to all that care bing wasted on illegal immigrants. I asked her to provide me with photographic evidence of cancer patients swimming the Rio Grande…

But a UCLA study has found that even adjusted for age and health status:

Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine.

Of course this isn’t news to us wonks, but here’s a quiz for ya; which one of me and the loony will be voting in the Republican primary? That tells you lots about our health care policy options.

POLICY: Me and the Republicans on NPR (no, not really)

So you can listen to my NPR appearance in Los Angeles on Air Talk hosted by Larry Mantle here (works better in Real Player). The other guest was veteran UCLA Professor Rick Brown, who was playing the lefty here–while I was doing my best to play the straight man and give a vaguely direct explanation of what I thought the Republicans were up to. If you’re as confused by Romney as I am, here’s the weekend headline about wanting coverage for all in 4 years that I’m referring to. That puts him to the left of Obama!

BTW I did this call on a cell phone from a hallway in San Francisco’s most expensive hospital (no prizes for guess which one) so my voice quality is a little spottier even than usual. Still it’s a short and relatively interesting piece.

An EHR We Can All Agree On, by Eric Novack

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NovackI have written about this previously directly and tangentially, but given that this is ‘open enrollment
’ period (for those who still have more than one choice), it is worth repeating.

I report this as a part owner of a small business whose costs are increasing every year while revenues are decreasing.

Therefore, I present to you all the new, improved EHR: Effective Hourly Rate.

The EHR should be given to all employees of all companies.

What it will consist of is simple: all of the total compensation divided into what that rate would be on an hourly basis. Let’s give an example:

Current situation:

Employee paid $18.00 per hour

Employee gets 3 weeks paid vacation (or 120 hours of ‘paid time off’) and does not miss other days (we will assume no overtime payments)

Assuming that this covers a full 52 weeks at 40 hours per week that equals 2080 hours in a year.

A bit more math: $18 x 2080 = $37,440.00

And that is all an employee sees.

Continue reading…

TECH: Bosworth launches new Health 2.0 venture

After several months of sometimes crazed speculation in the
blogosphere and tech press about his last project, former Google Health architect
Adam Bosworth says he is launching a new Health 2.0 company. The new firm,
which will be known as Keas, will be based in San Francisco.

Bosworth is scheduled to deliver the
closing keynote at the World Healthcare and Innovation Congress in Washington
D.C. December 9-11. The title of his speech will be “"Physics, Speed
and Psychology:
What Works and What Doesn’t in Healthcare and Why." The name is a play
on the headline of a talk Bosworth gave a year ago at Google’s  New
York offices dissecting the reasons that AJAX
(the now ubiquitous web development technique designed to speed web
page performance that he played a major role in creating while with
Microsoft) failed when it first came out. That talk was called
“Physics, Speed and Psychology: What Works and What Doesn’t in
Software and Why.”

Comment on the Health 2.0 Blog

POLICY: Wealth, fame and public radio

Those of you in Southern Calfornia, or listening in online,will get to hear my dulcet tones on “AirTalk with Larry Mantle” on 89.3 KPCC-FM and 89.1 KUOR-FM at 11 am PST this very morning. I’m going to be talking about the Republican candidates health care proposals. What? You didn’t think I knew that they had any? I guess they just counldn’t scrape up anyone else who claimed that they knew anything at all….

Here’s the link to the show’s webpage

Physicians: Sermo allowing docs to discuss chart errors about them! by Matthew Holt

Sermo got some press this week about a thread that’s of lots of interest to all of us–medical errors and inaccurate records:


Several years ago, Botney visited a specialist to check out a
bothersome lump in his cheek. He took some medicine and the problem
went away.Out of curiosity, Botney thumbed through his chart and was
surprised to find a note from the doctor saying he had a stroke."I
never even had the symptoms of a stroke. No visual changes, no
weakness, no numbness, nothing," Botney, an anesthesiologist at Oregon
Health & Science University, said in a telephone interview from
Portland.

The key difference here is that
physicians were talking about this with other physicians. The next
question is whether this will blossom as an issue because it’s now
being talked about online? Or will it get hidden under the medical
carpet as has been the issue of medical errors for all these years?

Also worth noting that one of the leading docs in the patient safety movement, Bob Wachter, has a new-ish blog out too that’s well worth a look. I’m happy to report that Bob is also now a contributor at THCB. If you haven’t yet, immediately sally forth and read his recent posts "Dennis Quaid’s Kids – Are VIPs Safer?" and  "When is a Medical Error a Crime." Both have interesting comment threads developing.Comment on this post at the Health 2.0 Blog

 

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