GoozNews: The Most Costly Earmark in S-CHIP
Increased risk of death. No benefit. Higher costs for taxpayers. The ongoing Epo saga, whose latest chapter is being written on Capitol Hill, is a perfect example of why our health care outcomes are second-rate, while our health care costs are second to none.
This is a great bit of digging from Merrill, and it shows why FFS or in this case, Fee for drugs is just a bad way of paying for medical care. Do read it.
This is very important research. I’m just not sure why.
I’m sure I don’t really get the deeper issues involved here, but sometimes its hard to not have your breath taken away by some people’s notion of a good idea. Maybe its because I’m not a true geek, but what I’m about to describe strikes me about the same way I feel as when I see a young adult with multiple facial piercings and hear her/him say "Aren’t these great!?"
Modern Healthcare has an interesting piece on a report that was developed by RTI, a contractor to HHS’ Office of the National Coordinator for Health Information Technology (ONCHIT). The report urges revising Electronic Medical Records (EMR) standards to make it easier for payers and the feds to access the records and spot fraud.
Now I’m as big a transparency advocate as the next guy, and I routinely explain to doctors how claims or clinical encounter data can be used to accurately rate their pricing and performance relative to peers within specialty. I believe we should use performance ratings to reward the high performers and to incent the poor ones to do better.
But to really get to the system we need, doctors first have to implement and use EMRs. They’re key to making the health system as a whole work better. Fewer than a quarter of physicians currently use them at this point. While there are still some buggy whip advocates out there, a large and growing number of doctors get that. Young physicians take it for granted.
Still, there are a lot of hurdles to installing an EMR system. They’re expensive. They force you to change your practice’s work flows. Some of the designs aren’t all that friendly. They’re complicated. And who wants to learn a new system. Heck, I know I’d like what it can do for me, but I haven’t gotten up the nerve to tackle iMovie yet on my Mac, and that’s about a tenth as complicated as an EMR with embedded practice guidelines.
We KNOW EMRs are a good idea but there are lots of reasons for doctors to say NOT YET. This Administration, to its credit (he said, grudgingly) has gloried in their advocacy for these new
technologies, what they can do, and how they can help improve quality and cost. (Remember Newt’s
line, "Paper Kills?")
So WHY would the guys leading the charge on EMRs announce that one of the really great things to use EMRs for when doctors finally bring them online is to WATCH AND CONTROL THEM MORE EFFECTIVELY.
Dumb, dumb, dumb.
But I’m sure I don’t see the big picture here.
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:
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.
This is a photo of some of what I’ve been up to while I was away….and to those of you who asked, yes it was as wonderful as we’d hoped, in an "oh so on the beach in Northern California" way.
While I’ve been off getting married my friend Brian Klepper has done an amazing job covering a huge variety of topics with insight and humor. Thanks very much to Brian, and I hope that we can keep him contributing to THCB. (He’s in lots of demand from other blogs and publications, and a great person to have speak to any group). Brian will also be covering the upcoming Health2.0 conference for THCB (as I’ll be a mite busy otherwise).
Finally the team working on Health2.0 has been doing an amazing job while I abandoned them for purely personal (if unavoidable) reasons. So I want to thank Indu, John and Sara for their incredible work. If the conference is half as as successful as our wedding, then it’ll be great!
Every month, some good soul hosts Health Care Wonk Review, an eclectic gathering of posts from around the expert health care blogosphere. This month, its Daniel Goldberg at the Medical Humanities Blog, and he’s assembled a genuinely superb collection of thoughtful essays. One of the underlying themes of THCB, of course, is the vastness and complexity of health care, and those of us really interested in the diversity of health care issues, dynamics and perspectives will find plenty to feast on here. Go on over and work through the ideas on display.
I sit on the Dean’s Advisory Councils of the Colleges of Health at two public universities in Florida. Both Colleges are led by extremely capable PhD nurses, and have a variety of programs that train students to be health professionals, including nurses.
A few months ago, I was startled when one of the Deans mentioned that
her Nursing program had 500 qualified applicants for 132 student slots.
In other words, at a time when the market wants her to gear up, she
turns away 3 qualified applicants for each one she accepts. As it turns
out, it’s a national problem. In 2006, Colleges of Nursing turned away 43,000 qualified applicants.
It’s not news that health care institutions face a critical nursing shortage. An April 2006 AHA report estimated that American hospitals currently need 118,000 RNs to fill vacancies. That number is expected to triple by 2020, to 340,000 vacancies.
HHS Secretary Mike Leavitt has a new blog.
While its hard to know what information the posts will contain once he settles in, it can only be a good thing for a public official to lay out his thoughts in such an open format. HHS and CMS lie at the heart of much of health care change now, so the establishment of a venue for exchange is extremely progressive and valuable.Kudos to Mr. Leavitt for going down this path. We’ll be reading with interest.
Fee-For-Service (FFS) reimbursement has been disastrous for the American health care system because, instead of encouraging the delivery of the RIGHT products and services, it simply encourages MORE, and independent of quality and safety. The system lacks transparency, so we haven’t been able to distinguish appropriateness from inappropriateness. As a result we pay for everything, rewarding excess. The industry has seized on this and cultivated excess as a core value. It’s a big part of why we’re in the fix we’re in today.
But FFS’ other insidious impact is that it has enabled – and I mean this in the clinical sense – doctors and hospitals to engage in behaviors fundamentally counter to their patients’ interests as well as their own. FFS has allowed physicians to remain in small practices where they lacked the scale to invest in information technology tools, group purchasing or offshore medical malpractice arrangements. As a result, care in the little practices that currently dominate the medical landscape is often more expensive and of lower quality than is typical in larger practices.
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.
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