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.
Outrageous!!
First and foremost—congratulations to Matthew and Amanda on their
wedding!!! Now to the outrage!!!
In Friday’s Boston Globe , health reporter Alice Dembner reports the plight of a 60 year old woman who has to pay twice the amount for health insurance as a 27 year old. “That’s discrimination!!” she says in the article.
Yet MSNBC reports that, “ a typical couple retiring in 2020 will have paid about $100,000 in lifetime Medicare taxes. ‘For that price, this couple is scheduled to receive about $500,000 in lifetime Medicare benefits over and above the premiums it additionally pays in retirement.’
Also, has anyone checked out how much more it costs to get auto insurance
for a 20 year old versus a 60 year old?
Hmmm…
All of us who have worked in policy during our careers know the old joke that there are two things you never want to see made: sausage and laws. Never was this more true than with Medicare D.
Earlier this week, Robert Laszewski at Health Care Policy and Marketplace Review wrote an eloquent and succinct piece called "Good Riddance to Karl Rove: How Part D Left An $8 Trillion Debt And Got Them Nothing," a genuinely damning indictment of the cynical use of power. Read Mr. Laszewski’s posts and you quickly get the fact that he is a keen, unbiased, open-minded, analytical observer of the Washington health care scene. His obvious knowledge about the circumstances and his stature lend terrific weight to his words. I’d urge every person who reads this blog to read Mr. Laszewski’s column, and to pass it around to your colleagues.
By now you know that the Health2.0–User Generated Healthcare
Conference organized by Matthew Holt (THCB) and Indu Subaiya (Etude
Scientific) is all set to take place on September 20th in San
Francisco. Among other things, there are four fabulous demo panels on Search, Tools for Consumer health, Providers and Social networks, and Social Media for Patients.
You would not believe how many people want to show their cool tools on these panels. Well it just so happens that we ended up with one spot left on the Social Media for Patients Panel. We already have the wonderful Amy Tenderich (DiabetesMine) to moderate. On the panel are OrganizedWisdom, DailyStrength, MedHelp, PatientslikeMe & SophiasGarden.
So how to choose the remaining panelist from so many great possibilities? Too tough for us to decide, so we’re throwing it over to you. The contenders, listed in no particular order with a line or two of description are below. Please go take a look—don’t worry if these don’t exactly fit your definition of “social media”—we have ways of shoehorning the most interesting sites into our program.
Over at The Doctor Weighs In, Bill Bestermann literally grabs our attention and forces feeds us a highly informative, and, dare I say, USEFUL physiology lesson in If You Want To Get It Up – You’ve Got To Get It Down. The subject is the one topic that men (and the women who care about men) really care about: erections. That’s right. Ever thought that even you (or your male partner), burly, strapping man among men, could be afflicted with erectile dysfunction? Get the skinny on the why, what it means and what to do about it from Dr. B. In the process, you’ll get a glimpse of the Marlboro Man and learn some fascinating background on how Viagra came about.
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.
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.
Professor Michele Mello, an expert on the health care justice system at the Harvard School of Public Health, has an interesting 9.5 minute audio podcast on why health courts would be an improvement over the current medical liability system. The development of her health court proposal was funded jointly by The Robert Wood Johnson Foundation and Common Good.
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