My crack sources tell me that you can soon get your fill of webinars from AHRQ on matters near and dear to a HC IT wonks heart. On Mar 15 there’s a webinar about Model Contract Language for Health Information Exchange. On Mar 28 there’s a webinar about (get this mouthful) the Socio-technical Aspects of Health IT and on April 10, there’s a webinar about the Massachusetts eHealth Evaluation (starring David Bates). If that lot doesn’t get you going, then nothing will!
Above the Fold
POLICY/PHYSICIANS: Reducing waste in US health care systems, by Walter Bradley
Walter Bradley is the Chairman of the Department of Neurology at the school of Medicine at the University of Miami. Previously on TCHB he wrote a piece on how we should solve the uninsurance problem. Today he takes aim at waste reduction.
R.W.Bush published a paper entitled “Reducing Waste in US Health Care Systems” in the current issue of JAMA (subscription boringly required). In this, he describes the application of the Lean Production methods of Toyota to eliminate waste. In this context, “lean” is “any activity that does not serve the valid requirements of the customer.” This approach is innovative and he was able to demonstrate that improving efficiency saved money, improved patient care and made the system more “user-friendly.” Waste is undoubtedly one of the elements involved in over-utilization that leads to the high cost of US health care. Others elements that have been suggested to be responsible for the US expending the highest proportion of GDP on health care of all nations in the world include bureaucracy and administration, malpractice insurance and defensive medicine, and the high cost of goods and salaries of health care workers.
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.
PODCAST/CONSUMERS/TECH: HealthFacts
BCBS of Minnesota has set up an interesting approach to transparency and measuring provider performance. They’ve created a site called HealthCareFacts.org for consumers to look at and compare provider details, set up a subsidiary called Consumer Aware to run it, and are now marketing it to the world. The model is nutritional labeling. I met Amelia Schultz (the VP of Sales at Consumer Aware) and she set up this interview with founder and CEO MaryAnn Stump. (The interview was recorded on Feb 14, but posting was delayed because I had to fix some technical problems with it. All better now, I hope!)
POLICY: A National Disgrace By John Irvine
When the story first came out, it didn’t look like much.
Just a few problems that needed correction: a little mold here, a few repairs
there, the inevitable complaints from disgruntled patients. But two and a half
weeks after the Washington Post ran a little story by reporters Dana Priest and
Anne Hull titled “Soldiers Face Neglect, Frustration At Army’s Top Medical
Facility“ the Walter Reed scandal has become without question the top story in the country.
Today, Priest and Hull return with another lengthy piece examining
conditions in the military healthcare system in other parts of the country titled
“Walter Reed Not an isolated case.” The two reporters say that after their initial story ran they were contacted by "literally hundreds of soldiers" from around the
country with similar stories to share. The pair writes:
Nearly 4,000
outpatients are currently in the military’s Medical Holding or Medical Holdover
companies, which oversee the wounded. Soldiers and veterans report bureaucratic
disarray similar to Walter Reed’s: indifferent, untrained staff; lost
paperwork; medical appointments that drop from the computers; and long waits
for consultations.
That appears to answer a question that many people had been wondering about. As New York Democrat Charles Schumer put it over the weekend “if it’s
this bad at the outpatient facilities at Walter Reed, how is it in the rest of the country?” On Sunday,
Schumer called for a bipartisan commission – possibly to be headed by former
secretary of state Colin Powell – to examine conditions facing returning
service men and women.
Predictably, conservative critics around the blogosphere are
pointing at the debacle as evidence that any government run healthcare system
would be a disaster. Kevin MD writes: “What’s happening at Walter Reed is small
sample of how government-run health care would turn out. Does the public understand
the implications of a nationally-run health care system?”
"Will the Bush-bashers join with free-market critics to effect real change and
help the troops who need and deserve better care? We’ll see," writes Michelle Malkin.
POLICY: In Defense of the VA System
Like fellow contributor Eric Novack, THCB alum Maggie Mahar has been following the Walter Reed story closely. Maggie doesn’t buy the criticism that the problems at the facility are due to the fact that Walter Reed is a government run hospital. She’s also unhappy about the fact that critics are using the occasion to target the VA system in general. Maggie is the author of the critically acclaimed “Money Driven Medicine: The Real Reason Health Care Costs so Much.”
Too many news reports about the scandal at Walter Reed use the story to malign the VA hospital system–and to suggest that when government gets involved in health care, the result is disaster.
First, Walter Reed is not part of the Veterans Administration Health Care System. It is a U.S. Army Medical Center.Secondly, while not every VA hospital is perfect, overall, the VA is one of the very best health care systems in the U.S.–thanks to a major overhaul by undersecretary of health Kenneth Kizer in the 1990s. Its electronic medical system has done an extraordinary job of co-ordinating care and all but eliminating medication errors.
As Business Week reported last year (July 17th, 2006) , “if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatments to the percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.”
A string of studies published in published in medical jouranls back up these claims. For the full story of the VA’s transformation. see Philip Longman’s “The Best Care Anywhere” in Washington Monthly, January 2007.
That said, the Bush administration has steadily cut funding for the VA hospital system, and as a result, access and waiting times have suffered. By 2005 the number of patients the Veterans Administration was treating had doubled over 10 years to roughly 7 million. Meanwhile, the VA had cut costs by half. Such efficiency is admirable– but at that point, the budget was too tight.
And that was 2005. As the war in Iraq dragged on, the number of wounded multiplied.
Yet just as this administration failed to provide fighting soliders with the armor they needed, it has failed to give the VA the resources it needed to keep up with the carnage.
HOSPITALS: VA perfection revisited By Eric Novack
THCB contributor Dr. Eric Novack has been following the unfolding scandal at Walter Reed Medical Center very closely. Eric feels the problems discovered by the Washington Post are indicative of deeper institutional problems at the VA. And deeper problems with government run healthcare systems in general. And as usual, he’s got something provocative to say about it.
When the topic of quality health care has come up at THCB, the 2006 study from Harvard touting the VA as providing the ‘best quality’ care in America gets regularly mentioned.
Reality, however, has finally reached the MSM and the public. This is not a Republican problem. This is not a Democrat problem. It is a non-partisan problem. It is a bipartisan problem. The problems have existed through Republican and Democratic Congresses and Administrations. And legislators and bureaucrats have been made aware of some of these problems for years and years.
And yet, nothing significant has changed. The missing interpretation: the absolute fundamental inability for government-run organizations to escape convoluted, bureaucratic, non-meritorious based hierarchies. Anyone still for VA care for all of the USA now?
CODA: From Matthew Holt While I believe that the VA still has its issues, apparently those in the private sector appeared to be convinced by the turnaround in its clincal quality indicators. Or at least Managed Care Magazine has been fooled into thinking that, if of course things are as bad as the WaPo’s collection of anecdotes tells us.
BLOGS: Technical note
I’ve just discovered that RSS can only handle one podcast per post. So for those of you who get your podcasts via RSS, I’ve republished the HIMSS interviews that I bundled in one post last week. If you’ve linked to the original then I’m afraid you’ll have to re-set.
POLICY: The Not So Common Good
Catching up from when I was gone….this article on health reform went up at Spot-on a couple of weeks back. It’s called The Not So Common Good.
We’ve been hearing a lot about the problems of the uninsured. We’ve
been hearing more how the cost of healthcare is making it harder and
harder for individuals to afford insurance, and for employers to
provide benefits to employees. Those are the drivers for why health
care reform has suddenly emerged as a political force – even if the
governor who once led discussion of the topic, Mitt Romney, is
backpedaling away from his "liberal Governor of Massachusetts" pro-gay,
pro-big government stance so that he can appear sufficiently
conservative to win a Republican primary or two.
But the train is out of the station on the reform message. Even though the chances of real reform are slim,
everyone and their dog has a plan. Most of these plans are
self-serving. And even the ones that aren’t are generally built on
continuing the employment-based health care system that got us into
this mess in the first place; Senator Ron Wyden, economist Vic Fuchs
and the single payer crowd being the honorable exceptions. Continue
POLICY/HEALTH PLANS: The individual market is screwed
Whenever you hear some “free-marketeer” complaining that people with incomes over $50K don’t buy health insurance and so uninsurance is voluntary, think about this woman, featured in the NY Times, who would love to buy health insurance but has cancer and so cannot—unless she comes up with $27,000 a year out of her $60K income.
The individual market is corrupt and evil, and inherently unfair. And the organizations that make their living there (hello HealthMarkets, Assurant, Golden Rule et al) are the kinds that you find on the bottom of your shoe. (I’m awaiting Jon Cohn’s book coming out next month to tell you more…).
It is of course not strictly speaking the insurers’ fault. They live in a world where they’re selected against by both sick people and the competition—so it is a collective race to the bottom. Just to remind you for the one millionth time, individual choices of health benefit plans can only be effective and fair within a universal single pool system that needs its rules and boundaries set very carefully, and has risk adjustment built in the back end. And don’t let the libertarians tell you that if you take away all the rules and regs natural pooling will sort it out, unless they’re prepared to move to N.Carolina, get cancer and see how they get on.
