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QUALITY/CONSUMERS: Wallace and some patient advocates

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Information Therapy center chair Paul Wallace is from Kaiser Permanente, who quite logically would be interested in Ix.

He notes that the medical care cost, and the costs of poor health to employers far exceed the medical cost. (Absenteeism. etc)

He also notes that no consumer is involved in designing consumer directed health care. How do we get “skin in the game” not to be a blunt tool like managed care? And he explains that the revenue that would pay for the care of the 20% has left the system. let’s not use blunt tools to solve complex problems. That means using co-pays to access selective care, but not for pharmacy, well baby care, etc. And are there incentives to use information therapy in those decisions?

He has a vision of putting the patient centered care integrating this around patients not their diseases.

Then it’s on to two patient advocates. Sue Sheridan (who gave a harrowing speech last year that’s well worth re-reviewing) and Jesse Gruman from the Center from Advancement of Health. Sue has got the CDC to engage consumers in telling mothers about the risk that jaundice can cause brain damage. So eventually this fall they are putting out information that are right for new mothers—not about the disease but “how can my baby get hurt and how can I do something about it. Sue thinks fear is a gift that will motivate. Jesse is not so sure, but know that we need to arouse the anxiety just enough to give them something productive to do. Last year Jesse told us about “blunters and monitors.” In other words some people want the second opinion, want to know everything, but others want the doctor to tell them what to do. But there is no neutral health information. So the people trying to engage patients in health information have a major challenge. But Sue thinks that we should create the demand for patients to be engaged because if they’re more involved they’ll have better outcomes.

Jesse thinks that using marketing methodologies that retail et al use to make people buy stuff they don’t really want/need (e.g. data mining connections) needs to be used to deliver information therapy and make people integrate it in their life. We also need to tell people what we expect them to do.

One of the most interesting questions is from a Canadian who is telling about how consumer health information in his hospital (McMaster, in Hamilton Ontario) is worked out in conjunction with marketing academics. In the US he says that this stuff seems to be part of the marketing department, and be kept as proprietary information.

QUALITY/POLICY: Information Therapy conference, the employer coalition view

So as I warned you, I’m at the Information Therapy conference in Park City, Utah.

Andrew Webber from National Business Coalition on Health. Tries to come at Information Therapy from the point of view of an employer—but an employer who was brought up as the son of a Minister living in Spanish Harlem.

Employers are figuring it out….he thinks they can improve quality while controlling costs, and do it by making the health care system more functional. Andrew thinks that employers really want a more productive healthier workforce. He thinks that there should be metrics for how Wall Street looks at individual companies on the health/productivity issue. So we need better stories to get employers to realize that they need to get on board with improving this.

But overall employers want to point at providers and call it their fault! (for a bunch of reasons). But he thinks that employers can do better and they’ve been a big part of the problem. Employers have created a toxic payment system, that pays for poor quality of care.

Andrew wants employers to take responsibility for it! Their vision is health purchasing reform via value-based purchasing community by community.

His 4 pillars (of wisdom) are

1. Performance measurements2. Transparency and reporting3. Payment reform (he wants population-based not a fragmented FFS-based payment)4. Informed consumer choice

But you all know that, so let me show you a photo I took in a slot canyon in Arizona yesterday (taken on my Treo no less!)

Photo_092406_010

Meanwhile, Andrew thinks that this is all wrapped up in the change of Federal incentives (and the recent directive) to do more transparency and get consumer purchasing on the national radar.

Personally I get very nervous when Information Therapy gets wrapped up in the ideology of consumer-directed health care. Somehow he manages to think that what HHS and Leavitt is up to and what RWJ is supporting are consistent with each other! But he does make the reasonable point that Ix needs to somehow connect with the wider movements. I just hope it gets done as a neutral issue without getting into a real war over the ideology. If Ix gets wrapped up in that it will be shot in the crossfire.

INDUSTRY/TECH/POLICY/HOPSPITALS: ID Theft Infects Medical Records

In an LA Times article called ID Theft Infects Medical Records Joseph Menn tells several terrifying stories of people who have had their identities stolen by other people who have used them to get medical care. Not only does this give those people the nightmare of having to try to deal with bills and insurance hassles (as if they weren’t bad enough already) for medical care that was done to someone else, but it also means that false information arrives on their medical records. One victim went ot the hospital for a heart attack and was nearly treated for diabetes she didn’t have. That could of course be fatal, if a healthy person was given insulin, for example.

Lots to think about for health care organizations and the rest of us in this article so read it all!

PHYSICIANS/PHARMA: The oncologists’ chemo junket flies above the radar

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You may have heard just a few things on THCB from Greg Pawelski, Matt Quinn, me and others about the oncologist prescribing franchise, and how it might just change physicians’ behavior a tad. Well Greg informs me that last Thursday the whole issue made it onto the NBC Nightly News.

Greg also notes that the community oncologists (well, he calls them something rather ruder, but he’s insulting the world’s oldest profession so I won’t use his language) have their own response. They are “outraged!”

HEALTH PLANS: Blue Cross cancellation story rumbles on

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With an election in less than 2 months, the state is finally wading into the Wellpoint BC cancellation mess. Blue Cross now faces a fine:

In the first sanction of its kind, California’s top HMO regulator fined Blue Cross on Thursday for illegally canceling a woman’s medical policy because she did not disclose corrective surgery she had 23 years earlier. The $200,000 fine might not be the last resulting from the state’s investigation of allegations that insurers dump sick policyholders to avoid paying claims, said Cindy Ehnes, director of the Department of Managed Health Care.

And Arnie has broken his silence:

“Californians — who make the right decision to have health insurance as security for themselves and their families — should not be afraid that if they use it, they will lose it because of confusing applications,” he said in a statement. “oh and please vote for me in 6 weeks” (OK he didnt say that last part)

Meanwhile, the east coast establishment has noticed—or at least Paul Krugman has—it’s the lead in his column today calling for single payer Medicare for all

TECH: Patient physician email only growing slowly

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So says HSC:

Only about one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-05, up from one in five physicians in 2000-01, according to a national study released today by the Center for Studying Health System Change (HSC).

Much more here

PHYSICIANS: Dr. Mom sounds off

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Angela Heider is no longer practicing as an OBGYN, and has written a book about why not, called The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future. What went wrong? Well she starts to explain in this piece:

Wanted.  Part-time.  Private practice seeks obstetrician and gynecologist.  Forty hours a week, some nights and weekends.  Pretax income $70k/yr and falling.  Life-altering medical malpractice claims average only 1/3 years.  Electronic medical record – partially functioning.  Administrative skills required.  Medicare, Medicaid, self-pay, and dozens of insurance plans accepted – billing, coding and prescribing proficiency needed for above plans.  Keep up with this ever-changing medical field and all technical skills on your time.  $80k exit fee due at termination of employment.  Expect childcare expense approaching $35k/yr.     Fortunately, I vacated the above position before the required $80k in malpractice tail coverage took effect.  Unfortunately for all of us, many female obstetricians are forced to make the same choices.  In my practice alone, five of nine female partners elected to retire within the past two years.  I left the practice after only three years when my inability to balance work and family life became obvious.  I was clearing less than $20k a year – and money wasn’t even the biggest problem.  Clearly, my case is only one example; my concern is that it is not the only example, but a nationwide trend for women in private obstetrical practices.

Much has been said about physicians and the part their greed plays in the current health care crisis.  Admittedly, many examples can be found of physicians who have milked the system, over-billed, over-treated, and committed outright insurance fraud in order to make more money.  On the other hand, some physicians have been praised for their utter selflessness, physicians who devote all of their time and resources to charitable care.

Most, myself included, do not fit the description of either extreme.  Like many Americans, we want to excel professionally, enjoy our work, have others appreciate the contributions we make, and raise our families comfortably.  As a physician, I would have been happy with my salary minus the bureaucratic nightmare the practice of medicine has become, the constant threat of catastrophic legal action, the ingratitude, and the long hours away from my young children.  Some physicians long for the honor that once accompanied the profession.  Others miss the joy associated with personal doctor-patient relationships.  Still others enjoy their work, but also want to enjoy their families.  Money is not always the bottom line.

My current job – wife, mother of three small children, new author of the book, The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future, and advocate for health care reform – doesn’t generate any income, but the benefits are better.  I hope to be a part of needed change in our health care system simply by telling my story.  The compensation is not important; the fact that I can enjoy and am proud of what I am doing is.  We can raise awareness by examining the effects the system has on individual doctors, patients, and communities.

We all depend on our physicians to provide quality medical care, to take our lives into their hands.  If for no other reason, should we strive towards health care reform so we can restore their job satisfaction?  Do we not want them to be happy when they are guarding our lives?  Do we not want the best and the brightest to continue to sign up for careers in medicine?  And how much should they earn anyway?

In my opinion, reform will be required in order to retain a qualified, diverse pool of primary care obstetricians and gynecologists for women across the country.  Such reform must include medical malpractice reform, as current rates make the cost of less than fulltime practice prohibitive.  Changes in the training of obstetricians and gynecologists could be made to allow for women to focus on either obstetrics or gynecology, thus improving their odds of being able to keep abreast of changes in practice patterns.  Finally, the enactment of a national health care plan with health care coverage for all would reduce the administrative costs and barriers to practice and improve physician job satisfaction.      

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