Today is Torture day 2006. That’s not an invitation for people to do more of it despite what our current Adminstration thinks. instead it’s UN International Day in Support of Victims of Torture. I’ve supported a London Charity called The Medical Foundation for the Care of Victims of Torture for years, and I invite you to check out their web site. Whatever your political views this is an organization that but for the accident of birth we might all need.
Millenson on the lack of real committment to patient safety. Acerbic and fantastic. A few quotes, but as they say in the blogosphere read the whole thing
If there is a quality crisis today, it certainly is not apparent from the actions of major stakeholders….
…on the fifth anniversary of the IOM report, the Institute for Healthcare Improvement launched its "Save 100,000 Lives Campaign." It is a wonderful campaign, even if four out of every 10 hospitals don’t participate. What does that say about the will to change?
…Imagine what might happen in the QI world if the head of the IOM publicly criticized by name those 40 percent of hospitals that declined to participate in the IHI safety initiative. Imagine if Congress reacted by holding hearings. Imagine if CMS asked the Joint Commission to investigate whether those hospitals were really as safe as they seemed to think they were. Imagine if there were class-action lawsuits filed. Imagine the impact this unprecedented kind of focused, multi-faceted pressure would have on the "will to change" and the cultural context of quality improvement. If you find this scenario unlikely, it may be because those promoting the quality agenda sometimes seem to display greater concern for those whose behavior they are trying to change than for those whom that behavior is hurting.
My buddy Laura Locke has a nice article in Time about San Francisco’s Latest Innovation: Universal Health Care. This one’s closer to the George Bush agenda than gay marriage—and I’m pretty sure that we’ll all have accepted gay marriage long before we’ve got to genuine universal health insurance. Essentially it’s about redirecting funds from the City and County back to the city and county health facilities, and making the uninsured pay into a pool. Not a bad start given that a City can’t do much, but it’ll run into trouble, just as I explained a while back when the proposal first came out because it’ll mean small low-wage businesses will have to pay more.
Everyone with half a brain knows that the drug “war” is lost and was always unwinnable and that the drug “problem” is only controllable by sensible legalization, regulation and education—as has been done with other addictive drugs like alcohol and tobacco. But it’s pretty rare that someone at the center of the drug “fighting” business—an industry with its mouth firmly attached to the teet of public funding—actually comes out and admits the truth. So when a drug Czar says so, perhaps some of his counterparts should listen.
Pity that it’s the Scottish rather than American drug czar who’s saying just that. But he at least comes from a place that has a real problem (remember Trainspotting) and an even more Calvinist past than we have over here. So there is perhaps some hope in the madness, although not much I’ll admit.
Here’s my follow up to Maggie’s interesting piece and it’s the editorial in FierceHealthcare later today
The non-profit hospital world has been in the news lately, and this week a study of all the studies ever done on the non-profit/for-profit contrast came out in Health Affairs. The story is pretty well known and the study confirmed that non-profit hospitals offer a little more charity care, and have slightly lower costs than for-profits. But then again, there are three factors that make those results a little less than great. First is that location matters and the non-profit category includes a great number of hospitals that are in unfavorable locations, like inner city areas and poor rural counties. Second, the behavior of their for-profit competitors over the years has tended to center on the border between scandalous and criminal. And far too many non-profits have been imitating that behavior, such as New Jersey’s St. Barnabas, which settled with the government for as much as it could afford for apparently over-charging Medicare by over $500m. Third, for-profits have stayed at around 15% of hospital beds for decades and aren’t expanding their market share much. So the main issue is how do hospitals overall behave.
The truth is that whatever the label put on an organization, in an environment where doing more and charging more brings more profit/margin, there will always be institutions and people within them that will fall temptation to taking the easy (and fraudulent) way to more money. Proponents of self-reform may point to the improvements in quality brought about with no financial incentives which were reported by IHI last week, but until we create incentives for organizations to do well by doing the right thing, the label will be largely irrelevant.
Eric Novack sees hope in the IHI’s 100K lives program which announced impressive results this week, and being Eric, he thinks that there’s a political message in there too. There’ll be more on his show this Sunday.
There’s an article out called “How We Die in America” which is from a new book called UNPLUGGED: Reclaiming our Right to Die in America, by William Colby.
The publisher is looking for a reviewer, so if you’re interested in reviewing a copy and having your review on THCB let me know by email
While I was away Health IT World published a short piece I wrote about the integration of the PHR with Information Therapy. Comments back here, if you please.
Brian Klepper was recently up at Medscape bemoaning the lack of physician leadership in righting the troubled ship of our health care system, and challenging physicians to do better.
He got lots of feedback, not all of it as negative as you’d think, and he had his own response. All well worth reading.
On the other hand, HSC says that in real terms we’re paying physicians substantially less than in 1995. I suspect that most of that pay "cut" was in the 1990s, and things seem to be picking up again, but — as one reader asked me — there is not that much good data on physician incomes, and in real terms they did very well between 1960 and 1990.
I’ve given my view on RelayHealth before—Nice product but apparently no physician or actual patient demand for it, well not enough that would have sustained a real business that didn’t get unbelievably lucky with its financing in the dotcom days. Now McKesson has bought it to roll it into their health management side that includes the old Access Health and a whole lot of other stuff. If you wnt to read more take a look at this Modern Healthcare article which by its title, McKesson deal gives docs new PHR purveyor, seems to think that RelayHealth is a PHR (stop laughing you at the back).
But what fascinates me is how this stuff happens in Corporate America. In 2000 McKesson purcahsed a company called Medivation. Medivation was tossed into its iMckesson subsidiary and obviously didn’t make it out alive. But the key point is that Medivation’s technology—at last when they bought it—did exactly what RelayHealth’s (the then Healinx) did. Given that neither of them has established much in the way of what you’d recognize as market share or profitability—cue yet more angry emails from Relay Health’s lovely marketing people—I assume McKesson is buying RelayHealth for the technology not to double up on market share. So that means whatever Medivation had has since been lost. And those of us who remember iMckesson may find this line from the story strangely familiar.
In addition to RelayHealth, McKesson’s personal health systems include in-home patient monitoring, web portal technology, triage software and personal emergency response systems. The full suite will include products and services from recently acquired HealthCom Partners, LLC, which provides patient billing solutions designed to simplify and enhance financial interactions between healthcare providers and their patients.
Longtime McKesson observers may not be too surprised —after all I don’t use their products, I just get my cues on their lack of interoperability that from HISTalk. But what I’d like to know is who’s getting fired for buying the same thing twice? For that matter when’s Charlie McCall finally going on trial for screwing up McKesson in the first place? It’s 7 years since that happened? Answers on a post card….
Coda: My best guess is that RelayHealth had c. $40m in funding in rounds C, D & E, so perhaps $45m overall. Now that no one’s feelings can get hurt, and now that the health care Internet is sexy again, I wonder whether their investors got out whole. I assume that we’ll find out in the next 10Q. Any guesses in the comments?
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