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POLICY/QUALITY: The intellectual backdrop has been created for P4P

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Here’s my FierceHealthcare editorial

Last week a study from Wennberg’s Dartmouth group showed that there were vast variations in the amount of "physician resources" used to produce similar care outcomes, in that case in intensive care settings. This week a RAND study followed up on data released in their much quoted 2003 study which showed that patients receive the correct care from their providers only a little over 50% of the time. This new study showed that there was little to choose between the care meted out to richer, better insured, whiter people and that given to poorer, less well insured minorities. So it appears that unlike in the rest of American life, money can’t buy you better quality. And given the amount of money being spent on health care in America, that’s not a satisfactory outcome.

Putting these two studies together shows that there will be much more concentration in the resources being used and the process and outcomes of care, and most importantly, that the intellectual argument has been created for providers to be paid for quality, performance and by extension cost-efficiency. This will not be an easy change for the system to adopt, and it looks as if it may be the major story of the next decade.

POLICY/TECH: Gingrich Discusses Health Care

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Newt is at it again. This is one speech for which I assume he didn’t get his $40K going rate as it was to the Florida House. As usual he said tech would solve all our problems— he should know enough to shut up about that line, or at least qualify it by now. My views on this are well known to THCB readers but suffice it to say it’s not an accident that health care doesn’t use IT the way Newt would like it to and his solutions appear to operate in a vacuum. Still if health care companies keep ponying up $200K a year for the right to listen to those brilliant statements (and not of course just to get close to a big Republican mover and shaker), who am I to judge? But in the middle he said this:

"Current federal law is stunningly stupid and destructive because it blocks hospitals from giving away electronic health records to doctors," he said.

Maybe I’m dumb but didn’t MMA explicitly say that this was OK? And hasn’t CMS and DOJ ruled that this is a safe harbor? And aren’t hospitals already doing this?

Then he said:

In many ways, he said, Florida is the nation’s most innovative state in health care.

I assume he was talking about innovation in spending three times as much as other states for the same results, and leading the league in health care fraud.

Meanwhile he’s speaking out about transparency in hospital supply pricing while my spies tell me that MedAssetts the GPO is a big backer. Although that’s not a bad thing given the opaqueness in traditional GPO business practices.

POLICY: China and American health care

I was reading an article about about political infighting in the Chinese Communist Party — a decidedly non-THCB topic — called A Sharp Debate Erupts in China Over Ideologies. (Traditionally the CCP has been like Republicans, all on message with no internal dissent. Apparently they’re becoming Democrats).

Anyway this one quote grabbed me:

In a subsequent interview with Business Watch, a state-run magazine, Mr. Liu said, "If you establish a market economy in a place like China, where the rule of law is imperfect, if you do not emphasize the socialist spirit of fairness and social responsibility, then the market economy you establish is going to be an elitist market economy."

Now does that remind those of you looking at the US health care system, and in particular our basically unregulated and self-serving insurance system, of anything in particular? I thought so.

(And don’t come after me about how our insurance system is already regulated enough, or I’ll set Jonathan Cohn on you….)

 

THCB: Any budding reviewers out there?

Dr. Robert McKersie has asked me to review his book In the Foothills of Medicine. Here’s what his web site says about it.

In the Foothills of Medicine shares one doctor’s intriguing true story from the front lines of medicine. Dr. Robert McKersie writes vividly and passionately about the patients whom he saw, touched, and thought about during his intense inner city internship in family medicine and medical treks to remote villages in Nepal.

I am so far behind on so many levels that I can’t commit to spending the time to read and write about this book, but one of you brave THCB readers might. If you do, I’ll publish the review on THCB.  So let me know by email and I’ll get it sorted out.

TECH: Can Medsphere prove the open source model in health care?

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medsphere
At HIMSS I had a quick chat with Scott Shreeve, the Chief Medical Officer at Medsphere. Medsphere’s product OpenVista, as you all know, is built on the VA Vista product — which is the main “open source” EMR code out there. To get it ready for the commercial market they had to remove the VA- centric features, rewrite the user interface and re-architect the middleware layer using open source technology. For commercial hopsitals they had to enhance the charge capture features for patient billing. They also had to enhance features in the ancillary department systems, and leverage and extend the current data base (which is written in MUMPS).

Their first client, Midland Memorial Texas, has 425 beds in 3 sites. They were facing approximately a $20m price tag for to upgrade their McKesson clinical system. Going with Medsphere is 1/3 the price of a new system but Medsphere had to interface with the McKesson billing system to get the gig.

Are they able to compete with Medtiech in the smaller hospital world? The business model is that they get paid for services and an ongoing subscription for managing it. So they have to provide the open source code, but ideally they want to get the subscription to manage it and so need to do a good job there. Aside from hospitals, they are going to stay in the bigger (i.e. medium-sized) ambulatory clinic market, but do have groups of small physician practices coming together to buy the system — so they do have some opportunity in other parts of the market. They think that they can do move that process down to small hospitals.

What are they doing to address that? They’re developing deployment models that work very quickly setting up systems. They’ve done it with pharmacy, lab & radiology and have have some tools to extend the system. But the software is thin-client but not web-based so there is stuff they have to do in terms of services and installs, and it’s hard to see them moving to a very small hospital market or ASP solution just yet. (They are, after all, waiting to show their first hospital client site fully live!)

And that "open sourceness"? They are changing some of the code and adding some of the new code set back to GPL, but they are keeping some of the code proprietarily for the interfaces and the GUI that they’ve built. So the open source purists may not think that Medsphere is pure open source, but the rest of health care IT will be watching with a great deal of interest to see if they can make a real business selling "free" software and undercutting the bigger guys.

BTW MrHISTalk had a nice interview with Scott a while back

POLICY/INDUSTRY: HSC on 10 years of change

Whe I was first figuring out the private sector in health care about 10-12 years ago while Hillary was trying and failing to get reform done, I heard a gazillion people, usually in the strategy or policy dividions of big plans and drug companies tell me that we didn’t need government reform because the market was going to sort it all out itself. And ten years after we got the market reform that meant we didn’t need governmnet reform. What happened?

"In a decade that saw the rapid rise and hard fall of tightly managed care, there was plenty of change but little progress in solving the cost, access and quality problems in the health care system," says Paul Ginsburg in the release about HSC’s 10 year retrospective.

 

You can read the full report here. It’s taken me ten years to figure out what went wrong. Let’s not have that happen again next time, eh.

assetto corsa mods