The Health Care Blog – Page 240 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Why Smart People Don’t Learn from Failures

Dec 1, 2018

By kent bottles, md

My ICSI colleague Claire Neely recently mentioned that the classic Chris Argyris article “Teaching Smart People How to Learn” had been an “aha” moment in her efforts to learn how to better teach and reach physicians. While I don’t think I have ever read that article, I had been impressed with Chris Argyris, especially his work with Donald Schoen. Claire emailed me the article, and it really is a classic that needs to be read.

Originally copyrighted by the Harvard Business Review in 1991, Argyris’ article succinctly outlines the challenges we all face in a knowledge economy, and he concludes that learning is imperative for individual and organizational success in such a global marketplace. People have to master technical skills, work effectively in teams, form productive relationships with clients, and critically reflect on and change their own organizational culture. Managers and leaders have to guide and integrate the autonomous but interconnected work of highly skilled people.

Argyris distinguishes between single loop and double loop learning. “A thermostat that automatically turns on the heat whenever the temperature in a room drops below 68 degrees is a good example of single loop learning. A thermostat that could ask, ‘Why am I set at 68 degrees?’ and then explore whether or not some other temperature might more economically achieve the goal of heating the room would be engaging in double loop learning.”

The Joy of Success

Dec 1, 2018

By JOHN HALAMKA, MD

As the year ends, I’ve spoken to many CIOs. 2011 was a hard year filled with Meaningful Use (including many upgrades to certified systems or self-certification), 5010 (the deadline for upgrading billing systems is January 1, 2012), accelerating compliance demands, new security threats, rapidly evolving technologies, and unprecedented demand for new projects driven by the consumerization of IT.

At the same time that CIOs and IT professionals are running marathons, they are being held accountable for events that are not directly under their control. They are not being congratulated for the miracles they create every day, but are being criticized for not moving faster.

What do I mean?

One CIO received a negative audit report because new generations of viruses are no longer stopped by state of the art anti-virus software. Interesting. The CIO cannot control the virus authors, nor the effectiveness of anti-virus software. No one in the industry has solved the problem, but audit firms revel in creating fear, uncertainty and doubt at the Board level as it enhances the reputation of the auditor.

Another CIO was held accountable for infrastructure demands that were not forecasted, planned, or communicated. CIOs do their best to be proactive, but in the world of Big Data, past trends may not predict future needs.

Another CIO was was given 10 goals and 5 unplanned urgent projects. She completed 8 of the planned goals and all the urgent projects, yet was told she only met 80% of expectations.

In a world that expects leaders to continuously perform miracles with constrained resources in limited time, we all need to step back and take our own steps to stop the madness.

With your own staff, celebrate the joy of success and focus on what really matters.

Our Cancer Journey – Week 2

Dec 1, 2018

By JOHN HALAMKA, MD

It’s been two weeks since my wife said “I have cancer” to my daughter.

It’s been a week since we described our workup thus far on my blog.

Reaction to our blog post was diverse, ranging from the HISTalk blog to the Boston Globe.

It’s a time of anxiety and unanswered questions. The diagnosis and staging phase has been described as one of the two major tension points in cancer. The other is the time after remission, when the worry about recurrence is a constant burden. One of our doctors recommended we keep a “family bottle” of anti-anxiety medication ready for those times when the stress exceeds our capacity to cope. Cancer is truly a family disease and the emotional impact extends from the patient to family caregivers.

Many friends and colleagues have offered prayers and support. A few have lamented that care coordinated by a physician-husband at a Harvard-associated hospital in Boston lacks equity since every wife/mother/daughter may not receive the same care throughout the US. Kathy and I agree. We posted these comments in response to those who speculated that Kathy’s care consumes an asymmetric amount of healthcare resources.

Food Safety: It’s Déjà Vu All Over Again

Dec 1, 2018

By Marion Nestle

In preparation for the holiday season, Secretary of Health and Human Services Kathleen Sebelius and Agriculture Secretary Thomas Vilsack held a press conference to promote the departments’ efforts on food safety.

They announced release of the administration’s progress report from its Food Safety Working Group.

They also highlighted additional places to get government information about food safety at home:

I didn’t pay much attention to these announcements until I read the slightly snarky account in Food Chemical News (December 22).

The Obama administration patted itself on the back today with a new report that both lists the accomplishments over the past three years of its Food Safety Working Group (FSWG) and identifies the group’s top priorities for the coming year.

Continue reading…

Physician Payment Sunshine Act Proposed Regulations Out

Dec 1, 2018

By Kathleen M. Boozang

CMS has published proposed rules for its implementation of the Physician Payment Sunshine Act (SUNSHINE ACT or Act), which was enacted by Congress as part of the 2010 Patient Protection and Affordable Care Act. In short, the SUNSHINE ACT requires life science companies to report annually to CMS their conferral of anything of value, whether it be payment for services or a dinner, in connection with a particular product of the paying company. By requiring CMS to post the information on its website, the Act seeks to ensure that interested patients become aware of physicians’ conflicts of interest that could affect their prescription of a branded drug or choice of a specific medical device.

The SUNSHINE ACT represents another example of the transparency movement, which has had varying degrees of success in either changing the behavior of the parties subject to disclosure, and/or enabling consumers to make better decisions based upon their access to the disclosed information. It is likely that the SUNSHINE ACT will impact physicians and manufacturers’ behavior more than it will enlighten consumers about conflicts of interest. Some physicians will simply conclude that accepting certain gifts or benefits from pharmaceutical or medical device companies isn’t worth having their names on the CMS website. Some companies have already discovered that they haven’t necessarily reaped the value of the costs of gifting many physicians, or that the cost of recording certain activities simply isn’t worth the return on investment. Unquestionably, certain transactions will continue to be valuable to both physician and company, and will continue.

Me too! It’s not fair! The Tragedy of the Commons in the Health Care Marketplace

Dec 1, 2018

By David Harlow

There are at least two conversations going on in the health care marketplace today, each focused on one of two key questions. One is: How can we achieve the Triple Aim? The other is: Why do they get to do that? (It’s not fair! I want more!)

Until we stop asking the second question, we can’t answer the first question. Why? Because all too often the answer to the second question is the equivalent of: It’s OK, Timmy, I’ll buy you TWO lollipops; pick whichever ones you want.

It’s the tragedy of the commons, transposed to the health care marketplace.

Recent cases in point:

Avastin
Tufts Medical Center – Blue Cross Blue Shield of Massachusetts grudge match
Mammography and PSA guidelines

1. Avastin. Late last year, the FDA yanked its breast cancer treatment approval for Avastin, based on a finding that it does not meet the “safe and effective” standard. CMS says it will still pay for the drug anyway, as will many commercial payors, based on physician judgment.

2. Tufts Medical Center – Blue Cross Blue Shield of Massachusetts. The contract negotiation (out in public view) focused, in part, on Tufts’ complaint that BCBSMA pays way more for health care services provided by another network, Partners Health Care, and that it should be compensated on the same scale. (Others have noticed this disparity too, and have found that higher payments were not accompanied by higher quality — see reports by Massachusetts state agencies.) In the context of the present discussion, we may wish to consider whether Partners should be paid less, rather than whether Tufts Medical Center should be paid more. This episode, according to some, will pave the way for more regulations.

No Savings from Raising Medicare Age

Dec 1, 2018

By Merrill Goozner

The Congressional Budget Office released an issue brief Tuesday that suggested lifting Medicare’s eligibility age from 65 to 67 would save the federal government 5 percent on projected outlays over the next decade, and only “a small share of those people would end up without health insurance.” The idea has been touted by numerous deficit reduction proposals, including those from Republican Paul Ryan and Democrat Alice Rivlin, the former CBO director.

It’s a bad idea, says Aaron Carroll, a professor at the Indiana University School of Medicine and director of its Center for Health Policy and Professionalism Research. “No one should be under the illusion that the federal government will save money by raising the Medicare eligibility age,” he said in an interview after attacking the report on The Incidental Economist website, which is widely read by health policy researchers and analysts.

First, it’s a cost-shifting plan, not a cost-cutting plan, he pointed out. “Someone has to pay for the health care of those older workers.”

What do Patients Really Want?

Dec 1, 2018

By Joseph Kvedar

I recently wrote about an innovator’s dilemma of sorts – or call it a paradox – in healthcare. The paradox is that as we look to innovate in healthcare, the very authority figures we must turn to for fact-checking our innovative ideas are conflicted and highly motivated to support the status quo. I’m talking about physicians of course.

In a fee-for-service world, physicians are both the fountain of relevant knowledge and the source of all revenue. So we have built our workflows, systems and processes around their comfort and success. As physicians succeed, so does the rest of the healthcare juggernaut. I know other industries fall victim to these kind of MC Escher-like business models, but it seems particularly acute in healthcare.

My belief is that this paradox makes our industry highly susceptible to under-imagining what real innovation could look like. We have some pretty deep blinders on, it seems. One of my favorite Steve Jobs legends is that when asked about the consumer research that led to the development of the iPad, he quipped, “We don’t expect consumers to be able to tell us what they don’t realize they need.” [I am paraphrasing, but this is reasonably accurate.]

Super Bowl Sanitation: “Washed Up” Giants Outpoint Docs

Dec 1, 2018

By Michael Millenson

Is the New York Giants bathroom more sanitary than your hospital room? Could be. And that player cleanliness may even have helped send the team to the Super Bowl.

Freakonomics co-author and self-confessed germophobe Stephen Dubner, working on a Football Freakonomics segment for the National Football League, noticed that every urinal in the football Giants’ bathroom had a plastic pump bottle of hand sanitizer perched on top – a phenomenon he promptly documented photographically.

Health care-associated infections cause more than 98,000 patient deaths every year. Yet as I’ve noted previously, the guy who just used the toilet at the train station is way more likely to have clean hands than the guy walking up to your bed – or into the operating room – at the local hospital. That’s based on my comparing hospital sanitation with the results of a surreptitious survey by researchers from Harris Interactive of more than 6,000 adults using restrooms at six high-volume sites across the country.

At New York City’s Grand Central Station and Penn Station, only 80 percent of men and women washed up. However, even Atlanta’s Turner Field, where just 65 percent of men washed their hands, looked positively sterile compared to hospitals. The Centers for Disease Control and Prevention found that baseline compliance for hand hygiene was just 26 percent in intensive care units and 36 percent in non-ICUs.

EHR and Practical, Tactical Outcomes

Dec 1, 2018

By Jonathan Bush

I hope people are watching the news around the Meaningful Use attestation data released by CMS recently, because it is so instructive as to the difference between where we are in health care and where the deliverers of keynotes THINK we are. Since last September, we’ve been publishing our Meaningful Use (MU) dashboard data and as of this week for example, we know that 83% of our Medicare MU doctors have attested to the measures.

But our constraints as a marketplace are at the practical, tactical level. According to our analysis, some 48% of what doctors order does NOT turn into a documented update to the chart within 60 days of that order. And we all know the average EHR makes docs go slower—causing employment by hospitals in large numbers—at large losses to the hospital. And NOW, based on the CMS data, it looks like a large percentage of docs are on track to miss a bloody lay-up of a bonus from the federal government! Do you guys really think we are going to build integrated ACOs that drive down hospitalization?

Pass it on—we are further behind than we think we are, and we need to hold ourselves accountable for PRACTICAL, TACTICAL outcomes before we even talk about grand outcomes like “total quality.” So what do we do? So glad you asked. I hazard three guesses, and you guys can throw in more… or challenge mine.

1. Make a market for health information exchange. Today, HIE is universally used as a NOUN. It’s a thing you buy from Aetna or Lockheed Martin or IBM. In every other information supply chain I know of, people who WANT info PAY others to give that info to them. They pay only when the info is delivered in usable form. This is, of course, not allowed in health care, but it can be. We should get behind legislation that allows for the most rudimentary mechanism for exchange in the history of man.