The Health Care Blog – Page 657 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Cost of Coercion

Feb 28, 2012• 4

By John Schumann, MD

Nora, a third year medical student, came to me in moral distress.

Ms. DiFazio, one of the hospitalized patients on her Internal Medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.

The first year doctor [‘intern’] with whom Nora was paired, Dr. White, vented to her:

“These patients come to us seeking our help and then refuse what we have to offer them,” Dr. White steamed.

At the bedside, the intern demanded to know why Ms. DiFazio refused the procedure. When no reason beyond “I don’t want to” was offered, Dr. White told Ms. DiFazio that there was no longer cause for her to stay in the hospital.

By declining the procedure, Dr. White informed Ms. DiFazio that she would have to sign out ‘against medical advice’ (AMA). To signify this she would have to acknowledge that leaving AMA could result in serious harm or death. In addition, Ms. DiFazio would bear responsibility for any and all hospital charges incurred and not reimbursed by her insurance due to such a decision.

Contraception Conundrum

Feb 27, 2012• 13

By J.D. Kleinke

What makes the contraception coverage debate currently raging in Washington unusually problematic is that both sides are exactly right. Female employees who receive part of their cash compensation in the form of health benefits have the right to benefits that include FDA-approved birth control methods. Employers defined by their religious values—not just churches, synagogues, and mosques, but also thousands of hospitals, universities, and charities—should not have to compromise those values with their own money, and the government has no right to trample the First Amendment by compelling them to do so. The Obama administration’s “accommodation” —shifting the new federal requirement to the insurers who administer those organizations’ health plans—is a cynical shell game that ignores the most basic tenets of business accounting.

As the problem is no more complicated than two sets of equally valid rights in direct opposition, neither is the solution all that complicated, at least in principle: employment and health insurance should have nothing to do with each other.

Unfortunately, this arrangement—a relic of the World War II civilian wage freeze and enshrined in the tax code as soon as workers got a taste of this new-fangled “fringe benefit” of employment—is now an enduring part of the U.S. healthcare system. The entanglement of our health insurance with our employment goes a long way toward explaining not just today’s conundrum over the birth control coverage mandate, but myriad other economic distortions, market dysfunctions, and cultural conflicts that define much of what is wrong with the U.S. healthcare system.

The Obama administration’s ‘accommodation’ last week is a cynical shell game that ignores the most basic tenets of business accounting.

Welcome to the DMV. Your Clerk Will Be With You Shortly.

Feb 27, 2012• 5

By David Whelan

Have you ever tried to use Medicare data to research a hospital? If so, I bet you’ve been disappointed.

Let’s say you live in Las Vegas and you have heart problems. There are three hospitals nearby. You’d like to know the answer to a simple question. “If I ever have a heart attack where should I tell the ambulance to take me?”

Medicare’s Web site that holds this information is called Hospital Compare. If you visit and search for Las Vegas heart attack care, above is what you’ll find.

Is that helpful?

As you can see the three hospitals within your search are all rated “No Different than U.S. National Rate.” In other words, they are all average. Do the same search in every other city that has more than one hospital and you’re likely to find the same thing. Or you might find that there was not even enough data to calculate an average result.

If you want to find a hospital that’s exceptional, there’s no way to search for it. You can also can’t search for a dud.

KP CEO George Halvorson on His Organization’s Mobile App Strategy

Feb 27, 2012• 1

George Halvorson is the CEO who initiated and oversaw the biggest (private sector) EMR implementation ever. What’s Kaiser Permanente doing to expand on that? How is the new technology changing their thinking about care? How fast does George think the rest of health care is changing (very) and can others catch Kaiser (he thinks it would help Kaiser if they tried)? And what about getting other non-Epic apps on that KP system? I spoke with George at HIMSS12 yesterday, and his views are well worth a listen.

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First Amendment Doesn’t Apply to Junk Food Marketing

Feb 27, 2012• 11

By SAMANTHA GRAFF

Every year food and soft drink marketers spend billions of dollars tempting children with junk, fueling an obesity crisis that’s already reached epidemic proportions.

Why aren’t policymakers stepping in to help protect our kids? In part because food and media companies are successfully using the First Amendment as a shield.

But new research paves the way for government to take action to protect children from junk food marketing, building a strong case to establish that much of this advertising falls outside the scope of First Amendment protection.

The controversy over whether government has the right to regulate food marketing to kids came to a head last summer, after a group of federal agencies proposed a set of voluntary recommendations suggesting how food companies could market to kids more responsibly. Food, entertainment and advertising lobbyists launched a massive campaign to derail the recommendations, arguing that the First Amendment protects industry from any government action involving food marketing to children.

The Fall of a Pink Giant?

Feb 26, 2012• 5

By Rachel Kerestes

The move a few weeks ago by the Susan G. Komen Foundation to stop providing grants to Planned Parenthood, the quick reversal after widespread backlash, recent staff resignations and ongoing controversy exposed a weakness in a brand many once thought unassailable. But women’s health may be better off for it.

As the self-described “global leader of the breast cancer movement,” Komen carries the weight of the breast cancer brand on itsshoulders. And women—the brand’s core constituency—took to the social media airwaves to decry what they perceived as hypocrisy by Komen. The breast cancer brand, many women argued, is built on supporting and improving women’s health and defunding Planned Parenthood flies in opposition of that mission.

Komen fell into the classic trap of seeming inauthentic to its audience. Despite pursuing an aggressive strategy to lay claim to the title of sole women’s health brand, thus allocating other causes and conditions to the margins, the foundation seemed surprised to find that it was viewed as representing the voice of women’s health.

Now that the dust is settling the question of damage remains. Will this misstep loosen breast cancer’s grip on its leadership position? And if so, is what’s bad for the breast cancer brand good for women’s health?

Make no mistake—breast cancer is the biggest brand in the history of disease. Everyone from the NFL to Yoplait to American Airlines attempts to get a piece of that brand equity each October by pink-washing themselves in solidarity. As the face of the breast cancer movement, the Komen Foundation is the main benefactor of all that attention raising an estimated $35 million each year from marketing partnerships.

It’s We, the Public, Who Are Flip Floppers

Feb 25, 2012• 7

By Peter Ubel, MD

As I pointed out in a previous post, Theda Skocpol’s wonderful book, Boomerang, provides many telling details about Bill Clinton’s futile efforts to reform the U.S. health care system in the early ’90s. The book details many of the mistakes that the Clinton team made in drafting and promoting the legislation. But the failure of health care reform does not rest solely at the president’s feet. Instead, we, the general public, are also to blame. We ultimately got the policies we deserved.

Skocpol relates a powerful anecdote that nicely captures the sense of public confusion surrounding the general public during the Clinton reform efforts. It was March of 1994, and the Clinton team was trying to convince reluctant legislators to craft a bill consistent with its general approach to health care reform, which was a politically moderate bill that shunned the single payer plan preferred by liberals in favor of a bill based on “managed competition,” an idea embraced early on by moderate Republicans. Around this time, a Wall Street Journal/NBC news poll asked people what they thought of a plan that would “guarantee a standard private health benefits package… and promote competition… and require employers to buy insurance” for their employees. This description fit the Clinton plan to a “t,” and 76 percent of the public viewed it favorably. The dude had found the policy sweet spot!

Only one problem. When that same poll asked people if they approved of the “Clinton plan,” only 37 percent demonstrated support.

Public contradictions over health care reform run even deeper than antipathy to anything Clinton-esque. In its own polling, for example, the Clinton team learned that any plan they crafted that emphasized guaranteeing people “standard or basic” health care benefits would fail, because people wanted “comprehensive benefits,” feeling like it was only these more generous benefits that would be relevant to their own lives. (The administration also learned that the words “plan” and “program” were, ahem, program killers!) At the same time that the public clamored for comprehensive benefits, people also expressed their skepticism that a Democrat like Clinton could craft a health care reform bill that wouldn’t burden the taxpayers with a huge new expense. Well, of course Clinton couldn’t do that. It’s kind of hard to give everybody a Lexus at Hyundai prices!

Better Ways of Thinking About the Future

Feb 24, 2012• 4

By Joe Flower

2012 and 2013 present an opportunity for health care executives to produce significant change. If we hope to be, as Buckminister Fuller said, “Architects of the future, not its victims,” we have to change the way we think in specific ways.

How do you learn to “Think Different” as Steve Jobs’ famous ads put it?

Let’s think about the structure of thought for a moment. The great experimental psychologist Daniel Kahneman, in his recent book Thinking, Fast and Slow, shows how much of our thinking and decision making is driven by illusions and assumptions, such as the “illusion of validity” (the false belief in the reliability of our own judgment), the “availability bias” (a biased judgment based on memories that are more easily available or more vivid) and the “endowment effect” (the tendency to value something more highly when we own it than when someone else owns it).

This makes sense. Kahneman’s analysis resonates strongly with my experience working with executive health care teams, including providers, health plans and suppliers, and with governments in North America, Europe and China over several decades. Smart, seasoned executives can make seriously poor judgments, especially when the environment changes.

Curiously, these illusions and biases and assumptions are driven by our experiences. So being more experienced does not necessarily exempt us from illusion, unless something in our process constantly and directly tests the results of our judgments (as, say, a robust retail market does on price setting). Even if the judgments are correct, they are based on an environment: in the jungle or the savannah, in a controlled market or a retail market, in a risk-bearing business arrangement or an endowed business arrangement. When our environment shifts, the illusions and biases and assumptions persist, even though they may be dangerously out of date.

Why Can’t the ICU Be More Like a Cockpit?

Feb 23, 2012• 17

By Peter Pronovost, MD

In the world of patient safety, we’re constantly reinforcing the importance of teamwork and communication, both among clinicians and with patients. That’s because we know that patient harm so often occurs when vital information about a patient’s care is omitted, miscommunicated or ignored.

Yet for all we do to improve how humans work together, clinicians compete against an environment in which there is very little teamwork or communication among the technologies that they need to care for patients. And there’s little that clinicians or hospitals alone can do about it.

Take, for example, the plethora of alarms from cardiac monitors and other devices that compete for clinicians’ attention. Vendors act as if we are in an alarm race, with each making their devices’ beeps more annoying but no clear prioritizing of the most important alarms. A study on one 15-bed Hopkins Hospital unit a few years ago found that a critical alarm sounded every 92 seconds. As a result, nurses waste their precious time chasing an ever-growing number of false alarms—or becoming desensitized to false alarms and ignoring them. Across the country, this has had tragic consequences, as patients have died while their alarms went unheeded. (Read a 2011 Boston Globe series about this issue.)

In most other high-risk industries, such as aviation and nuclear power, technologies are integrated. They talk to each other, and they automatically adjust based on feedback. Indeed, because of systems integration, pilots fly a small amount of a flight, and even in some treacherous situations, they hand over the reins to the autopilot. Although Southwest Airlines or the U.S. Air Force can buy a working plane, you cannot buy a working hospital or ICU. You must put it together yourself.

There are many other examples of how health care is grossly under-engineered. Consider these:

Is a New Federal Patient Safety Effort Doing Enough to Curb Medical Errors?

Feb 23, 2012• 1

By Michael Millenson

The Medicare program is betting on a new course of action to curb what one medical journal has dubbed an “epidemic” of uncontrolled patient harm.

The effort is pegged to the success of a little-known entity called a “hospital engagement network” (HEN). In December, the government selected 26 HENs and charged them with preventing more than 60,000 deaths and 1.8 million injuries from so-called “hospital-acquired conditions” over the next three years. That would be the equivalent of eliminating all deaths from HIV/AIDS or homicide over the same period.

Despite those big numbers, and an initial price tag of $218 million, it’s unclear whether the HENs are adequately ambitious or still only pecking away at the patient safety problem. While this is by far the most comprehensive public or private patient safety effort ever attempted in this country, it still aims to eliminate less than half the documented, preventable patient harm.

The inspiration for these networks comes from similar collaborative projects run by the Institute for Healthcare Improvement and other groups. Dr. Donald Berwick, IHI’s founder and president, headed up the Centers for Medicare & Medicaid Services for two years and launched a larger Partnership for Patients that includes the HENs.

In December, the government chose a mix of national and local groups — primarily health systems and hospital organizations — to run individual HENs. Each HEN is charged with spreading safety-improvement innovations that have been proven to work in leading hospitals to others through intensive training programs and technical assistance. Although the program lasts three years, initial HEN contracts are for two years, with an “option year” dependent upon performance.