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Let’s Just Keep Killing and Maiming Them

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By PAUL LEVY

Old patterns die hard. Back in March 2010, I posted a chart from the ACHE that Jim Conway had sent me showing a decrease in the ranking of quality and safety among priorities reported by hospital executives.

Now comes an article in Health, Medical, and Science Updates about a study by the Beryl Institute, entitled “The State of Patient Experience in American Hospitals.” Of those places surveyed, 51% were individual hospitals and 49% were hospital groups or systems. There was an even mix of urban, suburban, and rural facilities.

As in the prior ACHE survey, 69% of hospital executives rank things other than quality and patient safety as top priorities.

Any way you look at it, this is quite simply a failure of leadership and governance in American hospitals. There is a strange adherence to the view that “these things happen,” an apparent belief that a certain level of harm that occurs to patients is just the way things should be. It is as though the medical profession, hospital administrators, and hospital trustees have decided that the current amount of harm is the statistically irreducible level.Continue reading…

Why We Should Think Twice About Getting A CT Scan

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By SHANNON BROWNLEE & SAM WAINWRIGHT

There’s an eerie video up on YouTube, shot by a Japanese journalist who ventured into the evacuation zone surrounding the Fukushima nuclear power plant, armed with a camera and a radiation meter. The video looks like b-roll footage from a low-budget zombie movie, with roving bands of stray dogs and a soundtrack of the radiation meter’s increasingly frantic beeping.

Shortly after the earthquake that damaged the plant, the Japanese government evacuated residents from a more than 1,000 square mile zone. Last week, they raised the severity level of the crisis at Fukushima to a 7 out of 7, making it the worst nuclear disaster since the complete meltdown of the reactor at Chernobyl, in 1986. In its wake, worldwide fear of nuclear power spiked. The German government shut down seven of its 17 nuclear reactors, and plans to eliminate nuclear power by 2020. In the U.S., a Fox News Poll conducted in early April found that 83 percent of respondents thought a similar disaster could happen to an American nuclear plant.

People fear radiation for good reason. All ionizing radiation passes unimpeded through cells of the body, mutating or destroying DNA along the way. The danger level depends on the dose and the length of exposure. We’re exposed to small amounts of radiation all the time — from cosmic rays to the normal radioactive decay of soil, rocks and building materials. Even the granite in the U.S. Capitol Building emits low levels of radiation. These levels are harmless, but a high dose can kill, and prolonged or repeated moderate exposure can lead to cancer.Continue reading…

Neither the Republicans Nor the Democrats Want to Face the Provider Cost Problem

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By ROBERT LASZEWSKI

A key piece of Paul Ryan’s deficit reduction plan is to change Medicare as we know it. It appears his bold Medicare premium support proposal is failing to gain traction–it is dead as part of any deficit reduction deal this year. Worse, his Medicare proposal looks to be giving Democrats lots of political ammunition for the 2012 elections.

What lies at the heart of Ryan’s Medicare difficulties is that he would all but abandon future seniors (those now under age-55) to a health care system whose age-adjusted premium support would increase each year only at a rate equal to the increase in the consumer price index while their health care costs would likely continue to increase far faster.

Simply, Ryan just shifts the future burden of uncontrolled Medicare health care costs from the federal government to the senior. That will solve a big part of our federal deficit problem but hardly help people.

Yes, he offers a defined contribution health care solution with the promise of invigorating the markets and making costs lower. But we have had a form of Medicare premium support and private competition for years (Medicare Advantage) and there isn’t a lot of evidence the market can get the cost control job done on its own. (See: Defined Contribution Health Care—The Conservatives’ Silver Bullet)Continue reading…

What If You Give a Party and No One Comes?

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By PAUL LEVY

Here is a short update on a post I put up about a month ago about CMS’ proposed regulations for setting up Accountable Care Organizations. The ACO proposal calls for shared savings and other incentives for providers, with a transition after a few years to a real risk contract. But Congress put a “poison pill” into the concept because it was afraid to limit customer choice. At the heart of my argument was this point: “How can you be held accountable, as a provider group, if you cannot control the management of care of your patients?”

The latest news, according to my sources, is that even the most advanced ACO-like organizations like Geisinger and Mayo are not interested in signing on to this proposition. The financial risks can come crashing down quickly and are just too great.

In a recent Boston Globe interview, consultant Marc Bard explains how it would have to work for providers to agree to share risk in an ACO network:

Q. Some consumers fear they won’t be able to go to the doctors or specialists they want in the new system. Is that a legitimate fear?

A. The answer is of course. We can’t be spending 17.5 percent of our gross national product on health care and allow everybody to broker his or her own health care. So ultimately there are going to have to be trade-offs made. The public’s going to have to make them. The delivery systems are going to have to make them. Absolutely there are going to be limitations.

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and
front-line driven process improvement at Not Running a Hospital.

Health 2.0 Advisors at Tiecon 11

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By Marco Smit

At Health 2.0 Advisors we not only scan and analyze the healthcare innovation landscape incessantly, we also share our thoughts and insights with clients and at conferences at times. On that note, on May 13 at 10am I will be moderating a panel on cloud-computing in healthcare at Tiecon 2011. It is the first panel right after the ‘interesting’ Steve Case speaks – Marissa Meyer from Google closes on Saturday evening.

Cloud-computing is one of the topics that Health 2.0 Advisors will start sharing more perspective on in public this year, in addition to unplatforms/mobile, analytics, and care delivery innovation. What these topics all have in common is that they are forces rapidly changing the healthcare landscape (competitive landscape, business models, patient-provider dynamics, other) and companies are grappling where they all fit in with their strategies and business realities.

This Tiecon 2011 panel is a good reflection of that: cloud-based EMR-systems where a novelty 18 months ago, but the number of companies offering them (stand-alone or embedded in e.g. a practice management suite), has exploded since. But cloud-computing goes far beyond EMRs of course. That is why the panel will cover a range of experiences, struggles, and expectations for the future of the cloud from large (IBM, Kaiser Pemanente) and small – but rapidly growing (Practice Fusion, CareCloud) – companies that have cloud-computing in their DNA.

Marco Smit is President of Health 2.0 Advisors, the market intelligence arm of the Health 2.0 family.

The Quest for Price Transparency

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By ERIC LESPIN

A torn meniscus. It did not disable but it impaired, and unpredictably. My stomach learned quickly to tighten at the sound of A’s peculiar whimper in response to a crippling pain that would shoot through her at seemingly innocuous movements of the afflicted leg. We have health insurance of sorts, the type that will help you keep your home if tragedy strikes, but that does not shield you from the brunt of what most of day-to-day health care cost is about. We’re well practiced in deferring and foregoing care. Here however, we reluctantly acknowledged that a hospital would need to be visited and a doctor consulted.

Tests and a physical examination made clear that an operation was unavoidable. The doctor was a thoughtful man who conscientiously went through what the operation would entail. Surgery would take half a day, then back home by afternoon, convalescence over the following few weeks, with complete recovery the usual outcome. While not painless, the procedure seemed reassuringly routine. His tone was caring and his outlook about our case optimistic.

The admirable candor with which medical personnel have learned to speak about difficult topics concerning our bodies and our care did not extend to the costs involved. The question of what the procedure would cost, gently broached, initially baffled the staff, eliciting answer-deflecting counter-questions about the adequacy of our insurance coverage, but resulted in no quotes or estimates. Continue reading…

Hockey Teams and AED’s Save Lives

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By VIPAN NIKORE, MD

I’ve played over a thousand ice hockey games in my life, but I had no idea that last month’s adult men’s league game in Cleveland would be the most memorable. I grew up in Canada, three blocks from Wayne Gretzky, the greatest hockey player ever, but I wouldn’t be surprised if my recent game was more important than any game that my former neighbor played. This game was literally a matter of life or death.

I almost didn’t show up to the game. I had just landed in Cleveland from New York City after attending a close friend’s wedding. I’d landed at 8:15pm, jumped in my car and dialed into a conference call for my organization uFLOW, arriving and finishing my call barely in time for the 9:30pm puck drop. I didn’t plan my schedule around the game; the timing just happened to work out.

It was close to the end of the 2nd period when I heard our captain, Brandon Dynes, yell something and race off the ice. I soon realized he skated off to call 911. I looked down at the end of the bench and saw that our teammate Harley was unresponsive. Harley is 69 years old (though could pass for 50) and as the eldest player in our men’s league has been an inspiration to many of us. I quickly went over to assess him and found he had no pulse, was not breathing, and not responding to verbal or physical stimuli. I was fortunate that the opposing team had a physician playing as well, Dr. John Wood, an orthopedic surgeon. John quickly came over and could not find a pulse either. Knowing end organ damage such a anoxic brain injury can occur quickly, I grabbed Harley and layed him on the bench and started compressions, pressing his chest extra hard knowing I was going through a layer of hockey pads. I later quickly ripped off his pads off to assure better compressions.Continue reading…

I Wish We Were Less Patient

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By PAUL LEVY

The sad case of Kimberly Hiatt, a Seattle nurse who committed suicide months after being disciplined for administering a fatal dose to an infant, is starting to make the rounds. Josephine Ensign, for example, concludes her blog post on this by saying:

I am left with many questions. Why was the nurse treated so differently from the dentist or physician at the same hospital for similarly serious medication errors? If one in three hospital patients in the US experiences serious preventable adverse events and we know that it’s “the system, stupid,” why are most of our efforts put into educating patients to advocate for safer care? If nurses are simultaneously being told by hospital administrators to report errors and then facing serious retribution for making honest unintentional mistakes . . . what do I teach my students to do?

We can never know, of course, whether the suicide was related to the incident itself, the disciplinary action, or indeed, some other aspect of Hiatt’s life. But the sequence of events will cause many to draw the connection between the way Hiatt was treated after the accident and her death. In any event, though, the ambiguity as to whether or not it was connected does not take away from the kinds of questions raised by Ensign.Continue reading…

Yes, Thanks — We’ve Heard About Google Health

By SEAN NOLAN

Seems like everybody on the web (or at least in our little Healthcare corner of it) has an opinion on the news that Google Health is shutting down. Just in case you’re thinking about sending me the link — yes, I’ve heard. 🙂

First off — sincere thanks to Aaron, Adam, Missy, Paul, Marc, Crutcher, Alan, Eric, Alfred, and all the others over at Google who built a great service and fought hard for the idea that the only way to really fix healthcare is to consumerize it. There will continue to be plenty of short-term debates about privacy, data ownership, standards, etc., but ultimately it’s inevitable — we’ll get there, and Google Health moved the ball forward.

Second — what does this mean for HealthVault? The “buzz” online ranges wildly, but the real and simple answer is: nothing. As I said a few months ago, HealthVault is a key piece of our overall approach:

HealthVault is a critical component in our broader project strategy — which is to (1) connect care across the ecosystem, from the home to the clinic to the hospital to the research lab, and (2) do so in a way that includes and encourages innovation from as many different organizations as possible.

Solving only the consumer side isn’t enough — that’s why we have Microsoft Amalga on the enterprise side. Our two platforms combine to enable the transformative all-up story: enabling clinical integrations like mynyp.org and MedPlus, home monitoring programs with Kaiser, CCF and UMass, and so on.Continue reading…

CABG in Decline

By MERRILL GOOZNER

The number of Americans with serious heart disease in need of hospital treatment is on the decline. A new study in today’s Journal of the American Medical Association shows the overall rate of coronary revascularizations — ranging from the coronary artery bypass graft (CABG) surgeries to in-and-out catheter-based procedures like angioplasties and stent insertions — fell from just under 1,500 per million adults a quarter in 2001 to less than 1,250 per million adults a quarter in 2008, a 15 percent decline.

The most intriguing finding in the data was that virtually all of the decline was in the most serious cases — those requiring CABG, which fell by about a third. The rate of percutaneous coronary interventions (where they snake a catheter through the thigh into the blood vessels feeding the heart, propping them open with either drug-eluting or bare metal stents) remained virtually unchanged.

The study authors, who hailed from the Philadelphia Veterans Affairs Medical Center, suspect the decline in CABG was driven by “a sizable shift in cardiovascular clinical practice patterns away from surgical treatment toward percutaneous coronary interventions” using catheters (so-called PCI). In other words, in recent years people with serious heart disease are more likely to be treated with the less invasive procedure.Continue reading…

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