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Above the Fold

Hospitalist Co-Management Of Neurosurgery Patients

Dec 24, 2010• 3

By ROBERT WACHTER, MD

In this month’s Archives of Internal Medicine, my colleagues and I report the results of our early experience with hospitalist co-management of neurosurgery patients. We found stratospheric satisfaction among neurosurgeons and nurses, as well as impressive cost reductions ($1400/admission). At the same time, there was no impact on quality or safety, at least as judged by hard end-points such as mortality and readmission rates.

While these results might seem like a mixed bag, I believe that the overall impact of this service has been fantastic, for patients, surgeons, and our own hospitalists. Let me explain, beginning with a brief history of hospitalist co-management, folding in the history of our neurosurgery co-management effort (which we call the “Co-Management with Neurosurgery Service”, or CNS), and ending with some of the more subtle outcomes that lead me to feel that this is one of the most important things our hospitalist program has done since its inception in 1995.

A Brief History of Co-Management

When the hospitalist field took off in the mid-1990s, we projected that its growth would largely reflect the degree to which hospitalists assumed the care of inpatient internal medicine (and later, pediatrics) patients: those with pneumonia, heart failure, sepsis, GI bleed, and the like. Sure, I recognized that there would be increased opportunities for traditional medical consultation – we come when you call us – but I completely underestimated the siren call of co-management.

It turns out that once there are hospitalists in the house, the notion of having them actively co-manage surgical patients is hard to resist, for several reasons. First, many of the problems such patients experience before and after surgery are really medical, not surgical. Secondly, just as a hospitalist can provide on-site availability that the primary care physician can’t match for medical patients, he or she can do the same for surgical patients. (In this case, it’s not that the primary care doc is stuck in the office, but rather the surgeon is stuck in the OR.) Third, in an era of more widespread quality measurement and reporting, it seems likely that a hospitalist will improve quality measures such as DVT prophylaxis and evidence-based management of CHF more than a surgeon, flying solo, would be able to.

U.S. Health Care & U.S. Productivity: A Dissent

Dec 23, 2010• 39

By JOHN R. GRAHAM

One of the great myths about American society is that our lack of a “universal” health plan harms our competitiveness. The masters of this refrain, of course, are the American automakers. Years before driving themselves into bankruptcy and the unwelcoming arms of their new owners, the American taxpayers, they used to claim that they spent up to $1,600 per car on health care. This was more than they spent on steel, and a multiple of what they claimed their foreign competitors spent. In her well received book, Who Killed Health Care? America’s $2 Trillion Medical Problem – And the Consumer-Driven Cure (New York, NY: McGraw-Hill, 2007), Professor Regina Herzlinger of Harvard Business School claims that these complaints are inflated (pp. 104-105).

Furthermore, we don’t hear Mark Zuckerberg complaining that Facebook’s health care costs are preventing him from competing against foreign social-media businesses. Indeed, while all Americans complain about health costs, the argument that our health “system” reduces our competitiveness versus other countries with “universal” health care is actually quite weak. Indeed, the percentage of all firms offering health benefits actually increased from 66 percent in 1999 to 69 percent in 2010, and a greater number of smaller firms have begun to offer health benefits, according to the Kaiser Family Foundation.

One oft-cited metric is that the United States spends far more on health than other countries as a share of Gross Domestic Product (GDP). But this measurement can mislead. It is a ratio composed of a numerator and a denominator. The numerator – the real cost of medical care – has grown slightly slower in the U.S. than Europe. Advocates of government monopoly health care point out that Canadian and U.S. health spending as a share of GDP was about the same before the Canadian government took over health care, but diverged starting in 1970, soon after the government completed its takeover. They present this as evidence that the state can control costs better than the private sector. However, real GDP growth in Canada dramatically outpaced U.S. growth between 1969 and 1987, meaning that the denominator of the health spending per GDP ratio grew much faster in Canada, not that the numerator grew much slower, according to research by Professor Brian Ferguson.

Who Cares?

Dec 23, 2010• 3

By PETER KRUGER

The father of a wireless engineer, who made a good living designing mobile devices, contracted a rare and chronic form of athlete’s foot. Over the course of a few months, the father’s condition worsened and eventually he died. Vowing he would make sure that no-one suffered the way his father had during the last few weeks of his life, the engineer set about developing a wireless athlete’s foot detector.

After obtaining the backing of a venture capitalist, he licensed technology from a university spinout that specialised in bio-sensing and embedded it onto a wireless chipset, which he then packaged into a simple mobile device. The athlete’s foot monitor is now on the market and our wireless engineer is talking to a number of healthcare providers, including the NHS.

There are two important things about this story; first it is complete fiction – and second; anyone who has been involved in the wireless and mobile industry, will have come across real life examples of personal quests masquerading as business plans.

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Dec 23, 2010

New Law Lets the Feds Sponsor Prize Competitions

Dec 23, 2010• 2

By GLENN LAFFEL, MD, PhD

The repeal of Don’t Ask Don’t Tell and the ratification of a brand-new START treaty represent milestone achievements for the suddenly prolific lame duck Congress, and the press has covered these developments accordingly. But Congress passed another law amid this flurry of activity—the America COMPETES Act—and although the media didn’t cover this move nearly as vigorously, it is potentially quite significant and praiseworthy in its own right.

America COMPETES authorizes continued growth in the budgets of the Department of Energy’s Office of Science, the laboratories of the National Institute of Standards and Technology, and the National Science Foundation, 3 agencies focused on incubating and generating innovations designed to keep our country at the forefront of an increasingly competitive global economy.

Beyond this, in what many hope will become a bona fide turning point in the effort to leverage American ingenuity and innovation, America COMPETES empowers all federal agencies to sponsor prize competitions to spur innovation, solve particularly vexing problems in their domains, and advance their missions.

Prize competitions are proven to be an effective strategy for energizing our country’s innovators. The private sector and philanthropists use them increasingly. According to a study by McKinsey in fact, more than 60 prizes valued at $100,000 or more were introduced by such organizations between 2000-2007. Total prize money associated with these competitions approaches $250 million.

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Dec 23, 2010

Send in the Clowns!

Dec 23, 2010• 1

By David Williams

David is a long time friend and occassional contributor to THCB. And he politely asked if the THCB audience would be interested in helping contribute to the charity he works with–please read and give what you can–Matthew Holt

The Hearts & Noses Hospital Clown Troupe provides professionally trained volunteer clowns to hospitalized children in Greater Boston and training for other clown troupes worldwide. I’m chairman of the board of directors and hope you will join me in supporting the work of the clowns by making a donation.

Hospitalized children often experience stress, fear, and anxiety, which can become a barrier to healing. Hearts & Noses clowns are specially trained to provide relief for ill children and respite for their families. Our clowns strive to uncover the hidden spirit of joy and the creative energy that lives in the heart and soul of children− a spirit that is often dampened by the sterile and sometimes frightening clinical environment. Our clowns’ central goal is to engage, empower and give choices to hospitalized children.

After a life-changing trip to Russia with famous clown and physician Patch Adams, troupe founder Jeannie Lindheim began offering a series of seminars on hospital clowning in the 1990s. Lindheim, an actor, began training clowns to visit ill and disabled children at Boston area hospitals. She formed the Clown Troupe and worked diligently to build a strong, professionally-trained group of volunteers. More than a decade later, our clowns are still all volunteers and we have helped build clown troupes throughout the world.

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Dec 22, 2010

Health 2.0 News launches

Dec 22, 2010

By Matthew Holt

Today I'm very excited to tell you that Health 2.0 News is launching. We‚Äôve had the Health 2.0 Blog for several years now and of course have extensively covered the world of Health 2.0 and the Health 2.0 Conferences on THCB. But we‚Äôve been a little behind in tracking the news and activity that‚Äôs going on daily in the world of Health 2.0 companies.

Meanwhile the Health 2.0 organization has grown significantly to do much more than conferences. We‚Äôre now actively tracking several hundred Health 2.0 companies in a private database, we‚Äôre working on consulting projects, we have a major developer challenge program and we have more in the wings.

So from today the all new Health 2.0 News will be actively tracking industry news, showing video of Health 2.0 events, and having editorials from important Health 2.0 leaders. Please head over to Health2News.com and join us!