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Do Patients Want to Punish?

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LevyBy PAUL LEVY

There is a great debate set forth in the IHI’s Open School discussion of the wrong-side surgery case that  occurred at our hospital a few years ago. (I have written about this below, but there are some new postings.)

Kimberlee Ziga writes: I, as an RN working in an ICU, have also made mistakes. Thank God they have not been life threatening but nonetheless, they were mistakes. I was educated thoroughly and proven to be competent with testing. When I made that mistake, I was written up. I totally understood why. I am a licensed professional who is competent at her job, and that calls for accountability and responsibility. I believe all the medical staff involved should have been held accountable and disciplined accordingly. If that was my family member, I would have been irate for what they had to go through.

In contrast, Jessie Moon says: Paul Levy . . . made it out like it was a serious situation, but one that could happen to any surgery team. He* did not punish any one person, but instead he took care of the situation by asking, “how can we lower the chances of this ever happening again”, which makes the person and the family that this happened to feel better (or so I would assume), the public, as well as the workers in this hospital.

There are two parts to this question. What is the most effective way to reduce the likelihood of a similar event happening in the future? I have addressed this topic fully below. At heart, the answer goes to the definition of the “just culture” that has been adopted by a hospital.

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The trifecta: Reform idiocy, Hospital CEOs and the Obesity Problem

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By MATTHEW HOLT
It’s rare that you get such a delicious health care story combining human frailty, blindness and multiple stereotypes, but Julie Rovner of NPR found it. In fact I literally thought she’d been set up but she confirmed to me that it was true and put me in touch with the CMS spokesman who confirmed it. So remember, this really happened.—Matthew

An interim hospital CEO in Ohio Valley Medical Center, in West Virginia “found out” “advanced intelligence” from “word of mouth” sources in Washington DC that the “High Commissioners of the Healthcare Reform Bill” were going deny Medicare payments  to any hospital of which than 5% of employees were 25% overweight.

This rumor prompted the said CEO to panic. Now before I tell you what he did, let me tell you a little of his story. To quote the CEO as he tells it:

I am five feet, 10 inches tall. The guidelines (he’s referring to standard BMI guidelines) suggest that I should weigh between 151 and 163 for my medium frame. If you add 25 percent to the upper limit, I would need to be no heavier than 204 pounds. I currently weigh 272 pounds, down from 335. I would have three years to lose 68 pounds

That is indeed some challenge. Not to mention that the hospital is in West Virginia (albeit the northern sliver between Ohio & Pennsylvania) where the obesity rate is among the nations highest—there’s a reason that Jamie Oliver took his childhood obesity crusade there. In fact Ohio County, WV’s obesity rate is 32% according to the rather fun County Sin Rankings site. And as obesity tends to mean a BMI of roughly 25% more than the outer band of the guidelines, it’s a fair bet that somewhere close to 32% of the workforce is obese. So getting that number down to 5% would be a major struggle.

The interim CEO also wanted to promote not only his own weight loss story but the laudable activities of his hospital’s dietitians and its weight-loss programs. Here’s his counsel to hospital employees.

I strongly urge you to take advantage of the programs OVMC and EORH are currently offering employees who are battling with excess weight. Mary Velez is doing a fabulous job with Weight Watchers programs, and in addition, I have also been offering a program known as “Diet and Fitness for Love.”

And who could be against that advice?

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HIT Trends Summary for August 2010

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By MICHAEL LAKE

Picture 1

This is a summary of the HIT Trends Report for August 2010.

You can get the current issue or subscribe here

Large insurers make HIT commitments.  This month’s trends are dominated by national health plans revealing more about their HIT strategies.  Dr. Blumenthal called HIT a “team sport,” when asking for private industry support for meaningful use.  National insurers responded.  Humana announced that it will collaborate with athenahealth in 100 physician practices and pay for 85% of the costs of its EHR.  It will also pay a 20% bonus for hitting outcomes targets.  Ingenix, part of UnitedHealthcare Group, reported it is buying Axolotl, a leader in health information exchange.  Aetna announced a partnership between its ActiveHealth care management solution and IBM who will provide clinical decision support to providers in large groups using cloud computing.  And WellPoint told the WSJ that it is investing hundreds of millions of dollars to finance the HIT infrastructure for rural providers.  In response to a consumer advocate raising questions about an inherent conflict when payers support provider HIT efforts, health plans responded by insisting their focus is on improving patient outcomes which will lower costs.  Payer investments in provider HIT will be supported by its inclusion as a medical expense when insurers calculate medical loss ratios.  The National Association of Insurance Commissioners approved its inclusion in new MLR blanks.

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Health 2.0 Europe: Deep Dive by Pfizer

By Bianca Grogan

Cliquez pour la vidéo en français French
At the Health 2.0 Europe Conference, April 6-7, 2010, in Paris, France, Vincent Varlet, the Communication & eBusiness Director of Pfizer, France, gave a deep dive presentation. He talked about the e-initiatives for mobiles for both patients and doctors and the different services that Pfizer provides.

Health 2.0 Europe: Seach and Content

By Bianca Grogan

Cliquez pour la vidéo en français French

At the Health 2.0 Europe Conference, April 6-7, 2010, in Paris France, a number of panelists gave live demonstrations in regards to search and content. They discussed the question of how to make content on the internet useful and personalized for patients and consumers. The panelists showed different ways for finding information, finding the right information, and finding good quality information. On the panel were Segolène Ayme from Orphanet, Frankie Dolan from MedWorm, Célia Boyer from Health On the Net Foundation, West Shell from Healthline Networks, Steven Krein from Organized Wisdom, and Berci Mesko from Webicina.

Independent Advisors Prove Independent

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By MERRILL GOOZNER
Merrill GooznerJournalist-turned-stock-analyst Ramsey Baghdadi of Concept Capital, who formerly wrote for the RPM Report, tells TheStreet.com that Food and Drug Administration Advisory Committee recommendations are down to 52 percent “yes” votes this year, “the worst year since 2007.” He compares that unfavorably to 2009 and 2008 when the advisors gave positive nods 75 and 80 percent of the time.

Reasons for the tougher regulatory environment, according to Baghdadi? “First, the FDA is bringing more drugs in front of advisory panels due to changes in FDA law that require most new drugs to be reviewed by outside experts,” the article notes. “Second, stricter conflict of interest rules implemented by FDA (in the wake of the 2007 reform law) have made it more difficult for the agency to recruit experienced panel members.”

If inexperienced members without conflicts of interest are more prone to voting no, how does that explain 2007, when the current rules weren’t in place and there were still 50 percent “no” votes?Continue reading…

Beyond Meaningful Use: Three Five-Year Trends in the Uses of Patient Health Data and Clinical IT

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By DAVID C. KIBBE, MD and BRIAN KLEPPERDavid Kibbe, PhD

Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs. The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment. Doctors who get three-quarters of the way there won’t receive a dime. And a lot of uncertainty remains about dependent processes that CMS and ONC must quickly put in place, like accreditation of “testing and certifying bodies,” and the testing schemas for certification. All in all, we expect most physicians in small practices to sit on the sidelines until the dust settles, likely in 2012 or 2013.

Nevertheless, while it is good to get Meaningful Use behind us, it may be better still seeing beyond it. After all, the incentive payments for becoming a “meaningful user of certified EHR technology” are merely a small down payment on the savings that could be realized if health care supply, delivery and payment are affected by the changing policy and market environments over the next 5 years. The EHR incentive programs are meant to prime the pump by putting approximately $25 billion, give or take a few billion, into the hands of physicians and hospitals who adopt EHR technology during the 5 years between 2011 and 2016.

During that same time, by comparison, reductions in waste, duplication, and unnecessary procedures might mean savings of $100 billion to Medicare alone,# depending on whose estimate you believe and how effective you think the reforms will be in replacing payment for volume with payment for value. It might be a lot more. Conservative estimates are that 30% of our total national health care expenditure of $2.5 trillion, or over $800 million, is unnecessary and could be eliminated through real reforms. Some authoritative estimates argue that half or more of care costs are unnecessary, so the target jumps to $1.25 trillion a year.

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