Above the Fold
How to Win Docs and Influence Patients
Pretty much everyone agrees that we need to improve the quality of healthcare delivered to patients. We’ve all heard the frightening statistics
from the Institute of Medicine about medical error rates – that as many
as 98,000 patients die each year as a result of them – and we also know
that the US spends about 33% more than most industrialized country on healthcare, without substantial improvements in outcomes.
However, a large number of quality improvement initiatives rely on
additional rules, regulations, and penalties to inspire change (for
example, decreasing Medicare payments to hospitals with higher
readmission rates, and decreasing provider compensation based on quality indicators).
Not only am I skeptical about this stick vs. carrot strategy, but I
think it will further demoralize providers, pit key stakeholders
against one another, and cause people to spend their energy figuring
out how to game the system than do the right thing for patients.
There is a carrot approach that could theoretically result in a $757
billion savings/year that has not been fully explored – and I suggest
that we take a look at it before we “release the hounds” on hospitals
and providers in an attempt to improve healthcare quality.
Kathleen Sebelius, Healthcare Reform and the Budget
By
Today, according to the Associated Press and Washington Post, President
Obama will announce
Kathleen Sebelius as his nominee for Secretary of
Health and Human Services. She has a once in a lifetime opportunity to
execute healthcare reform – a popular President, a sense of urgency,
and enough resources to get the job done. What are these resources?
You'll find the Office of Management and Budget FY2010 Budget Overview Document online The full FY2010 Budget is expected to be released this Spring.
Highlights from the Healthcare portion of the overview document include:
*
A reserve fund of more than $630 billion over 10 years to finance
fundamental reform of our health care system, funded half by new
revenue and half by savings proposals that promote efficiency and
accountability, align incentives for quality, and encourage shared
responsibility. Examples of new revenue include a proposal that
individuals earning more than $85,000 pay higher premiums for their
Medicare drug coverage starting in 2011. Examples of savings include a
revision of payments to insurers that provide Medicare Advantage plans.
Those payments have been on average 14% higher than what the government
typically spends per beneficiary. Under the budget proposal, insurers
would be required to competitively bid to offer plans beginning in
2012, which the administration believes would lower per-patient outlays.
Classified: Fair Managed Care
What’s fair in managed care? Get involved. Join the conversation. FAIR
is an emerging national grassroots movement focused on changing the
debate about health care costs and holding managed care companies
responsible for their behavior. Supported by patients, hospitals,
physicians, business owners and policy makers, FAIR brings a unified
voice to the table at the peak of a national discussion on health care
reform.
HIMSS still raising that neutrality question
And although the fuss about CCHIT’s corporate issues seems to have been more or less settled, there are still some real questions about the inter-relationships between HIMSS, CCHIT and EVRA.
And frankly it doesn’t really help un-muddy the waters when HIMSS comes out with a guide for providers on how to spend all that lovely money that the Feds just tossed your way as though they’re a neutral body.
They call it the HIMSS Online Buyer's Guide. It’s actually a guide to companies that are exhibiting at HIMSS; or for a mere $395 a year you too can buy an ad in it. Now I know it’s a service from a company that runs conferences, publications and consulting. And given that’s something I do too in a much smaller way I have no problem with them doing that.
But given the influence HIMSS peddles on behalf of (mostly big) vendors, and the real concerns over the neutrality of CCHIT, perhaps they could change their terminology to make it a little more transparent about what this “Buyer’s Guide” actually is—a list of advertisers and vendors, not a neutral publication from a organization that only has providers & buyers at heart.
Health care reform : What we can learn from Costco
The most telling point about health reform in President Obama's budget is that, "Some researchers
believe that healthcare costs could be reduced by a stunning 30 percent — or about $700 billion a year — without harming quality if we moved as a nation toward the proven and successful practices adopted by the lower-cost areas and hospitals."
That sentence gives us some grist for forecasting some of the elements of health reform — in particular, the last phrase which talks about moving from higher-cost, unproven health practices to lower-cost proven approaches.
In a post earlier this week, I talked about the importance of understanding practice variations, especially those behaviors that lead to increasing costs without improving health outcomes. Under the New England Journal of Medicine paper's scenario, all practitioners would be incentivized to behave as if they practiced in Salem, Oregon and not Miami, Florida.
What will it take to "move" medical practices? We can take a page out of Costco's playbook to answer this one. Three Costco tactics which keep the business resilient will be relevant to this scenario: standardization, deployment of information technology, and tough negotiations with suppliers.
Commentology
David Longstreet had this to say in response to Andre Blackman's post last week on the the increasing importance of technology in public health. ("Why Technology is No Longer Optional in Public Health."
"the biggest change in software technology is the growing trend of specialization along industry disciplines. The healthcare field is too complex for "generalist" software developers. Those software organizations that specialize in healthcare have productivity and quality rates orders of magnitude higher than generalist firms.
This should not surprise anyone in the healthcare discipline because healthcare has understood the value of specialization for some time now. Unfortunately there are still software firms whose employees work for a bank one week and a hospital the next week…."
Christopher George wrote in reply to Bob Wachter's piece on the implications of comparative effectiveness research. ("Are We Mature Enough to Make Use of Comparative Effectiveness Research?")
"Because the only case which you discuss is one in which supposedly greedy doctors perform ineffective surgery for profit, one might be left with the impression that the principal problem in healthcare is restraining rapacious doctors.
It is well known in certain segments of the medical community that back surgery, and cardiac angioplasty are largely ineffective. It is also well known that regulators with government sponsorship have a limited grasp of statistics and science, and an uncanny tendency to target effective procedures as often as stupid ones. Don't be surprised if you don't like the result once a soviet style Supreme Extra-ordinary Medical Committee makes enforcable decisions about what heathcare is on your treatment menu.
Remember an early target of those who would use government to eliminate medical progress: The CT scan. The assault on the Cat scanner was nearly successful. When you torture the data enough, a CT scanner can seem like a silly thing to use. Why not practice like they did at the dawn of time?"
The President’s Budget
Earlier this week, I suggested that the Commonwealth Fund’s recent proposal for healthcare reform underlines just how difficult it will be to build a sustainable, effective, safe healthcare program for all Americans.
President Obama’s budget reinforces the message. His ten-year $634-billion plan for funding healthcare reform depends on “asking the wealthy to pitch in a bit more” (budget director Peter Orszag’s happy phrase), wringing some of the waste out of Medicare and Medicaid (cuts that are needed, but that will not be popular ); and strong-arming drug makers to raise discounts on Medicare drugs from 15 percent to 21 percent. About half of the money will come from changes in government programs, half from tax increases.
Health 2.0 more interesting than porn!
Last Thursday I gave a talk to a very high powered group, the National Committee on Vital and Health Statistics. My old colleague Matt Quinn is now working for the soon to be very rich Agency for Health Research and Quality (another HHS agency), and he lined up a series of talks for the committee on non-traditional data sources. Non-traditional, by the way, means about anything that isn’t from one of the huge Federal government household surveys (like MEPS) that’s used by HHS to analyze health care spending and consumption. John Halamka, CIO of BIDMC and Chair of HITSP, gave an excellent summary talk about data sources that are being collated and integrated in Massachusetts. It’s available on his blog here. Bear in mind that a LOT of work has already gone into putting various patient data sets together in that part of the country. The most encouraging thing was how relatively easy it was for BIDMC to interface with Google Health and Microsoft HealthVault, and how problem free those interfaces have been.
My talk was about Health 2.0, and given that it was less familiar to the committee I both introduced the concept of social networking and consumer tools, and discussed how it might be integrated into a national data capture strategy to improve quality reporting and hopefully spur improvements in medical care processes. Both talks are available here. You need to go to 4.48.00 or so to catch where I start. John’s talk is after the discussion
The Obama Health care Budget
Pieces of the health care portion of the Obama budget are leaking out.
Based upon published reports, the Obama “down payment on health care reform” will include:
- $634 billion to help pay for health care reform over the next ten years.
- $318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.
- Charging wealthier seniors more for the Medicare Part D drug benefit—as is done for Medicare Part B now.
- Cutting Medicare HMO payments by $175 billion over ten years.
- Reducing Medicare hospital payments by $17 billion over ten years by bundling inpatient and outpatient reimbursement to include the 30-days after discharge.
- Cutting Medicare hospital payments by $8.4 billion over ten years for re-admissions resulting from substandard care.
- Requiring drug makers to increase the rebates on drugs sold to Medicare patients from 15% to 21% saving $19.5 billion over ten years.
