The Health Care Blog – Page 945 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Whata Gupta Fuss

Jan 7, 2009• 4

By Matthew Holt

Mostly because he went off erroneously at Michael Moore in what I remember as two amateur policy analysts being unable to either get their facts straight or explain what was important, Sanjay Gupta’s floated appointment as surgeon general has got the left in a tizzy. And I agree that a neurosurgeon is not exactly who I’d go to for information about public health. But part of the amusement/confusion is that via a now contrite Merril Goozner, CNN’s Sanjay Gupta was confused with another Sanjay Gupta who was a big time recipient of drug company funding.

But does any of this this matter? I know that the rumor is that he’ll have input into health reform, but then again so does anyone who went to a Daschle house party. And if this position is so important, answer me this: who is the current Surgeon General and what notable thing has he or she done?

I knew you couldn’t do it sans Google….

If you really care, Val Jones has recently interviewed the last but one surgeon-general Richard Carmona. In your piece of trivia for today Carmona knows about Health 2.0, or at least is on the board of Healthline.

Anyway we may not have enough general surgeons according to their trade group, but why should the head of public health for the nation be a surgeon. Shouldn’t they be an epidemiologist? And why are they a general? Don’t we waste enough money on the military as it is?

Let’s Reboot America’s Health IT Conversation Part 2: Beyond EHRs

Jan 6, 2009• 9

By DAVID KIBBE and BRIAN KLEPPER

Yesterday we tried to put EHRs into perspective. They’re important, and
we can’t effectively move health care forward without them. But they’re
only one of many important health IT functions. EHRs and health IT
alone won’t fix health care. So developing a comprehensive but
effective national health IT plan is a huge undertaking that requires
broad, non-ideological thinking.

As we’ve learned so painfully elsewhere in the economy, the danger we
face now in developing health care solutions is throwing good money
after bad. We don’t merely need a readjustment of how health IT dollars
are spent. We need to reboot the entire conversation about how health
IT relates to health, health care, and health care reform. To get
there, we need to take a deep breath and start from well-established
and agreed-upon principles.

Most of us want a health system that, whenever possible, bases care on
knowledge of what does and doesn’t work – i.e., evidence. We want care
that is coordinated, not fragmented, across the continuum of settings,
visits and events. And we want care that is personal, affordable and
increasingly convenient.

Most of us also agree that, so far, we have not achieved these ideals.
In fact, health care continues to become costlier, quality is spotty,
and the gap between the health care we believe possible and the current
system is widening.

The demise of Medicare Health Support

Jan 6, 2009• 4

By Matthew Holt

I guess we knew it, but here’s the confirmation in the analysis of the first 18 months from CMS.

The summary: DM companies in Medicare Health Support enrolled healthier than average populations; they had limited to no impact on improving their patients’ care, satisfaction or outcomes; and didn’t save any money.

I wonder how Disease Management is going to fare in the future. It’s clear that this "occasional remote intervention" model needs to change.

Viciously Vladeck

Jan 6, 2009

The new Health Affairs is out and with it a lovely piece of vintage Vladeck.

In a review of a new book on Medicare by old Brookings warhorse Henry Aaron and fast rising UT Longhorn star Jeanne Lambrew, Bruce Vladeck soon turns off the main topic (their book) and onto his favorite–the inevitability of the outcome when Medicare tries to do something about health care costs, and the inability of the political system to do much about it.

Policy analysts make fun of politicians who claim they can balance the budget by eliminating "waste, fraud, and abuse," but with a straight face they then propose to control health care costs by making the system more efficient. Efficiency has hardly anything to do with it. What health care costs are all about is market power and the distribution of monopoly rents. Every other industrialized nation understands that and does something about it. U.S. providers and insurers understand it, too, which is why the more sophisticated providers resist any efforts to aggregate power on the buyers’ side. But the mainstream of U.S. policy analysis just doesn’t seem capable of even framing the question, let alone solving it.

Of course despite me convening panels with Valdeck on them a couple of times, he probably doesn’t think THCB is mainstream policy analysis 🙂

But just last week I said:

As I’ve been saying for a long time, to rationally rationalize the
health care system, we need to make cardiologists in Miami behave like
cardiologists in Minnesota with a consequent impact on the incomes of
doctors, hospitals and stent & speedboat salesman in high cost
areas (Yes, Jeff, I do mean Louisiana, New York, Los Angeles and Boston
too). If the Federal Health Board has teeth, that’s what it’ll do, and
the AMA, AHA, AdvaMed, PhRMA et al know it. Which is why the PhRMA front organizations have been railing against cost-effectiveness for so long.

We know the question. Sadly we also probably know the answer. Vladceck’s short piece is great fun, nonetheless.

The big Twitter Health care list

Jan 5, 2009• 9

By Matthew Holt

We’re all on here somewhere.

Let’s Reboot America’s HIT Conversation Part 1: Putting EHRs in Context

Jan 5, 2009• 7

By DAVID C. KIBBE & BRIAN KLEPPER

Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration’s investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I’d point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should–Matthew Holt

On Dec. 19, we published an Open Letter to the Obama Health Team,
cautioning the incoming Administration against limiting its Health
Information Technology (IT) investments to Electronic Health Records
(EHRs). Instead, we recommended that their health IT plan be rethought
to favor a large array of innovative applications that can be easily
adopted to result in more effective, less expensive care.

The
response to that post was vigorous. We received many comments and
inquiries from the health care vendor, professional and policy
communities – urging us to provide more clarity. One prominent
commentator called to ask whether we, in fact, supported the use of
EHRs. We both have been active EMR and health IT supporters for many
years. Dr. Kibbe was a developer of the Continuity of Care Record
(CCR), a de facto standard format for Electronic Medical Records
(EMRs), and has assisted hundreds of medical practices to adopt EHRs.
Dr. Klepper has been involved in EMR projects for the last 15 years,
and the onsite clinic firm he works with provides every clinician with
a range of health IT tools, including EMRs.

The Broken Window Effect

Jan 5, 2009• 6

By JOHN HALAMKA

Halamka As an adult I’ve returned to various locations from my childhood and
found the white picket fences, station wagons, and neighborhood shops
transformed into rough, run down, and unsafe neighborhoods. This did
not happen overnight. What happened in these places is the same thing
that can happen in a business or your personal life. I call it the
“Broken Window Effect”

Imagine the perfect “Lake Wobegone”
neighborhood where everything is above average. A baseball goes through
a window, but the owner decides not to fix it. Then, because the house
looks a bit shabby, another neighbor leaves a junked car on the street.
Then a bit of graffiti is not cleaned up. Then folks stop picking up
garbage from their yards.

The same thing can happen inside a house. One
pile on the floor doesn’t take too much room, so a few more piles are
put around it. Before long, all floor spaces have piles on them.
Maintenance items are deferred and junk is not tossed. Years pass and
eventually the house is unhealthy to live in, but no one really notices
because it happened so gradually.

Commentology

Jan 5, 2009• 1

Rick Peters, commenting on John Halamka’s post, the "Broken Window Effect" …

"Speaking of downtime – have you ever determined why your organization,
mine, and virtually everyone in health care does routine scheduled
system downtimes on Saturday nights? I understand the theory that it
gives you Sunday to recover, but there isn’t an ER in the country that
isn’t busiest Friday night, Saturday night, Sunday late
afternoon/evening, and Monday night (Tuesday if it’s a three day
weekend). More admissions to our institutions occur at those busy ER
times than at any other time. I would think that physicians in IT
organizations could change this – do routine downtime on Wednesday
night, and in reality do it Thursday morning between 3AM and 5AM –
that’s when things are quiet."

Maggie Mahar has this to say in the thread on Matthew’s "Critical of Critical"" post …

"As for group practice vs. solo practice–solo practice is becoming economically unaffordable. More and more younger doctors recognize this, and would prefer to work in a very large group, on salary. The Dartmouth reserach also confirms that the most efficient outcomes (high quality at a lower price) come in multi-specialty centers where docs are on salary."

Not exactly health care, but follow the money…

Jan 5, 2009• 3

By Matthew Holt

Michael Lewis has returned from writing about Jim Clark, technology, baseball and football to his first
topic; finance. (Liars Poker is still the best book about Wall Street ever) His two part piece with hedge fund manager David Einhorn this weekend in the NY Times is one of the best things I’ve seen on the current financial crisis and what to do about it.

It’s called The End of the Financial World as We Know It and How to Repair a Broken Financial World. (I recommend reading them both straight through). And yes, Lewis wants more transparency and more regulation.

Paul Krugman estimated last month that the share of GDP going to the financial sector increased from 5% of GDP to 8% of GDP over the past 30 years or so. What did exactly we get for the extra 3% of the economy that was extracted by Wall Street? The answer is pretty evident. And of course lots of other sectors of society, generally inhabited by people earning significantly less money, have suffered pretty directly as a result.

Of course, there’s another sector of the economy that’s increased its share of the GDP by an even greater amount in roughly the same time period (from about 9% to about 17%). No prizes for guessing which one.

Anyone care to justify what value that sector has provided?

Reprise….Critical of Critical

Jan 5, 2009

By Matthew Holt

For those of you who had better things to do than spend last week reading wonkish blogs, I point you towards my article about Tom Daschle’s book. In particular I encourage you to look deep in the comments, for a particularly fun spat between me and a reader called Nate–the type of spat that used to be very common on TCHB but sadly has become a little rarer now we’re all grown up!. The original piece is here and the comments get juicy around Jan 3.