Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?
Above the Fold
Pay Doctors For the Value They Offer Patients
When Medicare first created a fee schedule, critics suggested that it was a Marxist invention. Nevertheless, the schedule, which lists what Medicare is willing to pay for some 7,000 procedures, has become the master list for physician reimbursement in our health care system: Most private insurers peg their payments to the Medicare schedule.
The notion of deciding the precise worth of some 7,000 diagnostic and therapeutic procedures is mind-boggling. How exactly does Medicare do it?
The process began in the late 1980s when officials at the Department of Health and Human Services decided that the way Medicare paid doctors should be overhauled. At the time, Medicare was reimbursing physicians based on what was considered “customary, prevailing and reasonable” in a particular market — in other words the “market value” of the service in that region.
Instead, reformers urged Congress to begin paying doctors in a way that reflected the real cost, to the doctor, of providing the service. (This is where Marx comes in: rather than letting the local market decide what a service is worth “the system appears to be based on the Marxist ‘labor theory of value,’” sputtered Susan Mandel in a 1990 piece in the National Review.)
Health care in the YouTube era
By Bob Wachter
August 11th was the 2nd anniversary of the epic implosion of George Allen’s presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether health care has also entered the YouTube era.
Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him “Macaca,” a racial slur meaning “monkey.” Once the video hit YouTube, it went completely viral (this clip, one of many, has been viewed 350,000 times) and Allen’s promising political career was toast.
What does this have to do with health care? In the past 18 months, two powerful, highly troubling videos have surfaced of patients being left to die in ER waiting rooms. The first, in May 2007, involved a woman named Edith Rodriguez. Rodriguez began vomiting blood while waiting outside the King-Drew ER, and soon collapsed. Rodriguez’s husband called Los Angeles’s 911 system, but got nowhere. Then someone else in the waiting room called:
Health care in the YouTube era
Video of the woman dying in the emergency room waiting room at Kings Hospital.
Connecting the dots between gas and health costs
Rite Aid, a top retail pharmacy chain, awarded its first Fill Up & Fuel Up gasoline gift cards this week.
I’ve been writing about gas ‘n health care since the inception of the Health Populi blog; see this inaugural post.
Now comes a pharmacy connecting the dots between consumer spending categories: the interdependency of fuel and prescription drugs.
As the differences between price tiers of prescription drugs have increased over the past ten years, I’ve often asked pharma clients the question: what is the consumer’s marginal value of that $20 (or $30 or $50) co-payment compared to something else on their shopping list — say, a new electric razor for their husband, or that $95 jar of anti-aging skin cream?
Health reform for ordinary folks
When it comes time to vote in November, will Americans know what they’re voting for in terms of their health care futures? Will they understand what Barack Obama or John McCain’s health proposals mean for them?
Over at Columbia Journalism Review, Trudy Lieberman says they won’t given the current media coverage of health reform. The journalism professor critiques the mainstream media’s coverage for basically
transcribing the candidates’ pitches, and says the blogosphere is overly wonky.
"Exactly how will all these economic and political calculations and
pronouncements affect those who struggle daily to fill their
prescriptions, find a competent doctor, or pay their medical bills?"
she asks. "These are the people whose stories the media have yet to
tell."
In a series called "Health Care on the Mississippi," Lieberman examines how the presidential candidates’ health proposals will affect ordinary folks.
In Part 1, she goes to Helena, Arkansas, a town of 6,300 along the Mississippi River to talk with the working-class residents about health care. Currently, most knew "nothing of the coming health care battle being waged in their name," she wrote.
In Part 2, Lieberman examines how Helena’s head jailer and his diabetic adult son would fair under McCain and Obama’s health plans.
A Primary Care Paradigm Shift
********@*ol.com“>Dick Reece is a retired pathologist and a prolific health care commentator with an active following, particularly among physicians. An astute, incisive observer, he is the author of 10 books; the latest is Innovation-Driven Health Care: 34 Key Concepts for Transformation. He is regular columnist on HealthLeaders, and writes his daily posts at MedInnovation Blog. THCB welcomes him. — Brian Klepper
Something profound is happening in buyers’ and the public’s attitudes towards primary care and the health system. With inexorable rises in costs and corresponding decreases in access to primary care doctors, buyers and the public are mad as hell, and they’re deciding they’re not going to take it anymore. Something is badly and sadly wrong, and corrective measures are being put in place.
Signs of Paradigm Shift
Signs of a paradigm shift – a change in assumptions about the system’s basic structure – are everywhere. No longer do we accept the notion every patient should have a specialist for every disease, every life-improvement procedure, every orifice, and every organ. Care, it’s now assumed, must be coordinated to prevent people from falling through the cracks. We must stop wasting time and resources for patients and the system as a whole.
The U.S. system lacks timely access to primary doctors who oversee care. And specialty services are overused. Yet the U.S. has fewer primary care physicians per capita than any other country in the developed world. On the other hand, we have more specialists per square mile than other countries.
What’s Driving the Paradigm Shift?
• Major corporate buyers, led by IBM, which spends $1.7 billion on health care, have created an activist organization, The Patient-Centered Primary Care Collaborative. Paul Grundy, MD, MPH, IBM’s Director of Health Transformation, chairs the Collaborative. It is based partly on IBM’s experience in Denmark, where it owns a company, and where patient satisfaction with care is 97% versus 50% in the U.S. Grundy believes every citizen should have a personal physician, and every physician should be rewarded for offering same day access, managing a patient panel, and be compensated for telephone and email consultations.
• A vibrant movement is underway to “disintermediate” health plans. “Disintermediation” occurs when access to information or services is given directly to consumers. In the process, “middlemen” in the form of health plans may be ended, or their services transformed. That’s what consumer-driven health care is about, that’s why their existence in their present form is threatened, and that’s why health plans are moving rapidly to high deductible plans linked to health savings accounts.
• The “medical home” concept is gaining traction. This concept hinges on two ideas: 1) placing the primary care physician at the center of care by having him/her coordinate overall care; 2) giving primary care doctors “ownership” control of specialty care referrals. America wants a health system in which the primary physician uses a secure computer platform to coordinate efforts of specialists, pharmacists, therapists, and others. Increasingly patients don’t appreciate why they must fill out a new form at each doctor’s office, why doctors don’t communicate with each other, and why doctors duplicate tests and don’t know what other doctors do. A number of medical home pilot studies are now being conducted. To make medical homes happen, doctors will need financial incentives and support to introduce technology, and coordinate care. Payers will need to step up the payment plate to help medical homes become real.
• New business models to reduce cost and offer convenience are fast evolving. These include retail clinics, medical offices at the worksite, specialty clinics, urgent care clinics, elective surgical centers, and ambulatory facilities offering imaging, multiple specialty services, and one-stop care. Most of these are outside expensive hospital settings. Some are currently beyond the control of primary care physicians. At last count, there were over 1000 retail clinics, 500 worksite clinics, and roughly 3,000 urgent care facilities.
• The physician empowerment movement is growing. The Physicians’ Foundation for Health System Excellence, which represents state and local medical societies, has completed a survey of 300,000 primary care physicians to highlight their problems, to educate the public, and to persuade policy makers to take steps to enhance the supply of primary care doctors, to pay them better, and to give them tools to offer comprehensive coordinated care. Sermo, a physician social networking site, has 75,000 members and will soon issue an “Open Letter to the American Public,” signed by 10,000 doctors to reflect physician grievances and to indicate how the system can be improved. These efforts, coupled with the Patient-Centered Primary Care Collaborative, are designed to improve the lot of primary care physicians.
Conclusion: A new primary care paradigm is upon us and will fundamentally change how the U.S. delivers care.
Flacks peddle false “reality”
Such a pity that the NY Times has been so beaten up by the commies amongst us that it actually now feels that it has to point out where Peter Pitts and Janet Trautwein get their money. Although, as per the last time it let Pitts write an op-ed, it didn’t mention his day job as a PR man for pharmaceutical companies. After all, who could be opposed to “Medicine in the Public Interest” — after all it is in the interest of the public to pay for all and any medicine at any price that PhRMA chooses, right?
And let’s not get started on underwriters (for whom Trautwein is the main flack). After all Grace-Marie Turner thinks that they’re the health care heroes! Perhaps they’re heroes because they drive sick people into the uninsured population so that the under-paid clinical staff working in America’s public and community health system get to show their worth by caring for them —even if they’re less heroic than underwriters.
But that’s OK, Pitts & Trautwein can be printed in the NY Times cherry-picking problems with other countries health care systems. Because as we all know there’s absolutely nothing wrong with ours, eh?
And why should Pitts quote the peer-reviewed 2007 Commonwealth Fund study that showed that waiting times for surgery were longer in the US than in the communist hell-hole of Germany, when instead he was able to cite an 11 year old study about longer waiting lists for one specific type of surgery in the Netherlands, which has completely revamped its health care system since then. Something he and Trautwein have helped stop us doing — preserving a dismal status quo they obviously want to maintain.
Those two wouldn’t last 92 seconds in a debate with Uwe Reinhardt or Hillary Clinton.
On the other hand, there’s no letter from Karen Ignagni to make up the trifecta. Did she negotiate some summer vacation time along with her $1.3m salary?
Inappropriate ER use across the board
Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care. This post first appeared on his blog, Lets Talk Health Care.
A few months ago, the New England Healthcare Institute (NEHI) issued a report on non-urgent use of Emergency Departments. It didn’t get that much public attention, which is too bad. It offered some interesting insights.
First of all, inappropriate — or non-urgent — use of the Emergency Room was not limited to uninsured populations. It showed up across the board. People covered by private insurance, Medicaid and Medicare were just as likely to use the ER for non-urgent care as people without health insurance. About 20 percent of all ER visits by privately insured and Medicare patients were for non-urgent purposes. About 24 percent of all ER visits by Medicaid beneficiaries and people without any insurance were for non-urgent purposes.
Second, another 25 percent of all ER visits for each group were for primary care treatable/preventable maladies. In other words, almost half of all ER visits were either for conditions that could have waited at least 24 hours to be addressed, or could have been solved in a doctor’s office.
Prescribing a dose of healthy skepticism
By Sarah Arnquist
Headlines declare wine is good for your health. So is a small bit of dark chocolate. Then, they say it’s not. One day coffee is bad for you and the next it’s good.
We’re bombarded with health messages daily from companies selling things, advocacy groups promoting their agendas and journalists trying to sift through it all.
Who are you to believe? Unless you have a degree in epidemiology, it’s very difficult to discern the valuable information from all the garbage.
In his new book, “The Healthy Skeptic,” journalist Robert Davis gives readers some quick tips to become better consumers of health care information.
“A healthy skeptic carefully and critically evaluates each piece of advice taking into account not only its source but the science behind it,” Davis writes.
