The Health Care Blog – Page 997 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

A message you hope to never send

Jul 7, 2008• 7

By Paul Levy

First, an email sent out on Thursday morning. My commentary follows.

Dear BIDMC Community,

This week at BIDMC, a patient was harmed when something happened that never should happen: A procedure was performed on the wrong body part. With the support of all our chiefs of service, we are sharing this information with the whole organization because there are lessons here for all of us.

While respecting the confidentiality of both the patient and caregivers, here are the key facts: It was an elective procedure, involving an excellent team of providers. It was a hectic day, as many are. Just beforehand, the physician was distracted by thoughts of how best to approach the case, and the team was busily addressing last-minute details. In the midst of all this, two things happened: First, no one noticed that the wrong side was being prepared for the procedure. Second, the procedure began without performing a "time out," that last-minute check when the whole team confirms "right patient, right procedure, right side." The procedure went ahead. The error was not detected until after the procedure was completed. When it was, our patient safety division was notified immediately, and they in turn took all appropriate steps including investigation, reporting and corrective action. The physician discussed the error with the patient at the first opportunity, and made a full apology. The patient is now recovering at home from the injury, which is not life-threatening.

How do we disrupt the cycle of rising health costs?

Jul 7, 2008• 5

By Jane Sarasohn-Kahn

Last week two new excellent new reports on health spending asked, do
we get what we pay for?

The answer is, well, sometimes — particularly when you follow the perverse incentives that lead you on the money trail of waste, ineffectiveness and, worst of all, poor health outcomes.PricewaterhouseCoopers’ Health Research Institute and the Center for Studying Health System Change offer their views on this topic with slightly different lenses.

In You Get What You Pay For, PwC examines 20 health systems and finds that managing costs is the top ranked factor for re-engineering payment systems throughout. Costs are put ahead of quality, efficiency, or meeting demand. While prospective payment (a la DRGs) has been adopted in 20 countries belonging to the OECD, and two-thirds of those countries believe their payment methods will change as they’re not stemming cost increases.

"Better informed patients" are seen as an optimal way to manage demand — not increasing out-of-pocket payments, at least not as a strategy on its own.

Health 2.0 Accelerator — The waiting is over….

Jul 4, 2008• 5

By Matthew Holt & Indu Subaiya

For several months there has been discussion amongst Health 2.0 companies about the concept of a Health 2.0 Accelerator. It started with Marty Tenenbaum’s introduction of the concept in September 2007. It continued with the discussion at the San Diego meeting in March 2008. Since then conversations and meetings among a small group have continued to define a first cut at what the Health 2.0 Accelerator should be.

The basic idea is for organizations to collaborate to create “public goods” —frameworks and strategies that will help all concerned to advance the industry. The way to do this is via projects that tackle particular problems, and leave behind frameworks and utilities that all can use.

The reality is of course going to be more complex, but we’re delighted to announce that the first project concerning moving pharmaceutical data has been announced, and the first principles and statements about the future of the Accelerator are now up at its own wiki at Health2Accelerator.org.

We are now asking for everyone in the Health 2.0 Community to become members, suggest projects, and contribute to the wiki. This is very much a work in progress, but we believe that the potential is huge. Please go to the new site, and contribute by giving us your comments.

What the candidates’ searches say about them

Jul 4, 2008• 4

By Craig Stoltz

One of the fun parlor games of Election ’08 is to look at Internet data and figure out what they mean.

The answer may be "nothing," of course.

But let’s play along and look at the latest Hitwise data on popular search terms. HitWise, a company that tracks Internet traffic, counted the search words that sent people to John McCain or Barack Obama’s websites. [Here’s a press release about the findings on the candidates’ top Internet search terms.]

"Health care" didn’t make Obama’s top 5 search terms in the first quarter of 2008. In the second quarter, health care took the number 4 slot. [Q1’s top term was "gay marriage," Q2’s "abortion."]

Meantime, "health care" took the tops spots for John McCain in both Q1 and Q2.

So: Does this mean people think they already know Obama’s healthcare plan and don’t need to search about it on the Internet? Or, don’t they have much interest in the issue?

As for McCain, do the searches mean his plan is little-known and people want information on it? Or do those interested in McCain care more about healthcare than Obama’s voters?

Retreat to the parlor and discuss, please.

UnitedHealth trying to regroup for an uncertain future

Jul 3, 2008

By Matthew Holt

In an attempt to put that messy options back-dating business behind it, yesterday
UnitedHealth Group settled with CalPERS (the ever vigilant pension fund of California state employees) and other class action suit members. And they settled for a bunch — $985 million. That’s even more than ex-CEO Bill McGuire gave back in his long running attempt to apologize without admitting criminal liability. Although, of course, United’s stock is down so much from the halcyon days of 2006 that it would require me to take my socks of both feet to work out if McGuire’s remaining options are worth anything these days!

Meanwhile, the CEO of Brocade is in jail (or may be out on appeal, I’m not sure) for back-dating options that helped his employees — and hurt his shareholders. Yet, McGuire (and for that matter Steve Jobs) seem to my untrained eye to have done the same thing without severe consequences. I’m still baffled.

United’s business seems to be heading into more trouble. Profits are down, lay-offs are up, and overall membership is down. More people and employers can’t afford health insurance in a weakening economy. And don’t forget total enrollment in commercial employment-based insurance plans fell during the most recent economic expansion!

The only logical rescue comes from an expansion of government plans. But there’s of course the little issue of how much they get paid for those government plans! The long-term question is whether they will lose more on the Medicare Advantage roundabout under the next Administration than they make up on any universal health care swings.

UPDATE: Wall Street didn’t like it too much. UNH is down 9% today

Healthcare Unbound, and HHS Genomics Workshop

Jul 3, 2008

By Matthew Holt

There’s lots of activity coming up next week. Matthew Holt will be at a star-studded workshop about personal genomics put on by HHS in Washington DC Monday afternoon. Details are here and if you can’t get there you can see the webcast.

Meanwhile, the Healthcare Unbound Conference is having a session on Monday afternoon in San Francisco about Health 2.0. David Kibbe is the moderator, and our very own Indu Subaiya is on the panel with Adam Bosworth (ex-Google, now with Keas) and Cris Ross from CVS MinuteClinic.

Mitigating interference between electronic medical devices

Jul 3, 2008• 1

By John Halamka

Last week, JAMA published an article about the risks of active and passive radio frequency identification to other hospital equipment.

The Associated Press and ABC News issued major stories about it.

Although the study focused on RFID tags, the issue is more generic. Electronic Magnetic Interference (EMI) is generated by many devices including cell phones, laptops, and microwave ovens. Such devices emit RF energy which may interfere with the operation of sensitive electronic components used in medical equipment. The interference may be frequency related (signal jamming) or cause the device to fail because a chip or wire is exposed to too much energy from an emitting device. The very best defense is to have adequate shielding for medical equipment. It’s inconceivable that hospitals can keep patient care areas free of RF emitters. Thus, it is important for hospital clinical engineering departments to be vigilant in identifying potentially unsafe devices.

MARKETPLACE: Patient safety barbecue

Jul 3, 2008• 1

LeapforPatientSafety.org is hosting a patient safety barbecue in Aiken South Carolina July 4 to commemorate Patient Safety Day. The organization also has an online petition requesting increased protection for physicians who complain to hospital administrators regarding poor quality patient care.

AMA and AHIP go head to head with TV ads

Jul 2, 2008• 3

By Sarah Arnquist

The American Medical Association this week began a television ad campaign, lambasting Republican Senators who failed to prevent the July 1 automatic 10.6 percent Medicare physician fee cut.

In the one-minute ad, AMA President Nancy Nielsen says, "A group of Senators decided it was more important to protect the health insurers than seniors."

Just as Robert Laszewski predicted here last week, the doctors are coming out in full lobbying force.

But wait. The Association of Health Insurance Plans is also running ads filled with nice looking seniors saying that to protect seniors Congress must protect the Medicare Advantage program.

Who is a senior taking 10 prescription medications for six chronic diseases with a calendar full of doctor’s appointments to believe?

Here are the ads.

We need to make some changes to change health care

Jul 2, 2008• 5

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health Care, Inc., a nonprofit health plan that covers more than 1 million New Englanders. Baker blogs regularly at Let’s Talk Health Care.

One of the reasons the operating model in health care doesn’t change much over time is pretty simple: most of the people who think about it, write about it, work in it and study it have trouble seeing the model any differently than they see it today. I was struck, therefore, by Hebrew Senior Life’s Len Fishman the other day when he and I served on a panel at the 30th annual meeting of the Massachusetts Health Data Consortium. We were told to discuss health care 30 years from now — me from the plan perspective, and Len from the long term care perspective. I went pretty far out there in my remarks, imagining, among other things, a world in which there were no health plans at all(!). Len did too. His presentation on the future of long term care could not have looked more different than what we have today. He literally re-imagined the whole thing. It was startling — and refreshing.

This question — is the future just like the past, or something different — was raised again for me earlier this week when Brian Rosman — a good guy with whom I almost never agree — posted a blog on the Health Care for All Web site that basically said that more publicly available information on health care cost and quality could/might/will lead to higher costs and higher prices, because no one really cares about costs, and if they do, they’ll flock to higher cost options, because they’ll think they’re better than lower cost ones.