An Archipelago of Health Information Islands

Posted on December 27, 2012 by

Brian Klepper

Posted 12/27/12 on Medscape Connect’s Care and Cost Blog

My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended by an emergency physician, two hospitalists, three gastroenterologists, a pulmonologist, an infectious disease physician and an interventional radiologist. With the exception of one specialist who had performed a procedure on her two weeks earlier, this episode was the first time any had met Elaine.

Each clinician was familiar with her status before visiting her, because the health system has an enterprise-wide electronic health record (EHR) that aggregates information into each patient’s chart. The hospitalists coordinated the care process and also touched base with Elaine’s primary care physician and her oncologist.

In other words, the system worked exactly like we hoped it would but often doesn’t. Especially in complex cases like this, the likelihood of a positive result is enhanced if the team members have access to the same complete information, and if someone – in this case the hospitalists – quarterbacks the activity.

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Posted in Conflicts of Interest, Health Care Cost, Health IT, Policy/Law/Regulation, Politics, Quality | Tagged , , | 3 Comments

Putting Physician Practices Into Context

Posted on December 12, 2012 by

Brian Klepper 

Posted 12/11/12 on Medscape Connect’s Care & Cost Blog 

An organization’s ability to learn, and translate that learning into action rapidly, is the ultimate competitive advantage. 

Jack Welch

Physicians and medical societies in all specialties would do well to take a look at this article, published in the November issue of The Journal of Oncology Practice. Authored by Elaine Towle, Thomas Barr and James Senese of Oncology Metrics (a subsidiary of the oncology electronic health record firm Altos Solutions), this year’s National Oncology Practice Benchmark Report aggregates and analyzes data on a wide variety of clinical, operational and financial business metrics. There are 89 charts in categories – work units, patient visits, revenue, practice expense, pharmacy operations, clinical trials, and staffing/productivity – from oncology practices around the country. The focus here is on the practice. The report does not delve into relative patient quality or cost.

The authors have deep experience with oncology practice, and they note that the cornerstone of their firm’s approach is “to promote the discovery and adoption of best practices.” Towle and Barr previously ran oncology practices in New Hampshire and Ft. Worth. This is their 7th annual report, meaning they have had the benefit of years of immersing in and refining their work product.

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When Employers Collaborate To Manage Health Care Costs

Posted on December 9, 2012 by

Brian Klepper

Published 12/09/12 in the Eau Claire, WI Leader-Telegram

Note from Brian: This piece appeared last weekend in the Eau Claire, WI newspaper, and was written with the encouragement of employers in that community who, rightly, believe they’ve been raked over the coals on their health care costs.

This argument is mainly directed at other employers, as a way of explaining that there are alternatives. That said, the dynamics described here occur in almost every community in the country.

BK 711Even compared to national health care cost growth that has skyrocketed nearly 4 times as fast as general inflation for more than a decade, Wisconsin stands out and northwest Wisconsin stands out more. Eau Claire’s health care cost burden is a whopping 16 percent higher than the national average. This is pricing many individuals and employers out of the coverage market and sapping the region’s economic vitality and competitiveness.

As Robert Kraig meticulously details in Citizen Action’s Wisconsin Health Insurance Cost Rankings 2012, Eau Claire is Wisconsin’s second-highest cost health care market, with 2011 monthly premiums of $750.46, 9.1% higher than the state average of $687.68. (La Crosse is 1st, only a hair higher at $756.70.)

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Following the Money

Posted on December 7, 2012 by

Brian Klepper

Posted 12/06/12 on Medscape Connect’s Care & Cost Blog

On The Health Care Blog, veteran analyst Vince Kuraitis reviews a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect.

“The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In “The ACO Surprise,” our analysis finds that 25 to 31 million Americans already receive their care through ACOs-and roughly 45 percent of the population live in regions served by at least one ACO.”

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Posted in Analytics, Brian Klepper, Health Care Cost, Market Dynamics, Medical Management, Policy/Law/Regulation, Politics, Quality, Reform | Tagged , , , , , | 1 Comment

How Primary Care Became the Job Nobody Wanted (and How To Fix It))

Posted on November 23, 2012 by

Brian Klepper

Posted 11/21/12 on Medscape Connect’s Care & Cost Blog

Here a link on SlideServe to my plenary presentation on CMS’ relationship with the AMA’s Relative Value Scale Update Committee (RUC), and how/why it has undermined American primary care. I delivered this overview at the Medical Home Summit in Philadelphia earlier this year.

Meanwhile, the team – led by Paul Fischer MD, a primary care physician in Augusta, GA – that sued CMS and HHS over their failure to require the RUC’s to adhere to the requirements of the Federal Advisory Committee Act is awaiting the appeal court’s ruling that will determine whether the case is at an end or whether it moves forward into discovery.

Given the seriousness and far-reaching impacts of the problem, it is shameful that America’s primary care medical societies have shrunk from supporting this action. In doing so, and in yearning to continue to align and participating with the AMA and the RUC, they have become complicit with them. They have not only compromised the primary care physicians who are their members, but ignored the much larger problems of patients who are too often put at unnecessary risk through care they don’t need, and purchasers – individuals, businesses and governments – who have been exploited for more than 2 decades with costs that are double those in other industrialized nations.

Posted in Brian Klepper, Health Care Cost, Market Dynamics, Medical Management, Physicians, Policy/Law/Regulation, Reform | Tagged , , , | 1 Comment

Arriving at the Beginning

Posted on November 13, 2012 by

Brian Klepper

Posted 11/12/12 on Medscape Connect’s Care & Cost Blog

The most striking aspect of the election was that it decisively clarified the philosophical preferences of most Americans. And because the outcome was largely determined by minorities, women, and the young, it appeared to be a much broader and more independently-minded vision than most pundits have given the electorate credit for. That unexpectedly portends big changes.

Peggy Noonan’s analysis in the Wall Street Journal quotes a brutal summation by conservative activist Heather Higgins:

A majority of the American people believe that the one good point about Republicans is they won’t raise taxes. However they also believe Republicans caused the economic mess in the first place and might do it again, cannot be trusted to care about cutting spending in a way that is remotely concerned about who it hurts, and are retrograde to the point of caricature on everything else.

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Posted in Analytics, Health Care Cost, Market Dynamics, Medical Management, Policy/Law/Regulation, Politics, Quality, Reform | Tagged , , , , | 1 Comment

Irresistible Forces

Posted on October 29, 2012 by

Brian Klepper

Posted 10/28/12 on Medscape Connect’s Care & Cost Blog

At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me,

“No industry can grow indefinitely at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”

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Posted in Analytics, Brian Klepper, Conflicts of Interest, Health Care Cost, Market Dynamics, Medical Management, Policy/Law/Regulation, Politics, Quality, Reform | Tagged , , , | 1 Comment

Walmart Moves Health Care Forward Again

Posted on October 12, 2012 by

Brian Klepper

Posted 10/12/12 on Medscape Connect’s Care & Cost Blog

Walmart. Save Money. Live Better.Walmart’s sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006 – more than 300 prescription drugs for $4/month or $10 for a 90-day supply – and was widely emulated, disrupting retail drug markets and generating immense social benefit. Imagine the difference it made to a lower middle class diabetic who had been paying more than $120 per month for medications, and suddenly could get them for about $24.

Yesterday Walmart announced that “enrolled associates” – covered workers and their family members – needing heart, spine or transplant surgeries could receive care with no out-of-pocket cost at 6 prominent health systems around the country: Mayo Clinics (Rochester, MN and Jacksonville, FL); Cleveland Clinic (Cleveland, OH); Geisinger Clinic (Danville, PA); Mercy Hospital Springfield (Springfield, MO); Scott & White Memorial Hospital (Temple, TX); and Virginia Mason Medical Center (Seattle, WA).

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Posted in Analytics, Benefits, Brian Klepper, Consumerism, Health Care Cost, Market Dynamics, Medical Management, Physicians | Tagged , , , , | 9 Comments

Are You Ready for Intense Price Competition?

Posted on October 7, 2012 by

Note from Brian: The article below describes my recent keynote address to a large meeting of imaging center administrators, and appears in the Sept 2012 Radiology Today. I’m reposting it because it accurately reflects, in depth, the message that I tried to deliver.

Remarkably, the audience was evenly divided in their evaluations. Half thought it was a very important but difficult to hear talk. The other half thought I was a jerk and it was the worst talk they’d ever heard. My take on this is that the responses reflected an industry that has become comfortable with a lack of accountability and market forces, and that is highly threatened by change.

Jim Knaub

Published in Radiology Today, September 2012, 13:8, p18

A keynote speaker told administrators to expect businesses threatened by ever-increasing healthcare costs with new approaches that will change how imaging organizations compete.

When Brian Klepper, PhD, delivered his keynote speech to the audience at the AHRA annual meeting in Kissimmee, Florida, last month, it was not the feel-good speech of the summer. Klepper, whose companies develop and manage worksite primary care clinics for employers and manage specialty care for those employees, told the audience that his company had recently negotiated a deal in Indiana for $450 MRI exams in a market that had technical fees ranging between $1,750 and $3,200. That was the opposite of a warm and fuzzy message to the 900 or so imaging administrators attending the meeting at the Gaylord Palms Resort and Convention Center.

“Somebody like me is going to come in to your market, and your volumes are going to plummet because there is no way you can compete against a $450 imaging price when you’re currently used to getting $2,800 or whatever you’re getting,” Klepper told the audience. “That is the problem.”

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Posted in Brian Klepper, Health Care Cost, Imaging, Market Dynamics, Medical Management, Policy/Law/Regulation, Politics, Tools | Tagged , , , , , | 4 Comments

Strengthening Primary Care With a New Professional Congress

Posted on October 3, 2012 by

Brian Klepper

Posted 10/01/12 on Medscape Connect’s Care & Cost Blog

Three months ago a post on this blog argued that America’s primary care associations, societies and membership groups have splintered into narrowly-focused specialties. Individually and together, they have proved unable to resist decades of assault on primary care by other health care interests. The article concluded that primary care needs a new, more inclusive organization focused on accumulating and leveraging the power required to influence policy in favor of primary care.

The intention was to strengthen rather than displace the 6 different societies – The American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the Society for General Internal Medicine (SGIM), the American Academy of Pediatrics (AAP), the American Osteopathic Association (AOA), the American Geriatrics Society (AGS) – that currently divide primary care’s physician membership and dilute its influence. Instead, a new organization would convene and galvanize primary care physicians in ways that enhance their power. It would also reach out and embrace other primary care groups – e.g., mid-level clinicians and primary care practice organizations – adding heft and resources, and reflecting the fact that primary care is increasingly a team-based endeavor.

We have come to believe that a single organization cannot be serviceable. Feedback on the article suggested that several entities were necessary to achieve a workable design.

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Posted in Brian Klepper, Conflicts of Interest, Health Care Cost, Market Dynamics, Policy/Law/Regulation, Politics | Tagged , , , , , , , , | 4 Comments

Getting Engaged

Posted on September 21, 2012 by

Elaine Waples

We hear inspiring things about patient engagement.  The very concept has a hearty, spirited, “do-right” sound to it.

I spent many years in human resources. I remember the conversations we had around employee engagement as we searched for a practical approach. We realized that it is the employees’ belief that the company is moving in the right direction; that the work they do is meaningful and that they are committed to it; that the trust index of respect, credibility and fairness is high; and that employees are willing to work hard to help it get there.

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The Wrong Battles

Posted on September 20, 2012 by

Brian Klepper

Posted 9/20/12 on Medscape Connect’s Care and Cost Blog

This week the American Academy of Family Physicians (AAFP) issued a new report describing its vision of primary care’s future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care.

More surprisingly, though, it makes a point to insist that physicians, not nurse practitioners, should lead primary care practices. The important questions are whether nurse practitioners are qualified to independently practice primary care, and whether they can compensate for the primary care physician shortage. On both counts the AAFP thinks the answer is “no.”

AAFP marshals an important argument to bolster its position. Family physicians have four times as much education and training, accumulating an average of 21,700 hours, while nurse practitioners receive 5,350 hours.

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Primary Care’s Dilemma

Posted on September 13, 2012 by

Brian Klepper

Posted 9/12/12 on Medscape Connect’s Care and Cost Blog

Early in the new documentary, Escape Fire, which provides detailed portraits of US health care’s craziness, we meet Erin Martin MD, a young primary care physician in The Dalles, OR, who ultimately abandons her practice with low income patients. Time and financial constraints have frustrated her efforts to provide the care she believes is necessary to make a difference in people’s lives. Later, we see her in a business meeting with other primary care physicians in her new practice, reviewing financials. To maintain the practice’s revenues, they’ll need to see more patients, which means shorter patient visits. The defeat is palpable to her, to her colleagues and to the audience.

A few days ago, Rob Lamberts MD, 18 years into his practice, announced on The Health Care Blog that he was dropping out, leaving to go solo in a Direct Primary Care (DPC) practice catering to patients who can pay out-of-pocket rather than through insurance. Dr. Lamberts, a regular and characteristically sunny columnist, is workmanlike but chilly in his explanation.

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Posted in Brian Klepper, Health Care Cost, Innovation, Market Dynamics, Medical Management, Physicians, Policy/Law/Regulation, Politics, Quality | Tagged , , , | 1 Comment

Demanding More From Medical Homes

Posted on September 11, 2012 by

Brian Klepper

Published 9/4/12 in Medical Home News 

Never confuse motion with action. 

Benjamin Franklin

A reporter called the other day to tell me that several local health systems now had medical homes. “I don’t think so,” I said.  She was emphatic. “They just told me they do.” I asked whether their medical homes take fee-for-service reimbursement. “I guess so,” she said. “Doesn’t everyone?” “Almost everyone,” I said. “But if they do, that means they have a financial stake in delivering unnecessary care.” By definition, that’s counter to the idea of a medical home, which provides the right care at the right time in the right context. You can’t have it both ways.

Virtually every organization remotely related to primary care now wraps itself in the mantle of patient-centered medical homes (PCMH), and many flaunt their Recognition by the National Committee for Quality Assurance (NCQA) as proof that they’ve met a standard. Presumably employers and other purchasers, enthused by the buzz surrounding medical homes, assume these credentials translate organically to better care at lower cost.

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Posted in Health Care Cost, Innovation, Market Dynamics, Medical Management, Physicians, Policy/Law/Regulation, Politics, Quality | Tagged , , , | 4 Comments

Attitude

Posted on August 31, 2012 by

Elaine Waples

Posted 8/31/12 on The Doctor Weighs In

I’ve come to believe that seriously sick people are often subject to some very interesting comments from well-intentioned non-sick people. They are frequently inspired by #platitudes from self-help-books, Google chat rooms (heaven forbid), or beliefs that have been around for so long that they are a natural part of common discourse.

To be fair, when we are confronted with the uncomfortable task of talking to a sick person, our conversation can easily become a pre-programmed response that make us feel better for having said something uplifting, positive, sympathetic, or socially acceptable. It’s antiphonal, like the “god bless you” after someone sneezes..

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