Tag: Quality

More Information Is Not Always Better: Pulling Consumers Into Active Choices About Testing

Wendy Lynch

Posted 5/01/12 on the Altarum Institute’s Health Policy Forum

“I’m thinking of getting a full-body CT scan,” Jane said. “What do you think?” Here was a healthy, active 72-year-old with no specific symptoms considering an expensive screening test. When asked for a reason, she shared that strokes run in her family and a doctor told her that she might be able to see if there was a possible bulge in a blood vessel in her brain. Plus, while they were looking, the scan could see if there was some other problem.

When asked how it would affect her to know – do you think you would consider brain surgery if there was a problem? (probably not); what might you do differently if you knew? (I don’t know); do you know whether a bulge in her vessel would definitely cause a stroke? (not necessarily); she hadn’t really gone that far. She just thought she should know.

Continue reading “More Information Is Not Always Better: Pulling Consumers Into Active Choices About Testing” →

Why Do Hospitals Still Allow Preventable Adverse Events?

Michael Wong

Posted 5/01/12 on The Doctor Weighs In

Can Hospitals Afford to Give Away Money? If not, then why are Preventable Adverse Events Still Occur in Hospitals?

This are questions that I posed to lawyers, insurers, and healthcare professionals attending a major healthcare conference, the Crittenden Medical Conference.

According to the Institute of Medicine, each preventable adverse event costs about $8,750 — and this excludes potential litigation costs.

Can hospitals afford to give away money? So, why do preventable adverse events still occur in hospitals?

Continue reading “Why Do Hospitals Still Allow Preventable Adverse Events?” →

How Health Consumers Think About Cost and Quality

Nick Vailas

Posted 4/24/12 on Healthcare Transparency Now

Recent focus groups conducted as part of a study funded by a federal agency reported the following:

  • People are loathe to make cost and resource use a consideration in choosing health care providers and treatments, even when they are in high deductible plans
  • People will assume higher cost = higher quality if only given cost data
  • People assume more tests and treatments are better, unless information is framed explicitly in terms of potential harms and risks
  • People are interested, for the most part, on what it costs them to get care
  • There are some measures that people think could be very useful that are“cost” measures that they can see are also “quality “ measures
  • Example: costs/level of “avoidable complications”

Much of the data currently available will not respond to what consumers care about: (1) It doesn’t address their costs, (2) It doesn’t take into considerations variations in insurance design that affect what different individuals pay and (3) It cannot be clearly linked to quality measures.

It has been my experience that lower cost providers tend to be high quality providers.  The explanation for this is that providers that end to do high volume services of a particular kind tend to have greater efficiencies.

The price variability among healthcare providers is extreme and what patients are paying for their services in many cases is not a reflection of what it costs to deliver the services.  Thus pricing is all over the place.  Often time’s people will go and seek services based on a doctor’s recommendation and patients are given the information and share it with their doctor.  This will often influence the doctor as to where patients should receive their services.

There is no doubt that price transparency in services will change purchasing behavior of physicians and patients in seeking alternatives.

Source:  Engaging consumers with a high value healthcare system, by Shoshana Sofaer (2011)

How To Get Better At Harming People Less

Paul Levy

Posted 4/09/12 on Not Running a Hospital

Every day, a 727 jetliner crashes and kills all the people on board.  Not really.  But every day in America, the same number of people in American hospitals lose their lives because of preventable errors.  They don’t die from their disease.  They are killed because of hospital acquired infections, medication errors, procedural errors, or other problems that reflect the poor design of how work is done and care is delivered.

Imagine what we as a society would do if three 727s crashed three days in a row.  We would shut down the airports and totally revamp our way of delivering passengers.   But, the 100,000 people a year killed in hospitals are essentially ignored, and hospitals remain one of the major public health hazards in our country.

Continue reading “How To Get Better At Harming People Less” →

Another Stent Device Biting The Dust

Tom Emerick

Posted 3/26/12 on Cracking Health Costs

We’re seeing a trend.  The FDA approves a stent without proper testing.  Death and complication rates with the new stent increase, the FDA is force to review it.

Remember the controversy over drug eluding stents?

According to an article in the WSJ by Thomas Burton, the so-called Stryker stent…aka the Wingspan device… is increasing rates of  death of patients who have received them.  Following protocol a panel has been convened.  According to the WSJ article, “The FDA had asked the outside panel to advise it on what to do in the wake of a large study last year showing more strokes and deaths in patients with the Wingspan device than among those whose condition was treated using drugs.”

Further, “Researchers in the study concluded the rate of stroke in the patients who got the Wingspan device was ‘substantially higher than the rates previously reported
with the use of the Wingspan stent.’ ”

This is yet another reason for patients to be cautious in agreeing to a stent, and another reason employers need to consider favoring clinics who practise strict evidence-based medicine constructs.

Hope Lies with Residents

Paul Levy

Posted 3/1/12 on Not Running a Hospital

I remain relatively new to the health care field, but even in that short time, it has become evident to me that the pace of quality and safety enhancements and front-line driven process improvement in hospitals is inadequate given the scale and scope of harm that occurs to patients.  Indeed, it can be viewed as a paradox that the doctors of America, a group of dedicated, well-intentioned, intelligent, and highly trained individuals, constitute one of the top-ranked public health hazards in the county when as they work together in the nation’s hospitals.  That they collectively have not made much of a dent in the problem of reducing harm is, I believe, a product of their training.

As Brent James, Jay Kaplan, and others have noted, doctors are trained to be artists, to apply their intellect, creativity, intuition, and judgment to the care of each patient. That is well and good when the case is complex, but the vast majority of medical care is not complex.  It calls for standardization, adoption of protocols, and scientific experiments of process improvement to modify those protocols to enhance care and reduce harm.

Continue reading “Hope Lies with Residents” →

Dallas’ Parkland Memorial: Will Transparency Finally Rule

Paul Levy

Posted 2/15/12 on Not Running a Hospital

I recently reported about the reluctance of the board at Dallas’ Parkland Memorial Hospital to make public the consultant’s report prepared by order of CMS to review quality and safety issues in the hospital.  Well, it has not been released, but the Dallas Morning News secured a copy and has reported about it.  Here are excerpts:

Among the findings: Patient rooms were found to contain overflowing trash bins, excrement and blood. Hundreds of medications were improperly administered to patients. Dozens of beds remained empty despite crushes of patients seeking emergency care. Senior leaders kept critical information from the hospital’s board of managers. One patient died, apparently after receiving a drug without doctors’ orders

CalPERS Innovative Program for Hip and Knee Surgeries

Nick Vailas

Posted 1/24/12 on Healthcare Transparency Now

CalPERS – the California Public Employees’ Retirement System – covers 1.3 million retirees, managing both their retirement and health benefits.  It recently introduced a program for knee and hip surgeries that effectively tells beneficiaries that it will pay up to a specified amount for hospital reimbursement. If the beneficiary elects a hospital for which its reimbursement is higher, the beneficiary is 100% liable for additional charges.

CalPERS has brought two essential ingredients into play – both transparency in price and “skin in the game.”

Continue reading “CalPERS Innovative Program for Hip and Knee Surgeries” →

Tracking Adverse Events

Paul Levy

Posted 1/08/12 on Not Running a Hospital

A recent report from the Office of Inspector General at the US Department of Health and Human Services finds, unsurprisingly, that hospital incident reporting systems do not capture most patient harm.  A summary of major points:

All 189 sampled hospitals had incident reporting systems to capture events, and administrators we interviewed rely heavily on these systems to identify problems.

Continue reading “Tracking Adverse Events” →

High-Cost Hospitals: Because Patients are Sicker? Think Again.

Wendy Lynch, Ian Beren, Justin Shaneman and Nathan Kleinman

Posted 12/30/11 on the HCMS Blog

It’s not surprising news that inpatient healthcare costs vary from hospital to hospital; large differences in price for the same procedure are common. But the reasons for variation are less clear. Some hospitals have consistently more expensive fees for identical treatments. However, these differences do not necessarily reflect better care: a recent study found that some high-cost hospitals rank low in quality scores and some high-quality hospitals are relatively low-cost (1). Plus, evidence shows that spending more does not produce better outcomes, higher satisfaction, or more appropriate care (2, 3).

Some plausible reasons for price differences include higher negotiated rates with health plans, delivery of additional or unnecessary services, poor efficiency or management of hospital stays, or several other possible causes. Yet, the most common assumption most of us make when we see price differences among hospitals is that some hospitals have patients that are simply sicker.

A recent HCMS analysis of hospital use by employees of a large, regional employer refutes that assumption.+   The graphic below shows cost per admission at ten different hospitals in the same geographic region according to the severity of illness burden of the patients the hospital treated. Most hospitals fall along this expected cost trend, with a median cost of $2,300 per increasing unit of illness. However, a few had costs above that expected rate of $15,000 to $20,000 per admission.

Continue reading “High-Cost Hospitals: Because Patients are Sicker? Think Again.” →

Getting An EPIC Opinion Off My Chest

Vince Kuraitis

Posted 12/1/11 on e-CareManagement Blog

We need to be far more explicit in asking a subtle but critical question

What are acceptable bases of competition in health care?

My sense is that the distinctions here are not well understood and often go undiscussed, so I’ll quickly get to the point:

It’s OK for care providers to compete on the bases of quality, price, patient satisfaction, and many other factors

Continue reading “Getting An EPIC Opinion Off My Chest” →

Mr. Ness, Everyone Knows Where The Booze Is

Paul Levy

Posted 11/13/11 on Not Running a Hospital

A quality-driven physician colleague writes with frustration about two problems in his academic medical center.  I often hear similar comments from nurses and doctors, and so I present the examples for your consideration.

This hospital has a poor record with regard to hand hygiene (in the 30% range), and my colleague suggested at an infection control meeting suggested that the rates be publicly posted in the hospital to provide an impetus for improvement.  “I suggested that instead of being embarrassed, maybe we should OWN the data.” This, of course, is a standard and accepted approach in quality improvement.  S/he was told that the “the lawyers will not let us do this.”  S/he wonders, “Who, exactly, is our primary concern?”

Continue reading “Mr. Ness, Everyone Knows Where The Booze Is” →

Bravo To Brent James

Paul Levy

Posted 11/07/11 on Not Running a Hospital

Dr. Brent James last week was awarded Columbia Business School’s W. Edwards Deming Center for Quality, Productivity and Competitiveness. As described in the press release:

The Deming Cup grew from the center’s drive to highlight the achievements of business practitioners who adhere to and promote excellence in operations – the Deming Center’s area of focus. This award is given annually to an individual who has made outstanding contributions in the area of operations and has established a culture of continuous improvement within their respective organization.

Dr. James was recognized for his pioneering work in applying quality improvement techniques that were originally developed by W. Edwards Deming and others, in order to help create and implement a “system” model at Intermountain, in which physicians study process and outcomes data to determine the types of care that are most effective.

Imagine that, improving clinical care is consistent with efficiency in the health care system.  This has to be another lie, just like that stuff about Pronovost saving lives and reducing costs by reducing the rate of central line associated bloodstream infections.  Or assertions by that trio of fraud, Spear, Toussaint, and Kaplan.

This stuff can’t be true.  If it were everybody would be doing it.  Right?

Continue reading “Bravo To Brent James” →

The Great Finesse in Health Reform- Changing The Language

Richard Reece

Posted 10/13/11 on MedInnovations Blog

One man’s words are another man’s poison.

Anonymous

We were reasonably calculating in our approach. We consciously began using the language of the marketplace, rather than the language of medicine. We began talking in terms of “providers and consumers” instead of “doctors and patients,” for example. This, of course, was and still is highly offensive to many people in medicine, and we felt the old language was almost like the language of religion, and, thus, harder to use when trying to affect widespread change.

Paul Ellwood, MD, 1985, “Life on the Cutting Edge,“ Twin Cities Magazine, 1985

1n 1988 in Who Shall Care for The Sick: The Corporate Transformation of Medicine in Minnesota, I said that words matter in health reform, that use of “providers and consumers” signaled a transformation in American medicine, and that these words a “Grand Finesse” of American physicians, effectively distracting them from what was really happening.

I predicted physicians would become serfs of payers, physicians would be disillusioned , and ultimately, a doctor shortage would ensue.

Continue reading “The Great Finesse in Health Reform- Changing The Language” →

Why Transparency and Innovation Will Ultimately Trump Fee-For-Service

Lynn Jennings

The current FFS model does not compete in the open market the way that most services and commodities do, based on price, quality and availability.  If we had a transparent market for health care, providers would be forced to compete based on all three components.  Although most health care providers are paid based on some fixed fee schedule established by Medicare, HMOs or PPOs, a provider’s ability to differentiate is removed.  Consequently, the incentive to over treat becomes the only viable way to increase revenue.

Examine the health care market for services that are not covered by insurance, and you find dramatically different forces at play.  Prices have not escalated in the way that covered services have and, in fact, many elective procedures have declined in price. Medical tourism has flourished primarily in the cosmetic arena.

The internet, medical tourism and the public’s thirst for information have made transparency inevitable. But that evolution is being fought by nearly everyone with a stake in the old paradigm.  Large health plans and third party administrators perceive their value to be their networks and the confidentiality of those contracts.  Large health care providers, like hospital systems, also profit from the lack of transparency.

It will take small, independent, maverick providers to challenge the system by being transparent. As health care’s cost becomes increasingly unaffordable, purchasers will be more and more encouraged to shop for price and quality, and they will find providers who are willing and able to deliver transparency and value.  Once opened, that flood gate will never be closed!

Lynn Jennings is CEO of WeCare TLC, LLC, an online clinic and medical management firm based in Longwood, FL.