Tag: David Kibbe

Hurtling Down the Road to Ruin

Brian Klepper and David C. Kibbe

Posted 6/21/13 on Medscape Internal Medicine

BK 711dckibbeA recent New York Times article that focused on colonoscopies highlighted the questionable science, predatory unit pricing, and overutilization that characterize this procedure and much of US healthcare. Patients get routine screenings that, in other industrialized countries, cost one half to one thirtieth of what they do here, then are gobsmacked by bills equivalent to the cost of a good used car. Reporters and healthcare writers have covered this topic in all its intricacies thousands of times.

But Elizabeth Rosenthal, the Times reporter, zeroed in on the root of the crisis, which is how healthcare interests have shaped market and policy forces to their own ends. “The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.”

One result is that healthcare’s cost drivers are a multiheaded monster, frustrating simplistic solutions. Many physicians own a financial stake in the care they deliver, rather than being paid to manage the care process well. Pricing is typically unrelated to cost or quality, varies wildly among providers, and often comprises dozens of components that are impossible to understand beforehand. Insurance companies may make a percentage of total cost and so are incentivized to allow healthcare to cost more. Every level of the system is rigged.

Why EHRs Really Haven’t Made Us Healthier: A Response To Glen Tullman

Brian Klepper

Brian Klepper, Health Care Analyst and TDWI Writers' Group

Recently-fired Allscripts CEO Glen Tullman waxed progressive in a self-promotional Forbes article last week, describing the ways past and forward for electronic health records (EHRs) and health information technology (HIT). He may have been trying to recover from a damning New York Times article that clearly illustrated the relationships between campaign contributions, influence over health information technology policy, and business success.

Tullman recalls building EHRs that moved many physicians away from paper and the errors it fosters. He calls out David C. Kibbe, MD as an example of the forces wanting to preserve paper and opposing EHRs, with quotes from a 2008 blog post suggesting that the current crop are “notoriously expensive,” “difficult to implement” and unable to demonstrate care quality improvements. He predicts that, in the future, the industry will leverage open platforms and interoperability, yielding new monitoring and management utilities that can facilitate better care at lower cost.

Continue reading “Why EHRs Really Haven’t Made Us Healthier: A Response To Glen Tullman” →

Creating Value-Based Incentives for Primary Care

Brian Klepper and David Kibbe

Posted 6/2/11 on The Health Affairs Blog

In a remarkable recent interview, Donald Berwick MD, Administrator of the Centers for Medicare and Medicaid Services (CMS), eloquently described his vision of value-based health care.

Paying for value is an incentive…The underlying idea of improvement is that American health care, historically built in fragments, often cannot achieve for patients what it really wants to achieve…Health delivery system reform refers to really reconfiguring care into much more seamless coordinated-care operations so that people, especially those with chronic illnesses, experience continuity of care over time and space.

Continue reading “Creating Value-Based Incentives for Primary Care” →

Facing Uncertainty: Why Primary Care Physicians Must Act Now

Brian Klepper

Over the past four months, the germ of a long overdue primary care uprising has sprouted and begun to flower. When David Kibbe and I first tried to think through how to neutralize the RUC’s terrible influence on American health care, we realized the first steps had to be the primary care community’s refusal to continue “enabling” the RUC – we meant this very much in the clinical sense – through its continued participation and complicity. When the game is rigged against you, there is no benefit in staying at the table.

Primary care societies would visibly and noisily abandon the RUC, with the understanding that quietly walking away would be counterproductive in the extreme. It should be a highly publicized exit, filled with righteous indignation and clarifying for the American public how the RUC’s actions and relationship with CMS have shafted patients, primary care physicians, and the people who pay for health care in America.

Continue reading “Facing Uncertainty: Why Primary Care Physicians Must Act Now” →

Quit The RUC

BRIAN KLEPPER and DAVID KIBBE

Originally published 1/21/11 on Kaiser Health News

Recently, a Wall Street Journal expose and a New York Times column by Princeton economist Uwe Reinhardt detailed how vast health care resources are steered by the American Medical Association’s Relative Value Scale Update Committee — or RUC, a secretive, 29 person, specialist-dominated panel. Since 1991, the RUC has been the main, if unofficial, adviser on Medicare physician reimbursement – how specific procedures should be valued – to what is now called the Centers for Medicare & Medicaid Services. Many Medicaid and commercial health plans follow Medicare’s lead on payment, so the RUC’s influence is sweeping.

Continue reading “Quit The RUC” →

The Obama Team’s Success in Health IT

BRIAN KLEPPER

David Blumenthal, MD, National Coordinator for Health IT

Over at the Health Affairs Blog, David C. Kibbe and I have a piece that details how the Obama Administration’s Health IT team “unfroze” and turned around an entrenched Health IT market, and is making it, by virtually any measure, a highly successful one.

This was no small feat, and it took the coordinated effort of many, many people. With David’s counsel and encouragement, I was very proud to play a small part in testifying to an HHS panel in July 2009 on the apparent financial conflicts that were inherent in the relationship between HIMSS and CCHIT. That day of testimony facilitated extremely contentious exchanges, but was, in part, behind the decision to revoke CCHIT’s monopoly on certification, opening the door for new, more modern approaches in Health IT.

There were terrific contributions by many others who worked collaboratively and in good faith to craft the rules that would allow a better environment to the nation’s health IT to be nurtured and evolve. Particular mention should go to The Markle Foundation’s effort, led by Carol Diamond, MD, which brought many different constituencies together and shaped a consensus roadmap forward.

But, no question, the real heavy lifting and very strategic maneuvering was carried out by Dr. Blumenthal’s team along with Aneesh Chopra at the White House and Todd Park at HHS. Kudos to them. They have done the nation a great service.

Please check out the article at the HA Blog, where we go into much more detail.

 

The Silver Lining

By BRIAN KLEPPER and DAVID C. KIBBE

Massachusett’s voters’ stunning rejection of Democrat Martha Coakley, in favor of a not-very-impressive Scott Brown, should be exactly the splash of cold water that the Democratic party – and Congress as a whole – needed. The defeat can be understood in two ways: one large and one fairly small.

First, the large one. This will probably send reform back to the drawing board. Health care is too much in crisis and too pressing to be pushed completely off the table until certain issues – including both access AND cost – are addressed.

Second, this election marks the loss of a single critical Senate seat, but it is also very loud warning shot. The mandate received at the end of 2008 was a resounding call to throw out the Republicans who for more than a decade had ridden roughshod over American values. Yesterday, the Democrats, in one of their most secure strongholds, received the same message. Whatever people in DC think, rank-and-file Americans – not those on the right or left, but the swing voters in the middle who actually determine election results – are very unhappy with the gaming that’s been vividly displayed over the last year under the guise of health care reform.

The distaste expressed yesterday probably has little to do with the specific provisions of the bills, except for the largest generalities: that they expand coverage while avoiding a commitment to changes that could significantly reduce cost. But along the way, voters have witnessed — with an immediacy and transparency that has only been available as a result of the Web — lawmaking in its worst tradition. There was the White House’s deal making with powerful corporate interests like the drug manufacturers even before the proceedings began. And the tremendous lobbying contributions by health care and non-health care special interests in exchange for access to the policy-shaping process. Or the outright bribery of specific Senators and Representatives in exchange for votes. Last week’s White House deal with the unions that exempted them from the tax on “Cadillac” health plans until 2018 must have seemed like a perfectly OK arrangement to the people in the center of all this activity, but to normal people who read the paper, it was emblematic of the current modus operandi: If you have power and support the party in power’s muddled agenda, you get a special deal.

The most tempting mistake now for the Democrats would be to dig in. President Obama’s most appealing characteristic — the one that got him elected — was his embrace, his embodiment even, of approaches that would revise the traditional kinds of politics we’ve seen for the last year throughout the health care reform process. Of late, the most telling complaint about this Presidency so far has been disappointment that, once in office, he seemed to cave in so easily.

Undoubtedly, many Republicans are now rejoicing over the Democrats’ loss and the possible defeat of any health care reform legislation. That’s unfortunate. The health care crisis is real and remains unaddressed. The pressures it creates, particularly for powerful interests like business, will force Congress to return to it and develop meaningful solutions. Hopefully (though probably unlikely), Congress and particularly the Democrats, will be chastened and wiser. There’s a big opportunity here to make lemonade.

There is a new, bipartisan movement in Congress, highlighted on NPR two weeks ago, that would revisit the rules around the relationships between special interests and lawmakers. This is an issue that trumps and is more important than all others, because if every policy is ultimately shaped by those with enough money to buy Congress’ favor, then our democracy will be unable to hold.

The silver lining in yesterday’s election was that it was a mild, if critical, reminder that, whatever DC thinks, America’s center is just as displeased with the current governance as it was with its predecessors. Faced with a much larger rejection in the 1994 elections, President Clinton went on TV, took full responsibility, and then spent his time rebuilding. The good news is that today is a new day, and that, if they’re interested in what’s good for America over the long term rather than simply themselves over the short term, Congress has the ability to start again in ways that could please the American people and actually work to our collective advantage.