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”
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?
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)
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”
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.
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”
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