Posted 3/21/12 on Not Running a Hospital
The power of transparency, as I have noted, is that it provides creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.
MIT’s Peter Senge explains this more fully in his book The Fifth Discipline:
[T]he gap between vision and current reality is . . . a source of energy. If there was no gap, there would be no need for any action to move toward the vision. Indeed, the gap is the source of creative energy. We call this gap creative tension.
Continue reading “Our Aim Is At 100%. Other Than That, We Are At Zero”
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
David C. Kibbe and Brian Klepper
Posted 2/2/12 on the Health Affairs Blog
©2012 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.
Americans increasingly distrust what they perceive as poorly run and conflicted government. Yet rarely can we see far enough inside the federal apparatus to examine what works and what doesn’t, or to inspect how good and bad decisions come to pass. Comparing the behaviors of two influential federal advisory bodies provides valuable lessons about how the mechanisms that drive government decisions can instill or diminish public trust.
Continue reading “Trusting Government: A Tale of Two Federal Advisory Groups”
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”
The attached PP deck is a presentation I’ve given several times that has received an overwhelmingly positive, if frightened, reception.
It is, perhaps, the most disturbing public argument of my career (which is going some), because it tries to document the health care industry’s “capture” of health care regulatory processes, particularly those that govern payment. The result, as many people understand, is that the health care industry, in its rapaciousness, is effectively driving the larger US economy off a cliff.
Only one group, the non-health care business community, has the heft, influence and motivation to save us, though health care has done a good job dividing and conquering this sector as well, insinuating itself into many of the most powerful institutions (e.g., the Chambers of Commerce). It remains very unclear that the business community can be galvanized/mobilized from its malaise to turn this problem around.
The argument goes like this:
- The data are clear that the US’ health care economy is absorbing most gains in the larger economy, and driving the US economy toward collapse. For example, nearly all increases in total compensation have been directed at increasing health costs, which in turn flows into the health industry.
Posted 1/24/12 on Common Sense Family Doctor
When my wife delivered our second child in 2008, the hospital sent our health insurance company a bill for $8569. The insurance company then wrote off $4117 of that bill, paid $4352, asked us for a copayment of $100. When we found out last year that we were expecting again, we noted that my wife’s new insurance plan requires us to pay 20% coinsurance for all non-preventive care. That would have amounted to several hundred dollars of our 2008 bill, and knowing the rapid rate of health care inflation, we thought it would be good to find out how much it would cost this time around. So we went back to the same hospital, where we expect our third child to be born in a few weeks, and asked if they could give us an estimate of the charges. It seemed like a reasonable enough request, especially since the pre-admission consent form we signed specifically said that patients had a right to know what the hospital charged for its services.
Continue reading “How Much Does It Cost To Have A Baby”