What is adenoma? Give me a second…

Whether it is a function of less access to primary care physicians or the importance of the always-burgeoning internet…Web 2.0 has hit health care. Actually, this post is pretty late to the party…

What is Health 2.0? Go here. Some examples: iMedix, RevoultionHealth, Medstory, Healia, Xoova, Organized Wisdom, and (less 2.0 than the others) the industry’s gray lady: WebMD.

Its impact, I feel, to this point has been muted. But its time is coming. What will be the impact of Health 2.0 on health systems?

Hospitals will have to take into account the impact of these websites on the delivery of care. It is this notion of the
patient as a partner in the deliverance of care. Obviously it is the way it should be–patients participating in tandem with their providers.

But there are some consequences. With added knowledgeable in tow, more questions will be asked as patients feel better informed, which will increase the likelihood of lengthier conversations with providers. All good. But providers will need to spend more time with patients (like more than five minutes) and that means patient throughput will decrease. Given the current state of reimbursement in this country where we reward for more care, not better care, providers may not be able to see as many patients in the same amount of time.

Health 2.0 means changes for hospitals and providers, can we explore what some of them are?

BTW: adenoma.

Diversity isn’t just good, it’s necessary

Tom Peters does some cool things (ah, constantly!). One of my favorites is when he shares books he is reading. But a cooler thing is when he shares books (warning, it’s a PowerPoint) that influence his thinking.

That’s where I found this gem.

Scott E. Page’s book “The Difference” is about diversity. And not about our traditional definitions like skin color, religion, sexuality, and others. Those kinds of diversity are extremely important. But Mr. Page pushes the debate past all of that. Diversity is what happens when individuals with different “toolboxes” are brought together to solve problems. Mr. Page explores diversity as the many different ways people think.

Organizations are able (and should!) promote diversity to improve productivity, and the book outlines Mr. Page’s case. It is a very compelling read with takeaways that can be implemented (without too much effort) in the organizations where we work. His writing is understandable even though some of the ideas in the book can seem dense at start.

From the jacket, “The Difference” reveals that progress and innovation may depend less on lone thinkers with enormous IQs than on diverse people working together and capitalizing on their individuality…Page changes the way we understand diversity–how to harness its untapped potential, how to understand and avoid its traps, and how we can leverage our differences for the benefit of all.”

The New York Times has an interview with Mr. Page. Go check it out for a little more enlightenment.

Facials, massages, filet mignon…in the hospital?

The transition from patient as a patient to patient as a consumer has been a long time coming in health care. Recent example.

The patient/consumer experience is number one.

Interesting from the article: “Because the amenities are included in the cost of the stay, they’re covered by insurance.”

How far do you think insurance companies will allow hospitals to go in delivering five-star amenities?

3. Transparency is K-I-N-G!

Consumer-driven health care hasn’t (yet?) delivered on its promise, but one deliverable it has brought to us is transparency.

Still in a stage of infancy, the secret of what transparency can provide is out. Empowering patients to make decisions with useful and relevant information is a good (great!) thing. Making health care organizations accountable is of greater importance.

But like all change, a great many organizations are lagging behind on the movement. In order for transparency to truly work, everyone must share information–it must be the same information and measured the same way in order to be useful.

If you have studied Everett Rogers’ Diffusion of Innovations you know that individuals (and in turn organizations) adopt innovations at varying stages. The first stage is that of the early adopters. Beth Israel Deaconess Medical Center, headed by Paul Levy, has been an early adopter in the world of transparency. The first page on BIDMC’s website prominently displays a link to a page where the medical center details their innovative transparency efforts.

Mr. Levy has long advocated for transparency on his blog. The issue with this innovation is that in order for it to truly work, everyone must adopt it. And to this point, the great majority have not taken the steps that BIDMC has. Mr Levy writes in a BusinessWeek Special Report:

Several months ago, I started to post infection rates and other clinical information about Beth Israel Deaconess Medical Center (BIDMC) on my blog. I suggested, too, that it would be great if other hospitals in Boston would do the same thing. Not for competitive purposes, but to show the public that we were all willing to be held accountable and to demonstrate our commitments to quality improvement.

The response was either underwhelming or hostile. I received arguments against the idea because “the data wouldn’t be comparable from one hospital to the next,” and “the public won’t understand it.”

The Center for Medicaid and Medicare Services has started reporting data through a tool called Hospital Compare where consumers can compare a number of quality measures between hospitals. It’s a great tool. But I’m unsure how many consumers are privy to the knowledge that giving aspirin upon arrival can improve the care for AMI (heart attack).

I don’t think we should resort to combining all quality measures to come up with one less-meaningful all-encompassing measure to rank all hospitals. But we need to make information easier to understand for the average patient. And this is what BIDMC gets exactly right.

Making our organizations completely transparent is seen by some to be a huge risk. That makes one wonder what those organizations could be hiding. Increasing transparency not only helps consumers, it will make us better. And that should be the goal of being transparent: making ourselves accountable to ourselves.

Some more resources here and here, courtesy of Mr. Levy’s blog.

Principle #3
: Quality! Make it transparent. Report incessantly. Help (and encourage!) patients to understand it. Look ourselves in the mirror!

What goes around, comes back around

Remember the days when a house visit by a physician was the primary way of caring for a patient?

The service seems to be making a comeback. It’s not just something they do in France, either (for those of you who have seen Sicko).

I have come across two websites (one–this service seems really cool–, two) in the past few days of physicians who are more than willing to make house calls (after seeing this story in the New York Times in September). For those types of illnesses that don’t require significant medical technology it can be a great thing. The issue, as always, comes with cost. In the (mostly) free market that is the United States health care system, that means those who are able pay for the house visits and individual attention, do so.

House visits are a great idea. We just need more physicians to start. And that means lowering the cost so that demand is greater. And that means the reimbursement function needs to be completely rethought. And that means…

I appreciate the innovation and would like to see the model continue to expand.

Here, grandma, get yourself some new dentures

I am not-all-about the relatively recent gift card frenzy. First, I feel like I can deliver some pretty thoughtful gifts, no matter the holiday. Second, and more importantly, because so much money is wasted in the form of unused balances.

And now…

Think Well presents the health care gift card. Yes, I typed (and you read) correctly. The company says, “From college students and elderly parents to expectant mothers, the Healthcare Gift Card is a unique way to let loved ones know just how much you care.” Obviously, it is a gift to give when a $10 bill isn’t enough…plus it only costs about $5 to get one.

Springwise thinks it is a good idea.

Why not just give a prepaid Visa or Mastercard gift card? So the gift receiver has to choose to buy health care? Well what if the receiver doesn’t get sick? Well that’s OK, because the money stays on the card minus the $1.50 maintenance fee that occurs every month after the first nine.

Am I missing something here?

There’s an elephant in the room…

…and it’s time we address it.

The elephant: universal health care.

Important! This blog’s definition of universal health care: every citizen in the United States has the opportunity to be covered by affordable insurance.

Basic, I realize. But I am worried that if the definition gets wordy the possibilities of too many inclusions and too few exclusions increases greatly. And the point is to start the discussion, not end it.

Is it needed?
Is it achievable?
Can it be affordable?
What form should it take?

There are sure to be more questions…

In the coming weeks and months we will explore the various components of the many different options for how we provide medical care in this country. Some are in favor of a purely market-based system. Others are completely for a government run system. Most are for something in the middle. Disagreements will be plentiful as we explore different definitions and opportunities.

So there, the topic has been started. And I feel much better.

FICO scores in health care?

This caught my attention.

Healthcare Analytics is working on a “sort-of” medical credit rating the likes of which banks (and many other institutions) currently use to judge a consumer’s credit worthiness. Hospitals will use the score to determine patient’s likelihood of paying medical bills. The company says the score will only be used after care has been delivered.

Here’s my issue: patients often come back to hospitals/clinics. How are those hospitals/clinics going to prevent discrimination against patients who have had trouble paying bills in the past? Will treatment be refused? I know that is illegal in ERs but what about in the hospital or clinic setting? At the least, will low-score patients’ care be of the same quality as those patients with higher scores?

Some critics have raised security and privacy issues with the data. But this doesn’t concern me as much–I think workable solutions can be found to limit data and identity theft.

But some good: hospitals could better predict collection rates. And if this data could be used before a patient is treated, it would allow health systems to better allocate charity care instead of those charges ending up in the bad debt category on the balance sheet.

Here is some more.

Do you have any reservations?

A hospital that pays for its own pens?

A surprisingly popular story around the web this week was the policy implementation at Saint Mary’s Duluth Clinic in Duluth, Minn., to effectively ban any product (pens, clocks, clipboard, medical models, etc.) with pharmaceutical logos. All I can think about is the number of pens SMDC will now have to purchase…

I think it is a needed, ethical, step in the right direction. Removing the (however minute) influence these products may have on doctors’ prescribing patterns is a good thing, especially as we see more issues arise regarding the safety of some drugs. Forcing decisions to be made through the use of objective information is always a good thing.

The policy is outlined here in the Duluth News Tribune. Some banter here.

We’ve incorporated it here.