Models of success

So simple. Hoping there’s more:

Yet in studying communities all over America, not just a few unusual corners, we have found evidence that more effective, lower-cost care is possible.

To find models of success, we searched among our country’s 306 Hospital Referral Regions, as defined by the Dartmouth Atlas of Health Care, for “positive outliers.” Our criteria were simple: find regions with per capita Medicare costs that are low or markedly declining in rank and where federal measures of quality are above average. In the end, 74 regions passed our test.

It’s easy to get started assessing the patient experience

It’s easy to assess (and improve!) the patient experience in existing inpatient and outpatient facilities. Here’s how, with inspiration from Matthew May, to improve an organization’s focus on empathy.  First things first, drop the data (just for now and only for a moment…)

  1. Observe a patient(s). Ask a patient if they’re open to being followed during their entire visit/stay.  An easy way to start would be with a planned admission.  Proceed cautiously with a patient who first presented to the emergency room. Outpatient facilities should provide several opportunities in a single day.
  2. Become a patient. One way is to actually become ill and require health care services.  Sometimes that’s realistic, sometimes not.  The other is to become a patient just for the day.  Pluses and minuses for both, but an actual immersion into a patient’s shoes is the best way to experience health care.
  3. Include the patient(s). This is easy, too.  Plenty of people are willing to talk to just about anyone about their health care experiences.  Ask a patient or a group of patients to participate in a focus group.  Structure the conversation—but not too much; this is about listening to the patient’s observations, thoughts, wants, and desires.

There it is.  Three easy ways to start assessing the patient’s experience.  Start changing what can be changed tomorrow.

Updated: Back-of-the-napkining health care

Dan Roam and Tony Jones recently got together to visualize health care reform.  It’s good and easy to understand.  That’s Dan’s default—he’s the author of “The Back of the Napkin.”


Part one: Health care in America is a business (that it is, with the patient increasingly mattering less…aside from $$ brought to the system)

Part two: It’s not health care reform—it’s insurance reform (and that’s a big problem, paying attention primarily to the insurance side does little to rectify our growing problem)

Part three: What proposals are actually on the table?

Part four: Impacts and conclusions


So this means, from a health care perspective, we should not support “cap and trade?”  And that we should support ethanol subsidies?  As if health care didn’t have anything else to think about at the moment, Judith D. Schwartz writes that the industry’s dependence on oil should be a top concern:

One might not imagine oil and medicine would mix, but U.S. health care relies on cheap crude in multiple ways: from petroleum-derived pharmaceuticals (including such commonly prescribed drugs as aspirin, vitamin capsules, cortisone and many antibiotics, antihistamines, medicated skin creams and psychiatric medications), catheters and syringes to running and transporting high-tech machines and time-is-of-the-essence ambulance runs. This makes for great aseptic single-use equipment and complex, even heroic, surgeries, but it also leaves our medical system highly vulnerable to any disruptions to the oil supply — which experts say will undoubtedly happen, though no one knows exactly when.

Health care again adds jobs

Health care added jobs in July (as it has continued to do) according to the latest BLS report (pdf).  Two reactions:

  1. Good.  We need employers to add jobs.
  2. It increases health care costs, especially not such a good thing as the economy continues to struggle.

The Health Blog reports that total health care employment has risen from 13.3 million to 13.6 million jobs, with grown seen throughout the industry.

Winning…or losing?

Gosh, there’s a special place in my heart for civil, constructive, advance-the-discussion discourse. David Frum:

What would it mean to “win” the healthcare fight?

For some, the answer is obvious: beat back the president’s proposals, defeat the House bill, stand back and wait for 1994 to repeat itself.

The problem is that if we do that… we’ll still have the present healthcare system. Meaning that we’ll have (1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments.

We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.

Stop your screaming…

This is embarrassing.  Whatever your allegiances and opinions politically, this is no way to go about a debate.  Screams and chants and physicality in a public forum is irresponsible. This lack of civility is doing nothing for our need to have constructive discussion surrounding the issue.  There’s a real chance that a health care bill will get through Congress no matter how loud some people scream.  And when people start screaming, it’s difficult and uncomfortable for others to listen.  So if there is an actual point to your impassioned tantrum the people who need to hear it (the fence sitters), won’t (aren’t).

If you don’t think that the current reform proposal will solve these problems, then fine.  I’m not convinced myself.  But can we at least go about this in a constructive manner?  Please?

(Maybe I should reassess my naiveté…)

The snail’s route

Well isn’t this just flipped convention, Daniel Gross at Slate writes, “Simply by doing nothing, we’re slowly nationalizing health care.”

The system of employer-provided health care coverage is crumbling before our eyes, and for more Americans—and for more American insurance companies—government-funded health care is all that separates them from financial disaster. A Gallup poll found that the percentage of Americans who say they get their health insurance from an employer has fallen from 58.9 percent in January 2008 to 56.5 percent in May 2009, while the percentage who get it from the government (Medicare, Medicaid, VA benefits) has jumped from 26.5 percent to 29 percent. (The rest purchase it on their own.) But this poll understates the case. About 17 percent of payroll jobs today are government jobs. Crunch the numbers, and it’s more like 39 percent getting insurance from government sources (public programs and public-sector jobs) and about 47 percent from private-sector jobs.

It’s a fable!

I’m left wondering: who would I least like to be, the congressional intern flipping the charts or a fellow Senator in the audience musing about what my House counterparts are doing on their time away from Washington?

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