Learning by Surfing: Issue 7

Short, staycation version of Learning by Surfing: health care reading.

International health care is on the rise.  Which is good news for us in the United States since it will (eventually) force health care organizations to become more value driven.  But Americans going overseas for medical services often don’t receive the same level of care as the local residents.  From The New York Times, on health care for the poor in India:

“The poor are not dying and sick because they do not go to seek medical care,” he said. “In fact, the poor are going to doctors in droves. There are no good options for the poor. The private hospitals and care they are able to access is of very low quality, and when they try and access government care, they receive no attention whatsoever.”

Diversification.  The University of Pittsburgh Medical Center understands it as best as anyone.  UPMC and GE announced a joint venture this week, from the Health Blog:

The University of Pittsburgh Medical Center is one of those business-savvy hospital systems that almost makes you forget the “non” in nonprofit hospital. Case in point: The health system is putting $20 million into a joint venture with General Electric to launch a new imaging company.

The company, Omnyx LLC, aims to create a “virtual microscope” that would scan and store images electronically, the WSJ reports. It would be used by labs where pathologists look at microscopic slides to analyze human tissue — a field that’s been slow to digitize, partly because it can be tricky to turn some types of microscopic images into digital images.

When HD TVs first came out the prices were very high.  Us conscientious consumers waited for the prices to come down before purchasing.  And they did.  Why doesn’t this happen with medical technology? From Half MD (via Kevin MD):

Few professions can be as economically wasteful as medicine. Sure, we all love to bitch about politicians, but medicine really should take the award for financial pissing. We build wonderful technologies that can look at the inside of a person’s heart, check the electrical activity of the brain, read any component in a person’s blood, and even watch a baby move inside of the womb. However, all of these devices are made unnecessarily expensive by using non-standardized equipment and are being produced as new models that do nothing to bring down the cost of older versions.

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But the end result is the same: medical equipment can be produced at a cheap cost. The current system does nothing to reward us for developing innovative, cost-effective devices. Instead, we continue to throw away money on machines that can be produced by hobbyists for 1/100 of the cost.

Learning by Surfing: Issue 6

All health care. Links.

The Chicago Tribune reports on concerns of Chicago area hospital mergers:

Although the recent spike of hospital consolidations has yet to draw the attention of federal antitrust regulators, critics say the mergers could translate into rising prices as these bigger institutions gain more negotiating clout with health plans and self-insured employers.

“Time and time again, consolidation is bad for consumers,” said David Dranove, professor of health industry management for Northwestern University‘s Kellogg School of Management.

And any price increase could pique the interest of federal regulators.

I’ve written on this before.  It’s done better here by Half MD (h/t Kevin MD):

So there we have it. Evidence shows that white coats, neckties, stethoscopes, and artificial nails are a source of infectious disease transmission. My hospital requires medical students to wear white coats, wear neckties, carry stethoscopes with them at all times, and has no policy regarding artificial nails. And the result is that we do a pretty good job of infecting people with C. diff, MRSA, and Klebsiella. Maybe what we should be doing is telling everyone that all of our patients have HIV. That way, they’ll be sure to carefully protect themselves from any communicable diseases.

I heard recently that a hospital is being built in Iraq where patient beds take patient vitals, no provider necessary.  The logical question: is anyone doing that in the US? PSFK via Inhabitat reports on a building in Mumbai that will monitor the health of its residents:

A new futuristic building in India will spend as much time monitoring the health of its inhabitants as it will setting the temperature. Designed by James Law the 32,000 sq m egg-shaped building will both monitor occupants blood pressure and use vegetation for cooling when its built in 2010.

The Health Blog posts on interprofessional conflict (hint: read the comments):

A couple of months back, the group that advises Congress on Medicare funding suggested raising payments for primary care in a “budget neutral” way. Translation: Somebody else’s payments would be reduced. Surgeons aren’t too happy about that. Go figure.

The American College of Surgeons recently fired off a letter to MedPac, the advisory group, and copied several senators and congressmen who control Medicare’s purse strings.

Dr Joseph Martin, in The Boston Globe, is the latest to comment on the primary care shortage:

The question of whether there are enough doctors to care for patients, particularly if the nation moves toward a new scheme for universal health coverage, is the elephant in the room of the presidential campaign debate on health reform.

Fifteen to 20 years ago there were worries about too many doctors, particularly in some specialties. Now, the Association of American Medical Colleges is requesting medical schools to increase enrollments by 30 percent over the next seven to 15 years.

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Bottom line: the new requirements in medical care require new thinking in how to deliver that care.

The Happy Hospitalist has the most emotionally-charged indictment (and true) of our health care system that I have ever read (via Kevin MD):

As many of you know, I am a strong believer in allowing capitalistic market forces to create the correct balance of supply and demand.  To create the correct type of value and service available to a population.  Whether that be the correct number of primary care doctors.  The correct number of orthopaedic surgeons.  The correct number of pharmacies.  The correct number of nursing homes.  The correct number of hospitals.  Some folks argue that supply drives demand.  To some degree that’s correct.  But I also believe, more importantly,  that demand, as defined by the never ending flow from the Medicare National Bank,  drives the supply.  And it drives it in a big way.

Learning by Surfing: Issue 5

Here’s some health care reading.

Dr. Benjamin Brewer in The Wall Street Journal on pricing difficulties:

Why can’t you find out how much medical care costs before you’re treated? Even though I’m a doctor, I can’t get that information when I need it either.

A fall on our family’s spring vacation trip sent my daughter to a Tennessee ER for 13 stitches. The bill was $827. I figured the ER bill would be high, but I didn’t quite expect $63.62 a stitch. After insurance paid, my out-of-pocket costs came to $291 six weeks later.

Nobody I know would be willing to buy gas at an unknown price, only to find out the damage when the tab comes a month and a half later. But between the mind-numbing complexity of health-care charges and the reluctance of many in the health system to reveal their prices up front, you don’t have much of a choice.

BusinessWeek on the myth of retirees:

Other industries have jumped aboard, too. There are target-date mutual funds, investment funds that buy up retirement businesses, and expanded offerings from a variety of leisure industries, all counting on legions of retirees to fuel their growth.

There’s just one problem: The pundits are wrong. Through at least the next 25 years (i.e., past the time the last baby boomer turns 65), the retirement market will be far smaller than the oft-cited 78 million—regardless of whether one is referring to the number of people retiring or the number of living retirees. In fact, compared with today, the growth rate of either of those two measures will be less than 4% annually for the next 25 years—and could very well be zero.

Payment reform announcement from HealthBlawg:

The federales are now pushing the latest CMS demo promoting physician hospital collaboration. In other words, CMS is having another go at gainsharing from a slightly different angle. The information available on the demo at CMS website includes the formal solicitation (applications due August 15). It’s known as ACE – the Acute Care Episode demo.

Another attempt at payment reform from Fierce Healthcare:

The project, dubbed Prometheus–for payment reform for outcomes, margins, evidence, transparency, hassle-reduction, understandability and sustainability–is funded by the Robert Wood Johnson Foundation. Payments will be built around a total amount to be paid to all providers for a patient’s condition. The project includes 12 evidence-based case rates, which included input from health insurers, employers, physicians and others through a not-for-profit collaboration.

Learning by Surfing: Issue 4

Health care stuff to read.

The World Health Care Blog looks ahead to the coming privacy issues as health care (finally) goes internet:

So how do we manage ‘consent’ when it comes to private health information in this social media environment? This is one hell of a key question that needs to be addressed, and one that many are afraid to ask less it result in some draconian measures applied to all social media.

Do we have to accept a diminished private space to gain the benefits of social media? Will confidential health information become the entertainment for the ‘monitorial citizen’, part of the banal collective din of spectators who are fast becoming the new surveillance force in contemporary society? The values that are “animating our concern for privacy” are changing according to Zittrain, noting the age gap between those who use social media and those who shun it.

The health care debate we have most often concerns the issues we have in this country. I think it is important to remember that health is an international priority. Health in other countries increasingly has an effect on health in this country. And health care in this country apparently has an effect on health care in other countries. Health Populi reports:

Across the OECD countries, only 3% of health costs go to prevention. Yet we are well aware that once a person develops a chronic condition, it is much more expensive and difficult to reverse. It appears that the developed world is exporting sick-care medical systems to the developing world. This is a prescription for global health financing implosion — in addition to the extraordinarily negative impacts on business on a global basis.

The Health Blog writes a post that makes me really start to wonder how prevalent (and realistic) such doctor thoughts are:

Certainly, any doc (or anyone else, for that matter) who is not getting paid by the hour is likely to do some uncompensated work. But the issue does seem pretty compelling in the case of primary care docs, who work in a payment system that tends to favor procedure-oriented specialties.

“Just in the last three weeks, I have actually noticed three medication errors from specialists who prescribed medications for my patients because they did not have the full history,” (Ryan) Mire said. “I received those consultation notes, saw what the specialist prescribed, and said, ‘Absolutely not, do not take that medicine.’”

Yul Ejnes, a Rhode Island internist also on the panel added a couple other typical primary care tasks that aren’t reimbursable: “talking with family members,” and “just sitting down and thinking” about a case.

“Sometimes I wonder whether I want to keep doing this,” Ejnes said.

The culture of a hospital can be strikingly different during the evening hours. But the Health Blog explains that more than just the culture can be different:

After sundown the doctors get scarcer, the nurses fewer and the waits for just about everything get longer. There aren’t many bosses or seasoned pros around when things get sticky.

The result is a “stark discrepancy in quality between daytime and nighttime inpatient services,” David Shulkin, president and CEO of Beth Israel Medical Center in New York, writes in the current issue of the New England Journal of Medicine.

The lighter staffing in off-hours contributes to higher mortality rates, more complications from surgery and more frequent errors compared with the day side. Shulkin says we shouldn’t accept that. For starters, he writes, we need to scrap the notion that hospitals should run differently at night compared with the daytime. “We should be establishing equal standards for staffing and service and striving for acceptable outcomes for every hour of the week,” he argues.

Learning by Surfing: Issue 3

A gathering of the web’s good health care (related) stuff…

If we could just figure out the communication thing we would solve most of our issues. Here’s the piece (via Jay Parkinson) and a snippet:

Communication in medicine grows worse by the day. What should be a pillar of quality health care is instead a resounding failure.

Patients are rushed through office visits and often leave without having their questions answered. Labyrinthine barriers have to be overcome before speaking with a physician. Reaching a medical provider via the Internet is an impossibly daunting task. Doctors rarely talk to each other to coordinate treatment plans.

The Wall Street Journal reported a slow-down in retail clinic expansion this week. I’m not expecting that to mean the beginning of the end for retail clinics. The model is still viable and will prove valuable in helping our health care situation. From Kaiser Daily Health Policy Report:

The “boom” of walk-in health clinics at pharmacies, supermarkets and retailers “is showing signs of slowing,” the Wall Street Journal reports. As of May 1, there were 963 retail clinics in the U.S., compared with 125 three years ago. However, some retail clinic operators recently have closed 69 clinics in 15 states, and others, including CVS Caremark, have announced their intentions to scale back clinic expansion plans.

My belief of the connections between health care and education have been noted here previously. Richard Florida has provided something further to consider.  My point is that we can’t expect health care to continue to operate in the vacuum that it has (it won’t).  All possibilities (that we can think of) for the future must be considered.

I have often wondered what the efficient scale of a university is and, in particular, whether it would be better to create a second Harvard with the university’s wealth than to expand the first one. Maybe the Massachusetts state legislature will give the powers-that-be at Harvard an incentive to consider more radical expansion plans.

And if states and cities are willing to pony up billions for convention centers and stadia, and hundreds of millions in industrial incentives for factories, how much do you think they much come up with for a Harvard, or MIT, or Stanford, or Oxford relocation. Universities are already setting up foreign campuses. Trust me, it’s just a matter of time until this game gets big.

Learning by Surfing: Issue 2

A gathering of good stuff (health care related) around the web…

Maggie Mahar at Health Beat explores the question, “Can we reach a consensus on what we need to do to achieve meaningful health care reform in the U.S.?”

Yet there are still major issues that could divide reformers: Should we acknowledge that we won’t be able to cover everyone unless we learn to “control costs”? Should we move directly to a single-payer system? And finally, should we try to move quickly, to cover everyone, or should we aim for incremental progress while sticking, stubbornly, to first principles?

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Dr. Scott Shreeve on the personalization of medicine:

So lets start this out by talking about the personalization of medicine. This is typically thought of in a genetic sense, wherein people are customizing medications and therapies based on your individual genetic profile. Said in other words, the “Right treatment for the right patient at the right time”. However, most consumers already assume Right/Right/Right is happening, and more likely consider personalized medicine as a type of practice delivery style. This is where the physician knows the patient intimately, their social and demographic context, and the correct diagnostic or therapeutic approach given the patient’s preferences that have been learned throughout the relationship.

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Jen McCabe-Gorman was blogging from the World Health Care Congress this week and posted her thoughts on a developing theme: the medical home concept.

The medical home is about primary care. Primary care puts patients “primarily” at the center of the care spectrum.

The medical home is about care coordination. Care coordination is about putting the patient “primarily” at the center of the care spectrum, and then ensuring they stay there as they seek services at different locations.

Unfortunately, “primary” patient-centric, consumer-directed care in the US has devolved into the desperate pursuit of paperwork needed for payment.

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Nick Jacobs, CEO of Windber Medical Center, writes how his hospital is able to keep infection rates low at Hospital Impact:

Recently, we once again produced annual infection rates that are well below the average national rate of nine percent. In fact, they are eight percent below that figure. Although I believe that our outstanding success is due to our total and complete commitment to patient centered care, for those of you who are in need of more quantitative substantiation that is less subjective, we decided to provide that for you as well. So, we went directly to the source, our infection control specialist, Carol, and asked her to elaborate on some of the steps that she takes on a daily basis.

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The Health Blog talked with a few Democrats this week. They aren’t particularly optimistic of health care reform:

While the candidates talk about plans to cover the country’s 47 million uninsured, some congressional Democrats are, shall we say, lowering expectations.

Learning by Surfing: Issue 1

Often I find things I would like to share but don’t have enough days in the week to do so.  Solution: Learning by Surfing [working title].  Here will be links, comments, other stuff, etc. that time did not allow me to share earlier in the week.

Well, you know, effective markets aren’t created by vacuums. Markets are ways to channel human energy and ingenuity, but only when they’re transparent, when they’re structured, when you’re building on human social capital, when you’ve got talent and investment capital. If we really want to think about new solutions, it’s not just identifying the right people and the right programs; we need to create an environment where these people and solutions are able to thrive.

I am often transfixed by the similarities between health care and education reform.  The above quote is from Frederick Hess, the director of education-policy studies at the American Enterprise Institute, in a New York Times Magazine article discussing education reform through philanthropy.  I don’t know which industry’s problems would be easier to fix, but maybe if were to find solutions that work in one, we could solve the problems in the other.  Interesting outlook by Hess, “We can’t solve it without outside intervention.”

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1 Friday: 4 Futures is one component of a New York community based initiative that “seeks to engage Western New Yorkers in exploring possibilities and setting goals for a stronger, improved health care system for the eight-county region.”

The project’s goals are to 1) promote broader, informed civic engagement in our communities on matters of health and health care; 2) give voice on health care priorities to those who use and those who pay for health care; 3) define a people-driven set of priorities which can be tracked to measure progress toward the desired goals; and 4) learn lessons from other places about ways to improve our health care system.

1 Friday: 4 Futures seeks to help people think about the future of health care in New York through four intertwined stories (pdf) that takes place on one day in the future.  “The date is the same in each story but each Friday has been reached along a different path, with distinctly different outcomes for all involved.”

Just noting a different attempt at laying the groundwork for reform.

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The Comarow on Quality blog turned its forum over to a nurse for a blog post to write about her encounter with the health care system from the patient side when she took her daughter to the ED.  She documents her concerns, demands, and overall thoughts on the entire experience.  I always find it interesting when providers’ experiences with health care shift their thinking.

The discouraging part is that she came back for post two.  This time to address the (many negative) thoughts and comments of other nurses on her experience.  Interesting stuff.

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From the Health Business Blog:

American Public Media, which produces radio shows such as Marketplace, has launched Health Care Idea Generator, a website dedicated to a discussion of how to improve the American health care system. Everyone seems to have an idea or two on what’s wrong with health care and how to fix it, so the site is an attempt to harness that energy.

As I was reading the post, it struck me that all the of the ideas would effectively add costs to the system, which also was the opinion of David Williams:

Like so many of the health care ideas out there, all of these will end up boosting overall health care spending, which isn’t going to help our overall problems.

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Tom Peters and customer service.  Nothing is Irrelevant.

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From Al Dente:

To curtail Japan’s overweight population, the Japanese health ministry recently mandated that all waistlines among its 56 million workers over age 40 be below “regulation size” of 33.5 inches (for men). Any company failing to bring its employees’ weight under control–as well as the weights of their family members–will be fined up to 10% of its earnings by the government.