IT for Healthcare

Cincinnati Hospitals in Feud Over Health Alliance

Two Cincinnati-area hospitals, St. Luke and Christ, are engaged in a dispute with regional healthcare group, Health Alliance.  The two member hospitals are arguing that the group's leadership have made decisions that endanger their charitable mission to uninsured and indigent in the neighborhoods they serve.  In a bit of inspired hyperbole, an Alliance attorney likened the decision to withdraw to "dropping the nuclear bomb."  Presumably without the mushroom cloud, firestorms, and massive amounts of radioactive fallout.

Retail Clinics Enhance Primary Care Physicians Business

My initial reaction while reading this piece was that retail clinics would syphon patients away from already hurting private practices.  Then this:

Michael O’Neil, senior vice president and chief operating officer of Memorial Health System in South Bend, Ind., says the one-hospital system’s three MEDPOINT Express clinics have helped bring new patients into the network. “About 30 percent of the people coming in are not connected to a provider, and many require subsequent follow-up care,” he says. “We’re seeing a lot of our affiliated primary-care physicians get a number of referrals from these operations.”

Clearly the folks visiting these retail clinics are gaining much needed care at affordable rates; meanwhile, physicians are benefitting from bringing more of these folks - until now on the fringes of healthcare in America - into the system.  One hopes that the American healthcare system in general will also benefit from that early and preventive care many of these people would not have gotten otherwise.  I'm feeling optimistic today, so if you think my glasses are too rosy or see some reason(s) why Wal-Mart providing your healthcare is inherently wrong, let me know.

Menu of Services & Prices (MEDPOINT)

The Healthcare Payer Debate

There's a pretty hot debate going on over at Brewed Fresh Daily right now about the merits and pitfalls of our current healthcare payer system versus universal/single-payer healthcare (versus some as-yet-undiscovered-but-undoubtedly-infinitely-better system).  It probably isn't going to solve any of the world's problems but it is fun to watch!

Link

Speaking of Stakeholder Involvement. . .

At the end of this post, and as an echo to Dr. Rob Lamberts' calls here, we called for greater patient participation in the transformation of healthcare, especially the adoption of HIT measures and incentive policies such as P4P.  As if on cue, we then ran across this post by Dr. Steve Beller, also at The Medical Blog Network, on this exact subject.

If the American public is to ever stand up and demand meaningful change, they would need a sensible rallying point, something they can understand and support, and something that is powerful enough to withstand the push-back from the mighty self-interests gaining from the status quo who will resist such change. . . .

If I’m correct, rallying the public first requires educating them about why feeling insecure about their health and finances is the most rational reaction to the current healthcare system. They then have to debate what changes are necessary to transform the system, which requires further education, along with good collaborative communication for discussing and evaluating ideas.

Interesting.  There's a longer thread at The Health Care Blog with some back and forth on this subject.

There's also an article at abcnews.com that touches on the Healthcare IT revolution and it's role in bringing about better, more efficient, more cost-effective care:

 

Better availability of information will improve quality and customer service, but it is by no means certain that the adoption of information technology will inevitably lead to big cost savings.

Some efficiency will be gained by eliminating transcription costs and reducing duplication of tests, but better information may actually lead to higher spending. After all, with more information about their conditions, patients may seek additional treatment.

Information can be used to hold down health care costs, but that requires political will. . . .

If we choose as a society to use information for hard decisions, costs will be contained. But the model will be different from the

United Kingdom

and

Germany

. We'll use incentives and cost sharing, not outright bans and price controls. Examples are emerging in the public and private sectors.

The political will required will come of greater understanding and participation on the part of all Americans when it comes to their healthcare, the options they face, and how new technologies impact those options.  The "rallying point" required is two-fold: 1) "Better availability of informaiton. . . . " and 2) better communication of that information.  As healthcare consumers (patients) learn to demand more of each, they will become better partners to their doctors in the ongoing process of their own health maintenance.  That's a goal both doctors and patients can get behind. 

Changing Culture Improves Care

Dr. Brent James, a Harvard-trained surgeon and statistician working with Utah's Intermountain Healthcare, is working hard to change the culture in which physicians practice.

When James began researching to compare treatment results, he found the discrepancies were staggering.

"It turns out that physicians mis-estimate the truth about 20 to 50 percent," James said.

He found doctors were far less accurate if they relied on their memories rather than on computer data. Armed with his statistics, James began to change the medical culture.

This article is brief but has some good information.  Also, check out Dr. Rob Lamberts' blog on The Medical Blog Network for analysis from a practitioner:

Many physicians oppose pay for performance, saying that it is so wrought with problems that it will cause more problems than it solves. I think, however, that one of the main reasons they oppose it is fear of finding out that their quality does not stack up.  In our practice, analysis of our data showed significant deficiencies in certain areas. Rather than get upset by these deficiencies, however, we were able to correct these problems and greatly improve the care for our patients.

That sort of blunt assessment may not win many friends in the healthcare community but it seems to us that it's exactly what is called for today.  There is clearly a disconnect between the community of healthcare providers (generally) and the best interest of patients.  According to Dr. Lamberts: The patient is often left out of the discussion regarding EMR and P4P. I believe that they stand to have the greatest benefit from the adoption of these changes.  We need to find ways to include every stakeholder in this discussion and work to better understand how the tools of technology can help create more efficient, higher quality care settings and improve communication between physicians and patients - all while ensuring that physicians are compensated for the increased quality of care they provide.

Small & Medium Practices to Demo P4P

CMS announces a new three-year pay-for-performance demo program for small and medium physician offices.

Under this demonstration, physician groups will continue to be paid on a fee-for-service basis. Participating physicians will submit data on up to 26 quality measures related to the care of patients with diabetes, congestive heart failure and coronary artery disease, as well as the provision of preventive health services such as immunizations and cancer screenings to high-risk patients. During the first year, the program will be a “pay-for-reporting” initiative to provide baseline information on quality and to help physicians become familiar with the quality measurement process. In subsequent years, practices will be eligible to earn incentives of up to $10,000 per physician and up to $50,000 per practice annually.

Link

Looming Shortage of Geriatric Specialists in US

This story is an interesting counterpoint to our usual high-tech focus.  According to leading medical experts, there is a "mismatch between supply and demand" for elderly care specialists that will cause serious problems down the road.  Much of the problem revolves around the fact that care for the elderly isn't sexy.  According to Dr. Marie Bernard, "[Medical students] want to do laser-guided this and endoscopic that."

[Caring for the elderly is about] common-sense remedies in a health care system that rewards the heroics of specialists, in both compensation and prestige.  The best-paid doctors are those who do the most procedures; radiologists and orthopedic surgeons top the list with average annual incomes of $400,000. Geriatricians, who do a residency in internal or family medicine and then a fellowship in geriatrics, are near the bottom, at $150,000 a year.

Technology's great but ultimately, as stories like this prove, it's just a tool that helps caring, talented folks find ways to heal people.  We think that's important to keep in mind when discussing technology's impact on healthcare.

 

Hospital Tax-exemptions Debated

Crain's Chicago Business ran this story today on the fight Provena Health is facing over what the state terms "seriously insufficient" charity care and the resultant revocation of Provena's tax-exempt status.  Provena's CEO, Bill Foley, says, “We’re fighting for non-profit health care throughout the state and the country."  He pointedly disagrees with the Illinois Department of Revenue's "seriously insufficient" comment, responding that the decision is “very insulting . . . to everybody associated with our organization.”

While Provena claims that it provides millions of dollars in charitable care annually, the state counters that Provena Covenant (the Provena Health hospital in question) spent only $832,000 (0.7% of its revenue of $113 million) on “charitable care” in 2002.  The debate revolves around how to define "community benefit" and what tax breaks that benefit ultimately entitles hospitals to enjoy.

Our interest in this story stems from an April article in the Cleveland Plain Dealer exploring the same issue as it pertains to Cleveland Clinic and University Hospitals Health System.  Here in Northeast Ohio the debate is heated, considering the state of school funding and the dollars that these institutions would be contributing in that direction:

"Between the Clinic and UH, they're spending over $1 billion in construction," [Cuyahoga County Treasurer James] Rokakis said. "When you ask them to contribute an insignificant amount of money" to help the schools, they balk.

The hospitals counter that:

they provide a vital community service and that their vast army of employees pays millions of dollars in income taxes. Losing their tax exemptions would damage their viability and endanger one of Northeast Ohio's most successful economic engines, they argue. The Clinic, for example, has $3.3 billion in annual revenue and employs more than 34,000 people in Northeast Ohio.

Frankly, we find it hard to argue with that logic.  Northeast Ohio needs the Clinic more than the Clinic needs Northeast Ohio at this point.  With healthcare becoming such an economic driver in this country (and this region) it seems misplaced to worry about $20-30 million in taxes that hospitals aren't paying when big corporations and sports teams are getting massive tax breaks and delivering little in the way of jobs, etc. . . .  Add to the 34,000 Clinic employees the number of folks here making a living by doing business with the Clinic and you've certainly got more healthcare jobs here than the Cavs have created!  And "over $1 billion dollars in construction" sounds like an investment most regions would love to see coming from just two local businesses - hardly a point to start your complaint with.

So we'll give the final word to CCF:

"We have spent hundreds of millions of dollars over the years adding facilities to this campus," said Michael O'Boyle, the Clinic's chief operating officer. "We have added thousands and thousands of jobs both here and throughout the region. No one entity, not the Cleveland Clinic or anybody else, can solve every problem."

Study: Basic MD errors lead to malpractice

An article from The Star-Ledger at NJ.com declares:

Basic errors made by doctors, including tests ordered too late or not at all and failure to create follow-up plans, played a role in nearly 60 percent of cases in which patients were allegedly hurt by missed or delayed diagnoses, a study found.

The story goes on to discuss recommended solutions to the problem:

The study's lead author, Tejal K. Gandhi, director of patient safety at Brigham and Women's Hospital in Boston, said the research shows that doctors could use more help in making decisions. Things that could help include more use of electronic records, better algorithms for making evaluations and the use of nurse practitioners to help ensure that follow-ups actually occur, she said.

Link

Healthcare Costs Continue to Rise

From the New York Times:

A widely followed national survey reported yesterday that the cost of employee health care coverage rose 7.7 percent this year, more than double the overall inflation rate and well ahead of the increase in the incomes of workers.

Link