Physicians thoughts on medical care decisions and third-party payers [Reblog]

An excerpt from Quality vs. Quantity by By MICHEL ACCAD, MD at The Health Care Blog (4 March 2016)

“If we bear in mind that medical care consists of decisions and choices made in the face of uncertainty, then the quality of a decision can only be determined in real time, in a specific context, in light of all its alternatives. A third-party payer—public or private, single or multiple—cannot possibly obtain the needed knowledge to make that determination. For an outsider, the quality chasm is metaphysically impossible to cross. Measuring quality is grasping at straws.”

[Report] Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

From the 1 January 2014 report at Health Affairs

Abstract

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power.

This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care.

High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins.

Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates.

Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

 

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Improving Health Care through Mobile Medical Devices and Sensors

From the 22 October 2013 Brookings Report

Health care access, affordability, and quality are problems all around the world and large numbers of individuals do not receive the quality care that they need. Mobile technology offers ways to help with these challenges. Through mobile health applications, sensors, medical devices, and remote patient monitoring products, there are avenues through which health care delivery can be improved. These technologies can help lower costs by facilitating the delivery of care, and connecting people to their health care providers. Applications allow both patients and providers to have access to reference materials, lab tests, and medical records using mobile devices.

Complex mobile health applications help in areas such as training for health care workers, the management of chronic disease, and monitoring of critical health indicators. They enable easy to use access to tools like calorie counters, prescription reminders, appointment notices, medical references, and physician or hospital locators. These applications empower patients and health providers proactively to address medical conditions, through near real-time monitoring and treatment, no matter the location of the patient or health provider.

In this paper, part of the Mobile Economy Project, Darrell West looks at specific applications and inventions, and discuss how mobile is transforming health care in the United States and around the world. He argues that mobile health helps frontline health workers and health care providers extend their reach and interactions – enabling them to be more efficient and effective in their provision of medical assistance. And in the conclusion, West recommends several steps that will speed the adoption of mobile technology in health care.

• Policymakers should encourage the use of mobile devices for health care. Moving to electronic systems for service delivery will save money, improve access, and provide higher levels of quality in both developed and developing nations.

• Nearly three-quarters of medical expenditures takes place on a small number of chronic illnesses including cardiovascular disease, cancer, diabetes, and asthma. We should encourage the use of mobile systems that monitor patient symptoms and provide real-time advice on treatment and medication because they have the potential to control costs, reduce errors, and improve patients’ experiences.

• We should work to remove barriers to adoption of mobile applications that aid in chronic disease management and make these tools much more widely available.

• With growing knowledge about diseases, genetics, and pharmaceutical products, the practice of medicine has become far more complicated. Health providers need access to as much accurate data as they can get on how to treat various ailments.

• One of the barriers to cost containment and quality service delivery has been the continued reliance in many locales on paper-based medical systems. In a digital world, one cannot imagine a costlier way to run a health care system.

• On the issue of government regulation, the FDA has finalized its guidance on how mobile applications and regulated mobile medical devices are to be treated in an effort to clarify some of the ambiguities and help further innovation. Having clear rules that encourage desirable behavior is the best way to move forward in mobile health.

Editor’s Note: This paper is released in tandem with the panel discussion: The Modernization of Health Care through Mobile Technology and Medical Monitoring Devices on October 22, 2013.

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Nurses’ Assessment of Hospital Quality Often On the Button

 

From the 8 October 2012 article at Science Daily

A new study from the University of Pennsylvania School of Nursing affirms a straightforward premise: Nurses are accurate barometers of hospital quality.

Perceptions from nurses — the healthcare providers most familiar with the patient experience — about hospital quality of care closely matches the quality indicated by patient outcomes and other long-standing measurements.

“For a complete picture of hospital performance, data from nurses is essential,” said lead author Matthew D. McHugh, a public health policy expert at Penn Nursing. “Their assessments of quality are built on more than an isolated encounter or single process — they are developed over time through a series of interactions and direct observations of care.”

Nurse-reported quality accurately correlated with outcome measures including death and life-threatening post-surgical complications, and patients’ reports of the care experience, wrote Dr. McHugh…

 

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Analysis Of Interventions In 5 Diseases Offers Guidelines To Help Close The Gap

 

Racial/Ethnic Disparities in Self-Rated Health Status among Adults with and Without Disabilities — United States, 2004–2006. MMWR 2008:57(39);1069-1073.

 

From the 19th July 2012 article at Medical News Today

Major disparities exist along racial and ethnic lines in the United States for various medical conditions, but guidance is scarce about how to reduce these gaps. Now, a new “roadmap” has been unveiled to give organizations expert guidance on how to improve health equity in their own patient populations.

Finding Answers, a national program based at the University of Chicago and funded by the Robert Wood Johnson Foundation, seeks evidence-based solutions to reduce racial and ethnic health disparities. Its new roadmap, outlined as part of a symposium of six papers published in the Journal of General Internal Medicine (JGIM), builds upon seven years of administering grants, reviewing literature, and providing technical assistance to reduce health disparities.

The roadmap’s architects hope it can provide direction on creating effective and sustainable interventions as the health disparities field shifts from measuring the problem to taking action. ..

…The paper highlights the initial need for recognizing disparities and commitment to their reduction, and suggests that programs to reduce disparities should be integrated into broader quality improvement efforts at clinics, hospitals and other health systems.

“In the past, people did disparities work or quality work, but the two wouldn’t touch one another,” Chin said. “We’re merging the quality improvement field and the disparities field.”

The roadmap also contains advice on designing interventions to address disparities, drawing upon systemic reviews of disparities research in various diseases. Five such reviews – on HIV,colorectal cancer, cervical cancer, prostate cancer and asthma – accompany the roadmap article in the JGIM symposium.

Researchers identified characteristics of successful interventions across the five new articles and previously published reviews of cardiovascular disease, diabetes, depression and breast cancer. Effective projects were found to utilize team approaches to care, patient navigation, cultural tailoring, collaboration with non-health care partners such as families or community members, and interactive skill-based training.

The reviews also identified potential targets for reducing health disparities that have yet to be examined..

..While offering general guidelines for best practices, the authors point out that the specifics of any organization’s effort to reduce disparities must be custom-fit to the patient population and community. …

References for this article

The paper, “A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care,” was published on July 13 by the Journal of General Internal Medicine. Five systematic reviews of disparities interventions in HIV, colorectal cancer, cervical cancer, prostate cancer and asthma accompany the main article. The articles are open access, and can be read here:http://www.springerlink.com/content/0884-8734/27/8/
The publications were funded by Finding Answers: Disparities Research for Change, a Robert Wood Johnson Foundation program, with direction and technical assistance from the University of Chicago. More information about Finding Answers and the Roadmap to Reduce Disparities can be found athttp://www.solvingdisparities.org.
University of Chicago Medical Center

 

 

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The State of Quality Improvement Science in Health

The State of Quality Improvement Science in Health

What Do We Know About How to Provide Better Care?

By: Devers KJ

In: Quick Strike Series

Publisher: Urban Institute

Published: November 2011

“The well-documented problem of quality, the Affordable Care Act’s numerous quality provisions, and economic realities for public and private payers have increased pressure on providers to improve health care quality. This paper reviews the evolution of QI initiatives, the current evidence about whether QI interventions work, QI’s promise for the future, and how to help it find success in health care.

The paper makes recommendations for enhancing QI efforts in health care, including providing stronger incentives for health care providers and organizations to prioritize quality; improving education, training, and technical assistance for providers; leveraging electronic health records or other health information technology that can support QI efforts; and increasing collaboration between federal agencies, foundations, private purchasers, professional associations, and industry groups.”

A disconnect between medical resources and health care delivery

Image via Wikipedia

by MAGGIE KOZEL, MD at KevinMD.com (November 27, 2011)

Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness.  What if we put our brains, energies and passion behind designing the smartest health care system possible?

That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics.  Thestudy, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and anticipatory guidance.  No big surprise that the longer the duration of the well child visit, the greater the likelihood that the content of the visit was aligned with recommended practice guidelines from the AAP.  The discouraging news however is that one third of visits were reported as being less than 10 minutes in duration; these occurred to a greater degree in private practice.  Longer visits of 20 minutes or more made up 20% of the encounters, and were more likely to occur in community health centers.

 

The big winners in the pinch for time?  Guidance on immunizations and breastfeeding were offered in 80% of even the shortest visits.  The biggest loser: developmental assessments, which don’t even achieve a mediocre occurrence of 70% until we pass the 20-minute mark for visit duration….

…

Our fee for service approach to health care dictates that procedures and tests pay well while addressing a child’s emotional problem gets a doctor little more than a backed up waiting room.   From the patient’s view, underinsured children have to rely too much on emergency rooms, while insured parents can only get basic child rearing advice from someone with a medical degree. Health insurance companies and the pharmaceutical industry shape medical practice – and our collective health – through their reimbursement policies, marketing and aggressive lobbying.  So 25% of US children are on chronic medications, while half the children in pediatric practice are not receiving basic screening and advice. The obsolete business models that the health care industries rely on are like the tyrannosaurus-rex in the room, emphasizing expensive, short term quantity rather than cost-effective long term quality, while cognitive care – a high level of skill and expertise delivered face to face in a personal manner – is what is becoming extinct.

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CMS Launches Tools and Initiatives to Help Improve American Health Care Quality

The Centers for Medicare & Medicaid Services (CMS) announced a new tool for patients and caregivers, and other enhanced initiatives, to empower consumers to make informed choices about their health care, and to help improve the quality of care in America’s hospitals, nursing homes, physician offices, and other health care settings.

From the  5 August 2011 press release

“These tools are new ways CMS is making sure consumers have information about health care quality and important information they need to make the best decisions about where to receive high-quality care,” said Dr. Don Berwick, the CMS Administrator.  “These efforts are designed to also encourage providers to deliver safe, patient-centered care that consumers can rely on and will motivate improvement across our health care system.”

The steps announced today include:

·       A Quality Care Finder to provide consumers with one online destination to access all of Medicare’s Compare tools — comparison information on hospitals, nursing homes and plans: www.Medicare.gov/QualityCareFinder.

·       An updated Hospital Compare website, which now includes data about how well hospitals protect outpatients from surgical infections and whether hospitals care for outpatients who are treated for  suspected heart attacks with proven therapies that reduce death: www.hospitalcompare.hhs.gov

Read the entire press release 

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