Why American Health Care is So Pricey

Americans pay more for health care than people in many other developed countries, and Elisabeth Rosenthal is trying to find out why. The New York Times correspondent is spending a year investigating the high cost of health care. The first article in her series, "Paying Till It Hurts," examined what the high cost of colonoscopies reveals about our health care system; the second explained why the American way of birth is the costliest in the world; and the third, published this week in The Times, told the story of one man who found it cheaper to fly to Belgium and have his hip replaced there, than to have the surgery performed in the U.S.

To hear the Fresh Air interview with Elisabeth Rosenthal, to go http://www.npr.org/2013/08/07/209585018/paying-till-it-hurts-why-american-health-care-is-so-pricey

Hospital Charges in US Vary Wildly

As discussed in the Time article on "The Bitter Pill", the government is publicly revealing how much hospitals charge, and the differences are astounding: Some bill tens of thousands of dollars more than others for the same treatment, even within the same city.

 For example, the average charges for joint replacement range from about $5,300 at an Ada, Okla., hospital to $223,000 in Monterey Park, Calif., the Department of Health and Human Services said. That doesn't include doctors' fees.

 "It doesn't make sense," Jonathan Blum, Medicare deputy administrator, said Wednesday. The higher charges don't reflect better care, he said. Blum said the Obama administration hopes that releasing the information, at www.cms.gov online, will help lead to answers to the riddle of hospital pricing - and pressure some hospitals to lower their charges.

 The database also will help consumers shop around, he said. "Hospitals that charge two or three times the going rate will rightfully face scrutiny," Health and Human Services Secretary Kathleen Sebelius told reporters. Moreover, consumers will get insight into a mystifying system that too often leaves them with little way of knowing what a hospital will charge or what their insurance companies are paying for treatments, Sebelius said.

Here are hospital charges in Tucson:

Read on...

A usability issue: Medical devices constantly beeping

I found this article in the AZ Daily Star on an AP report about delays in treatment due to medical devices constantly beeping.   The article goes on to say that hospital workers are "desensitized" to the beeping and so ignore the noise, leading to "at least two dozen deaths a year on average," a hospital accrediting group reported.  Like alert fatigue, where clinicians ignore alerts because they get so many of them that they override them (a simple workaround).   The beeping devices include those that measure blood pressure and heart rate, among other things. Some beep when there's an emergency, and some beep when they're not working. That can lead to noise fatigue and the delay in treating a patient can endanger lives, the accreditation commission says.

Read on...

TQM and Physician Involvement

In the case we read about Virgina Mason's use of Toyota's Production System (TPS) and the associated management philosophy of Total Quality Management, which was adopted widely among health care delivery organizations in the early to mid 1990s (p. 5 in case).  Experience with these techniques was mixed, with some observers arguing that TQM was not applied correctly in health care and others arguing that the approach was ill suited to an industry in which the underlying science was based on biology not physics, cause and effect relationships were poorly understood and the primary worker (the doctor) was only loosely affiliated with the organization.

In a 2003 survey by Casalino and colleagues found that even after more than a decade of focus on process improvement, physician groups’ use of the of tools for process management, such as clinical practice guidelines, disease registries, and performance measurement and benchmarking was limited.

One important factor in whether or not TQM gained traction in a health care delivery organization and was effective was physicians’ involvement in hospital governance. The alignment between physicians and the health care delivery organization (defined as “the degree to which physicians and organized delivery systems share the same mission and vision, goals and objectives, and strategies, and work toward their accomplishment”) was an important determinant of whether physicians adopted a range of clinical management practices aimed at improving clinical performance.

We will next read how Intermountain Healthcare changed clinical operations.  As an example of how Intermountain uses lean management strategies, here is a video that gives you an idea of how early attempts at TQM can work today.

L. Casalino, R.R. Gillies, S.M. Shortell et al.,“External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients With Chronic Diseases,” JAMA (2003), 289, 434-441.

The Direct Project: Exchanging Health Information Over the Cloud

I found this site at IBM Developer about the Direct Project.  This is a cloud-based, open source, Java-based client that allows secure email to be sent in health IT systems.   The articles starts by stating,

"Cloud computing has been a game-changer in promoting system interoperability and reducing IT costs in almost every other industry, but it has been difficult to adopt the cloud computing paradigm for health IT. Today, health IT in the cloud is mostly limited to hosted electronic health record (EHR) providers for small practices such as eClinicalWorks and PracticeFusion (see Resources)   Such providers focus on hosting data and services (in the software-as-a-service or SaaS model), but not on data exchange. Large hospital systems have so far not adopted cloud computing in any meaningful way."

The article provides great technical and practical information about the history of Direct, how it works, and the challenges it faces.  There are also links to other resources.

New ACO expands in Tucson

In today's Arizona Daily Star, the headline reads, "New 'accountable' model of health care expands here."  I mentioned in class that TMC had an ACO, called Arizona Connected Care.  The CIO is a UA Masters in MIS alum, Michael Griffis.  You can check him out on LinkedIn. (Maybe there's a project there for some of you.)

Arizona Connected Care, is what's known as an "accountable care organization."  It is the only accountable care organization in Southern Arizona, and it's the first markets where UnitedHealthcare is partnering with an ACO.

At least three accountable care organizations are operating in Arizona. Patients do not need to do anything to participate. As long as their care providers are part of Arizona Connected Care, they will see no changes other than more follow-up and attention from providers in the organization.

The article goes on to say that thousands of Southern Arizonans enrolled in UnitedHealthcare "will soon be able to get care through a unique local business that's intended to contain spiraling medical costs by giving patients more attention."  The goal is fewer chronically ill patients and fewer hospital readmissions.

"Monitoring patients after they are discharged can help keep them from falling through the cracks and improve communication between various providers like a hospital, nursing home, physical therapist and rehab center," officials say.

Read more from the article, and check out Arizona Connected Care.

Growing Pains as Doctors' Offices Adopt Electronic Records

Information technology has transformed much of the American economy, but its use in health care still lags, especially when it comes to electronic medical records.  Here's an example: The state of Colorado runs a computerized registry where any provider who gives a child a vaccine can report that information. The system should help kids stay current with their immunizations.

But the state's computer system isn't compatible with most of the ones doctors use, so many practices don't update the central database because it's just too much extra data entry, says Dr. Allison Kempe, director of the Children's Outcomes Research Program at the University of Colorado School of Medicine. That means doctors and researchers like her, who try to keep kids' immunizations on track, can't rely on it to make sure a vaccine isn't missed or given twice.

We're talking thousands of data fields around things that are life and death," says Farzad Mostashari, the national coordinator for health information technology at the Department of Health and Human Services. His office is charged with leading American medicine's digital transformation.  Patients would get better care, at lower cost, if health care systems could share patient records easily. But that won't happen until doctors and hospitals start getting paid for being smart about IT. 

Read more, or listen to the story.... and follow links to Kaiser Health News at the end of the article for other excellent news on health and healthcare.

When Doctors Don't Listen

I was driving to school and wished I could share this with you in the moment.    It was on the Diane Rheem show, and she was interviewing two doctors about a book they just wrote, "When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests."

The United States spends $2.5 trillion on health care, accounting for more than 16 percent of our gross domestic product. But more spending has not translated into better results: the U.S. consistently ranks below other countries on delivering quality health care. A major culprit in rising costs is medical testing, which totals $250 billion extra every year. In a new book, two Harvard doctors say physicians rely too much on algorithms and formulas to make a diagnosis, leading them to order unnecessary tests. How to get the right diagnosis and better care from your doctor.

The focus of the book is on 8 pillars that patients can do to get the care they need.  

Here is the Diane Rhem show about this topic.  Here is the transcripts, or you can listen to the audio. If nothing else, read the excerpt from the book, as well as the comments from others.  

Add your own thoughts to this post.    Have you are a loved one or friend experienced doctor visits where tests are done before they truly understand what is wrong with the patient?  Do you think the 8 pillars will work?  Why or why not?

UA@WORK

  Maybe you've seen this "Smart Moves" icon around campus.  The U of A is helping employees and students be able to identify programs, services activities and food choices that promote a healthy lifestyle.  David Salafsky, director of health promotion and preventive services for the Campus Health Service. "We have a great campus community that promotes walking, biking and a range of physical activities. A lot of programs are already in place. This is really about identifying them."

I've asked David to come to talk to our class.  Follow other UA@Work initiatives.

Would you be more likely to use services that had the "Smart Moves" icon?  Why or why not?