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Recently, the Massachusetts Health Care Quality and Cost Council unveiled its new website, My Healthcare Options.  While intended to directly support consumers and physicians as a decision-making tool, the site unnecessarily penalizes otherwise good hospitals through inconsistent ratings, by presenting those ratings without context, through a bias against larger hospitals, and by penalizing hospitals for compliance on reporting data transparently.

 

Although the site attempts to answer such questions as, “My doctor sees patients at two hospitals. Which one should I use?”  in many categories, the data is not consistent enough to adequately offer a patient choice.  Angioplasty, one of several methods to deal with a heart condition, has no ratings; the variance on quality is so small as not to matter.   In other categories, one may find disclaimers, even on where ratings are applied: “Data is not available to calculate Statistical Significance” or “Not different from Average Quality.”  Isn’t the point of a rating system the fact that it provides definition?

 

The danger with the site’s approach to ratings is that it lacks context.  Stars are awarded according to the sample size and the measurements are relative.  This will lead to more, not less, confusion on the part of patients.

 

By example, if one searches for a hotel in Boston, selections are ranked based on a star rating according to well-established and widely-available criteria.  Hotels must meet a minimum threshold to maintain their ratings.  For example, amenities like fitness centers or pools are generally necessary if a hotel wants to achieve three stars.  Cities may have numerous hotels at a variety of star levels, but all four star hotels are comparable in their service, regardless of location.  For example, Boston maintains twenty-six 4 star hotels while comparatively-sized El Paso, TX boasts only one.

 

If one searches for a book on Amazon.com, ratings are based on customer experience of that product and these ratings are cumulative.  Since books are published with a certain size of audience in mind, the ratings become statistically significant once a few dozen reports are in.  Without fail, most books are above average  — 2.5 stars or greater.   Is that because books are largely a matter of personal taste?  Perhaps, but it also stems from the fact that the commercial editorial process ensures that there’s not so many absolutely lousy books published.

 

The new Council site applies this star motif – well established as threshold criteria in hotels or experience of consumer products online  – in a way inconsistent with consumer expectation.   In areas with sufficient data, 30% of hospitals must be given either a 1 star or 4 star rating, while 70% must be given a 2 star or 3 star rating.  In some cases, the ratings are undermined by disclaimers.  In others cases, category ratings are avoided.   What if the worst hospital in Boston is still better than the best hospital in El Paso?   Wouldn’t that be worth knowing?

 

Hospitals who have invested in building relationships with patients, their families, physicians and the community at large are right to be concerned with how the Council’s site portrays them.  The site is clearly intended to influence volume and bias against larger hospitals.  On the homepage, it notes, “This website can help you answer questions such as…  Would I get better care for this health problem at my local hospital or a large medical center?”

 

The correct answer is that it depends: quality measures can be influenced, in part, by pedagogical selection of the staff.  Some very fine “large medical centers” are lower ranked than their “local” counterparts, despite the fact the AMCs legitimately provide more options for treatment.

 

Consider angioplasty again.  It is a very safe procedure that requires a less significant investment than an open heart surgery program.  It is easier to find staff trained in the procedure.  It is also a procedure where the reimbursements are higher than the costs of delivering services.   In this case, hospitals of various sizes can offer angioplasty services to their community.   If a patient needs open heart surgery, however, the scale of the undertaking is much, much higher.  Those patients must be passed on to those “large medical centers.”  Aren’t overall outcome measures of heart attacks influenced by these administrative choices, choices which are based financial necessity?

 

Or consider that the few large medical centers in Massachusetts are located in urban areas, where populations are less homogenous and less likely to receive preventative care.  Evidence shows that culture, class, and ethnic background of patients can measurably influence outcomes.

 

The majority of hospitals operate on razor thin margins – margins which, with the slump in investment portfolios this year, might disappear entirely – and those hospitals depend on a few diagnostic categories, like angioplasty, whose reimbursements fund their emergency rooms.  Would the state of Massachusetts prefer all heart patients from Worchester drive to Framingham if that means all the ERs in Worchester will close?

 

This new site is applying criteria that was never intended to penalize hospitals and yet now does exactly that.  To champion transparency as a method of helping hospitals report on and improve their quality and safety measures is very different from assigning them a bell-curve grade based on those results.  Already, hospitals are under increased pressure due to recent Medicare’s “never events” policy to not pay for complications created by medical error.

 

If the rating scale were absolute – as some other national reporting standards are – then we could know how well the average hospital was doing and which hospitals were above or below that average.

 

If this approach were followed, perhaps all of the rest of the stars would flatten out, eliminating most observable differences.  Yet that’s going to happen anyway.  As Medicare begins to increase restrictions on reimbursements for medical errors, private insurance will certainly follow suit.  The general level of quality, as in book publishing, will be dictated by market forces.

 

While I do not envy the challenge the Council has undertaken, if the site were recast with a more absolute model, only the truly outstanding, in either direction, would be highlighted.  Perhaps this would make for a less compelling website.  But instead of pitting hospitals unnecessarily against each other or confusing consumers who are already confused, our state could spend its energy working to learn from the leaders and helping reform those who need it most.

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Dec
11

My Healthcare Options

Posted by: Paul | Comments (0)

The long, long, long awaited — and perhaps feared — Massachusetts quality and cost site just launched yesterday, entitled MyHealthcareOptions.

Despite a funky stretched out picture on the homepage and a cartoony rating stars that evoke a Mario Brothers outing more than Michelen fine linen, I’ve been having fun poking around the site already.

True, I am giving a webinar about cost and quality today so I would be remiss in not discussing such a site, but I am intrigued by brand promise of the site:

This website can help you answer questions such as:

  • My doctor sees patients at two hospitals. Which one should I use?
  • Would I get better care for this health problem at my local hospital or a large medical center?
  • How does this hospital compare to others for the treatment I need?
  • I pay for some of my health care. How can I get quality care at the best price?

I am fascinated by #1 and what it says about the evolving role of the patient and the physician relationship… I will ask our webinar attendees and see what they think about the issue.

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Nov
24

WWDD — What Will Tom Daschle Do?

Posted by: Paul | Comments (0)

The former Senator Tom Daschle has been picked for the HHS top spot, and there’s been some excellent speculation — I mean, coverage about what Daschle might do once in office.   I think we often miss the forest for the trees when we talk in these grand policy terms.  Sure, the healthcare system is broken.  I think you’d be hard pressed to find anyone who disagrees on that point, but it’s very difficult to agree on how it’s broken.

WWDD?  Let Americans pay for healthcare, regardless of job status, and create a healthcare Federal Reserve to oversee the policies and power of the Federal Healthcare program. 

The conversations we need to have from a policy side are precisely around what kind of healthcare Americans want in this country: the best for all, the best for some, or the most efficient for all?  The solutions look much different for each scenario.

Also from WSJ:  Five Health Myths Busted. 

#2 is a joy for me.  It perfectly represents our natural ability to misjudge trade-offs, but I would temper Mr. Hensley’s position by the simple fact that, at the end of your life, you prefer a few extra years to a Corvette you might have preferred along the way.  (Assuming they’ll still be making those next year, but I digress.) 

And I’m not so sure that’s a bad thing.

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Nov
19

Winding down our travel season…

Posted by: Paul | Comments (0)

Despite travelling extensively, it was a real pleasure to speak at CHPRMS last week.  We had a great session on the changing nature of trust and how social media networks are resetting consumer expectations.  It was a fun time and a great crowd of about 100 people who remained engaged (and awake!) for an hour after lunch.

Sometimes that’s a mean feat.

We’ve been fortunate this year to help shape the content of a few different society meetings such as this.  Our last event for the year is coming up and I’d thought I’d pitch it here.  I’ll be speaking on a New England Society for Healthcare Strategy (NESHS) webinar on December 11, 2008

If you’re not a member and you live in New England, you should consider it. NESHS provides great value for the membership fee.  And hey, you’d get to listen to me!

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MedTouch Webinar: The Impact of the Global Financial Crisis on Healthcare, Part II from MedTouch on Vimeo.

The news about the financial sector meltdown is everywhere, but how will it impact healthcare?

In this second part of a special webinar, Paul Griffiths, the CEO of MedTouch, will walk through how the sub-prime crisis led into Wall St. failures, which has spilled over into the bond market, threatening usual routes of funding for healthcare, muncipalities, and non-profits.

We’ll review what hard decisions providers will have to make over the coming year, and talk through some possible short and long term results from the financial bailout.

The Impact of the Global Financial Crisis on Healthcare

What you’ll learn:

* Why the financial crisis started
* Why the crisis will make it harder for hospitals to stay in the black
* Which healthcare providers should do today

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We’ve done a fair amount of research this year on the impact of the physician shortage and how it will hamstring the marketing, planning, and delivery of healthcare services in the future.

The silent killer is patient access.   The less chance a patient has of being seen quickly, the worse off he or she will be.  Having an adequate supply of doctors is the basic ingredient of healthcare delivery.  And primary care doctors, who provide those front-line services, are getting even harder to find.

Here’s three reasons why you might be facing an uphill battle, wherever you are.

1. Supply is dwindling.

The AMA reports that nearly half of its members are 50 or older.   If you segment out primary care docs, the news gets worse.   Medical schools are graduating an increasing rate of some specialists, but primary-care graduate rates are falling as medical school becomes an increasingly costly investment.   In the wake of the Patriot Act and the falling value of the dollar, there’s also the fact that more international students are going back home instead of staying put.   (Thomas Friedman calls this the “reverse brain drain” in his book, The World is Flat.)

2. Demand is growing. 

The US population continues to a) grow and b) require more healthcare.   From an economic point of view, there’s no reason to think demand will curtail any time soon.  In fact, hospitals are seeking to drive more care to newly created Centers of Excellence to address complex diseases and conditions.  As more people demand more care from more providers, the rate of demand increases in both directions: hospitals need more doctors to improve patient access as well as treatment.  A client recently told me that a few treatment positions added to ease the strain on the existing physicians were now completely swamped with diagnostic visits.

3. Increasing alternatives to traditional practice models.

While graduating physicians can choose to start or join a traditional practice, there are a variety of other avenues as a result of the changing demands of new docs.  Whether hospitalist positions, physician-run speciality practices, locum tenens assignments, or roles within bio-tech companies, these options often provide fewer hours and more work/life balance than the classic physician practice model.  (Example: many hospitals around the country are now paying for “on call” services.)  Considering that 50% of the med school population are now women, these options will increase, primarily clustered around delivering less hours and less stress.

What’s the solution?

More on that later this week, but we’ll give you a hint: it has something to do with our upcoming webinar.

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Jul
10

Why Even Google Can’t Fix Healthcare

Posted by: Paul | Comments (2)

Of my last post about open source food, Jeff Jarvis commented:

I wasn’t suggesting that the kitchen should be turned over. I’m exploring the ideas of openness even in restaurants. For example, I’d like to know which dishes get ordered more so I can use that in my decision. Or perhaps diners can suggest improvements in recipes. And so on.

Next I’m tackling health. Since that’s your expertise, how do you think Googlethink could come to health care? Could it? Can doctors and health institutions be more transparent? What would we learn from aggregated and open data? Would there be value in a social relationship among patients? And so on. I have some ideas but I’d love to hear your thoughts.

From my point of view, the biggest challenge in healthcare institutions is the institutional thinking that goes on behind the scenes. Many good hospitals are trying to keep it all together, given the unfair hand they’ve been dealt: price-setting from insurance payors, even lower price-setting from the government, and the legal responsibility to treat anyone sick enoug to walk through their ER doors. Add in overall costs of service delivery increasing at a time when the costs of insurance are biting Joe Q. American’s pocketbook and Michael Moore’s Sicko… well, it’s a rough time right now in healthcare.

This leads to institutional thinking: how do we keep this boat together? And the simplest answer is command and control leadership. Don’t take risks, don’t innovate, trim costs wherever possible, etc. That’s not a critique — I’m sympathetic to the challenges here — but it does mean that providing patient access to data inside of a hospital is risky because it opens the hospital up to more risk.  Patient benefits be hanged!

I have been point-blank told, at more than one hospital, how much they’d like to get rid of system X or software Y, but they can’t. Even though it doesn’t work and there are better products available, they just can’t. It would be too costly — politically or capital-wise.

From an infrastructure standpoint, most hospital software is cumbersome, expensive, and (let’s face it) old. The sales cycle for a hospital engagement is often 18-24 months — contrast that to a Google service: free, immediately available, updates whenever you want! As good as the technology is, each hospital technology infrastructure is a jigsaw puzzle that barely fits together as is, never mind inviting a behemoth like Google into the mix.

A typical patient experience, from a hospital standpoint, goes as follows:

  1. I’m healthy.
  2. I’m worried I’m sick and go online to get health information.
  3. I see a doctor/RN for diagnosis.
  4. I go to a hospital for treatment.
  5. I am discharged.

Being a patient in a hospital is a terminal experience: it ends in discharge or death! The medical systems were created long before Starbucks convinced every industry that consumer relationships were what mattered (thank you, SB, for getting the stinky breakfast sandwiches out; here’s a to a $30 stock price again.)

Google Health might end up being a great tool for diagnosis but hospitals can’t embrace it… unless so many the physicians demand it for their patients.

The churn and noise about hospital transparency is basically saying, “Here’s proof we don’t kill that many people.” Transparency = quality of outcomes for a hospital. But in 5 years, that won’t matter. Once the measures of quality are open to the public, the payors and Medicaid/Medicare will use it as an excuse to stop paying hospitals with lousy outcomes. So, overall, the healthcare experience should get better. But that doesn’t mean we’ll know any more or less about the process.

I place much more faith in the power of patients to self-organize in a way that wasn’t possible even two years ago. With sites like PatientsLikeMe, patients in recovery — discharged, perhaps from a hospital — are about to connect about their quality of treatment in a real-time, clinic study fashion. Sites that provide disease/condition/treatment communities will be where hospitals can knock it out of the park. Imagine if every cancer patient in your town heard that XYZ Hospital was the best — from the site moderator!

That’s where the openness will come from: empowering patients who had great experiences to market the hospital with a level of authenticity not possible any other way. We just ran a few webinars on this topic — so popular, agencies and competitors showed up in droves to hear what we had to say. That tells me we’re striking a chord.

But, as I always say, the nice thing about talking about the future is that it’s difficult to be proven wrong. :)

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Here’s a no-brainer from the Atlantic: dingy hospitals rooms have a negative impact on patient care.

Over the past decade, most public places have gotten noticeably better looking. We’ve gone from a world in which Starbucks set a cutting-edge standard for mass-market design to a world in which Starbucks establishes the bare minimum. If your establishment can’t come up with an original look, customers expect at least some sleek wood fixtures, nicely upholstered chairs, and faux–Murano glass pendant lights.

I was just listening to a web video promo about the Amazon.com Kindle where said author (Michael Lewis) talked about how great it was to pass the hour long wait with his new digital reader.  Because, you know, the magazines are 6 months-old Sports Illustrateds.

“Except for the computers you see, it’s like a 1980s hospital,” says Jain Malkin, a San Diego–based interior designer and the author of several reference books on health-care design. “The place where patients spend their time 24/7 is treated as if it’s back-of-the-house.”

What the article didn’t go on to do was prescribe an solution: bulldoze old hospitals?  Make medical treatment virtual?  Open retail clinics?

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From our sister blog, adamcontent.com, is this post about what consumers actually want.  (Hint: It’s not 64-ct scanners.)

http://adamcontent.com/hospital-patients-want-convenience/ 

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Forbes magazine’s recent issue has a cover with a patient escaping from an ER, wearing only a paper johnny, and the text “Stop That Patient!  Big, risky hospitals don’t want you going to small rivals — where you could have safer, better surgery.”  You can read the article, entitled “Bad Medicine“, on Forbes’ website, but the message to me is clear: consumers want to understand the quality of care they can expect to receive before they check in.

I’ll admit to only a cursory understanding of the issues surrounding these physician-run hospitals and the legal implications of referring your own patients to a facility you have an economic stake in.  (Despite protests that such a conflict of interests can lead to unnecessary surgeries, one of the physician-run opponents, HCA, has itself been sued over excessive and unnecessary surgeries resulting from direct compensation plans to physicians under its employ.)

A growing trend we’ve been seeing for years is the need for consumers to understand their healthcare choices, options, and risks.  One of the top reasons that consumers visit hospital websites, according to a 2006 Forester survey, is to research hospital care and quality.  A shockingly small amount of hospitals provide any kind of this information, even spawning a sub-industry as a proxy for quality results — healthcare institutions pay large fees to HealthGrades for the analysis, reporting, and ranking of their hospitals on the numerous lists HealthGrades produce.

And the free market is rushing to fill the gap.  In addition to hospitals licensing HealthGrades results or paying for consumer-satisfaction surveys from Press Ganey, sites like NetDoc or Revolution Health are attempting to make sense of the confusing data surrounding patient outcomes to help consumers make decisions.

But the last line of the Forbes article really caught me and I’ll leave you with it here.   Forbes gives the parting shot in the argument to hand surgeon Blake Curd.  As a summation of why docs should be able to own hospitals, Blake throws down the gauntlet:  “Physicians innovate in health care,” he says.  “Hospital administrators do not.”

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