…We must also address the crushing cost of health care.
This is a cost that now causes a bankruptcy in America every thirty seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. In the last eight years, premiums have grown four times faster than wages. And in each of these years, one million more Americans have lost their health insurance. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas. And it’s one of the largest and fastest-growing parts of our budget.
Given these facts, we can no longer afford to put health care reform on hold.
Already, we have done more to advance the cause of health care reform in the last thirty days than we have in the last decade. When it was days old, this Congress passed a law to provide and protect health insurance for eleven million American children whose parents work full-time. Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives. It will launch a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time. And it makes the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.
This budget builds on these reforms. It includes an historic commitment to comprehensive health care reform – a down-payment on the principle that we must have quality, affordable health care for every American. It’s a commitment that’s paid for in part by efficiencies in our system that are long overdue. And it’s a step we must take if we hope to bring down our deficit in the years to come.
Now, there will be many different opinions and ideas about how to achieve reform, and that is why I’m bringing together businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue next week.
I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.
While many trivial actions do prompt Facebook to post an alert to all your friends… striking someone off your list simply is not one of them.
It is this policy that Burger King ran afoul of this month with its “Whopper Sacrifice” campaign, which offered a free hamburger to anyone who severed the sacred bonds with 10 of the friends they had accumulated on Facebook. Facebook suspended the program because Burger King was sending notifications to the castoffs letting them know they’d been dropped for a sandwich (or, more accurately, a tenth of a sandwich).
The campaign, which boasted of ending 234,000 friendships, is history now — Burger King chose to end it rather than tweak it to fit Facebook’s policy…
The ad, which proclaims a Whopper is stronger than friendship, is the first I’ve seen involving the de-leveraging of social networks.
I had thought, back in the day, Facebook did alert one to the changes in tides of friendships so I understand the nature of the policy: one’s social network should only grow. But it does underscore how loose those bounds are: by Burger King’s math, every facebook friend is worth about $.25
In the wake of the Madoff disaster, I have read some minor op-eds citing Social Security as the biggest Ponzi scheme ever.
Really?
Honestly, I would think that this kind of talk might not warrant coverage from CNBC, whose article “The Real ‘Mother’ of All Ponzi Schemes” likens our national safety net for seniors and the poor to losing your money in fictitious investments.
I quote:
We feel bad for the people who came late in investing with Bernie Madoff and got burned when his Ponzi scheme fell apart. Now, I don’t begrudge anyone their social security benefits, but I also don’t want my generation to be feeling sorry for itself when our time to collect comes around and the money isn’t there.
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 tonot 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.
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.
Three more awards for MedTouch clients St. Dominic Hospital in Jackson, Mississippi; Wolfson Children’s Hospital of Jacksonville, Florida’s Baptist Health; and the Rehabilitation Hospital of the Cape and Islands.
CAMBRIDGE, Mass.– MedTouch, a leading provider of interactive, web-based solutions for health care organizations, announced three more client awards for the strategic development of St. Dominic’s Hospital,Wolfson Children’s Hospital, and the Rehabilitation Hospital of the Cape and Islands website, www.rchi.org
“All three of these hospitals have a distinct mission, vision, and market. Their websites embody that distinction through a customized approach,” said Paul Griffiths, CEO of MedTouch. “The fact that each of them was distinguished enough to warrant an award, specifically for their design, is encouraging. It proves that distinctions do matter and brands can be successfully elevated online, to a new level of interactivity and engagement.”
“We’re excited to receive this award,” said Kace Ragan, Director of Marketing for St. Dominic’s. “Our objective in redesigning our site was to strategically differentiate our hospital’s mission and services to our consumers. Thanks to the help of MedTouch we’re ’shamelessly succeeding’ in our marketing efforts.”
“Wolfson Children’s Hospital wanted to design the new site around the needs of parents, while playing up the fact that we’re totally focused on children,” stated Melanie Husk, VP of Marketing and Communications at Baptist Health. “The MedTouch team captured just the right balance… using sophisticated thinking that translated to a site that’s not only easy to use but also captures the essence of our brand.”
“MedTouch delivered an engaging, consumer-oriented site that is fully aligned with our strategic goals,” said Carole Stasiowski, RHCI’s Director of Marketing and Community Relations. “What’s more, their Content Management Software, ContentBridge, gives us the ability to integrate the site with other marketing communications vehicles and to respond to opportunities in a timely manner.”
About MedTouch
MedTouch delivers web intelligence for healthcare. Whether delivering web sites, online marketing programs, or empowered technology with provable ROI, MedTouch is dedicated to shamelessly promoting its clients’ success. Those clients include nationally-ranked academic medical centers, community hospitals, rehabilitation facilities, health plans, and health care-related not-for-profits.
Having gone through my venture capital financing hazing in the late nineties, one of the features I’ve noticed about businesses that get funded are those which have a “disruptive” model to them. VCs enjoy the idea that their investments will not only create value for their own businesses but, in the words of a (very successful) VC firm, First Round Capital:
We love investing in technologies and business models that are able to shrink existing markets. If your company can take $5 of revenue from a competitor for every $1 you earn – let’s talk!
Now, there are some solid economic reasons for this objective in a start-up. If you can shrink existing markets and remain profitable, you’re more efficient and the free market will reward you as the eventual winner. It works great for discretionary spending, like a new ATV or cell phone gadgets or weight loss creme, but it does not work well for healthcare.
You see, dear readers, if you work at a hospital, that market is you.
You will notice a variety of entrants into this space who are all fired about how bad healthcare is and, sure enough, they’re right. Healthcare is broken. As I said on my last post, we can all agree on that. The question is why, and what can be done about it.
One answer is that we need to give the individual patients the access to the “best” doctors, regardless of location or cost and empower them with the “best” knowledge for how they can navigate the arcane healthcare system. That way, we can cause a consumer revolution! Because, you know, consumerism is the best! Rah, rah, yeah!
I understand that our American education is insufficient when it comes to fundamental economic knowledge, nevermind the essentials of game theory, but I wonder, have these people ever seen A Beautiful Mind?
If so, they might grasp the fundamentals of at least John Nash’s work on competition and scarcity: an individual striving for their own gain cost without regard for others costs the group as a whole more than if the group conspired together to allocate resources collaboratively. (A vast over-simplification, for which I apologize, Mr. Nash.)
In other words: there is nothing to suggest a purely individualistic, consumer-driven healthcare strategy will produce any more “efficiency” than our current system and much to suggest it will create considerably less. As some get much, much better care (and pay for it), others will necessarily get much, much worse care.
Healthcare is not a pure commodity because it is a social good and the same rules don’t apply.
This is why, although I share the sentiments of many of these companies, at MedTouch, we choose to work with hospitals. When hospitals stay healthy, they can continue to serve the communities in which they are located. That’s a (socially) good thing.
I’m all for efficiency, but efficiency at the cost of disrupting the healthcare delivery mechanism for the poorest members of our society is not just a bad idea, it’s un-American.
As my father passed away in a nursing home on Christmas Eve a few years ago, I’m donating our blog today as part of the Engage With Grace Blog Rally.
Although we had some of these conversations with my father, I wish we’d had them all. I would have much preferred to be with him when he passed. Instead, we were all far away, planning to see him later in the week.
Here’s more on the project and what you can do:
What if we took a brief moment to ask that most un-askable question: what would you want to happen in the case of serious or terminal illness? Wouldn’t it be so much better if you’d had the chance to speak with your loved ones in advance, and had recorded their and your wishes about end of life care in a safe and secure place? That place is http://www.engagewithgrace.org.
Engage with Grace is a movement – a movement with one simple goal: help ensure that all of us can end our lives in the same purposeful way in which we live them. It takes advantage of one thing – the fact that most of us do a lot of talking. So it asks you one thing: Download this One Slide – One Slide with just five questions…five questions designed to get the conversation about end of life care started – with each other, with our loved ones. Just One Slide – just five questions.
Here is what we are asking you: Download The One Slide (available at www.engagewithgrace.org). Share it any time you can – at the end of presentations, at dinner, at your book club. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started. Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Donate just two minutes to adding just this One Slide to the end of your presentations. Get others involved.
Help ensure that all of us – and the people that we care for – can end our lives in the same purposeful way we live them. Just one slide, just one goal. Think of the enormous difference we can make together.
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.
#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.)
