Cooperating for better care.

Robert Whitcomb

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Beyond geography: A Minn. system’s service-line successes

Health & Health Networks discusses h0w Allina Health, a 12-hospital Minnesota system,  is using a ”patient-centered, clinician-driven approach to manage its eight clinical-service lines, with a ninth planned for 2015”.

”The goal is to provide reliable, evidence-based, continuum-based care that is of high value,” Christine Bent, senior vice president for clinical-service lines, told H&HN. ”The idea is that, for anyone who enters our system, their outcome doesn’t vary based on geography.”

”Bent and Allina President and Chief Clinical Officer Penny Wheeler, M.D., oversee the entire service line structure as a team. Each of the service lines is managed across the system by a steering committee that reports monthly to Bent and Wheeler.”

”Within each service line are several multidisciplinary program committees chaired by doctors and organized by medical condition across all locations that offer treatment for a particular condition. …Allina uses a similar approach for hospital-based services, such as critical care and emergency medicine.”

”The service line management strategy has resulted in a number of scripted workflows that reduce variation in care and cost, ” H&HN reports.

 

 

 

 


12 steps in building a medical practice

 

How to build a successful medical group in 12 steps.


Nonprofit hospital CEOs’ rich profits

 

Roy Poses, M.D., in his Healthcare Renewal site, complains again about richly paid hospital chief executives laying off healthcare professionals and being sanctioned for offenses and yet collecting millions of dollars in severance payments.

In this case he’s writing about Cape Cod Hospital.

Dr. Poses continues on the warpath of discussing the “marked contrasts between how well top hired managers of non-profit hospitals were doing, and how their institutions were doing.”


Skepticism swells about new medical products

remedies

Many years too late and many billions of dollars wasted,  physicians, insurers, regulators and, most important, patients are starting to think much more about what is being called medicine’s “gray zone.”

As Modern Healthcare notes: “Many drugs, devices and procedures may have been proven effective in the clinical trials …submitted to the FDA.  But after they are widely deployed by physicians and hospitals outside that carefully controlled trial environment, they {often} don’t achieve the same outcomes. Sometimes they perform worse than cheaper alternatives already on the market or do more harm to patients.”

Complaints about the poor performance of pricey, heavily marketed and sometimes perilous new medical stuff had for a long time mostly been limited to consumer advocates. But now they’re getting a long-needed more skeptical look. That’s driven in part by the flood of ailing and aging Baby Boomers into the maw of the healthcare sector. The country simply cannot continue to spend at the rate it has been spending.

 


Or your money back!

 

Michael Kirsch, M.D., asks in MedCity News whether patients should get a money-back guarantee as with some other products and services.

He discusses ”how difficult it can be in medicine to assign credit or the blame for the outcome. The only secure guarantee in medicine is that there are no guarantees.
If any reader is not fully satisfied with this post, the full purchase price will be promptly refunded – no questions asked.”


 


Accenture report on health ‘ecosystem’

 

canary

 

An Accenture report identifies several crucial sectors of investment in healthcare that could profoundly change the industry.

In its analysis of the first round’s State Health Innovation Plans, Accenture identifies some of the following major investment areas:

Digital tools and telehealth.

Payer database reforms.

Community care management.


Nursing homes seek guardianships to get patients’ assets

 

oldwoman

 

Some nursing homes are suing to obtain guardianships over residents in order to seize assets of those who owe them money. Will hospitals and other healthcare organizations take similar actions, especially as the the flood of aging people swells?

 

The New York Times reports that ”few people are aware that a nursing home can take such a step {of filing for guardianship}.”

But, says The Times,  ”the practice has become routine, {at least in New York State} underscoring the growing power nursing homes wield over residents and families amid changes in the financing of long-term care.”

”At least one judge has ruled that the tactic by nursing homes is an abuse of the law, but the petitions, even if they are ultimately unsuccessful, force families into costly legal ordeals.”


America needs insane asylums

jail

Prisons now function as the asylums for many in America.

The article’s authors say:

“For persons with severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community-based treatment, the choice  {now} is between … prison, homelessness and acute hospitalization or long-term psychiatric institutionalization. The financially sensible and morally appropriate way forward includes a return to psychiatric asylums that are safe, modern, and humane.”


People might die, but kill the ACA

cemetery

Michael R. Strain, of the conservative American Enterprise Institute, says in an oped that ending the Affordable Care Act might or might not kill some people but that killing the ACA in world of limited resources would not be immoral.

 


Vast differences in prices for knee, hip surgeries

knee

A study  by the Blue Cross and Blue Shield Association shows gigantic price variations  across America for  the same kinds of knee and hip surgeries.

Will this new transparency lead to more equal and reasonable costs? We’d guess that since most insured patients are now being called upon to pay more of their medical costs as part of high-deductible policies, that there will indeed be price pressure — downward.

 

Erica Mobley, director of communications at the Leapfrog Group, an employer-backed organization that promotes healthcare quality, told Modern Healthcare that quality and safety measures have to be released in conjunction with price information.

”’Displaying cost information is great,’ Mobley said. ‘But it really is important that people and organizations who display this information think more than just cost.’ …”Blue Cross does rate higher quality providers for a handful of procedures, including knee and hip replacements,” Modern Healthcare noted.

Fine, still, indications are that patients will be most interested in cost of these common but very expensive procedures. Orthopedic surgeons may see their revenues fall substantially as a result of the new transparency, which  lets payers of all kinds finally  be able to do real comparison-shopping.

More and more patients will be traveling to the least expensive places for surgery. That means  that teaching hospitals  in some big cities may take a big hit in the next few years as the pricing gaps become vividly apparent.


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