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Better but fewer metrics, please

March 18, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Christine Cassel, M.D., president and chief executive of the National Quality Forum, said the healthcare-quality movement’s biggest challenge is to “reduce the noise and increase the signal strength” of measures  to assess  individual hospitals and healthcare systems. She said that healthcare has gone from having too few quality measures to having too many.

Given that, as well as the accelerating  shift to value-based payment models, “it is even more important that we get the measures right,” she said.

Dr. Cassel said that is that many metrics need more science behind them.

Her biggest goals for the NQF, as reported in FierceHealthcare:

  • “Align quality measures among all payers.
  • “Identify more actionable, meaningful measures.
  • Achieve greater consistency and rigor with consumer information.
  • “Leverage new technology and big data to identify and assess quality metrics.
  • “Make sure measure reflect actual clinical quality, not factors like socioeconomic status that are out of health systems’ control.
  • “Attribute results to specific providers.
  • “Improve consumer engagement. ”

 

Fisher: One group could be a Medicare ACO

March 13, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

In this interview, Dartmouth’s Elliott Fisher, M.D. often called “The Father of Accountable Care Organizations,” talks about the direction of healthcare. Among his observations:

”Can narrow networks or MA plans be aligned with ACOs? I think so. You can imagine a policy environment in which a single organization could easily be a Medicare ACO, part of a Medicare Advantage plan or offered on the exchanges. The key would be to align organizational requirements, performance measures and payment incentives.”

 

Experts applaud ‘Next Generation’ ACO’s

March 12, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , , ,

 

applause

Experts applauded the Centers for Medicare & Medicaid Services’ “Next Generation” Accountable Care Organization (ACO) plan, which asks participants to take on more financial risk in return for more  potential reward. The aim is to move away from fee for service to capitation as payers push healthcare industry toward a value-based reimbursement system.

“It’s a real effort to move away from shared savings or limited risk models. On both counts it’s an important step,” said Mark McClellan, M.D., a former CMS administrator,  told FierceHealthcare.

Larry Kocot,  a visiting fellow in the economic-studies program at the Brookings Institution, agreed. “I do think CMS should be credited for thinking creatively to extend the model to meet the needs of providers no matter what stage they are at within the ACO program,” he told the news service.

Farzad Mostashari, M.D., former national coordinator for health- information technology, told Clinical Psychiatry News Digital Network that the new model will likely suggest how CMS will structure other ACO’s.  “This is directionally, absolutely where the Medicare Shared Savings Program (MSSP) is headed.”

“We are hopeful the changes they proposed and the comments received that they will make the MSSP program more accessible and more friendly to a number of providers,” said Kocot, who also served as a senior administrator of CMS.

FierceHealthcare reported that Kocot said he’d like the CMS to establish a ”fourth track that would lead to full capitation. He recommends tracks that reflect a continuum of ACOs that may begin with little risk and end with the full capitation model.”

Notice the crocuses

March 12, 2015by Robert Whitcomb in Uncategorized tagged , ,

crocus

 

Michael W, Kahn, M.D., writing in the New England Journal of Medicine, tells of a lesson in mindfulness  — and the importance of crocuses as spring approaches — he received as a young and harried resident  from an old lady and her also old  and courtly Boston Brahmin physician.

”{The doctor} would have had a good chuckle over his gin and tonic at my making such a fuss about his offhand remark. He would correctly say he was just being human, possibly adding that — in the words of a song from his youth — he was accentuating the positive. True enough; and in an era when many physicians and patients alike bemoan the lack of time in healthcare for ‘being human,’ should doctors voluntarily add to their responsibilities the task of promoting mindfulness in themselves and their patients?”

Yes, obviously.

 

Recommended repairs for ACO’s

March 6, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , ,

roadrepair

Elliott Fisher,  M.D., former U.S. Sen. Judd Gregg and  James Weinstein, M.D., offer prescriptions in a Modern Healthcare essay for fixing Accountable Care Organizations.
They write that the recent  U.S. Department of Health and Human Services announcement by that Medicare will work to accelerate the transition to new payment models was  … ”an important step in the right direction. But without significant regulatory—and perhaps legislative—changes to current models, HHS’s ambitious goals are not likely to be achieved. ”
The writers conclude:
”First, the financial model for ACO’s should offer them a greater share of their initial savings (to help fund start-up costs), provide stronger incentives to induce and maintain participation from low-cost provider organizations, and foster alignment of payment schemes across all payer types—not just in Medicare. This strategy will encourage the growth of shared-savings models and motivate high-performing healthcare systems to join the ACO programs.”The second strategy would improve patient engagement in ACOs by modifying how Medicare beneficiaries are assigned to an ACO: Beneficiaries should be given the opportunity to choose to join their ACO; for those not actively choosing, those eligible should be assigned at the beginning of the year (so that their ACO can contact them). Medicare should also test a benefit design that uses modest financial incentives to encourage patients to seek care within their ACO or from providers outside the ACO whom the ACO recommends. Simultaneously, to make such incentives possible, supplemental Medicare plans should be restricted from covering first-dollar beneficiary costs for non-ACO services.”

Video: Tough to change unhealthy habits

March 5, 2015by Robert Whitcomb in Uncategorized tagged ,

 

Video: Ajay Sood, M.D., an endocrinologist at University Hospitals Case Medical Center, in Cleveland,  discusses why it’s so difficult to get patients to improve their health by changing their lifestyles.

‘The power of our hands’

March 5, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Writing of her  own near-death experience, pediatrician Catherine Humirowski, M.D., writes in a riveting JAMA piece:

“Let us not forget these fundamental resources of our profession—the power of our hands, our voices, and our rational thought—for these are free but priceless, so if value is the ratio of cost to worth, theirs is infinite.”

More information=less treatment

March 3, 2015by Robert Whitcomb in Uncategorized tagged , ,

Austin Frakt, a health economist, and Aaron E. Carroll, M.D., a pediatrician write about how patients would opt for less treatment if they had more information. They’re responding to an article in JAMA Internal Medicine, the first  to “systematically review the literature on the accuracy of patients’ expectations of benefits and harms of treatment. They examined over 30 studies that assessed whether patients understood the upsides or downsides of certain treatments. To a great extent, patients didn’t.”

Consider that in ”the 34 studies that assessed understanding of benefits, patients overestimated their potential gain in 22 of them, or 65 percent.”

The two writers go on: ”Why do patients err in assessments of risks and benefits? One reason could be that what they know is driven by the messages they hear. Doctors, direct-to-consumer ads and the media can skew our perceptions. They tend to focus on the benefits, but rarely quantify them. healthcare centers, screening advocacy programs and pharmaceutical ads all push us to talk to our doctors about getting treatment without talking about actual gains.”

 

 

 

Digital opportunities in Obamacare

February 24, 2015by Robert Whitcomb in Uncategorized tagged ,

 

Andrey Ostrovsky, M.D., discusses the hidden digital health opportunities in this MedCity News piece.

New Partners chief’s global market

February 23, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

earthy

 

The new head of Massachusetts behemoth Partners HealthCare, David F. Torchiana, M.D., a heart surgeon, will have his hands full as the system  continues to reappraise its controversial expansion plans after pushback from state regulators eager to limit its market power in the state, especially in Greater Boston.

Dr. Torchiana must deal with antagonism fueled by what some perceive as  the 10-hospital Partners’ arrogance and high prices.

Dr. Torchiana, seeming to refer to more restrained ideas about further Partners expansion in the Massachusetts, said future growth projects may be more  out of state and abroad.

Alan Sager, a professor at the Boston University School of Public Health,  told The Boston Globe that he’s not convinced that the new chief, who has been running Partners’ physicians network, will run things  much differently than the outgoing Gary Gottlieb, M.D

“I don’t know how much difference one individual can make. Partners has been saying for 20 years that its mergers would reduce costs and improve quality, and there’s no evidence they’ve done that. . . Now they want to expand to other states, other countries, other planets. That may or may not be good for Partners. But there’s no reason to suppose that would be good for the people who live and work in Massachusetts.”

With Massachusetts General Hospital and Brigham and Women’s Hospital and the affiliated Harvard Medical School, Partners certainly has the global  prestige to expand its marketing, albeit probably not to other planets for a few years.

Rich patients around the world like to tell their friends that they’ve been treated at MGH and or the Brigham, in the same way they brag about being treated at, say, the Cleveland Clinic, the Mayo Clinic, Johns Hopkins and M.D. Anderson. Even Boston’s snowstorms don’t scare them away.

 

 

 

 

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