Cooperating for better care.

Thomas H. Lee

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The great potential of improving nonvisit care

They write in NEJM Catalyst that “Face-to-face interactions will certainly always have a central role in healthcare, and many patients prefer to see their physician in person. But a system focused on high-quality nonvisit care would work better for many others — and quite possibly for physicians as well. Virtually all physicians already use nonvisit interactions to some extent, but their improvised approaches could be vastly improved if health systems were designed with such care as the explicit goal.”

To read their essay, please hit this link.



The perils of picking the wrong hospital


The New York Times summarized the findings of an important and alarming new comprehensive study:

“Researchers have found that patients at the worst American hospitals were three times more likely to die and 13 times more likely to have medical complications than if they visited one of the best hospitals.”

The study,  in the academic journal PLOS One, shows “there is considerable variation in outcomes that really matter to patients, from hospital to hospital, as well as region to region,” Dr. Thomas H. Lee, M.D., a longtime healthcare executive not involved in the research, told The Times.

The Times reported that “The study’s authors looked at 22 million hospital admissions, including information from both the federal Medicare program and private insurance companies, and analyzed them using two dozen measures of medical outcomes. Adjusting the results for how sick the patients were and other factors, like age and income, the researchers discovered widespread differences among hospitals. Even a hospital that had excellent outcomes for heart care might have poor outcomes in treating diabetes.”

To read the study, please hit this link.

To read The New York Time’s article on it, please this link.

Trying to identify a ‘good’ hospital merger isn’t easy


Leemore S. Dafny, Ph.D., and Thomas H. Lee, M.D., writing for the New England Journal of Medicine, look at the difference between good and bad hospital mergers.

“A ‘good’ merger or affiliation is one that increases the value of healthcare by reducing costs, improving outcomes, or both, thereby enabling providers to generate and respond to competition. The all-too-common alternative is a merger intended to reduce competition — to ensure referral streams (which would otherwise be earned through superior offerings) or to help providers negotiate higher prices and thereby avoid the difficult work of improving outcomes and efficiency.”

“Although regulators can sometimes stop a ‘bad’ merger, they cannot create a good one,” they note.

“The harsh reality is that it’s difficult to find well-documented examples of mergers that have generated measurably better outcomes or lower overall costs — the greater value that is publicly touted as the motivation underlying these combinations. The most consistently documented result of provider mergers is higher prices, particularly when the merging hospitals are in close proximity. Providers’ hopes for improving value by consolidating and then integrating care within merged entities remain objectives rather than accomplishments in most organizations.”




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