Cooperating for better care.

Robert Whitcomb

Author Archives

Common sense and buzz words for sale

Scott Becker, in Becker’s Hospital Review, translates  the ideas of Harvard Business School Prof. Michael Porter and Thomas Lee in looking at how to succeed in healthcare in the next couple of years as including:

* Building a  dominant healthcare system for maximum pricing power.
*  Applying the ”80/20 rule” to most opportunities, talent, revenues and cost areas. The rule basically means mean that 80 percent of your outcomes come from 20 percent of your inputs.
* Testing new areas but doubling down on winners.
*  Embracing ownership of physician practices.

Of course, some of these ideas are recycled banalities — or just sense for sale at very high hourly rates.

 

 


A bid to curb readmissions using real-time home data

 

MedCity News reports that Healthfirst, a not-for-profit health plan with more than a million members in New York, ”is teaming up with eCaring as part of an effort to reduce unnecessary ER visits and hospital readmissions, using real-time patient data generated through home care.”

”Healthfirst members who are dual eligibles for both Medicare and Medicaid and who are enrolled in the its CompleteCare Special Needs Plan will be targeted by New York-based eCaring, which will apply its data analysis and cloud-based monitoring software, by way of tablets.”

 


CEO’s think boards moving too slowly

The Center for Healthcare Governance has looked at what it sees as the necessary new duties of hospital boards in context  of the current vast changes in healthcare. In a nutshell, the survey said that hospital chief executives did not think that their boards were moving fast enough to keep up with the new demands.

The center says that in addition to the push to emphasize healthcare quality (as measured by outcomes) and fiscal fitness, boards need to learn more about physician-staff alignment and community health (which, of course, includes much more than medicine).

The center’s  2014 National Healthcare Governance Survey was based on information from chief executive officers and board chairs.

The survey found that chairs scored their boards higher than did the CEOs did in evaluating the boards’ pace  in examining new governance models for possible adoption; having frank strategic discussions  to understand what change in their organizations meant for new strategies; and  developing  strategies for transformational change.

 

 


For-profit chains looking to bright 2015

 

sunrise2

 

Beth Kutscher, writing in Modern Healthcare, looks at why for-profit hospital chains have  bright financial prospects for 2015.

She cites the for-profits’ talents for cutting costs and new marketing initiatives to drum up patient volume.

But nonprofit-hospital chains continue to sputter.

 


The decades-old ‘looming’ primary-care shortage

lube

She writes:

“Our constant inability to address this shortage is also immutable, and it has been so for all the decades we could have used to train more primary care doctors.

“Whether by design or by happenstance, we are now working hard to reduce demand, and perceived need, for actual doctors in primary care, and at the same time, we are working equally hard, if not harder, to increase the soothing volume of cheap and inconsequential services which are considered part of primary care.”

Along the way, she also returns to the old, half-joking, half-serious comparison of primary care and Jiffy Lube.


Value of transparency in physician payments

edison

Thomas Edison with his searchlight cart.

 

Here’s a discussion in JAMA of the value of transparency in physician payments.


Patient choice and equity in Sweden

Flag_of_Sweden.svg

This article in The New England Journal of Medicine looks at patient choice and equity in Sweden, where there’s universal healthcare but the decision-making  is highly decentralized, with power given to county councils that ”own and operate almost all hospitals and a majority of primary care facilities.”

P0licies change with the varying preferences of center-right and center-left governments about such matters as pharmacy privatization, but a consensus remains that  high-quality healthcare should be available to all.

 

 

 

 

 


Mickey Mouse, M.D.

(Video included in link.)

Lisa Suennen  writes in MedCity News:

”I expect we are going to see a lot more collaborations between healthcare and consumer products companies like unlikely alliances {one between Disney and Eli Lilly} that go at the core of two of the most serious healthcare challenges: health literacy and behavior change.

”If we could ‘fix’ those two problems, I suspect that we could cut the costs of the healthcare system by at least a third by eliminating many of the medical errors, treatment compliance problems borne of lack of understanding and cultural medical miscues.”

”Healthcare companies had better co-opt those consumer brand companies into helping them communicate with consumers or they may just end up working for them.”


Feds sue rich Fla. cardiologist over lucrative tests

heart

The Feds have joined  two lawsuits that allege that Florida’s Asad Qamar, M.D., who was Medicare’s highest-paid cardiologist in 2012, taking in $18 million in reimbursements  that year, got patients to have unnecessary invasive heart testing to boost his income.

Modern Healthcare reports that in one of the lawsuits Dr.  Qamar and his group ”routinely waived patients’ Medicare copayments and deductible payments so that, the suit says, ‘patients had no reason to turn down services and would oblige Dr. Qamar’s improper recommendation that they consent to all manner of procedures for which there was no medically indicated need.’ according to the lawsuit. Qamar and the institute would then bill the government for the full cost of the treatment.”

A lawyer for the cardiologist said:

“Dr. Qamar practices under the highest medical and ethical standards. Any claims to the contrary are unsubstantiated and the doctor will defend himself vigorously against these baseless allegations.”

It’s interesting that so many of  alleged overbilling involve Florida physicians, but then, it does have so many people on Medicare.


The Blue Shield-Sutter battle

 

giants

Siphnian Treasury at Delphi, North frieze, c. 525 BC, detail showing gods facing right and giants facing left.

Blue Shield of California  alleges that Sutter Health, which runs 23 hospitals in northern California, is charging excessive prices and doing it in sneaky ways that hide its expensiveness from the public. But Sutter, for its part,  said state data show that its per-hospital-discharge prices are at or below its peers.

The Los Angeles Times reports that the legal dispute between the giants has prevented Blue Shield and Sutter from reaching a new contract that would affect many employers and consumers.

Blue Shield is telling about 280,000 health plan members that they ”might lose network coverage with Sutter doctors and hospitals”  in the  fight, the paper says.

Some groups have accused Sutter of  sneakily imposing anti-competitive actions and illegally inflated prices.

“‘Blue Shield is demanding significant rate rollbacks as well as several changes to language that has been in our contracts for years, Sutter spokesman Bill Gleeson said. ‘Rate rollbacks of the magnitude that Blue Shield demands would have a negative impact on the level of healthcare services we offer.”‘

The Sutter case but one large example of complaints about big hospital systems’ pricing power,  which has grown as they buy more and more physician practices and outpatient medical facilities. Perhaps the most famous complaints are those involving Partners HealthCare, in the Boston area.

”James Robinson, a University of California at Berkeley professor of health economics, published a study in October showing hospital ownership of physician groups in California led to 10-20 percent higher costs overall for patient care,” the Times reported.

“Consolidation can create better coordination and efficiencies in healthcare. However, it can also create opportunities for higher prices.”

 

 


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