The Public Interest

We Need Bookkeepers – Not Insurance Companies

2007-06-26T19:18:00Z

I’m one of those people who resisted the idea of a Single-Payer, Governmental system for purely financial reasons. My fear is that the government (and we taxpayers) will be taken for a bundle. But you know what? We’re already being taken as it is!

And, I still fear that most people will think of the Single-Payer system as a (excuse the pun) ‘cure-all’ for healthcare. The drawback, of course, is that we need to address more than just ‘paying’ for healthcare. Results by medical condition published for all to see – and from which all can learn – are critical to improving healthcare treatments. In addition, each healthcare professional would have his/her results recorded so we could identify and choose those professionals who are best at what they do.

If we were to set that up, the entire medical profession could learn which treatments are both most effective and cost efficient. Armed with that information, we would be able to rely on our information and medical professionals for our care. Then we would only need a central payment system for paying the bills.

Maybe we need to set that up by state. But rather than creating another government entity, each state could hire bookkeeping firms to collect monthly fees and pay for all expenses incurred. Like any good bookkeeper, these firms would be expected to look for anomalies. In addition, at the end of each year, the bookkeepers could work with an auditing firm to verify all is as it should be.

And bookkeeping firms don’t make additional profits by denying the services they pay for. So the goals:

1. We all pay into one system (whatever you call it), and that system is managed by either hourly or salaried workers who make bonuses by catching errors – not denying services.

2. We collect results on all medical professional by medical condition, risk-adjusted for each patient which are then published on the web for review by all.

With the two major functions in place, we have a chance at having an efficient and effective healthcare system.

Medical Right Hand – Please Meet Your Left!

2007-06-19T17:26:00Z

My mom has multiple myeloma. She’s on medications that are adversely affecting her potassium levels. So much so, that one day, I was directed to take her to the hospital emergency room right away.

While there, we first had to wait in the hallway – all the rooms were filled. That wasn’t ideal, but we were fine. Then they did find us a room with a few other patients. A doctor came in to talk to the patient in the bed next to us. We heard him ask: So, you have a fever? And you’re coughing up sputum – what color?

Well, that was all I had to hear. I went out immediately to speak with a nurse. I told her my mom has cancer and the patient next to her seems quite ill.

(For those who don’t know, cancer patients are particularly susceptible to catching colds, flu, etc. In fact, it’s made quite clear that cancer patients have to avoid people who have any contagious illness no matter how minor.)

Well, the attendant did take steps to have my mom moved out of that room. The attendant who put her in that room in the first place was then chastised by the nurse. He said he didn’t know anything about my mom having cancer – no one had told him.

I had told the hospital staff as we came in and registered that my mom has cancer. I repeated it to the nurse. So why didn’t the attendant know? Apparently, that hospital still runs on paper – not fully automated. Now I know a lot of doctors have reams of reasons why they shouldn’t have to learn a new system. Mostly, they revolve around making a doctor learn a new system – how inconvenient.

But where does the patient’s safety fit in that argument? Once again, the patient is the last in line when it comes to healthcare. We need to insist, yes, even legislate the installation of computer systems for medical care and the collection of results by medical condition adjusted for patient risk. Healthcare needs to return to being about a patient’s health.

(See my The Public Interest blog: www.the-pi.info or website: www.the-pi.org for details and comments. A point of interest: some doctor s have found that, by switching to computers, doctors can safely increase patient service while reducing errors.)

When the Right Medication Costs Too Much

2007-06-12T21:26:00Z

Or so says the health plan. Micromanaging healthcare has become the latest fashion for health plan providers (I know that’s what we’re supposed to call them, but let’s face it—they’re insurance companies!).

I know I told you about my running in circles to get my prescription cleared, but now they’re picking on my 76 year-old mom!

I came into her apartment. We said our hellos, and then, almost in tears she tells me: They sent me a letter. They won’t pay for my medicine unless I can prove I’ll die without it.

The letter went on to say that if there were a cheaper alternative that they already cover, they want her to use that. We’d have to ask her doctor to write a letter saying she’d die without the recommended medication.

Well, my mom has cancer. Guess what – she would die without it! Yes, of course there are cheaper alternatives – that research has proven don’t work! Am I supposed to tell my mom, sorry, you have to take this ineffective medication because it’s covered by insurance???!!!!

Where do they find the people who are willing to write these letters? What incentives do they offer them to, in effect, attack ailing senior citizens? What kind of nation are we that we shamelessly punish the aging and ailing?

My mom, by the way, has worked all of her life. From the age of 17, she has either worked for others or run her own affairs. Even now, she has a small consignment business. Is this the reward we can expect after working all of our lives?

You know another interesting part: This health plan is one of those prescription drug plans our president set into motion that was supposed to ‘take care’ of medications for seniors. Our tax dollars subsidize these programs to the hilt. And yet, they pay people to pressure seniors into taking less expensive, ineffective medication. Now I’m going to be sick!

How to Pay for Results Collection for Healthcare

2007-06-06T17:56:00Z

How to Pay for Results Collection for Healthcare

It will cost too much…

I’ve seen this thrown out as a reason why we shouldn’t go through the effort of collecting risk-adjusted results by medical condition. As I stated in previous blogs, Porter & Teisberg found that costs have been reduced by collecting results by medical condition.

Obviously, ‘it will cost too much’ is just an excuse to avoid accountability.

So, I decided to look for a reasonable source of revenue to help offset the costs of this effort. Here’s the thought: use a portion of the spending on healthcare advertising. I found numbers for pharmaceutical companies first. Some interesting points:

From the National Institute for Healthcare Management:

· "Spending on "direct-to-consumer" (DTC) advertising of prescription drugs rose 35% from 1999 to
2000 — from $1.8 billion to $2.5 billion. DTC ad spending has more than doubled since 1997."

· "Drugs that are heavily advertised to consumers typically rank high in sales -- 6 of the top 10 drugs
advertised through DTC were among the top 20 drugs in dollar sales and in the number of prescriptions
dispensed in 2000.

· Sales of the most heavily advertised drugs have increased much more rapidly than for other drugs – from
1999-2000:

-the dollar sales of the 50 most heavily promoted drugs increased 32%,
while the sales of all other drugs increased 14%;

-the number of prescriptions sold for the top 50 promoted drugs increased 25%,
compared to 4% for all other drugs."

From the Kaiser Foundation:

· "This means that each additional dollar spent on DTC advertising in 2000 yielded $4.20 in additional
pharmaceutical sales in that year.

· Promotional spending by pharmaceutical manufacturers has risen steadily in recent years, more than
doubling from $9.2 billion in 1996 to $19.1 billion in 2001, an average annual increase of 16%. …
promotional spending (86%) remains directed at physicians."

Hmmm…. What if we asked advertisers to give ½ of 1% of their annual advertising budgets to pay for results collection and posting on the web? At $19.2 billion, ½ of 1% equals $95 million – gee, that ought to do it, don’t you think? And that’s just pharmaceutical companies. Add in the advertising dollars spent by hospitals, doctors, health insurance providers – I think we’re covered for the next decade!

So this idea that we can’t afford to collect these results because ‘it costs too much’ isn’t even close to valid! After all, if the information is available online (excuse me, that’s accurate information vs. promotional advertising), pharmaceutical and other healthcare companies will not need to advertise so much! The truth is, we can’t afford NOT to do this.…For our health…and out budgets!

When You Have to Play Doctor

2007-05-29T16:27:00Z

When You Have to Play Doctor

Yes, that’s exactly what I had to do. My mom was recently diagnosed with multiple myeloma – a cancer of the blood that destroys bone…

We’re coping…just. But the part that disturbed me, almost as much as the diagnosis, was the lack of someone being in charge of the ‘patient.’ What do I mean? Here’s what happened…
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My mom was in horrible pain. Her PCP at the time gave her some pain meds, but that was all. We then took her to a pain clinic in an effort to find out what was wrong. Initially, she had a compression fracture of the spine. We were making an effort to limit her movements so she wouldn’t make it worse. But it did get worse…a lot worse.

Ultimately, we took her to another PCP who said take her to the hospital. My mom wanted to go to the hospital that had all of her previous info. That’s where we found out she had cancer.

At first, we didn’t believe it – there’s no cancer in our family. They said the cancer had caused her to be anemic. I explained that she, her sister and I (I’m the daughter) were all somewhat anemic all our lives. But my mom continued to have problems. They had to give her blood transfusions because her blood count was low. And the original PCP was back on her case (He was associated with that hospital; not the new PCP).

A few days later, they gave her two more transfusions. Then I remembered something. I asked, "Mom, weren’t you taking high blood pressure medication at one time? You’re not still taking it, are you?"

Well, as the patient, she was taking whatever they gave her. I had her ask the nurse who responded basically saying ok, if you don’t want them anymore, we won’t give them to you.

Can you believe it – they were still giving her high blood pressure medicine to lower her blood pressure even as they gave her blood transfusions to increase her low blood count!!!!! What if I hadn’t asked??? What if I hadn’t remembered??? (Oh by the way -- now that she's off those meds, her blood pressure is a normal 126 over 70. Seems she never had high blood pressure!)

Makes you wonder how anyone gets out alive…

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Dr. Health Plan

2007-05-22T18:29:00Z

Dr. Health Plan

No, I’m not kidding…My specialist has been struggling to find the right HRT (hormone replacement therapy) for me. I’ve tried over 10 different combinations of hormones – none of which have worked long term unfortunately.

So, you’d expect my health plan to have understood that I can’t simply take any old formula, right? Wrong! But it’s easy to figure out why my health plan chose to try to pressure me into using a particular HRT – again!

You may have heard of Premarin. That stand for pregnant mare’s urine (yes, that’s right – a horse’s pee). Premarin was promoted as the anti-aging drug for middle aged women – almost a fountain of youth. Premarin was supposed to eliminate hot flashes and other, more debilitating menopause symptoms. In addition, Premarin was thought to reduce heart attacks, strokes and cancer among women.

Sound too good to be true? You bet! In fact, the NIH cancelled its study of Premarin before it was completed –why? Because it was causing too many women to (get this) experience increased heart attacks, strokes and cancer! Well there’s mud in your eye!

After that study was cancelled, most women on the drug ceased using it. Initially, Wyeth, its producer, sent letters to doctors and patients saying that Premarin was safe if used only for four or five years. So women should feel safe continuing Premarin for that time. Nonetheless, most women did not renew their prescriptions.

But it appears Wyeth came up with another approach. When I tried to fill my new prescription for a non-horse-urine HRT medication, my health plan rejected it, saying I should use Premarin instead! This despite the NIH cancellation which I had told them about the previous time they tried to refuse my non-Premarin prescription. Makes you wonder what kind of a deal Wyeth offered my health plan, doesn’t it?

I had to pay in full, call my health plan, call my doctor to fill out a form, now I’ll have to call my health plan back again so I can fill out a form --- Phew! Once again, this demonstrates that the patient’s health is not a priority in our current healthcare system.

More Successes from Results Reporting

2007-05-16T20:17:00Z

Cardiac Surgery: "Cardiac surgeons pioneered the development and use of outcome measures more than three decades ago." The Veterans Administration started it off in 1972 with a ‘multihospital database’ of unadjusted mortality rates for cardiac surgery. Then there were other players, but in 1989, the Society of Thoracic Surgeons (STS, www.sts.org) developed risk-adjusted measures and "began collecting voluntary adult cardiac surgery data and compiled a national risk-adjusted database."

Then the New York Department of Health required similar risk-adjusted outcomes reporting for coronary artery bypass graft (CABG) procedures. Independent cardiothoracic surgeons came up with these measures. "In the first four years of New York’s reporting program, death from cardiac surgery fell by 41%."

Wow!

Other states (New Jersey, Pennsylvania, and California are listed in the Book) followed suit with similar results. I guess my question is: How can anybody argue against these results? What – it’s better to have more dead people than have outcomes published??!!!! Pa-leaze! But it seems that only the Cleveland Clinic publishes its "outcomes with comparisons to the national averages" – all others are blinded (i.e., not listed by facility).

But the movement continues. STS has been working on their system, adding measurements and working with the National Quality Forum (NQF) to develop a set of nationally accepted cardiac measurements.

NQF is a DC nonprofit whose mission is: "to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs." You can find more information on NQF’s website: www.qualityforum.org.

Even some health plan providers see the value of publishing risk-adjusted outcomes for medical conditions. "Starting in the 1990s, a number of health plans, including several Blue Cross Blue Shield affiliates, made participation in the database a criterion for being included in their preferred provider list."

Knowing Past Results Improves Current and Future Results

2007-05-08T15:55:00Z

More Examples of Results Improving Healthcare

Pediatric Oncology demonstrates the incredible improvements results analysis can offer. "In the 1960s, childhood cancer was nearly always fatal within five years. Today the survival rate is over 75%..."

Wow!

According to the Book, "the tragedy of young children suffering and dying created a sense of urgency and a sense of community to improve treatments." A true feeling of cooperation, sharing data, ‘good communication and mutual support’ made this effort so successful.

The Book goes on to say that it could be even better. Right now, "blinded data is collected and used solely for comparing treatment protocols in clinical trials." Clinical trials typically focus on just one part of a treatment. "Systematic patient registries" would allow "researchers to examine more aspects of care." Nothing like having the whole picture when you want to make decision, huh!

And we still don’t know which doctors conduct the procedures/ processes best. So there’s no way to learn the potential improvements their insights could offer.

Transplants

We’ve all seen movies about Organ Transplants going to the highest bidder. So this medical condition got the government’s eye early on. A nonprofit, the United Network of Organ Sharing (UNOS), has a federal contract to collect unblinded data for all transplants. Reported on the web, "this system contains data regarding every organ donation and transplant event occurring in the U.S. since 1986," according to UNOS’s website: www.unos.org.

UNOS also uses Social Security’s death information to track mortality. "UNOS…makes recommendations to the Department of Health and Human Services about policies for how organs should be allocated to patients on the waiting list. Thus, statistical data on transplant outcomes affects allocation rules."

Although the Book doesn’t give specific rates, it does say that "Performance in transplants has continued to improve, while better results have led to successful transplants in sicker patients…More patients are being treated by excellent providers, who often are willing to negotiate lower prices."

More successes to follow...

Examples of Results Reporting Successes

2007-05-01T20:57:00Z

Examples of Results Reporting Successes

Founded in 1955, the Cystic Fibrosis Foundation (CFF) was the thrust behind collecting results data for this children’s disease. Since they began, the lifespan for patients have improved from 10 years in 1966 to 18 years in 1972 and to 33 years in 2003! These improvements occurred even though results are not published by clinic (They call this ‘blinded for individual centers’).

Results reporting is voluntary, but the CFF offers grants to clinics to collect the data. They publish a registry that they estimate holds data on 93% of patients. Interesting to note -- the best performing clinics continue to have patients that live the longest. Sure would be nice if all children, regardless of which clinic they went to, could benefit from longer lives. But that will only happen once we get results data on an individual basis.

When kidney dialysis was first developed in the 1970s, it was too expensive for most – only extremely rich people could afford this service. But the American Association of Kidney Patients showed dialysis for patients with end stage renal disease (ESRD) not only survived with dialysis, but could even live normal lives. No dialysis meant death.

Congress heard – they enacted the ESRD Act in 1972. This covered all ERSD patients under the age of 65 for dialysis under Medicare. In 1978, Medicare came up with an oversight plan. They charged a $0.50 fee, taken from the reimbursement, to pay for regional administrative networks. In 1988, "the US Renal Data System (USRDS) was established to collect, analyze, and disseminate data about ESRD outcomes to foster research and to monitor quality."

Until Medicare required results reporting, hardly any reviews were conducted. By tying the reporting to reimbursement, Medicare made results reporting happen for ESRD patients. This data was public and not blinded. Patients and doctors alike could look at specific results like anemia, hemoglobin, and mortality rates for all providers except the Veterans’ Administration, which is not covered by Medicare. If a provider slips below accepted standards, the network sends out coaches.

The upside is: outcome data is mandatory. Unfortunately, it’s limited to 5% of patients from October to December due to the paperwork involved.

(This demonstrates another aspect of improving healthcare: We need to get medicine into the 21st century. Right now, you can’t email your doctor – after all, they’re not paid to read emails; you have to go and pick up your x-rays – they’re not digitized; you have to fill out the same forms over and over again from one doctor to the next – because they’re not kept and shared electronically. Electronic data collection could not only make complete results reporting viable, but also cut some of those redundant costs.)

From 1989 to 1997, mortality rates have improved by 17% for dialysis patients. In addition, results also "revealed that attention to quality is crucial for cost reduction." So not only could we end up with better care, but also, less expensive care as well. This is something we’re used to in electronics (like computers, which get cheaper, faster and more powerful all at the same time). Well, now we have to get healthcare to follow the same pattern of success!

More successes to come...

Results Reporting -- A Baby Step for ICUs

2007-04-24T19:11:00Z

Results Reporting -- A Baby Step for ICUs

Acute Physiology And Chronic Health Evaluation (APACHE)

For those who say no to results reporting -- you're too late! Healthcare professionals have begun to recognize the need to evaluate total information -- not waiting for costly, long-term clinical trials -- to improve healthcare delivery. APACHE is a first step for Intesive Care Units (ICUs).

This system is not actually capturing results data – it "analyzes patient data to rate the severity of acute illnesses and probabilistically predict outcomes." Then doctors in the ICU can use these risk-adjusted predictions to evaluate how their patients are doing. Now this is a little technical for me, but as I understand this, doctors can determine if their patients are doing as well as the predictions (based on clinical data) say they should be doing.

This was developed by A Dr. Knaus in 1978! So, this is not a new idea. The first roadblock – no surprise – was funding. No one wanted to pay to continue collecting the data and create prediction models. Then Cerner Corporation bought APACHE in 2001.

The system was continuously updated. But some ‘members’ of the medical community demanded ‘expensive and time-consuming clinical trials’ be conducted. They wanted to have ‘each specific aspect of process improvement’ documented before they’d accept and use it. That just slowed the whole effort down.

Despite that, for over a decade, the Mayo Clinic has used APACHE successfully and found some areas to improve to save more lives. And now hundreds of hospitals use APACHE. But public reporting of ICU results is not required! So yes, each hospital may be able to make internal improvements, but they can’t learn from each other to make wide-scale improvements! Jeez!

Looking at it from a patient’s perspective, you could go to a hospital that uses APACHE thinking it’s got the latest and greatest ICU, when in fact, it never learned some aspects of ICU care that another facility found could kill you! Worse yet, even they wouldn’t know they didn’t have the best care possible – so they’d turn around and do the same deadly thing to the next patient! Who decided this makes sense??!!!

Excuse me, but this kind of deadly arbitrary CYA activity just drives me crazy.

Now, something called the Joint Commission on Accreditation on Healthcare Organizations (JCAHO), has endorsed APCAHE, but they only use process performance (not actual patient results) for determining endorsements. Although following a proven process is a good thing, by itself, it’s not enough. You can do all your paperwork correctly and still kill the patient! We need this evaluation system to be fully enacted by including patient results.

Now, I’m not big on ‘big government.’ Nor do I like the idea of over-regulating an industry. But, "providers’ fears of accountability for results" are holding back the measuring of results which would naturally lead to improvements in our overall health and lower costs. That’s why we have to legislate results reporting.

Step 1 -- Where to Begin

2007-04-18T15:47:00Z

Massachusetts the Model -- Why?

I’m suggesting Massachusetts as a starting point for two reasons:

1. The outgoing Massachusetts governor recently legislated universal coverage (meaning everyone in this state must
have some health insurance just like they must have car insurance or pay a fine) starting July 2007.

2. I live here – so I’m subject to number 1!

Although I think it’s a good idea to make coverage universal, I’m not comfortable wit the seeming lack of planning for the long-term affect of that decision. Yes, there is a safety net for the very poor. But as usual, the working class gets no support. Government officials have already started scrambling to find ways to plug the holes in this legislation. But right now, it looks like another dam is about to burst on some of us.

The governor assumed that costs will go down for individuals because more of us will be signing up. You know, I’m having a hard time believing that health plans are going to reduce their costs because we will be compelled to buy their product.

And I don’t have any confidence that prescription drug prices will go down either. I do wonder if it isn’t a good time to invest in health plans, though – their stocks are likely to go up! More importantly, there’s no incentive to either track or improve results accompanying this edict. All the law is really doing is compelling people to either buy health insurance or pay a fine.

So the clock is ticking. The sooner we can get this done, the better for all of us in this state. And if we can get it right in this state, we can make it better for all of us in this country! (NOTE: California made its announced plan for universal coverage while I was in the middle of preparing this. So you Californians may want to get on board as well!) We have to get the legislature to require useful data collection.

‘Useful’ Data Collection? Is there any other kind?

So you may be thinking – what’s with the qualifier – useful? Isn’t the whole point of data collection to get useful information?!

Of course it is. But once you add politics, well, it’s very easy to end up with use-less data! Why am I so cynical? Because it’s already happened! Well, maybe that’s a bit harsh – it’s not entirely useless. It’s just frustrating to see them get so close and then back away – and some of this was started decades ago! We’ll just have to help them on the ‘courage’ front!

More to come…

Don't Get Hurt -- It'll Make you Sick!

2007-04-10T19:25:00Z

Oh, You’re Hurt – Well Now We’re Going To Make You Sick, Too!

I know this is slightly off-message – but I can’t help myself! Get this:

My husband got hurt working at his job. A fellow pressman was running a machine nearby. When my husband heard a familiar sound (The last time he’d heard it, he’d had to help another pressman pull his injured hand out of a press), he quickly turned and ran to help.

Luckily for the other pressman, something else caused that awful sound. My husband went back to work, as he says, ‘bull-dogging’ 300 pound rolls of paper on a web press. Unluckily for my husband, he ended up injuring himself with a hernia! (Damn hero! Forgot he’s getting older!) Oh, well. Hernia operations are routine these days, right?

Here’s the rub: Workman’s Comp denied his claim because they had ‘insufficient evidence’ to prove he got the hernia on the job, so they refused to pay. Meanwhile, Blue Cross denied his claim also because, well, it happened on the job, so they’re not responsible for covering it.

Can you believe this!

We were still fighting – even after my husband had the operation. He had to go to what Workman’s Comp calls ‘an independent doctor’ who was to make the final determination as to when the hernia occurred. Somehow, he made this final determination a week after the surgery was completed – can you believe that!

It’s bad enough my poor husband was limping around the house – did they have to add financial stress to his injury as well? Just another indication that healthcare is no longer about health.

(BTW – Workman’s Comp finally came through – about a month later! But, the hospital is still billing us for co-pays even though Workman’s Comp is responsible for paying them in full!)

We Need Healthcare Results -- Works for Rice!

2007-03-27T17:14:00Z

We Need Results – Works for Rice!

When I cook rice on lower heat for a longer time (vs. higher heat for a shorter time), it comes out fluffier and tastier. How did I figure this out? – I tried each way and tasted my results!

Right now, a few medical sectors already volunteer or are compelled to report results by medical condition. For instance, Medicare requires participation in some form of results collection for dialysis reimbursements. This effort has improved mortality rates and contained costs for dialysis. (See the Useful Data Collection section below for more details; and you can always check the Book).

But for results reporting to be truly effective, all hospitals, doctors, medical staff/teams – all need to participate in open data collection and assessment on results on all medical conditions. And that has to be made widely available to us all.

No surprise -- there’s some resistance. Imagine having to indicate how many of your patients died at your hand? Ugh! It’s almost morbid! But, we need that data along with patient condition to properly evaluate what works best for which patient types.

What does patient condition mean? Let’s say you’re 30 years old, exercise, eat reasonably well, have a healthy family history and you have a heart attack. (Maybe it’s the stress of your job). Now let’s say your 85 years old, you sit a lot, eat whatever you like, smoke, drink, both of your parents died of heart attacks, and you have a heart attack. Let’s say the 30-year-old survived but the 85-year-old did not.

Well, it’s not fair to say 1 success for the 30-year-old’s doctor and 1 loss for the 85-year-old’s. The patient’s condition before treatment will naturally affect the outcome. The Book likes to call that risk-adjusted results. And hey, if the 30-year-old died and the 85-year-old lived – well, I want the treatment the 85-year-old got!

But this kind of disparity is part of the reason why the medical profession is concerned about collecting results – will it be done fairly? Some medical providers claim you can’t have valid risk-adjusted results reporting. What if I serve the elderly – if you compare my results to a doctor who treats the young, I’m going to look like a killer!

Obviously, we don’t want to turn this into a witch hunt. And we don’t want to create a rush to treat only young healthy people – which, of course, would defeat the purpose of healthcare! So we have to insure that data is collected using sound risk-adjustment factors allowing for patient condition, which is not as far-fetched as some would have us believe.

Risk-adjusted results reporting is already happening in some areas of medicine. (See Examples of Results Reporting Successes below). A major objection could be more about lawsuits than anything else. After all, if you have to admit you could have conducted a procedure better than you did, will that not leave you wide open to a lawsuit? Obviously, this needs to be addressed (which the Book does in a later chapter, which I haven’t read yet, so I’ll talk about it later, too!)

But, we have to get around all of the resistance. Believe it or not, some efforts were made decades ago – and then cut short! (See Useful Data Collection below.) So we can’t be subtle about this – we need to take decisive action. If we legislate the collection of results incorporating patient condition and make it available to everyone (post it on the web, for instance), the focus will have to shift from the reasons why not to try, to what needs to be done to make this workable. Two intelligent academics (the authors of the Book) can’t do this on their own – they need the public to stand behind them in this effort. Ehhemmm... That’s us!

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Mission -- Reason for Being

2007-01-25T20:22:00Z

pPI -- THE PUBLIC INTEREST (the-pi.org; the-pi.info)

Reason for Being

Special interests have so overtaken our political system, that some of the basic interests of all of the people either don’t get addressed or get the ‘band-aid’ treatment. Thus, the pPI has been born. This is not a rightist or leftist organization. pPI is for people, not ideologies.

The first challenge of the pPI is healthcare. Right now, the only way an insurance company can make money, is by denying the very services they’ve been hired to manage. They have no real incentive to help patients – that just costs them more.

As for our political representatives – they have the best healthcare package any one could ask for. If they try to make anything more than minor changes in our healthcare system, they could lose their healthcare for themselves and their families. I ask you – would you give up such coverage – work against your own family’s best interests? That’s a lot to ask of anyone. Now add in the myriad special interests and their lobbyists who are making a fortune off the current system. Do you think they’ll let Congress stop their gravy train? Of course, you don’t.

So what are we going to do about this? There have been books written, institutes have conducted studies enough…now is the time to solve the problem.

Healthcare Goal

Devise a healthcare system for the US that meets the following objectives:

1. A capitalist model that has the patient as the capitalist.

2. Shift competition to patient care and away from cost-cutting and service denial by measuring quality of service (patient’s health results) vs. process compliance.

3. Relieve American businesses of covering healthcare for employees so they can better compete with non-American companies.

4. A system that focuses on prevention vs. treatment after the fact.

Once established, we have to come together with the specific plan that we are prepared to support by collecting signatures, signing petitions, and pushing for referendums state by state until we establish a national program that works for all the people.

Healthcare Based On Value

I used to think a Single-Payer System (jargon for government subsidized) was the right way to handle healthcare – then I did some research. The most successful Single-Payer System I could find was Belgium’s. They have combined government and private spending in a unique way that covers basic healthcare for nearly everyone -- nearly. And even they’ve already had to put a cap on spending.

And from the British Times Online regarding the National Health Services of Britain, we have: “In one example of the cash-saving strategies, seen by The Times, a primary care trust in Yorkshire has told hospitals that they will not be paid for some non-essential operations, while patients will not be given a hospital appointment in under eight weeks.”

The article goes on to say “the immediate suspension of treatments for varicose veins, wisdom teeth, X-rays of the back, operations for carpal tunnel syndrome, bunions, arthroscopy of the knee, and grommets for the ear, among others, “ has been announced. Yikes!

In America, our system has its own problems. Costs are rising exponentially but improvements are lagging. Right now, ‘healthcare’ here is more like the game hot potato – pass the cost off to the next guy. Unfortunately, patients are the last ones in line. So we have to be the ones who take action to change this process.

The Basics

For healthcare to become cost-effective and efficient, we have to compete on value to the patient. That means we have to track results so we can determine which procedures, hospitals, doctors, medicines are the most effective in treating each medical condition.

Now, I can’t claim this idea. A couple of academics (Michael Porter based at and Elizabeth Teisberg at Darden Graduate School of Business) worked out the strategy with all of its details. See their book: Redefining Healthcare, Creating Value-Based Competition on Results. I’ll be referring to this book throughout, calling it simply the Book. ). The basics are:

1 “The focus should be on value for patients, not just lowering costs.

2 Competition must be based on results.

3 Competition should center on medical conditions over the full cycle of care.

4 Results information to support value-based competition must be widely available.

5 Innovations that increase value must be strongly rewarded.”

(I’d add universal coverage as well – we need to have everyone in the system and switch the focus from treatment to prevention. More on this later.) So why hasn’t this strategy been enacted? Resistance from medical professionals and health plan providers who fear either loss of profit or excessive law suits. And anyway, if you could do your job and get paid without anyone reviewing your performance, would you want to give that up?

Operation

Remember the game Operation? It was an electronic board/patient with removable organs. As the doctor, you had a tweezer-like instrument to lift the organs out of the holes they rested in. If you touched the sides of the hole, the board buzzed you.

Now, health plan providers (insurance companies) have been trying to adapt to the spiraling increases in healthcare costs by playing doctor! By denying us treatment, that’s exactly what they’re doing. I think we need to buzz them! They in no way bring improvements to our medical system this way. And if they want to maintain or increase their profits, they, too, will have to take a new approach to healthcare.

Misconception

We’re all so used to volume purchasing/ discounts, it seems only natural to apply it to healthcare. The problem:

Whether a doctor injects one or 20 patients – it takes the same amount of time to inject each person. The volume of patients doesn’t reduce the amount time the doctor needs to spend with each patient. So it likewise doesn’t decrease actual cost. In this scenario, the only way for costs to go down is for the doctor to spend less time with each patient (in effect, inject you faster!). This is not good for anyone’s health.

To their credit, some insurers (like Blue Cross - BCBS), are making some efforts to adapt productively. BCBS has hired experts to review different treatments patients may use. In the value-based model, insurers would be more like patient partners. They would expand these review efforts to include all treatment options and all medical personnel options. The focus would not be on controlling costs, but on the patient’s health. In the long run, a healthy patient costs less than a sickly one!

According to the Book: “Companies such as Honeywell…have added services to assist their employees obtain” information about medical conditions. Under the program, employees can call Consumer’s Medical Resource Company (consumersmedical.com), “for up-to-date, practical information on forty specific diseases.” “Honeywell estimates that it has cut more than $2 of healthcare expenditures for every $1 it spent on [the] program.” So you see information can save money.

Honeywell has the right idea -- patient advisors can help improve healthcare and ultimately reduce costs. Ideally, insurers would be the ones to connect patients with advisors and various forms of information. Accompanied with widely available results by medical condition, this kind of information will improve healthcare AND cut costs in the long run.

For insurers to see the benefits of this approach requires removing companies from the healthcare mix. Right now, companies are the major buyers of healthcare coverage. As such, insurers need to respond to companies’ interests, which, for the most part, is lower, immediate cost. Since the best short-term price often doesn’t afford the best quality service or long-term cost savings, we patients lose under company-driven healthcare.

For us to take control, to be the capitalist who benefits, well, we have to be the buyers, too. And don’t kid yourself—we’re already paying one way or another! From jobs lost to overseas companies which don’t have to cover healthcare for employees, to increases in our rates to cover people without insurance – we’re already paying. We’re just paying for the wrong things.