HEALTH CARE: Real World Solutions That Really Work

For quality-oriented health care communities across America, "yes we can" has nothing to do with politics.  It's about what they do every day. In red states and blue.

Four of the top health policy experts in the nation -- a bipartisan crowd, by the way, and they are all physicians -- convened representatives of 10 of high-quality, low-cost communities in Washington recently (we wrote about it). In a New York Times op-ed today, they explain why the rest of the country should take note: this can be our future.

Instead of screaming at each other about fictional plots to have the government start euthanizing people,  we should pay attention. They write (emphasis ours):

We have reached a sobering point in our national health-reform debate. Americans have recognized that our health system is bankrupting us and that we have dealt with this by letting the system price more and more people out of health care. So we are trying to decide if we are willing to change -- willing to ensure that everyone can have coverage. That means banishing the phrase "pre-existing condition." It also means finding ways to pay for coverage for those who can't afford it without help.

HEALTH POLITICS: Don't Call It Comeback

New Hampshire has been a crossroads for many a campaign. Obama's town hall in Portsmouth, NH, today, may prove to be just such a watershed moment in the fight to reform health care (transcript here).

Portsmouth native Lori Hitchcock introduced the president. A single, self-employed mother, Hitchcock has been denied coverage because a preexisting medical condition. Her plight, and that of 12.6 million other Americans, is the subject of a new report, Coverage Denied, released today on HealthReform.Gov.

It's a story familiar to Obama from the letters he reads each day, and one which helped frame the narrative of the day's discussion. "Change is hard," the president noted, "And it doesn't start in Washington, it starts in places like Portsmouth, with people like Lori." The audience responded with chants of "Yes We Can."

HC4HR: A New Model for Accountable Care

Recently we had the chance to sit down and talk with Donna Katen-Bahensky, the president and CEO of University of Wisconsin Hospital and Clinics and a member of Health CEOs for Health Reform.

In the video below, Katen-Bahensky describes her organization's efforts to change the dynamics of modern medicine through the principles of accountable care organizations (ACO).

HEALTH REFORM: We Can’t Fix Health Care By (Merely) Fixing Health Care

The health reform bills wending their way through Congress lay the groundwork for a long overdue shift in our system. Right now, as guest blogger Dr. Ira Byock writes, we don't have a "health" care system, we have a "disease care" system. After all, he reminded us, the word "patient" comes from the Latin: one who suffers.

The pending bills would expand prevention and wellness, create medical homes in Medicare (and encourage them in Medicaid), strengthen primary care and care coordination, and start to tackle avoidable hospitalizations and rehospitalizations. The Senate HELP committee even starts to address some of our needs in long-term care. But Dr. Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center and the author of  Dying Well argues that if we want to finally address our runaway cost and quality challenges, we must  to think outside the conventional health financing box, toward a system that literally cares for and about  our health. 

QUALITY: The True Meaning of a Ghostwriter -- Is it All in the Game?

On the streets of Brooklyn in the mid-90s, Ghostwriter was a friendly spirit who taught a group of racially diverse friends the value of reading while helping them solve mysteries like: "Who pulled the fire alarm?" and "What's up with Alex?

Alas, in the pages of medical journals today, a ghostwriter has a more negative and controversial meaning.

The front-page of today's New York Times has an in-depth report detailing the questionable practice of medical companies hiring writers to ghostwrite articles which tout the benefits of their products while downplaying risks and potential alternatives. It's one more reason to have unbiased government-funded comparative effectiveness research to help us figure out the best ways to treat patients.

QUALITY: Every Patient, Every Time

The term "cookbook medicine" gets thrown around a fair amount these days, especially surrounding stepped up comparative effectiveness research.  Most professionals in the health dialogue agree that this information will help improve the quality of care by deepening our understanding of what works for whom, when.  But standardization also has its opponents, on the right, the left, and among some physicians.

But if  there is one generally agreed upon best way to conduct bypass surgery, and another one that's been found to result in higher mortality, wouldn't you want your family member's physician to follow the cookbook? 

The Institute for Healthcare Improvement (IHI) is an unwavering supporter of using evidence to improve and standardize certain processes that are known to improve patient outcomes. They recently hosted a webinar to advertise four collaboratives that they are continuing and recruiting members for this fall: Transforming Care at the Bedside, Improving Perinatal Care, Reducing Readmissions by Improving Transitions in Care, and Reducing Sepsis Mortality

QUALITY: More Quality Improvements at Providence Medical Center

We wrote recently about Providence Medical Center in Everett, Washington, and itsr innovations in health care quality. Everett now gets a look as one of "10 model communities throughout the USA able to provide top-notch care at relatively low prices" writes USA Today.

Over the past five years or so, the hospital expanded the leadership role of physicians to promote consistency and quality in care delivery, and in trying to address all the things that can go wrong when a patient transitions from one care setting, or care provider, to the next. . USA Today highlighted another one of Providence's quality innovations, shortening length of hospital stay and improving patient satisfaction during and after heart surgery. That involved re-examining care transitions too.

Providence is one of the few U.S. hospitals to create a "single-stay" heart surgery unit so patients remain in one place from the moment they leave the operating room until they're discharged. As patients need less life-support technology, it's simply removed from the room.

COST: Physicians, Like Normal Humans, Not Immune to Economic Incentives

A recent front-page Washington Post story examines the issue of physician imaging self-referral.  The story highlights a Midwestern urology practice whose imaging orders increased 700 percent in less than a year after they purchased their own CT scanner. 

The practice's attorney told the Post, "The standard of care for a certain category of patients may require a CT scan and the practice may have decided to purchase a CT scan as a result... Any assertion that there is some wrongdoing simply because of an increase in scans is unfounded... (The practice) understands its obligations very well and complies with all applicable standards."

This reminds me of the Upton Sinclair quote: "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

In fact, the story told in the Post is consistent with nationwide trends.  According to the CBO, Medicare spending on MRI and CT scans rose at an average annual rate of 17 percent from 2000 to 2006. That amounts to spending two-and-a-half times the amount taxpayers were paying in 2000 compared to 2006.

IN THE STATES: Creating a Picture of Health(y) for the Nation's Capital

Washington DC is not the picture of health.

I'm not talking about political dysfunction. I'm talking about the health of the people who live here.

That may be changing.

The city has gotten lots of attention for its edgy school chancellor and education reform; it's also begun (with far less fanfare) a pioneering attempt to address health challenges in a city with a serious, and costly, burden of chronic disease.

Life expectancy in the nation's capital is eight years lower then the U.S. average. Mental illness, HIV/AIDS and cardiovascular disease rates are high. Lots of people are overweight; diabetes is a big problem, leading to a high rate of serious kidney disease and amputations. Costs are high (although the uninsured rate at under 11 percent -- 2007, pre-recession -- is lower than the national average of about 16 percent.)

HEALTH REFORM: 450,000 Doctors Can't Be Wrong

In letter delivered today to the U.S. Senate, seven organizations representing close to a half a million doctors expressed their strong support for passage of health care reform in 2009. (This is apart from the crucial AMA endorsement of the House health reform bill.).