September 28th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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I have opposed Medicare’s use of claims data to evaluate the quality of medical care. Quality medical care is the goal that must be achieved. However, no one has described the measurement of quality medical care adequately.
Physicians recognize when other physicians are not performing quality medical care. Physicians recognize when another physician is just testing and performing procedures to increase revenue.
These over testing physicians are a small minority of physicians in practice.
Quality medical care is not about doing quarterly HbA1c’s on patients with Diabetes Mellitus. Quality medical care is about helping patients control their blood sugars so their HbA1c becomes normalized. It is about the clinical and financial results of treatment.
The clinical and financial results depend on both patients and physicians. Patients must be responsible for Read more »
*This blog post was originally published at Repairing the Healthcare System*
December 6th, 2010 by Happy Hospitalist in Better Health Network, Health Policy, Opinion
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Looking for a great story about the state of hospital care in America? Look no further. The Health Care Blog has a great article by hospitalist Dr. Robert Wachter that sums it up nicely. It’s about money. Thats how hospitals get paid. That’s how everyone gets paid. It will always be about money. We don’t pay doctors, nurses, or administrators with smiley faces and candy canes. We pay them with cold hard cash. For example:
One of the physicians, an invasive cardiologist, stopped me in my tracks. “Actually, our hospital already provides a tremendous amount of support and feedback,” he said. “When I perform a catheterization or angioplasty, a hospital staff member watches the entire procedure, she sometimes suggests mid-course corrections, and as soon as I’m done she provides me detailed feedback on whether I met all the best practice standards.”
“Wow,” I said. “Your hospital is really taking quality seriously!”
“Oh,” he replied, mischievous smile on his face, “she’s not from the quality department. She’s from the billing department.”
The question should not be how do you get profit out of medicine. The question should be how do you get quality into profit. We need profit. The last thing you want in this country is universal VA health care. Trust me on that. Americans would never stand for it. But how do you get both? Read more »
*This blog post was originally published at The Happy Hospitalist*
October 20th, 2010 by EvanFalchukJD in Better Health Network, Health Policy, News, Opinion, Research
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Who do you think is likely to be a better doctor: A board certified graduate of one of the top medical schools in America, or a non-certified doctor trained in a foreign country?
If your answer is “I have absolutely no idea,” then you’re probably spending a lot of time looking at the “report cards” that pass for measures of health care quality. And you’re probably confused.
Researchers in Pittsburgh studied 124 process-based quality measures in 30 clinical areas. These process measures are the state-of-the-art ways in which government and private insurers are checking up on the quality of medical care. They include things like making sure patients with heart problems are prescribed aspirin, and that women get Pap smears. The researchers compared these measures against other, simpler measures, like medical education, board certification, malpractice claim payments, and disciplinary actions.
The result? You couldn’t tell the differences among doctors. Read more »
*This blog post was originally published at See First Blog*
June 7th, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, Opinion, Research
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Last week I heard a lecture about Accountable Care Organizations by a physician leader working for one of the major hospital systems. His discussion made me realize that large physician organizations and hospitals are spending lots of time solving problems of quality medical care. In my opinion quality medical care has not been adequately defined.
A working definition right now is to decrease hospital stays, efficient medical care for a disease at lower cost, avoidance of medical errors in the hospital, and avoidance of hospital acquired infections. These are important goals. They must be attached to monetary incentives. Many of these problems can be solved now.
The solution demands the development of processes of care. An important question is how much money will process improvement save? I estimate that this process improvement could save an estimated 7 to 10% of the healthcare dollar.
The real question should be focused on how to repair the healthcare system by decreasing costs while improving the health of Americans. Read more »
*This blog post was originally published at Repairing the Healthcare System*
