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Brown And Healthcare: Massachusetts Isn’t An Emerging Conservative State

I’ve lived in Massachusetts almost my entire life.  So, like everyone else, I was surprised by last night’s stunning election results.  To think, in Massachusetts we elected a Republican to serve out the rest of Ted Kennedy’s term.  It’s one of the few times where I would say it’s possible that a dead man is actually rolling in his grave.

The explanations – coming mostly from out-of-staters – are already coming in.  Coakley was a bad candidate.  Brown worked hard and showed he wanted it more.  It’s the economy.  These are all reasonable, and probably true, but I think they miss what the election was really all about. Read more »

*This blog post was originally published at See First Blog*

Is Lack Of Kindness The Greatest Barrier To Healthcare Reform?

Ancient people couldn’t understand why solar eclipses happened, so they looked for explanations that fit what they saw:

A recurring and pervasive embodiment of the eclipse was a dragon, or a demon, who devours the sun. The ancient Chinese would produce great noise and commotion during an eclipse, banging on pots and drums to frighten away the dragon.

They weren’t crazy, although if we accept their explanation, their solutions seem pretty illogical.  I mean, would a dragon big and powerful enough to eat the sun really be scared away by people banging on pots and drums?

I guess I don’t understand the skittishness of giant sun-devouring dragons.

But this the trouble.  When you come at a problem with a faulty premise — and insist on keeping that premise — it leads you down some very strange paths. Read more »

*This blog post was originally published at See First Blog*

Small Hospital Places A Bet With Big Insurance

Blue Cross Blue Shield of Massachusetts and Caritas Christi Health System are announcing a new agreement that some suggest may be a model for the rest of the country.

Under it, the non-profit insurer will stop paying the non-profit hospital on a fee-for-service basis for certain insureds:

Under the deal expected to be announced Friday, Caritas . . . will be paid to take care of about 60,000 Blue Cross members in its new program — whether or not they get sick. Caritas will use some of the payments for preventive services to help keep patients healthy. If Caritas can keep health-care costs under a certain budget, it can make a profit. But if health-care costs go over the agreed-on amount, Caritas is on the hook. . . . . Blue Cross is adding a carrot: If doctors and hospitals can meet certain quality targets, they can earn a bonus of as much as 10% on the value of the deal. Read more »

*This blog post was originally published at See First Blog*

Is This Really How We Should Measure Physician Quality?

The OSHA-ization of health care quality continues.

A research group and a consulting firm have been hired by the state of Massachusetts to head up a new initiative to publish cost and quality information on Massachusetts doctors.  But the quality measures they will use are the same old ones we have seen for a long time.  They mean very little to most patients, and even less to doctors as a measure of how good their work may be.

To understand what I mean, look at what is being measured.

For the category “Adult Diagnostic and Preventative Care,” there are only four quality measures.  They are:

  • rates of colorectal screening tests
  • the number of patients in an insured population who lowered their blood pressure in a given year
  • correct imaging test use for lower back pain
  • rates of use of a spirometry test for COPD

The good news is Massachusetts doctors do better than the national average on these measures.  The bad news is it’s hard to say what that means as far as how good any doctor is who is measured this way.

Maybe it’s better in women’s health.  There, the four quality measures are:

  • rates of breast cancer screening for women 40-69
  • rates of cervical cancer screening for women 21-64
  • rates of chlamydia screening for women 16-20
  • rates of chlamydia screening for women 21-25

Hmm.  So if I am a 30 year-old woman trying to figure out how good my doctor is, the only thing that is being measured is whether he does a cervical cancer screening on me or not.  How about pediatrics?

  • rates of well visits
  • correct antibiotic use for upper respiratory infections
  • follow-up with children starting medications for ADHD

I could go on, but there’s a pattern.  All of these “quality” measures are crunching medical billing data and styling it as a quality metric.  And so every metric is going to be focused on things that are easily measurable by a review of those bills.

But there’s a more disturbing pattern.  The information is simply not valuable to consumers.  Worse, I think it is deeply misleading.  A medical group that does chlamydia screenings on 100% of its patients may be good or bad – or it just may be smart enough to know that if they do the state of Massachusetts will rate them with five gold stars.  But consumers won’t be able to tell the difference. All they will know is that practice A is “high quality,” while practice B isn’t.  Some doctors are starting to sound the alarm about this.

And this is the larger point.  Our health care is organized in a way that systematically undervalues the thinking, processing and deciding aspects of medicine- the things that really matter to you when you’re a patient who is sick trying to get help.  Our system treats medicine as an assembly-line process amenable to assembly-line metrics.  But it’s not.

Doctors, like others in professions requiring judgment and reflection, need time to think, and ought to be judged by how well they do that. Since the leading cause of misdiagnosis is a failure of synthesis – a failure by the doctor to put together available information in a way that leads them to the right conclusion – our system ought to be built around helping make sure this happens each and every time.

So, instead of a web site where you could see how often a medical practice does chlamydia screenings, imagine you could find out how often doctors at a hospital got their patients the right diagnosis and treatment?  Now that would be a useful way to measure quality.

*This blog post was originally published at See First Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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