American health care continues to rank as the least cost-effective system in the developed world. Why? You might be tempted to say that, until recently, there was no incentive to change. A purely economic view is that the costs to healthcare providers have been greater than the payoff.
The economic landscape is changing. Quality reporting, value-based purchasing, Meaningful Use, risk-based contracts, and other reforms have created rewards and penalties intended to improve the value of health care. Will they work? Well. . . Ask instead, “How could they fail?” Continue reading
I have the opportunity to travel around the country, interacting with health plans and provider systems as they work out new payment models and new systems of care delivery, and I see an intense interest in these new models coupled with many theories on their pathway to success.
Weighed against the medical literature, three things are apparent:
- Most of the theories on improvement focus on processes that may have small relevance to outcomes.
- Most of the interventions at play are in very early stages and are very incremental.
- Interventions most likely to be linked to big outcomes are culturally challenging and being held at bay for the moment.
A major impact on outcomes requires bold action. Continue reading
I was fortunate to serve on the NQF Task Force on Risk Adjustment for Socioeconomic Status or other Sociodemographic Factors (SDF)i. This report generated more comments than any other NQF Task Force Report – ever. Of the 700 comments received in reaction to the draft report, the vast majority (more than 98%) were in favor. CMS was one of a very small number of institutions opposed to the initial report. While the final report contains significant modifications to the initial report, much of the spirit and substance remains. Continue reading
I previously discussed how selection of principal diagnosis may impact quality. This ripple effect (like a pebble on a pond) may occur when one works in a silo, ignoring other departments such as quality. If only the ripple effect was the lone “offender” in which CDI and coding may impact quality outcomes. Consider a spider web: intricately designed and seeming impervious. However, as strands get broken, the web collapses.
In review, CDI professionals and coders are tasked with obtaining and capturing a complete picture of the patient’s encounter for appropriate reimbursement, accurate reflection of severity of illness (SOI) and risk of mortality (ROM) and outcomes of care. Historical models of CDI programs and coding processes focused predominately on the first two tasks, without acknowledgement of how this may affect quality outcomes (potentially fracturing the spider web). Continue reading
Earlier this year, The Journal of the American Medical Association (JAMA) published a widely publicized but limited article on medical homes in Pennsylvania that found little improvements in quality and no improvements in costs or utilization associated with medical homes. The authors concluded medical homes may generally “need further refinement” — a phrase that was taken by many in the press to mean that medical homes “don’t work.”
Subsequently, there has been much debate and little clarity around the promise of medical homes. Continue reading
Continuous quality improvement is well known to us and integral to the culture of 3M. We often think of this as process improvement, employing Six Sigma and Lean methodologies. There is a distinctly human aspect to evaluation of individual and critical team performance because of opportunities for personal growth and refinements to team dynamics, respectively. Tremendous value is achieved when individuals bring absolute honesty and integrity to the process. Continue reading
Two trends are forcing greater consumerism and price sensitivity in health care. One is that Medicare, Medicaid, and some commercial insurance carriers, are starting to show patients and employers the prices facilities charge for common procedures. Another factor is that patients with high-deductible health and account-based plans have an incentive to consider cost when choosing services and providers.
How consumer-savvy are patients? They can search for providers by quality measures on a number of websites including HealthGrades.com and QualityCheck.org. But it’s not as easy to find out what providers charge for, say, an MRI or sinus surgery and compare prices to quality measures. Continue reading
I have never been able to skip a stone, but I do enjoy watching the ripples expand until they disappear. Or do they?
Clinical documentation improvement (CDI) has been around for quite a while and the function has changed throughout the years. Initially, the focus was on appropriate financial reimbursement for resources provided to patients. As quality of care became more transparent, the scope expanded into accurate reflection of severity of illness and risk of mortality. Today, the role of clinical documentation has grown far beyond these two functions. Continue reading
The AHIP conference in Seattle this month includes three consumer retail executives on the agenda. In leading up to the event, the media cited one of the speakers, the former president of Trader Joe’s, and suggested that health care should take some cues from the retail grocer.
Stop right there. Health care should not imitate the business model of Trader Joe’s, known for its folksy story-telling and unique selection of private label foodstuffs. The healthcare market is significantly different from grocery stores in ways that make it difficult to be consumer friendly: Continue reading
Those in public health believe that everyone is entitled to breathe the same clean air, drink the same safe water, and eat the same uncontaminated food. Public health protects and promotes health for everyone — regardless of race, sex, age, socioeconomic status, whether among rural or urban dwellers, whether the employed or unemployed. The basis for charting progress has been measuring and monitoring health indicators using epidemiologic tools and methodologies that account for variations in the population, such as identifying risk factors for certain conditions and geographic considerations.
But what about equity in access to health care, health information and health security? Continue reading