Happy New Year to all our readers! Before the ball drops in Times Square, catch up on five of our most read blogs of the year: Continue reading
WIFM (what’s in it for me) is a common question in health care. With too many patients and not enough hours in the day, compounded by requests for additional documentation regarding medical necessity/continued need for inpatient admission, quality outcomes data can quickly fall down to the bottom of the provider’s to-do list.
Let me be clear on one thing. Providers do care about quality data and how their care is perceived, some more than others. Asking any surgeon to comment on a potential complication is fairly easy. But providers need better, more detailed information about how quality beyond operative complications impacts them and their practice of medicine. What follows is a partial list of WIFMs for providers from a quality perspective: Continue reading
The Triple Aim is a construct developed to move past the trade-offs typical in health care improvement: improved quality at the expense of increased costs, decreased costs at the expense of quality or access, improved guideline adherence at the expense of patient experience of care, etc. The Triple Aim defines success as simultaneous improvement in population health and outcomes, patient experience of care, and cost trends. Continue reading
Medical care produces both benefits and harms. There are risks associated with care delivered in the hospital, including infections, medical errors and delirium. There are side effects associated with medication and, ultimately, there are risks associated with all medical procedures. When a patient is suffering from a painful or debilitating illness, it is understandable how they might overestimate the benefits of medical care and underestimate its risks in an effort to obtain a cure or symptom relief. More worrisome is that some physicians may be poor estimators of risk. The medical community often ascribes to the adage that it is better to act than do nothing, whereas “nothing” may be in the best interest of the patient. Continue reading
Pardon the bad play on words, but “it was the best of hospitals, it was the worst of hospitals.” Within the past week I interacted with two healthcare organizations and had the chance to discuss not only how they report, but improve their quality outcomes. In order to protect both the guilty and the innocent, I will only state that both are large academic medical centers with similar services, physician leadership and quality organizational structures. In comparing the two organizations, the gargantuan differences in reporting frustrate me, and the ethics of the leaders involved in quality at one institution frankly disgust me. How can we accurately measure, and ultimately improve, quality outcomes if all are not “playing” honestly? And yes, I acknowledge that “gaming” in quality scores has been occurring for decades. But does that make it right?
Patient reported outcome measures matter. The subject is capturing an increasing amount of attention as clinicians strive to reduce suffering by trying to figure out what matters to people (see the New York Times article, “Doctors Strive to Do Less Harm by Inattentive Care”).
Helping people with chronic conditions achieve better outcomes is a foundational principle of population health management and value-based contracting. Continue reading
Maybe solo primary care practices are dying, but so what?
This question led some folks at Mathematica Policy Research to look into solo primary care practice and the results are interesting.¹
They looked at a handful of states and found that the ratio of solo and very small practices varies quite a bit but represents a significant proportion of practices. While on average 13 percent of primary care physicians practice solo, this represents 46 percent of practices. 65 percent of practices have one or two physicians. Continue reading
There is plenty of speculation about the fate of hospitals and healthcare IT. The uncertainty could make it difficult for hospital executives to set strategies for the coming year. Yet, there are a few near-certainties as we go into 2015. Here are three resolutions hospital executives should make to keep pace with 2015 trends. Continue reading
At the start of the New Year, I can’t help but reflect on how much patient care has changed in my 25+ years. Many things that were common practice back then were either not necessary or even sometimes harmful. An example would be Foley catheter placements. Foleys for “everyone” whether they needed them or not!
However, the advent of superbugs with increasing antibiotic resistance has also meant an increase in catheter-related UTIs. Organizations became focused on prevention, using different catheter materials thought to prevent colonization, and by evaluating the need for insertion and/or continued placement. It certainly didn’t hurt that catheter-associated UTIs (CAUTIs) were determined to be hospital-acquired preventable conditions that CMS would not reimburse, and were also factored into quality outcomes metrics by quality assessment programs or organizations. Continue reading
Thinking about all of the various quality initiatives currently out there or under development, I can’t help but think about what we DO with all of this information. Certainly accuracy is important for accurate quality scores, but isn’t accuracy important for a more basic and important reason?
Prior to joining 3M, I was employed as a nurse manager at a 600+ bed hospital. I was responsible for the CCU, CVICU and CV step-down units. Early on in my tenure, the quality and infection control departments presented statistics to the nurse managers on our infection rates by unit. To say it was concerning would be an understatement. We were tasked with developing a meaningful strategy to reduce the incidence of hospital-acquired infections and our strategy was two-fold: education and surveillance. We educated all stakeholders on the current statistics and the hospital protocols for reducing hospital acquired infections. Continue reading