- Dr. Ted (he’s not me) | The Economist – Comment from a user of The Economist.com that refers to the Kaiser Permanente study showing a 21.5 % decrease in office visits in Hawaii. (see http://content.healthaffairs.org/cgi/content/abstract/28/2/323 ). I agree that the majority of care to Americans is provided in small practices, as well as the idea that physicians who want to perform virtual care find it difficult with today's reimbursement approach. (50% of the reason I’m posting this is to clarify that I’m not this Dr. Ted. I post comments on others’ blogs as “Ted Eytan.”
Posts Tagged ‘health affairs’
Dr. Ted (he’s not me) | The Economist
April 27th, 2009 | Popularity: 15% 0 comments | Leave a replyHealth Affairs — Selected Abstracts on Accountable Care Organizations
March 26th, 2009 | Popularity: 22% 0 comments | Leave a reply- Health Affairs — Selected Abstracts on Accountable Care Organizations – A few articles recently published about “ACO’s” which would aggregate physician practices in groups of 5,000 beneficiaries for quality improvement and shared savings. Could be an impetus for smaller practices to collaborate on health information technologies.
Now Reading: Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care. Health Affairs. 2009 Mar 1
March 13th, 2009 | Popularity: 50% 15 comments
Note: the article no longer requires a subscription for access (3/14/09)
The much anticipated health information technology issue of Health Affairs, and in it is an article written by Carleen Hawn about Social Media in Health Care. The links above to to the Health Affairs site, but it appears a subscription will be required to view it, so hopefully readers have access to an institutional or other subscription to read it.
The genesis of this article was a discussion that was started in July, 2008, at the American Board of Internal Medicine’s forum on Patient Centered Care, where i presented about some of these concepts. This was followed up with discussions with myself and other leaders in the field, such as Jay Parkinson, MD, from HelloHealth, Bob Coffield, a well known legal expert in the area of social media, as well as real patients.
I actually attended the briefing announcing the release of this issue in Washington, DC, and was pleasantly surprised to see that the article is billed on the front cover of a very full catalog of scholarly works. Who would have thought 4 years ago that an article about social networking/media would be front cover material for the Health Affairs issue on Health Information Technology. This says a lot about the impact that social media, or perceived impact, in this area of health care! At the same time, I think Matthew Holt correctly points out that there’s a part two (and three and four) to be written covering what’s below the tip of the iceberg.
In addition to the information mentioned in the article, Carleen Hawn also consulted with some of my favorite innovators in health care, including Scott Shreeve, MD, and the team at the Kaiser Permanente Sidney Garfield Center for Health Care Innovation.
In addition to these contributions, I would also mention the contribution of the California Healthcare Foundation, whose leaders, including Veenu Aulakh, MPH, Sophia Chang, MD, MPH and Sam Karp, stimulated the development of the crowdsourced definition of Health2.0 mentioned the article with a simple question to me: “Ted, what is Health2.0?” (my answer was, “I don’t know, let’s ask the crowd.”)
And, I would also like to mention that innovation like this comes from health care organizations and systems that are able to say,”Not everything has been tried before,” and in my case this is/was Group Health Cooperative, who have learned from our early blogging experience and now bring their physicians and staff online for the world to learn about what they are doing to reinvent primary care. I’ve been engaged in maybe a few conversations over the past few years about why health care organizations should be transparent and it’s helpful for everyone to have an example of why this works well for everyone.
Thanks again to Carleen Hawn, The Health Affairs Team, and The American Board of Internal Medicine Foundation for taking the time to explore this topic for America’s patients (that’s all of us).
Now Reading: “What’s the ROI on that scanner you just bought?” – Use of Medical Imaging in the United States
December 1st, 2008 | Popularity: 22% 0 comments | Leave a reply
The quote in the title of this post is the paraphrase of a conversation I have had more than a few times with someone who has asked me, “Ted, what’s the return on investment for web services for patients?” The answer I have usually gotten when I ask the question back is usually no answer.
Two papers just published in HealthAffairs provide a little more background for that conversation. The first is about the growth of the use of imaging technology in the United States. As you might expect, it is growing, and more with every new scanner put in operation.
To put things in better perspective, I created this graph from the data, showing the increase in the number of scans/beneficiary. In 2005, there were 547 CT scans per 1,000 Medicare beneficiary, or about 1 scan per 2 beneficiaries. What the article doesn’t mention is that the radiation load from a CT scan is high, anywhere to 15 – 100 times the dose of radiation from a chest X-ray. Medicare reimburses, on average $308 for a CT scan, $713 for an MRI.
A basic return on investment analysis is performed for abdominal aortic aneurysm (AAA) screening, which shows that as more people are screened using CT, less are screened using catheter angiography (which is more invasive). This is good, except, the reduction is less than 1:1, so there is overall expansion of screening to more people, and more procedures to fix AAA associated with this. The problem is that there isn’t data on whether this is overall a good thing or not from a cost/benefit perspective.
Because CT and MRI are a physician preference item, reimbursement and use is typically physician directed, which can create conflict (see Jaime Robinson’s paper in the same Health Affairs issue for more about this).
It’s interesting that the adoption curve of CT/MRI looks a lot like the adoption curve of personal health records in organizations that prioritize them, like Kaiser Permanente and Group Health Cooperative.
Currently, Medicare pays $0.00 per certified empowered/activated patient (potentially defined by more than 2 accesses to a comprehensive personal health record in 6 months).
So we know from this is example that it’s possible for health care to adopt technology. How can we recreate the magic of the CT/MRI adoption curve for something that’s patient directed? I have some ideas but want to see your comments first.
Now Reading: 25 Percent of Large Medical Groups Use Data from Patients to Improve Care
October 14th, 2008 | Popularity: 34% 0 comments | Leave a reply
Only 10 percent reported that most of their physicians would strongly agree with statement that the group regularly incorporates feedback from patients in improving care and developing new services.
This is among the largest medical groups, the ones with the greatest infrastructure.
This figure comes from the attached article, published in Health Affairs , which is a survey of a sample of the largest medical groups in the United States (those with 20 or more physicians), with the exclusion of Independent Practice Associations (due to theoretically less infrastructure present), and via self-report of the CEO’s/Presidents/Medical Director. In other words, this is best case.
With regard to online access:
Thirty percent of medical groups use group visits for patients with chronic illnesses at a majority of their practice sites (data not shown). A similar proportion reported that most of their physicians communicate with patients via e-mail “occasionally,” although only 1 percent reported that physicians use e-mail with patients daily. Nine percent said that a majority of their patients could access some part of the group’s EMR online.
Unfortunately, the performance of the medical groups surveyed lessens as the size of the group does. I thought it might be possible that smaller practices in this group might employ greater efforts to incorporate patient feedback. That could still be the case, since groups with less than 20 physicians are not included here (and those are the overwhelming majority of places where Americans receive their ambulatory medical care).
What about measuring “Medical Home-ness”?
Although some argue that “ medical-homeness” is better evaluated from the patient’s perspective than from the physician’s, others balk at all attempts to measure aspects of the PCMH as overly reductionist. Regardless, the demand for clinical practice “ transparency” remains a reality of the current policy environment, and success of the model will depend in part on continued multistakeholder involvement in the development of standardized, comprehensive assessment tools.
How, in a Health 2.0 world, could we combine the significant expertise of NCQA and lighter weight solutions to support patient involvement in the measurement of medical home-ness? Would this approach also guide medical groups to select the right infrastructure improvement projects for themselves and implement them quickly? This fits in nicely with the LEAN concept of “seeing the impact of what you do,” by getting smaller bits of feedback soon, combined with more comprehensive feedback over time.
Maybe a parallel iPhone Medical Home measurement application will surface …. see what you think.
Now Reading: Three Articles on Health Information Technology Adoption
September 1st, 2008 | Popularity: 35% 0 comments | Leave a reply
When I read these I thought about what my opinion was about them, and what I might write in a blog post about them. I didn’t really want to critique their opinion or lay mine on top, because I think the pieces stand up well on their own, and I am no more connected to the facts than these authors are.
So I thought I’d just end up writing a post that said that I read these articles (I know, uncharacteristic of me).
Then, I stepped on the Washington, DC Metro, and this advertisement, for a local hospital stared me in the face:
I looked at it several different ways – on the one hand, the implication is that if your child has a serious spine problem, they will take care of it. However, if you do not have a child with a serious spine problem, should you go elsewhere for primary care, or are they good at that, too?
Is 3-D imaging today’s marker for quality health care? That’s what brought me back to the point of these three pieces.
In my travels, I don’t often see advertising for health care organizations that say, “Come to us for your primary care, your child is more likely to be immunized by us.” Or, “Come to us for all of your care – we’ve been rated the best listeners in DC.”
Here’s another example from my Twitterfeed. How did health care come to this?
What these pieces do for me is support the work to move to a system where the customer is the patient. The care experience should be as good as any a person can get from any other industry, online or offline, and one that is accountable to it for the things patients care about. It’s not how many personal health records there are, but how often patients and families make meaningful decisions to stay healthy because of them.
For me, this is where the energy comes from around patient access, patient and family involvement in care, and in the design and improvement of the health system.
Finally, I just re-acquainted myself with this quote yesterday, from my reading of A Fortunate Man, by John Berger about a country doctor in 1967. Here’s what the author said about computers in medicine back then.
It may be that computers will soon diagnose better than doctors. But the facts fed to computers will still have to be the result of intimate, individual recognition of the patient.
Was he right? (rhetorical question)
Health Affairs Blog: Mark Leavitt “not magical just practical”
August 22nd, 2008 | Popularity: 27% 0 comments | Leave a replyHealth Affairs Blog: Health IT Initiatives: Not Magical, Just Practical
Thoughtful quasi-blogpost* from Mark Leavitt, MD, who is also the Chair of the Certification Commission for Health Information Technology (CCHIT). In the post, Mark very nicely acknolwedges the number of dedicated volunteers in the CCHIT process – I know from experience that this group is working hard and is very talented (way more than I am).
*the quasi part is that I notice that the Health Affairs blog appears (to me anyway) as more of a Web 1.0 publication with comments, than a blog in the spirit of blogs. It might be nice to tweak the HTML title tags a bit for easier embedding into other blogs, and maybe shorter, more personal posts, in the spirit of blogging. I think Health Affairs has been on the leading edge to adopt the blog format in the first place to be sure, now perhaps they could go a little farther to support interaction with the people in health policy in a more behind the curtain way…
Update: Physician Impact on Healthcare Finances
March 5th, 2008 | Popularity: 16% 0 comments | Leave a reply
Catlin A, Cowan C, Hartman M, Heffler S, the National Health Expenditure Accounts Team. National Health Spending In 2006: A Year Of Change For Prescription Drugs [Internet]. Health Aff. 2008 Jan 1;27(1):14-29. [cited 2008 Mar 5 ]
Reducing waste in our health care system is important. The latest data shows that 83 cents of every health care dollar spent is spent by physicians. Making the systems that carry out these orders efficient is a good goal; working with physicians at the point the orders are written (or typed) is also important.
