Tag: health

Health Business TV: Medical inflation, health kiosks, Home Care Delivered, hospital clowns

June 27th, 2014 by

In this third edition of Health Business TV, I discuss Home Care Delivered (whose board I’ve just joined), medical inflation and my appearance on Al Jazeera, health kiosks, Hearts & Noses Hospital Clown Troupe and an upcoming webinar about the small group health insurance market.

Please subscribe to the YouTube channel and tell your friends!

If you’re interested in the AIS webinar on July 9, called Insurer Strategies for the Turbulent Small Group Market you can click here to register. You can use the code I mention during the show to get a $75 discount.

There will be no episode next week, since it’s the Fourth of July.

By healthcare business consultant David E. Williams of the Health Business Group

Eagerly awaiting the death of defensive medicine

September 3rd, 2013 by

I’ve always been annoyed by proponents and defenders of defensive medicine, i.e., doctors ordering unnecessary tests to stave off lawsuits. Not always, but often enough, it is a case of physicians shirking responsibility, blaming others, and acting in a self-serving manner. Attitudes haven’t changed that much, if Defensive medicine: A solvable problem in Healthcare Finance News is to be believed.

A Medscape survey cited in the article asked physicians who’s been sued to give advice to others:

Among the remarks: “Document more often, more thoroughly… get rid of rude, demanding, noncompliant patients… practice more defensive medicine.” One advisor went so far as saying: “Don’t assume ANYTHING!! If it hurts, CAT scan it. If it hurts between the nose and the toes, consider it a heart attack and stress-test everyone from 9 to 90!”

A 2010 survey of physicians found that doctors thought 26 percent of health care costs were due to defensive medicine.

Although there may be a knee-jerk reaction to test more rather than less, there’s no evidence that the amount of testing has anything to do with the likelihood of a lawsuit. In a fee-for-service environment, more testing puts more money in the doctor’s pocket, so I’ve always been skeptical of the “defensive medicine” explanation for over-testing.

Now that capitation in various guises is coming into vogue, physicians and hospitals are going to look at things a little differently. I’ll bet the same doctor who recommends indiscriminate scans and stress tests today will find some other approach to risk management once financial incentives are re-aligned. With a bit of luck, that will sound the death knell of defensive medicine.

Thankfully there are other approaches to protecting against lawsuits, including not making errors in the first place and apologizing when mistakes do occur. I’m sympathetic to physicians who get sued, but we shouldn’t make too much of their defensive medicine advice.

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By David E. Williams of the Health Business Group.

Patient experience debuts in Minnesota

August 16th, 2013 by

Minnesota residents now have a robust, objective resource to compare the patient experience of care across medical clinics. The statewide Quality Reporting and Measurement System, created by a state reform initiative in 2008, has already rolled out public reporting of clinical quality measures. The new patient experience measures are based on more than 230,000 survey results and will complement the information that’s already available.

I’m a big fan of publicly reported patient experience measures. They enable easy comparisons across different types of physicians, are based on patient reported information, and are relatively straightforward for providers to improve if they make it a priority. We’ve had statewide reporting on patient experience in Massachusetts for several years, and I’ve found the information to be useful and accurate.

Minnesota Community Measurement (MNCM) collected and analyzed the data, which is available at www.MNHealthScores.org.

“For the first time, people in Minnesota can get information about the experience that other patients, like them, have had at physician practices across the state,” said Jim Chase, MNCM president. “The survey includes important information for patients about access to care, communication, and interactions with staff. Sharing this information can help patients know what they should expect and help physician practices learn what they can do to improve the results.”

I encourage patients and family members to review the information and take it into account when choosing a practice. Health plans can and should incorporate patient experience into their network development and pay-for-performance plans.

The information on patient experience is presented at the practice site level. In general that’s ok, especially for process-sensitive measures such as ease of making appointments. However other important elements, such as communication, do vary significantly by provider even within the same practice. Although it’s more expensive to collect the data at the individual practitioner level –due to the need for larger sample sizes—the results are more valuable. Maybe with time we will see a move in that direction.

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By David E. Williams of the Health Business Group.

Pets in the hospital: I'm keeping an open mind

July 16th, 2013 by

I’m not an animal lover, so it’s difficult for me to relate to the idea that a pet is a real part of the family. But I’ve met enough people who genuinely feel this way, and read the statistics, so I accept it. I have also heard about therapy animals visiting sick children and adults.

Therefore it wasn’t a huge surprise to see a USA Today story about hospitals that are beginning to allow patients’ own pets to visit them in the hospital. There are some health, safety and noise concerns, but at least some places, like the pediatric hospital in Jacksonville are letting it happen. The kids, many suffering from cancer and with unpleasant prognoses, are enjoying it, at least anecdotally.

There is some research on the impact of dogs:

Unfamiliar dogs have an “energizing effect,” creating a memorable event and elevating the day’s excitement; familiar pets, on the other hand, provide a more calming and reassuring effect, said Emily Patterson, an animal welfare scientist of the American Veterinary Medical Association.

“When a trained therapy dog visits, it’s like getting a strange person to perform music. It adds excitement to your day. When your dear pet visits, it’s like a friend is visiting you. It reconnects you with your community. You feel trusted and reassured,” Patterson said.

It seems like an interesting area of study, but I also wonder to what extent such research can be done objectively.

Health care deal sites –I'm quoted and I'm skeptical

July 9th, 2013 by

DealWell, a new company  that offers online health care deals, is the subject of a story on KERA, the NPR station in Dallas. I’m quoted in the audio and text versions.

Like other sites, the health care deals on DealWell tend toward ancillary services that aren’t typically covered by health insurance: dentistry, LASIK, massage, etc. You can also find some medical imaging and weight loss surgery.

I’m all for health care shopping and transparency, but I’m not a big fan of these sites and I don’t expect them to have a major impact on mainstream health care. (On the radio I refer to DealWell as “a little sleazy,” although the CEO disagrees!) Here are some of the problems:

  • DealWell uses a Priceline-like mechanism: accept the price posted on the site or bid less and see if your bid is accepted. This is a clever feature, but think about how it impacts trust. If I can’t trust my doctors to tell me the real price of the service upfront, why should I trust them about anything else, like whether I need a service in the first place?
  • Providers who offer these deals are paying DealWell in addition to offering cut-rate prices. Presumably they would like to make back their investment. The price-based shoppers on these sites are likely to go to a different deal-making dentist next time, so a tempting way to make real money is to recommend services that may or may not be needed. Even the initial packages that are offered may be more comprehensive than needed. Dental deals typically include teeth cleaning, a full set of x-rays and oral exam. Not everyone needs all that
  • These deal sites do not integrate with insurance.  The first patient cited in the article got an MRI for $400 on DealWell when she’d paid over $1000 before. But who is paying for MRIs out of pocket these days? Even with a high deductible plan it would make sense to shop around within network rather than going outside of insurance and paying cash. And if the plan doesn’t approve the MRI or ultrasound it’s probably because it’s not medically necessary
  • Continuity of care is eroded when patients see different providers every time

I can envision a limited role for these sites for patients who need services outside of the traditional medical system. But the big strides on health care transparency and affordability are being made today within the context of the Affordable Care Act and with transparency companies such as Castlight.