Posts Tagged ‘Institute for Healthcare Improvement’

America’s Healthcare System Needs Improvement: Study

Wednesday, November 2nd, 2011

The American healthcare system is not very healthy, according to a wide-ranging new assessment of the system that covers 42 measures of healthcare delivery, the United States scored just 64 out of 100.  “Costs are up sharply, access to care deteriorated, health system efficiency remains low, disparities persisted, and health outcomes fail to keep pace with benchmarks,” concluded the 2011 National Scorecard on U.S. Health System Performance. The report was issued by the Commonwealth Fund, a nonprofit healthcare policy foundation.

There are some bright spots on the report.  For one, the number of Americans who are controlling their high blood pressure rose from 31 percent in 2008 to 50 percent in 2009.  Additionally hospitals have improved their ability to care for patients with heart attacks, pneumonia, and other common conditions.

The Commonwealth Fund report also determined that the typical U.S. infant mortality rate is 35 percent higher than the top-performing states.  Other wealthy countries still have infant mortality rates that are significantly lower than the best-performing states in the United States.  If the U.S. did as well as the top-performing country in that category — France — 91,000 fewer babies would die prematurely each year, Cathy Schoen, senior vice president at Commonwealth Fund said.  “These statistics are real,” she said.  “They are real human lives.”  Other “areas of concern” include childhood obesity, preventive care and infant mortality.

Another issue is cost, an oft-cited statistic that the U.S. spends more per person on healthcare than any other country.  According to the Commonwealth Fund report, the nation in general spends twice as much as comparable countries, but doesn’t have better care to show for it.  “We are headed toward spending $1 of every $5 of national income on healthcare,” the report’s authors said.  “We should expect a better return on this investment.”  The high cost of healthcare takes a toll on personal finances, the report said.  By 2010, 40 percent of working-age adults had medical debt or difficulties paying medical bills, an increase of 34 percent when compared with 2005.

It is important to note that the majority of the report’s data is from 2007 – 2009, prior to the passage of the Patient Protection and Affordable Care Act (ACA).  The healthcare reform law is likely to lead to improved scores on some of the categories, particularly access and affordability.  For example, 25 percent of residents in 15 states lacked health insurance.  The ACA will require that all Americans have health insurance in 2014.  It also will reduce eligibility requirements for Medicaid so more low-income people will be eligible, and provide government subsidies to others who can’t buy insurance on their own.

The report’s authors remain optimistic that the health reform law will address many of the problems highlighted in the report.  “This scorecard illustrates that focused efforts to change the healthcare system for the better are working and are worth the investment,” said Maureen Bisognano, president and CEO of the Boston-based Institute for Healthcare Improvement.  “If we target areas where we fall short and learn from high-performing innovators with the United States, we should see significant progress in the future,” said Dr. David Blumenthal, commission chair and professor of medicine and healthcare policy at Massachusetts General Hospital and Harvard Medical School.

Writing in the Huffington Post, a Social Epidemiologist at Columbia University, thinks that the price Americans pay for their healthcare is too high.  “It’s well known that Americans pay more for less when it comes to healthcare than just about any other country in the world.  In 2009, we spent nearly $8,000 per person to provide medical care to just over 80 percent of our population — that compares, for example, to just under $3,500 spent per person in the U.K. to provide care for the entire population.  To add injury to insult: our counterparts across the pond get an extra year of life for their $3,500 than we do for our $8,000.

“Why do we pay more for less when it comes to our health?  Every policy wonk has his theory.  Common ones include the high cost of American medical education (which is too expensive), or that permissive tort laws in the U.S. enable lawyers to profit from the health system (which is true).  But while each of these theories, and others, explain small quirks in our health system that certainly contribute to it’s gargantuan price tag, they don’t address the fundamental issue with our health system.  And that’s that our market-driven system introduces perverse financial incentives for medical providers that don’t align with the health or wellbeing of Americans.  This leads to wasted money and lost lives.

“In our healthcare system, the fundamental billing unit is the “procedure” — doctors charge per action, diagnostic or curative, taken on the part of a patient.  While, on the surface, rewarding doctors for each step they take to make a patient better may seem fair, it has disastrous consequences for the structure of our health system.  Chief among them is our top-heavy specialty physician structure,” El-Sayed concluded.

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What’s at Stake? Medicaid, Not Medicare

Monday, June 27th, 2011

Seventy percent of Americans oppose cuts to Medicare and 57 percent are against cutting Medicaid, even when they are aware that the programs constitute an outsized weight in the federal deficit.  Of the two wildly popular programs, Medicaid is the most vulnerable.

Writing in the Washington Post about a report from the Kaiser Family Foundation about the health of Medicare and Medicaid, Ezra Klein says “It doesn’t matter whether Eric Cantor says he’s bargaining for the Ryan budget or not.  The GOP cannot privatize and voucherize Medicare.  They can’t even get close.  It’s too easy an issue for Democrats, too dangerous an issue with seniors, and too slipshod a policy even for Michele Bachmann.  The attack on Medicaid, however, is another story.  That one might actually work.  And if it does, it’ll actually be worse.  ‘in-the-know political circles,’ says Chris Jennings, who ran President Bill Clinton’s healthcare reform efforts, ‘it’s just assumed Medicaid is going to be hit.  No one is going to want to touch Medicare.  Medicare is where the political juice is.  But we’re going to need savings.  So that leads to Medicaid.’  There are two reasons Medicaid is more vulnerable than Medicare.  The first is who it serves.  Medicaid goes to two groups of people: the poor and the disabled. Most of the program’s enrollees are kids from poor families, though most of the program’s money is spent on the small fraction of beneficiaries who are disabled and/or elderly.  These groups have one thing in common: They’re politically powerless.”

It’s a little-known fact that Medicaid covers more people than Medicare. In 2010, according to the Department of Health and Human Services, Medicaid covered 53.9 million people, compared with Medicare’s 47.3 million.  Additionally, Medicaid patients are also among society’s most vulnerable.  “Kids (and) pregnant women are the vast majority,” according to Health and Human Services Secretary Kathleen Sebelius.  “But then older seniors, many of whom are in nursing homes…and very disabled individuals” are also covered by Medicaid.

Although states and the federal government share the cost of Medicaid, what grates on some governors is the rules that come with the money.  “Governors just want flexibility to run our states,” said Republican New Jersey Governor Chris Christie at the annual National Governors Association meeting in February. “We don’t want to pay 50 percent of the cost of Medicaid and have zero percent of the authority.  And I don’t think that’s an unreasonable thing to be asking for.”  Governor Haley Barbour of Mississippi agrees.  “If I could get total flexibility, I would take a two percent cap in a heartbeat,” he said.  Barbour’s preference is to receive a lump sum – what it gets now from the federal government, plus two percent to fund Medicaid.

Dr. Donald Berwick, administrator of the Center for Medicare and Medicaid Services, (CMS) said “There’s a right way to reform Medicare and a wrong way,”  Berwick believes that the direction he is taking — modeled on his successful patient safety campaigns at the Institute for Healthcare Improvement – will bring about needed healthcare change.  The Obama administration’s efforts to improve patient safety are more or less bipartisan.  There is little cause to dispute CMS’ data: the agency spent $4.4 billion in 2009 caring for patients harmed in hospitals and an additional $26 billion on patients who were readmitted within 30 days.  The Partnership for Patients, funded through the Patient Protection and Affordable Care Act (ACA), seeks to reduce preventable injuries by 40 percent and cut hospital readmissions by 20 percent in just two years.  According to CMS, achieving the Partnership’s goals will result in 1.8 million fewer patient injuries, allow more than 1.6 million patients to recover complication-free and save up to $35 billion in health costs.

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius described contentious portions of the ACA as the inaugural steps toward entitlement reform.  Sebelius criticized proposals to transform federal Medicaid funding into block grants for states.  When some lawmakers asked her to speak about the Obama administration’s alternative proposal to rein in entitlement spending, Sebelius pointed to two provisions of the new law.  The ACA created a new board of independent experts that will recommend Medicare payment cuts.  Its recommendations will take effect automatically unless Congress blocks them — and proposes equivalent savings.  According to Sebelius, the panel represents “a big step in terms of entitlement reform that actually doesn’t potentially cause harm to our seniors.”  She also pointed to an HHS effort to create new methods of dealing with people who are eligible for both Medicare and Medicaid because those patients represent a lopsided share of the programs’ costs.

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Donald Berwick: Healthcare’s Greatest Motivational Speaker?

Monday, March 7th, 2011

The Centers for Medicare and Medicaid Services (CMS) is planning an exhaustive patient-safety initiative that will draw from already-known strategies for safer care. “Let’s make the best the norm,” said Dr. Donald Berwick, CMS administrator, citing as evidence of the efficacy of such initiatives the unfavorable patient events that – happily — are now virtually nonexistent at some of the nation’s hospitals.  Berwick is renowned for his “100,000 Lives” and “Protecting 5 Million Lives from Harm” campaigns, which he initiated when he headed the Institute for Healthcare Improvement before moving to CMS.

Berwick praised the Patient Protection and Affordable Care Act, as well as the information technology it supports to create the best possible healthcare delivery system.  Both offer tools that will allow coordinated-care plans for patients and encourage caregiver teams to manage those plans.  One of the tools will be accountable care organizations (ACO).  Berwick said the regulations defining ACOs under Medicare as “imminent.”  According to Berwick, the regulations will be in the form of a “notice of proposed rulemaking,” with a 60-day public comment period.  “This will be our first stab at that definition.”

Quality News Today notes that “Motivational efforts and inspirational talk may seem more the bailiwick of Super Bowl coaches than government bureaucrats.  But when one considers that Berwick’s successful career as a national leader in healthcare quality improvement boiled down to fostering an internal drive on the part of individuals and organizations to do better work, the efforts perhaps are no surprise at all.”  Berwick said that CMS’ strategy will focus on building operational excellence; improving care for individuals; integrating care for populations; and improving the health of populations and communities.  “We do have tremendous knowledge about how to make care safe,” Berwick said.  Some organizations have remarkable records in patient safety, but there are only “pockets of excellence.”  Berwick wants to “bring excellence to scale” and believes that CMS is up to the task.  “We can do well with a joyous work force, we can’t without it,” Berwick said,  “I myself will be teaching the first four 90-minute classes on improving the work.”

John Rother, executive vice president for policy for AARP, the Washington-based advocacy group for people 50 and older, applauds Berwick’s emphasis on patient safety. Changes have saved “lives and money,” Rother said.

Unfortunately — and despite excellent intentions — errors still occur in hospitals, even with the new safeguards. Ten years ago, the Institute of Medicine published its landmark report “To Err Is Human:  Building a Safer Health System.”  The report estimated that 44,000 to 98,000 deaths occur every year because of preventable medical errors in American hospitals.  According to Manoj Jain, an infectious-disease specialist and an adjunct assistant professor at the Rollins School of Public Health at Emory University in Atlanta, “But, to make hospitals really safe, we need to take a leap.  We need to build a culture in which patient safety is the priority not just for the quality improvement director but also for every nurse, doctor, administrator, aide, housekeeper, dietary worker and hospital board member.”

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Possible Medicare/Medicaid Chief Brings New Ideas to Medicine

Thursday, April 29th, 2010

Dr. Donald Berwick, nominated to head Medicare and Medicaid, wants to reward physicians for better outcomes. Dr. Donald Berwick, a Harvard-educated pediatrician and Harvard Medical School professor, is President Barack Obama’s choice to head the Centers for Medicare and Medicaid Services (CMS), the parent agency of Medicare and Medicaid.  A sharp critic of the way healthcare is delivered in the United States, Berwick believes the system is inefficient and lacks an efficient information-sharing apparatus.  In addition to his practice and academic work, Berwick is the founder of the Institute for Health Care Improvement, a think tank that focuses on “cultivating promising concepts for improving patient care and turning those ideas into action.”

Berwick believes in improving the quality of healthcare so physicians are rewarded for better outcomes rather than on a per-procedure basis.  Although it’s unlikely that this idea could be applied to the medical profession, Medicare and Medicaid are large enough that changing the traditional way healthcare is delivered would echo throughout medicine.  Together, Medicare and Medicaid cover 100 million Americans – approximately one-third – and accounted for $750 billion of federal spending in 2009.  According to the Congressional Budget Office, that totals 20 percent of the federal budget.

Berwick’s nomination, which requires Senate confirmation, has some opposition, primarily from Senator Tom Coburn (R-OK) who is a practicing obstetrician.  “One concern I have is that he’s an advocate of comparative effectiveness,” Coburn said.  “There may be one or two or three ways of doing something.  I want to do what’s best for the patient, not necessarily what’s cheapest.”

David Helms, CEO of AcademyHealth, is a Berwick supporter.  According to Helms, “I think Don Berwick as a practicing physician will be able to communicate with other practicing physicians in a way that’s persuasive.”

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