No, this is not about getting a heart attack from shoveling snow (though that is a real phenomenon). It’s about how the rising cost of health care is eroding the ability of state and local governments to fund investments in infrastructure. This becomes most apparent when that infrastructure is stressed, as it is, say, during a snow storm. Case in point: Boston.
As a former resident of “beantown” I can attest to the fact that snow is a constant part of the winter landscape there. We could always count on the first snowfall to come before Thanksgiving (and could never count on being done before April. I recall one depressing year where it snowed in May! So I was not surprised, and was even a little nostalgic, when I witnessed Boston’s second major snowstorm of the year last week. I was, however, surprised at how much the city struggled to cope with the snow, and in particular, how poorly the public transportation system held up under the circumstances. With another snowstorm this week, the system failed completely. I was in town taking an executive education course at the Kennedy School of Government about healthcare delivery, which got me thinking about the connection between a failing transit system and healthcare.
Continue reading Snow Storms and Healthcare
Steven Brill made a name for himself with an article in Time magazine back in 2013 entitled “Bitter Pill,” in which he harshly criticized how health care providers (especially hospitals) inflate the costs of their services. The piece created a lot of buzz, and some backlash from hospital groups and others. Now it seems that Mr. Brill has had a bit of a “sick-bed conversion.”
He has a new piece in the January 19th issue of Time called “What I learned from my $190,000 open-heart surgery: the surprising solution for fixing our health care system.” Since Time won’t let you read the article without subscribing or paying, I will save you the trouble. It seems that what he learned is that health care providers – the same ones he vilified in 2013 – were pretty great when they were taking care of his heart in 2015. In fact, he now believes that the way to “fix” healthcare is to “let the foxes run the henhouse” by allowing large integrated health systems become insurance companies and compete on price and “brand” and regulate their profits to assure that they are acting in the public interest. Yeah, well, no kidding.
Continue reading So What Else is New?
I wrote recently about the need to take into account patient characteristics when using patient outcomes to compare the quality of care provided by different physicians. That is a well-accepted principle, and the need for so-called “risk-adjustment” applies not only to evaluating physicians, but also to evaluating hospitals and larger care delivery systems. There has been a smoldering controversy, however, about which patient characteristics to consider and, in particular, the implications of including socioeconomic factors in such comparisons. This controversy played out again in a recent issue of the Annals of Internal Medicine.
Here is the core of the issue.
Continue reading Adjusting Outcomes
A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy – a global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America the world over,” but I liked it. I thought it captured a deep truth about the Navy, which is that it is undoubtedly a “global force” and that the force exists for a good purpose, but I guess most people thought that it made the Navy sound too much like a bunch of social workers.
I was reminded of the phrase, and of an experience I had while serving in the Navy Medical Corps, when I read a recent article in the Annals of Internal Medicine. A Navy physician retold the story of a mission he was on to a remote village in Honduras. He and his team were flown into small villages, where they would “see dozens of patients each day and dispense an assortment of symptomatic medications” and where “the most practical health benefit that we provided villagers consisted of hundreds of tooth extractions.” He further noted that “although advertised as humanitarian missions, these exercises provided US military personnel with experience working with military and civil authorities from host nations.”
Continue reading A Global Force for Good
I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with healthcare in America today.
Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a history of coronary disease and had an intracoronary stent placed some years back. He is asymptomatic on a typical “cocktail” of meds including aspirin, a statin, and an ACE inhibitor. Over the summer, he had a routine follow-up visit with his cardiologist, who detected a carotid bruit. After a duplex sonogram and a CT angio, a high-grade unilateral internal carotid stenosis was identified, and carotid endarterectomy surgery was recommended. My friend called me to see if I could recommend a surgeon in the city where she and her father both live.
Continue reading The Good, the Bad and the Ugly
I was traveling recently and, as I typically do, I bought a copy of Fast Company magazine to read on the plane. I don’t subscribe, but I find that it often has interesting articles on the intersection of technology and business. In the July/August issue, there was an article about GE and its CEO Jeff Immelt that I think has important parallels with the current transformation of healthcare delivery. Continue reading The Next Wave
I really do not understand how Congress “works.” While it busied itself with passing a law that fails to fix the clearly broken “sustainable growth rate” formula for Medicare physician payments, it added in a surprise for the entire healthcare industry: a provision that mandates a delay in the adoption of ICD-10 by CMS. Continue reading Now What?
There were 2 articles in the New England Journal of Medicine this past week that caught my eye. Although they appear to address very different subjects, I believe they have an important connection. Continue reading Health Care Costs