Feb
4
Share the Care
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Share the Care
Carl Heard, MD, MMM
A Poem to aid Healthcare Professionals in work flow and outcomes redesign
The reapportioned vigil of healthcare
Begins with those who are aware
Of a new and loving way
To carry forth the sick and gray
By reaching with an open hand
To gather those who understand
That the wheel in which we run
Must be tossed, not redone
We may feel we’re on our backs
When swift change rends and attacks
The work that we must do
Within the team of me and you
But this is just the place
To redesign and erase
Crazy times too busy to think
To a place where problems shrink
From the burden that is disease
We will learn how to ease
The suffering of patient and colleague
From worthless routine we will be freed
To help people choose a life of vigor
Whether rich or poor or ditch digger
Those we strive to help mend
Are just us in the end
Feb
4
TO FIX OUR HEALTH CARE SYSTEM WE MUST ADDRESS ITS MOST FUNDAMENTAL FLAW: “YOU GET WHAT YOU PAY FOR”
Millions of lives will be improved in the process, says physician-researcher
As a primary care physician and researcher, I believe that the most fundamental challenge in reforming healthcare is recognizing that our system rewards physicians by the number of patients they see each day (encounters) and by the procedures they perform. As a result we have a medical system that is very good at delivering encounters and procedures, but remarkably less capable of improving the health of individuals. The concept of “quality care” is oft spoken but, in reality, ignored. The result is that Americans are getting from our health care system what they’re paying for: encounters and procedures rather than “measurably improved health.”
This is a troubling reality on professional, ethical and public policy levels. It is my conviction that the only way we can improve patient health and reign in escalating healthcare costs is by reforming the way physicians and clinicians are compensated.
Today primary care provider compensation is based on the false assumption that all encounters provided — or measures of quality — are equal. (Even when “pay-for-performance” reform measures are incorporated, compensation is still linked to encounters. This is akin to redesigning a car without considering the type of fuel it will use. Instead we must recognize that the difficulties and relative costs in helping patients choose a healthier future are particular to the individual. The failure to recognize and quantify this fact has been the root cause of resistance to quality and the evolution of value based compensation.
Electronic health records, impressive computing power, and advances in predicting the probable health future of individuals have created the circumstances which allow the public and private sectors to pay for measurably improved health. In other words, we are now able to create payment relationships which align compensation with what is desired of the healthcare system: objectively improved health. Once this model of compensation is wide spread I imagine it will unleash the amazing force of our market economy to improve the health of the American Public.
Payment for encounters and procedures, regardless of the impact on survival or avoidance of future diseases, will further confound efforts to improve the health of the population at large and make the deficit worse through uncontrolled growth in healthcare costs. As a member of the non-profit Western Clinician’s Network (WCN), I am developing an approach using predictive analytics to calculate the contribution by provider and patient to the changes in health outcomes. WCN is compiling the determinants of a patient’s ability to choose a healthier future, and creating unbiased measures of the provider’s impact on these outcomes. While our work is being conducted with community health center patients, the results apply to the entire healthcare industry.
The immediate benefits of our research will 1) help the primary care health home movement to evolve; 2) focus resources for patients with specific diagnoses (e.g. chronic diseases such as diabetes; Hypertension; Heart Disease etc.); 3) aid practices in redesigning compensation relationships with third party payers and Accountable Care Organizations; and 4) cause a profound shift in the practice of medicine and unleash an untapped capacity for innovation, quality improvement, and cost reductions.
The challenge for lawmakers is to finally embrace the fundamental tenet of economics and begin to design a healthcare industry that is properly aligned with that which every person ultimately desires: measurably improved health.
# # #
Carl Heard, MD, is a self-described “horse and buggy” doctor practicing medicine in his beloved Nevada. A graduate of the Medical University of South Carolina, Charleston, S.C., Dr. Heard completed his residency in Family Practice at the University of California, Irvine and also earned his Masters in Medical Management from the Marshall School of Business at the University of Southern California. In addition to his research activities with the Western Clinician’s Network, Dr. Heard serves on the agency’s Board of Directors. Western Clinician’s Network is a non-profit 501(c)(3) organization. It was founded in 1992 to provide education, training, peer support and research in order to improve primary care and public health.
Feb
4
Heavy Equipment and Medicine
Filed Under Published Articles | Leave a Comment
Heavy Equipment and Medicine
Offered for Publication in WCN Newsletter, July 2011
All Copyrights reserved
Just a few days ago I was performing a routine Commercial Driver’s License Examination for a patient, and had the luxury of time to get to know him better. We struck a conversation about his work. He and his colleagues are in the process of creating a method of using multiple sources of data about the heavy equipment they manage to predict the probability of failures. They visit sites, and acquire data on bull dozers, earth movers and other extremely valuable pieces of equipment.
The information acquired is analogous to that which we acquire in medical practices: vital engine component performance; frequency of oil changes and its chemical analysis; maintenance records; break down/system failure reports; age of equipment and other objective measures of equipment “health.”. These are similar to blood tests, cardiograms, etc. These managers of valuable equipment are challenged with technical obstacles, such as integration of information from multiple sources, and the variations of operators. They ultimately strive to accurately estimate the costs of maintenance, and the breakeven point for taking equipment off line and planning for replacement.
The advantage is that they have a less complex set of metrics, and are able to work in an ethical environment driven entirely by economics. In spite of these advantages their effort parallels the recent developments in healthcare. We are finally getting to a point that data acquisition is inherent in the work we perform in healthcare through electronic health records. The analysis of this data is the next wave of technological opportunity that will revolutionize not just health care but also heavy equipment management, and virtually every information intensive industry in the world.
The accumulation of data and its use to estimate future problems is in general called predictive analytics. An over simplified description of predictive analytics is the accumulation of data, the warehousing of data (collecting, organizing and “scrubbing” of multiple sources of data) and then the analysis of that data to predict the most likely future. It is intuitive to consider this in machines, where mechanical failure rates are well documented through lab testing of a limited number of systems. In healthcare this seems practical, but given the exponentially larger number of variables seems an impossible task.
In part an analogous process of predictive analytics is inherent to the intellectual processes of healthcare professionals. Professionals acquire data through examinations, diagnostics and laboratory tests and create a diagnosis, prognosis and treatment plan. The ability to accurately predict the future (prognosis) is one area where we as people could dramatically benefit from the experiences of heavy equipment managers. When we accept that the “peripheral brains” provided by predictive analytics can enhance our abilities, we can finally expect that we will get closer to the error rates currently enjoyed in the airline industry, or many others we have come to expect to perform as promised. Even to the point of accurately understanding the costs and expected benefits of aggressive management.
Understanding the progress made in managing expensive and mission critical equipment will lead us in Medicine to practice more effectively, and to aid pts in understanding the risks and benefits of a wide and growing array of options. Ultimately we will finally be able to understand the contributed value of preventive care, and the benefits of routine examinations, or oil changes. The most expensive and mission critical equipment in the world is in our hands, and it is time we used the same technological advantages that the mining industry currently and routinely incorporates.
Jan
8
New Posting
Filed Under References | 1 Comment
For those interested in or searching for the Right Next Door Project concept description, please check out the Active Projects page. I am seeking links that will allow a trial of the proposed concpet, but have found out that it will likely require a confidentiality agreement with the vendor I am currently in discussions with. Please check again soon for possible links.
Nov
12
Masters in Medical Management Graduates
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Most of us made it to graduation!
MMM, USC Class of 2009
Nov
4
Tribal Leadership
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Logan, D., King, J., Fischer-Wright, H., Tribal Leadership, Leveraging Natural Groups to Build a Thriving Organization, New York: Harper Collins Publishing, 2008. I learned of teh work of Dave Logan and his colleagues through courses provided by him and Fischer-Wright. Dave is an electric presenter, and both his book and lectures provide a crystaline insight into the psycho-social basis of group behavior. The case is made for corporate environments, but the information he shares also reflects groups of all type. I believe the message awakens a consideration of the employer/employee relatinoship and casts light on the responsibility inferred by the power of the employer and the obligation to create a work environment that helps encourage teh development of the individual.
Nov
4
Trend Analysis
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Introduction: The following are general trends affecting the health care market in general.
Trend #1: Physician staffing shortage: A combination of economic forces is now colliding within the US healthcare market that will drive fundamental shifts in health care delivery systems. There has recently become a majority of physicians in medical school who are female. In studies of work force trends as relates to gender, it has been described that 75% of women 5 years out of residency will not be practicing full time. In addition women are less likely to commit to jobs that require call or extraordinary work practices that have been hallmarks of the medical system within the US. In fact there is a growing trend of graduating physicians to expect more humane and manageable work requirements in both men and women. In spite of these forces, our educational and training system for physicians is fundamentally limited in its ability to produce qualified physicians due to limits on residency slots and the costs of medical education.
There is also a rapidly growing demand for medical services which is driven by a rapidly aging population. This has been well documented and is due to an ever increasing life expectancy, and with longer life comes more accumulated disease burden for the individual. This is exacerbated by an uneven population trend which corresponds to the baby boomer generated
An seemingly endless array of medical options are also being created by a very competent medical services creation systems (pharmaceutical, genetic, procedural etc.) combined with the above economic and practical forces results in a profound and of yet under appreciated staffing crisis that is now being felt in programs for the underserved but will soon affect the health care industry in general.
Trend #2: Electronic Health Records: For the entirety of my career, there has been the promise of an electronic health record that would reduce costs by reducing unnecessary duplication of tests, and improve quality of care by rendering health records legible.
These promises and more are finally becoming reality. Currently there are several vendors who offer software products that can somewhat efficiently accommodate the demands of documentation and the manipulation of information required. There are still several years of work ahead before the electronic health record actually assists in encouraging appropriate decisions but the promise is now easily identifiable.
Trend #3: Industry focus on outcomes measures: The health care industry is now creating incentives programs and grading systems for measuring those direct indicators of adequacy of health care. Examples of this include the use of Angiotensin Converting Enzyme Inhibitors for Congestive Heart Failure or Hemoglobin A1c’s for diabetics to name just two chronic diseases and key indicators. The number and degree of sophistication of these measures is truly impressive when examined industry wide.
These measures are rapidly becoming bench marks for assessing medical systems in both consumers and insurers. The managemtn of the large number of measures for acute and chronic disease makes an electronic health care record inevitable. Through the use of these measures medical care systems will become better delivers of care or likely will become obsolete.
Trend #4: Informational plurality and increasing level of education of patients: the internet is now becoming a major source of information for patients. Patients now tend to be more informed, and at times are more informed than their health care provider in their specific concerns. Information is no longer the exclusive privilege of the professional.
Trend #5: Rapidly escalating health care costs as depicted as a percentage of Gross Domestic Product. There is generally agreed a limit to the percentage of GDP that can be spent on health care; as that limit is examined there will be an increasing economic mandate to prove that the desired effect of improved health care for the population is being realized
Trend #6: A growing national conversation about universal health care: If universal coverage is actually realized there will be a shift in focus to health care maintenance. Currently our system of paying for health care favors ignoring the added costs of ignoring significant health care concerns. The fail safe services of the emergency rooms, and the largely non-emergent care provided underscores the illogical nature of a non-universal system.