History of Health Care

Saw this on the ye olde interwebs today


2000 BC : "Eat this root"
1000 AD : "That root is heathen, say this prayer."
1500 AD : "That prayer is superstition, drink this elixir."
1800 AD : "That elixir is snake oil, take this pill."
1900 AD : "That pill is ineffective, take this antibiotic."
2000 AD : "That antibiotic is artificial, eat this root."
:)‎ Full story...

2008 Health Accountability Health Care Report

So here's why I haven't been posting too much lately...

I've been working on two major projects and this is one of them. I finally got the Health Accountability Report Card out today, it covers all hospitals and HMOs in NY, NJ, CT, VT and RI.

It's huge, but my other project - due in December - is even more exciting, stay tuned.

The report card started off as a printed HMO report in 1999, I first put it online in 2002 I think.

I've been slowly adding more and more to it, three years ago I added hospitals and last year I included NJ. Here's a brief, OK, not brief summary of what's in it.

The team that puts this together is large, all in all about 25 people contributed their expertise to the report. The short story is that it's a public data gumbo, it collects up about 20 data sources from which we extract roughly 250 measures. For each measure, if we can find a standard comparator we run a variance analysis to find out if the HMO or hospital deviates significantly from the state average. We then simply paste a red, yellow or green circle onto the data to give you a really quick idea of just how well the HMO or hospital you're looking at is doing.

On the HMO side you can review quality of care data from NCQA HEDIS scores. This covers stuff like getting the correct medicines, asthma and diabetes care, vaccinations and that sort of thing. Also for HMOs we have a customer satisfaction survey results from CAHPS surveys. We then scoop up retail premium rates for standardised plans.

Unfortunately states differ slightly in how they measure HMOs, so we can't make a national comparison across the board, so in this report you're seeing either a comparison to a state average or a regional average.

On the hospital side it gets way more complicated. HHS puts out the Hospital Compare data for download, so we grab that and crunch some additional measures to derive composite topical scores from the appropriateness of care measures. This year we also got to add patient satisfaction score and Medicare reimbursement rates.

The real fun part was requesting discharge data from five states. I actually requested data from every state that borders New York, plus Canada, and I went with the four I got back. That data is a full set of every single hospital discharge in each state, deidentified. In it you can see primary diagnoses, age, gender, enough to make some serious measurements. So, we have the AHRQ Inpatient Quality Indicators as well as new this year some Patient Safety Indicators, recently endorsed by the National Quality Forum. These include mortality rates and adverse events.

I did have to lose Caesarean section rates, but I'll keep hunting for an NQF endorsed measure for this.

In addition, we calculate number of cases, average length of stay and average hospital charges. Besides that there's the now-recurring Leapfrog patient safety measures. Cardiac surgery mortality came out this year for the most part, but it'll be back next year.

Here's a full list of all the measures.

Go check out the report and please, please, please send me your feedback.

Now I'm going to sleep.‎ Full story...

USA Hospital Patient Satisfaction Report

It's not widely known, but Medicare began collecting survey responses recently that asked patients a number of questions about their recent hospital stay. CMS has not restricted this to Medicare patients only, they call anyone who is eligible, regardless of payer. My boss was kind enough to give me the opportunity to take the data from Medicare and make a consumer-oriented report card that is easy and quick to use.

The site is AboutHealthSatisfaction.org and is completely free to use, no registration required, and does not contain ads. The source data is available on the Hospital Compare Web site put out by CMS, but it's hard to get to, hard to read, and restricts you to only a handful of hospitals to compare at a time. However, CMS makes the data freely available for download, so this is what I came up with.

Please go check it out, and let me know your thoughts and feedback here. I plan on updating the site every three months when the fresh data comes out. Right now I have three editions of the data, so you can even track numbers from quarter to quarter. Go have a look, and check back here to let me know what you think.‎ Full story...

Yowser

Herald Sun reports: A gynaecologist and two trainee doctors in northern Greece have been handed suspended prison sentences after forgetting a 22-centimetre medical spatula in a patient's abdomen.

The three accused and a scrub nurse today received suspended prison sentences of between 10 months and a year.

The oversight took place during minor surgery on a 45-year-old woman at a hospital in the northern city of Serres in January 2005.

The patient soon developed breathing problems, a skin rash, fever and a gathering of fluid in her abdomen.

Her doctors initially attributed the problems to an allergic reaction and gave her medication but a CAT scan subsequently found the missing surgical instrument.

The patient had been awarded €50,000 ($98,000) in damages in a prior civil trial.‎ Full story...

Interoperability, EU Style

Seriously, is anyone in the US paying attention?

Twelve countries. Three years. Internationally-accessible personal health records. Wow.‎ Full story...

Medicare Payment Changes

The Miami Herald has a very readable piece on exactly how the new Medicare policy on certain services that will no longer be paid for will work out.

Makes a very clear argument for and against some of the conditions that are now deemed "preventable".‎ Full story...

Certain Wooden Arrows

(This isn't about health, but it *is* about transparency.)

Sure is good to know the Senate is on the ball getting legislation rushed through. One has to wonder how they found the time to insert an entire mental health parity act, an energy bill, tax code reform and this gem:

SEC. 503. EXEMPTION FROM EXCISE TAX FOR CERTAIN WOODEN ARROWS DESIGNED FOR USE BY CHILDREN.

(a) In General- Paragraph (2) of section 4161(b) is amended by redesignating subparagraph (B) as subparagraph (C) and by inserting after subparagraph (A) the following new subparagraph:

`(B) EXEMPTION FOR CERTAIN WOODEN ARROW SHAFTS- Subparagraph (A) shall not apply to any shaft consisting of all natural wood with no laminations or artificial means of enhancing the spine of such shaft (whether sold separately or incorporated as part of a finished or unfinished product) of a type used in the manufacture of any arrow which after its assembly--

`(i) measures 5/16 of an inch or less in diameter, and

`(ii) is not suitable for use with a bow described in paragraph (1)(A).'.

(b) Effective Date- The amendments made by this section shall apply to shafts first sold after the date of enactment of this Act.

This is an Amendment to Treasury Regulations, Subchapter D, Sec. 48.4161(b)-1, which imposed taxes on fishing and hunting equipment. Obviously, a huge part of saving the country's failing economy, tax cuts for underage bowmen. The parents-of-children-who-hunt-with-bows voter block is of course crucial for any incumbent. Thanks to the Emergency Economic Stabilization Act of 2008, H.R. 3997, these kids can now hunt tax free. As long as they're using *certain* wooden arrows...

Thanks to Josh Zeidner for the heads up.‎ Full story...