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...

PBS Tonight: Critical Condition

Just a quick heads up that Critical Condition airs tonight at 9 on PBS. Info here. (Two videos in one day! Aren't you lucky?) So set your DVR or get home in time or whatever, just try to watch this tonight. Should be quite the buzz tomorrow.



From the site: Roger Weisberg's Critical Condition is a powerful, eye-opening look at the health care crisis in America. In an election season when health care reform has become one of the nation's most hotly debated issues, Critical Condition lays out the human consequences of an increasingly expensive and inaccessible system. Using the same cinema verite style he employed with Waging a Living (P.O.V., 2006), Weisberg allows ordinary hard-working Americans to tell their harrowing stories of battling critical illnesses without health insurance. ‎ Full story...

Veni, Video, Vici

Wow. Good enough for NASA astronauts, good enough for pilots, good enough for health care providers? An interesting video, about, um, video.


...‎ Full story...

Getting There...

An information exchange of a thousand patients begins with a single discharge.

The Nationwide Health Information Network, basically a separate Internet of health care organisations and systems, underwent it's first real test last week. Among other achievements, we saw the creation of a fabulous new acronym: DURSA. Stands for Data Usage and Reciprocal Support Agreement.

In the test, 19 organisations demonstrated the ability to access and retrieve patient level data, albeit fictitious patients, from NHIN partners, which include DoD, the VA, and SSA.

A live test with real data is scheduled for December, but ten years from now, we'll be looking back at this test as the first successful day we exchanged data, I think this is truly the the beginning of the end of the beginning. We're nearly there. I can smell it.

I've been attending the AHIC meetings remotely, but couldn't make it to this one due to my being Nyquil'ed up to the gills for a week, but you can read more about this truly momentous occasion at GovHealthIT, HIT News, and for bonus points here's an article on the national EHR in the UK, which has finally grown a pair and decided that patients who don't want to be included on the national system need to opt out of the program.‎ Full story...

Stop Touching My Buttons!

I've railed about this before, but I had to fill a prescription today and it still bugs the living bejesus out of me.

I went down to Rite Aid, filled my scrip for antibiotics, and was told to wait a few minutes.

During that time I watched five other customers pick up their medications, and each time the pharmacist or assistant would lean over the counter and quickly tap the buttons on the little digital readout that says "I decline to be counseled", negating the option for the customer to even see the message let alone ask what counseling they might need.

For one thing, whenever I talk to pharmacists there's the usual conversation that they are the last bastion of customer protection, that it is only they who can spot fatal errors, typos, wrong meds and the like. And yet every time I go near a pharmacy I see this occurring.

According to the Office of the Professions:

Pharmacists or pharmacy interns must provide counseling:

* before dispensing a medication for the first time to a new patient
* before dispensing a new medication to an existing patient
* if the dose, strength, route of administration, or directions for use have changed for an existing prescription previously dispensed to an existing patient

...

If you are having a prescription re-filled or you are having a prescription filled for a drug or medication you have been treated with previously, pharmacy staff must offer to provide counseling in keeping with the processes described above.

If you pharmacists are so important to the world, and I *do* think you are, let us click our own buttons. Evidently there's not a pharmacist - in New York City at least - who believes counseling is all that important.

Which is it?

I would dearly love some commentary on this. Have you seen the same thing happening? Does your pharmacist counsel you? Would you want said counseling?‎ Full story...

If I Had Seven Hundred Billion Dollars...

The alternate title for this piece is "USA To Ensure Universal Access To Credit"

Seven. Hundred. Billion. Dollars.

Seven.

Hundred.

Billion.

Apparently, a few banks not going bankrupt is more important to the US than everyone having universal access to affordable health care.

This $700 billion is on top of the billions already spent shoveling loans and bailouts to Detroit's Big Three, AIG, Fannie and Freddie and Bear Sterns. bringing the grand total to 1.2 TRILLION dollars.

TRILLION!

According to this report by the AMSA puts the cost of single payor universal coverage at $34 to $69 billion. That used to sound like a lot of money. As of this morning, that's chump change. (As an aside, the big four investment banks, as was, paid out just over 30 billion in bonuses last year...)

Of course, that doesn't include the Federal studies by the Congressional Budget Office and the General Accounting office that show single payer universal health care would save $100 to $200 billion per year.

Hell, let's call the cost a round 100 billion. Hell, let's tack it on to this amazing piece of bailout legislation right now. All we do is print the money anyway, right?

What's more important? Consumers having universal access to credit? Or health care?

Apparently, a couple of finance wonks are going to make that decision for you.

The best part? Ploughing 50 billion into creating a single payor system is apparently too much government in your health care, we don't do nationalised here, no thank you sir, we like smaller government.

Pretty sure we just nationalised a large chunk of the financial sector though... Can I have my shares now please? Wouldn't it make more sense for the government to buy up the actual mortgages, instead of pouring money into hedge funds that risked their livelihood on vaporous mortgage-backed instruments?

Go read this article in Time if you haven't already, and see if there's anything in there you can find it in you to disagree with.

For more fun, read this article on AlterNet which has ten easy ways to pay for this mess without sucking it out of our wallets. My favourites? Tax the stock transactions like everyone else, and get capital gains taxes in line with income tax rates.‎ Full story...