Was in St. Louis (great city!) over the weekend…and talked health care goings on during the product testing phase of the Anheuser-Busch Brewery Tour.

Anyway, how do St. Louis and Columbus compare when it comes to health care? While it may take some significant time to compare every aspect of health care delivery, treatment, reimbursement, etc., the Dartmouth Atlas makes comparing everything-Medicare simple.

For instance:

Average Total Medicare Reimbursement
National: $6968.21, St. Louis: $6569.24, Columbus: $6367.26

Acute Myocardial Infarction Discharges per 1,000 Medicare Enrollees
National: 8.44, St. Louis: 8.36, Columbus: 6.53

Be forewarned: you could spend an endless amount of time on this site if you’re inclined to useful information…

From the website:

The Dartmouth Atlas Project works to accurately describe how medical resources are distributed and used in the United States. The project offers comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians, in order to provide a basis for improving health and health systems. Through this analysis, the project has demonstrated glaring variations in how health care is delivered across the United States. The project is run by The Dartmouth Institute for Health Policy and Clinical Practice (TDI).

Have fun.

Shouldn’t it be this way?

Why it’s not in some settings is (not!) understandable, change now or forever hold your peace…

Ohio’s attorney general is pushing for a variety of changes.

…I would study this: if employers paid their employees to work-out (read: cardio and weights) during the work day (like an hour), would the lost productivity be made up by lower health care insurance costs?

With individuals working 70, 80, 90+ hours/week they probably lack the time to get some quality elliptical machine time in (not to mention the need to relieve some stress on the bench press).

If you live in a Super-Tuesday/Super-Duper-Tuesday/Tsunami-Tuesday/(Insert your own super modifier)-Tuesday state, please vote today.

An addition to a previous post.

The Wall Street Journal gives us another example of private industry backing an organization dedicated to reducing health care costs and improving quality.

Bridges to Excellence pays doctors bonuses for higher quality care. According to the article, “Last year, the program paid out roughly $10 million in bonuses to doctors in the 18 states where it is active.”

In class we have been talking about quality–no doubt a needed discussion as we enter the workforce.

Six Sigma, Lean, Lean Sigma, IHI, Baldridge. And the countless other programs/iterations/combinations/mash-ups in existence.

But any quality program discussion necessitates other conversations. Importantly: 1) implementation and 2) sustenance.

No doubt any health care worker has been through some sort of the “flavor of the month” experience except for maybe a select, chosen few.

Seth’s post gives it straight, “I don’t want to use a tool unless I’m going to use it really well. Doing any of these things halfway is worse than not at all. People don’t want a mediocre interaction.”

Partially implemented and poorly sustained quality programs damage the patient interaction.

Why don’t we ask, “are we fully, top-priority-like, completely committed to this?” when it comes to implementation…er, real implementation?

Whether you’re a health care newbie or a vet, go read this. You’ll learn something, probably even more.

Dr. Michael Wilkes writes a great editorial.

“What is the role of a doctor?”

Starting right now, what do you want from your doctor?

Dr. Wilkes provides a few suggestions from an audience he recently spoke to:

• Knows me and my family.
• Is a good listener.
• I can reach when I get sick – even on weekends.
• Is working for me – not an insurance company or a hospital.
• Cares.
• Treats me with dignity and respect.
• Won’t go home because their shift is over with my problem still unresolved.
• Explains things so I can understand them.

Dr. Wilkes was struck by something that wasn’t on the list, “No one – not a single person – said they wanted the smartest doctor or a doctor who was an expert at medicine.”

Anyway his point: asking (and answering!) this question delivers two things: 1) insight on how to retool medical education and 2) information we can use to measure performance.

Two extremely relevant and important things. But I don’t think we should stop there. What do nurses expect from physicians? How about hospitals? Other relevant stakeholders?

And once that process has started we need to start asking questions about our hospital. What do patients want from the hospital? What does the community want from the hospital? What do providers expect from the hospital?

And we won’t stop there. Questions will be asked about, and of, all providers. Processes will be questioned. Governing bodies will be questioned. The analyses will continue until all have been analyzed and the questions have been answered.

These discussions, though time consuming (this is the greatness of being a virtual system), will lay out expectations from the start. These discussions will allow us to deliver the best care possible. Our expectations of each other will be on the table allowing us to focus on what matters most: patient care.

Principle #4: Asking questions not only promotes learning, it encourages discussion. We will ask questions from the beginning. And not stop. Incessant questions = incessant improvement!