Kevin Kelly has an interesting take on an article at the The Guardian:

The price of total personalization is total transparency.

The original phrasing from Seth Finkelstein:

We cannot expect that having large warehouses of data on individuals will be free from unintended consequences, especially when there are incentives to try to build highly detailed models of everyone’s lives. The price of total personalisation is total surveillance.

Hospitals are under fire to become completely transparent.  That’s a good thing.  Here’s the challenge: while hospitals become more transparent, so is the personal information of the people inside the hospital (employees included).  But it may not even be the fault of the hospital.  With more and more information divulged in web searches, social networks, online activities, emails, etc. the patient may need to consider their personal transition from privacy to transparency.

Pure brilliance this week at the World Health Care Blog.

Like Dr. Jay Parkinson’s (the coolest doctor in the world btw, here is his full-time blog) flat out indictment of our health care system:

Let’s talk about the characteristics of people who use healthcare in the US:

1. They spend someone else’s money on routine and specialized goods and services. “The United States has the best healthcare someone else can buy.”

2. They have no easy way to gain knowledge when they need it (like Pricegrabber) about how much they will “spend” on a given service and, often times, product.

3. If they do have knowledge about the amount they’ll spend, it’s often in the form of the amount of the co-pay (a heavily discounted price that cheapens the value of a doctor’s visit to a near meaningless ten dollar bill).

4. There is no way to shop for value.

5. There is no way to have the consumer experience similar to a visit to the Apple Store because doctors are paid for volume rather than the retail consumer experience.

6. Online rating systems are terribly flawed. Only people with an agenda (either a great experience or negative experience) go out of their way to rate their doctors. Therefore, “consumers” have no ability to measure value.

7. Value, in the mind of the consumer, is how long they waited for an appointment, how long they waited in the doctor’s office, how much they had to pay for the medication they were prescribed by a physician, and how much of the transaction their insurance covered.

8. All of these “values” are worsening in the minds of consumers in the current healthcare climate due to the trends showing an ever-increasing cost-shifting to employees and decreasing physician reimbursements causing an increased volume of patients in the doctor’s offices.

9. Value, to consumers, is increasingly becoming “Did I actually see my doctor?”

A host of bloggers are covering the World Health Care Congress in Washington D.C. There is a lot of good stuff to comb through. Here’s the first post with bios of all who are blogging this week. Start there and read through the rest.

So there are lots of campaigns right now with an aim of calling attention to health care insurance issues. Cutting through the clutter of everyday advertisements/messages/marketing etc. can be a challenge.

Enter the Insur-Animals. “The Worst Animal-Headed Superheroes Ever!” (Their description, not mine.) Self-campaign-deprecation may not be the way to go…

A group in Connecticut offers healthcare4every1 which “is a statewide advocacy campaign committed to organizing an active, vibrant and diverse network of concerned residents to build public and political support for achieving universal health care in Connecticut.” You can read about their campaign here.

That What’s New section hasn’t been updated since August (I’m assuming this is an ominous sign of the campaign’s impact). Regardless, I appreciate the alternative effort. And maybe some chic pop-culture digital artifact to look back upon in 30 years.

I really enjoy when my hours of web cruising pay off (for the record, they almost always do…but what I’m talking about here is when they really pay off).

With that, my most recent discovery is fantastic.  I would encourage you to visit Jen McCabe Gorman’s Health Management Rx. It’s an absolutely fantastic read and she regularly dives into health care issues from completely different perspectives…which, as you know if you have been reading here for awhile, jives with what we’re trying to do.

An example:

I could write a book on the subject of bringing Gen X and Gen Y Directors onto Boards (hmmm), but for now, let’s titrate this future-of-governance thing down to simple solutions.

You. Need. Healthcare. Leaders. And. Thought. Leaders. Under 40 (Under 30). On. Your. Boards. NOW.

Recruiting fresh new voices to join your board is a big component of ‘guitar hero healthcare.’

Guitar Hero Healthcare? Yes, read about it here.

Stuff like this is what gets me out of bed in the morning.  Enjoy.

On Friday the Center for Medicare and Medicaid Services (CMS) took a big step toward helping patients more-completely compare hospitals. We wait to see if anyone takes advantage of that opportunity.

CMS recently updated and improved the Hospital Compare website. From the release, “For the first time, consumers have the three critical elements — quality information, patient satisfaction survey information, and pricing information for specific procedures — they need to make effective decisions about the quality and value of the health care available to them through local hospitals.”

The Hospital Consumer Assessment of Healthcare Providers and Systems survey collects information from over 2,500 hospitals and allows CMS to report ten measures of patient satisfaction in addition to 26 quality measures with more to come.

This has been well covered in the blogosphere.   Avery Comarow, the editor of U.S. News’s annual Best Hospitals issue, fully explores the HCAHPS survey and the Hospital Compare website:

Here’s how it will work: No more than six weeks after they are discharged, adult patients who spent at least one night in a hospital (omitting those admitted for psychiatric reasons) will be surveyed by mail or phone. Each hospital will need to contact as many patients as needed to generate at least 300 completed responses per year to the 22-item questionnaire. Every month or quarter (it’s up to the hospital), each facility will report its results to the federal Center for Medicare and Medicaid Services. CMS will adjust the responses to correct for patient age, size of the hospital, and other lurking biases. Results will be posted, hospital by hospital, for the most recent four quarters’ worth of data and will include national and state averages and other information to put the numbers into perspective. CMS says it will look closely at the survey responses, make on-site visits, and otherwise try to control hanky-panky. (Hospitals can continue to commission their own surveys and even put the questions on the federal survey, but the federal questions have to be listed first.)

Mr. Comarow also has a very nice review of the website and some tips on using the service.  The Health Care Blog also covers the update.  The Wall Street Journal’s Health Blog humorously headlines that Hospital Quality Measurement Leaves the ‘Pong Era.’

Not everyone may agree with the utility provided by the updated Hospital Compare website—dare I say some may even be upset that patients are able to compare hospitals on such subjective measures as patient satisfaction?  But this is a good thing—and if a hospital doesn’t like its reported data, the solution is simple: improve patient satisfaction.

A couple of observations from interweb reading this weekend…

We’ve heard/read/thought much about the impact of technology and preventive medicine on health care costs. That they will force them down. And they likely can (and will). But some contrarian thoughts exist…

First, a great thought posted at e-patients: “Technology is always framed as an end and it is not. It is a means. The “end” for most people is getting the information and care they need.” Good stuff.

Second, from the New England Journal of Medicine about preventive medicine (hat tip: Health Populi):

Some preventive measures save money, while others do not, although they may still be worthwhile because they confer substantial health benefits relative to their cost. In contrast, some preventive measures are expensive given the health benefits they confer. In general, whether a particular preventive measure represents good value or poor value depends on factors such as the population targeted, with measures targeting higher-risk populations typically being the most efficient. In the case of screening, efficiency also depends on frequency (more frequent screening confers greater benefits but is less efficient). Third, as is the case for preventive measures, treatments can be relatively efficient or inefficient.

Anyway, as you know if you listen to presidential stump speeches or just catch the highlights on CNN/MSNBC/FOX News/etc. when candidates speak of their health care reforms they tout the benefits of technology investments and preventive medicine. It’s always good to hear something from the other side, especially when thoughts are provided with evidence.

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.

There is a plethora of information on anything health care on the web. Below I’ve listed several foundations that produce quality research on an array of topics in health care. Their research is worth the read.

RAND Corporation: “a nonprofit institution that helps improve policy and decisionmaking through research and analysis.”

The Kaiser Family Foundation: “a non-profit, private operating foundation focusing on the major health care issues facing the U.S., with a growing role in global health.”

The Commonwealth Fund: “a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.”

Robert Wood Johnson Foundation: “the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans.”

This was published a while ago, but nonetheless worth a read. The Commonwealth Fund is full of resources related to improving our health system (that’s their mission…). Every one of the stories is going to affect us as health care practitioners in the very near future, if they are not already.

Anyway, if you read much on the web concerning health care, you will see The Commonwealth Fund research oft cited. A good site to know about.

Are you interested in pursuing a Master in Health Administration (MHA) or MHSA, or a MBA with a health care focus (as you can see there are a few different names for a degree to become an administrator in a health services organization)?

A great place to start is this website. It is a very extensive listing of health administration programs. Start exploring. And if you have any related questions email me, I’ll give you my thoughts.