e-Patient Dave

Democratizing Healthcare

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Partnering WITH Patients: the IOM gets it right! (And I have a suggestion.)

IOM logoI often compare the “listen to patients” movement to other social movements from my delightfully long life. :-) One of the folk songs of my adolescent years was Bob Dylan’s “The times, they are a-changin’.”

And so they are.

Last fall the Institute of Medicine – the pinnacle of academic medicine – published a major report, Best Care at Lower Cost, which I’ve mentioned here repeatedly. Assembled by an absolutely blue-ribbon team, it has many quotable items, but my favorites is this: (Page S-11, page 34 of the PDF)

Patients Included badgePatient-Clinician Partnerships

Engaged, empowered patients – a learning health care system is anchored in patient needs and perspectives and promotes the inclusion of patients, families, and other caregivers as vital members of the continuously learning care team.

Read that carefully. A lot of people who work in medicine don’t yet know about this report, and many who do haven’t yet had it sink in. A perfect example is Medicare, with their well-meaning paternalistic project “Partnership for Patients.” Note: it’s a partnership for patients, which is not something you’d say if you thought of patients as someone who’s on your team.

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The Big Ugly continues: “Hospital charges bring a backlash”

Here’s the next episode in what I’m starting to call “The Big Ugly” – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.

Medicine’s certainly not going to die – we need it – but the Institute of Medicine says (see links below) we have massive overspending, and when the overspending shrinks, that too will hurt.

Today’s Boston Globe has the newest item: Hospital charges bring a backlash:

Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay.

Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers. …

The Globe published a story in January about a patient charged $1,525 in operating room and facility fees for a minor skin procedure. Yeah, the doctor charged $354 for her services, and the hospital (Lahey Clinic) added $1525 of overhead. Another patient is quoted as sounding like (amazingly) an empowered consumer:

“I am willing to spend my money for my doctor — I am getting expert care,’’ said the New Hampshire resident. “I am not willing to pay $500 to sit in a waiting room.’’

Watch for more stories of overhead charges, and more, as organizations gasp for air, and ask consumers to bear the burden. See other stories in the links below, like the chain that put its E.R. docs on quota.

What to do: [Read more…]

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Collapse couldn’t happen in law, and it can’t happen in medicine. Right?

If you care (or worry) about the crunch-time that’s beginning in medicine, read this post last Tuesday on the Harvard Business Review blog:

Creative Destruction Visits the Legal Profession

It has strong echoes of what I wrote last month in As the crunch hits, will the best survive? That post talked about how much pain there’s likely to be as we try to solve the $750 billion of unnecessary spending in US medicine.  Until now I wasn’t aware of how much the legal profession has been hit by changing realities. Items from the HBR post:

  • “In the ten years or so since running that course, the assumptions underpinning a lot of the business models at law firms have come unraveled. Just as we argued, a lot of the lower-end, but profitable, work is now being done by cheaper providers or has been automated”
  • “Legal budgets have come under intense scrutiny as the Great Recession’s aftermath grinds on.”
  • “And — gasp — lawyers are now realizing that if nobody is looking after the business end of things — ahem — in other words, being strategic, the entire operation can come to a crashing halt. Witness the spectacular bankruptcy of once high-flying Dewey & LeBoeuf.”

Yeah, the bankruptcy of a once-high-flying law firm. More:

  • “The problems started to become urgent when young lawyers, armed with freshly minted degrees, either couldn’t get legal jobs or, worse yet, couldn’t get jobs at all.” Only 55% percent of 2011 graduates had a law-related job nine months after graduation.

Imagine if only 55% of med school graduates could find a job. Can’t happen, right?

That’s at the low end. And at the top?

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Reprise: The healthcare waste pit is BIGGER than the fiscal cliff.

For my last post of the year, as word filters out that Washington still can’t fix “the cliff,” I’ll do something rare: repeat something from just a few days ago. This needs to sink in for everyone who wants to fix America’s medical costs:

The “fiscal cliff” is big, but America’s excess medical costs are 30% bigger.
(Not total costs – just the waste that needs to be trimmed.)

As we start 2013, think about that.
Think how much commitment and guidance
it will take to fix it.

Some providers are working really hard to improve effectiveness,
and some insurance companies are too.

Some aren’t.

A lot of people’s income depends
on keeping things the way they are.

During the change, how will we ensure
that families and the best workers in the system are protected
while inefficiencies are pruned?

Here’s this week’s post again, tweaked just a little:

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The healthcare waste pit is bigger than the fiscal cliff.

Two weeks ago I talked about the magnitude of America’s $750 billion of unnecessary spending (per the Institute of Medicine). I put it this way:

If Intel, Microsoft, Apple, GM, IBM, Ford, Chrysler and Dell all went out of business, it still wouldn’t add up to that much.

I found another way to comprehend it. Hold onto your hat: $750 billion is bigger than the whole Fiscal Cliff we’re so scared about.

Yes, way bigger than that cliff in the news – the fiscal cliff that’s so big Grover Norquist caved in on his tax pledge, so big it embarrassed Speaker Boehner when he STILL couldn’t rally his troops – that cliff is “only” $560 billion, according to Wikipedia as of today.

I do amateur arithmetic :-) so I was quickly able to calculate that $750 billion is 30% bigger than $560 billion – even without a calculator!:-)

$560 billion + 30% (another $168 billion) = $728 billion.
(Okay, so that’s still shy of the $750b. My point stands.)

Our august leaders Norquist, Boehner and Obama speak of the Fiscal Cliff in desperate terms – but I don’t hear anyone speaking with the same urgency about the healthcare waste pit. But it’s going to hit us all, so  you and I – all of us who have a stake in the future of healthcare – ought to be thinking what we’ll do in the coming years as this industry rationalizes to a saner spending level.

The changes will be substantial. As I said in the earlier post, we must detect and protect the good work of the best providers. And above all as fights unfold over the shrinking ocean of money, we must ensure that families who need care are indeed taken care of.
__________

(While we’re at it, recall this 2009 post: I’m sick of hearing Washington talk about savings “over ten years” … how are we supposed to make sensible judgements if a $5 billion saving (a drop in this bucket) is inflated to “$50 billion over ten years”?)