Thursday, August 31, 2006

Simple Things Can Be Hard to Learn

Providers of health care are under a lot of pressure to use computers to improve quality and reduce cost.

One popular application has been computerized physician order entry (CPOE). The idea is to have physicians enter their orders into computers rather than writing them out longhand. When an order is entered, information is displayed that potentially leads to better decisions by the physician.

Well, it doesn’t necessarily work. The Colorado Permanente Group in Denver reports that CPOE in that organization “did not improve physician compliance with laboratory monitoring alert recommendations.”

Commenting on that report, Susan Horn (The limits of technology, Modern Healthcare, August 7, 2006) described a project in which a group of nursing homes set out to reduce the incidence of pressure sores, enlisted the aid of information technology, and achieved a reduction of one third in a year’s time.

The difference between the two cases seems pretty obvious. The nursing homes had an improvement they wanted to make and used information technology to achieve it. The Permanente Group bought and implemented technology in the hope that it would produce improvement. The nursing homes succeeded. The Permanente Group failed.

Ms. Horn went on to point out that “…no technology…will cure our healthcare system of its ailments” and that technology is “….no panacea, but rather a tool for solving problems.”

In other words, the right approach is to figure out what problem you want to solve, develop a plan for solving it, and then use technology to support the plan.

Seems simple enough.

But the simple things in life sometimes seem the hardest to learn.

Saturday, August 12, 2006

Who Benefits?

Perhaps most people have now heard of hospitalists, a relatively new if inelegantly named medical specialty. As the name implies, hospitalists serve as doctors for hospitalized patients. If your medical condition requires that you be admitted to the hospital as an inpatient, you may be cared for by a hospitalist rather than by your regular physician.

The apparent advantages are obvious. The doctor is always near at hand and intimately familiar with hospital routines. No time is wasted traveling back and forth from office to hospital. Office practice is not interrupted by the needs of patients in the hospital.

It is a growing specialty. According to an article in the July 24, 2006 issue of Modern Healthcare, their numbers have grown from about 900 ten years ago to over 15,000 now and are expected to double in the next ten years.

I find the economics of this development interesting. So far as I can see, there is nothing in it that adds to the amount of medical work to be done. Nor am I aware of anything in it that reduces the amount of income available to support the physician services provided.

Yet for some reason the programs are not self-supporting. According to the Modern Healthcare article, some 97% of hospitals with hospitalist programs are subsidizing them to the tune of some $50,000 to $60,000 per year per hospitalist physician.

Hospitalists are well paid, but not inordinately so. The Modern Healthcare article reports their average annual salary during 2006 as $182,279.

All of which raises the question of who is benefiting financially from the hospital subsidies, which would seem to be a net addition to the amount of money going to support physician services.

Friday, August 04, 2006

Managing Care vs. Benefit Packages

The recently enacted Massachusetts program for reducing the number of uninsured includes provision for subsidizing health insurance on an income-related sliding scale for those with incomes of less than about $60,000 per year for a family of four.

According to an article in the August 2, 2006 issue of the Boston Globe, the intent is to give four competing managed care companies the right to enroll the beneficiaries of subsidized coverage. These companies now provide managed care for Massachusetts Medicaid.

The theme of the article was the proposed requirement that the package of benefits offered by the four companies be basically similar. A couple of the companies complained about that. They wanted to design their own package of benefits.

They were not very specific about their reasons, but my suspicion is that a standardized package forces them to compete mainly on the basis of price and customer service. That requires them to manage care – something they would rather not do.

It will be interesting to see how it turns out. If one or more of the companies actually succeeds in providing care more efficiently, that could attract a lot of attention.

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