Archive for August 2008

NPR’s “Talk of the Nation,” Featuring Don Berwick and Yours Truly

Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important, since "Talk of the Nation" spent 30 minutes yesterday interviewing Don Berwick and me about it… on the day of Hillary’s speech!To listen to the show, click here. Also, here’s an article from USA Today that got the ball rolling, as well as Avery Comarow’s thoughtful blog on these new reports.Here are a few observations about the new CMS (Centers for Medicare & Medicaid Services) initiative, some of which I made on the NPR broadcast:First, I see this as a healthy and inevitable trend. We are moving away from a singular focus on process measures – which have real advantages (no need for case-mix adjustment; they can be measured at the time of care) but are too narrow and game-able – and toward blending in reports of outcomes. There are now…

My Colonoscopy… And Dave Barry’s

When I launched this blog, I vowed not to dwell on personal matters – you’ve heard nothing about my older son's lab work (remarkable), my younger son’s cartooning (awesome), or my golf game (never mind). But I simply must tell you about my colonoscopy today.Well, actually I won’t. But I wanted to raise the topic to implore you to do two things:Most importantly, if you’re due for one, go ahead and get it. It could save your life. Remember, the evidence supports a colonoscopy at age 50 if you are at average risk, and age 40 (or 10 years before the earliest age of diagnosis in a first degree relative with colon cancer) if you have a strong family history. Former White House press secretary Tony Snow, who died last month at age 53, should have begun screening in his late 20s, since his mother died of colon cancer at…

Is it “Macaca” Time in Healthcare?

August 11th was the 2nd anniversary of the epic implosion of George Allen's presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether healthcare has also entered the YouTube era.Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him “Macaca,” a racial slur meaning “monkey.” Once the video hit YouTube, it went completely viral (this clip, one of many, has been viewed 350,000 times) and Allen’s promising political career was toast.What does this have to do with healthcare? In the past 18 months, two powerful, highly troubling videos have surfaced of patients being left to die in ER waiting rooms. The first, in May 2007, involved a woman named Edith Rodriguez.…

Post-Vacation Potpourri: Items Interesting, International, and Ineffably Sad

Just returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced.First, the final “no pay” list. I’m not sure if this was CMS’s intent, but their trial balloon of possible additions to the “no pay” list included so many ludicrous items that the final list seems nearly rational. You’ll recall the proposed list; yes, the one that made me near apoplectic: including such easily measurable and preventable entities as Legionnaire’s disease and delirium. Luckily, these and some of the other wrongheaded items were jettisoned somewhere inside the sausage factory of CMS's Baltimore HQs. The final list includes just three new entities:Certain Surgical Site Infections Following Orthopedic and Bariatric SurgeriesHospital-acquired Hypoglycemia and HyperglycemiaDeep Venous Thrombosis or PE Following Joint ReplacementsBefore…

Is “Patient-Centeredness” a Healthcare MacGuffin?

Last week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin?What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Chicago’s Hines VA reminded us that the MacGuffin was one of Alfred Hitchcock’s favorite directorial strategies. Hitchcock defined the term this way:MacGuffin: a plot device that motivates the characters or advances the story, but the details of which are of little or no importance otherwise.I loved Richardson’s analogy when I heard it, but its utter aptness became clear only as the conference proceeded. Let’s start with the areas of general agreement (thanks to Jim Naughton, Chair of the ABIM Foundation, for articulating these points):Patients’ preferences should be respected.We should attend to patients’ emotional needs, context, comfort and meaning.Patients should be engaged and empowered.There should be shared decision-making that promotes patient autonomy.Family and…