By HOLLY RAMER, Associated Press Writer Holly Ramer, Thu Dec 24, 8:52 am ET
CONCORD, N.H. – When Laura Davie's doctor suggested she go to the hospital next door for her first mammogram last year, she went online instead.
Though she ultimately chose the facility her physician recommended, Davie used New Hampshire's HealthCost Web site to compare how much her insurer would pay various hospitals for the procedure.
"I was surprised by the spread, and I was surprised by cost, and I was surprised by how much less the hospital in Massachusetts was compared to the hospitals in my area of New Hampshire," said Davie, who lives in Barrington and works at the University of New Hampshire. "I found it very user friendly and very easy to see the differences."
As employers continue to shift costs to workers through high-deductible health plans, consumers are starting to shop around. Even though Davie's relatively low deductible meant she would pay the same amount anywhere, she wanted to choose the least costly option to send a message to her employer and insurer.
SUMMARY: Ten years ago, a national panel of health care experts released a landmark report on medical errors in the American health care system. Published by the Institute of Medicine, "To Err is Human: Building a Safer Health System" estimated that as many as 98,000 people died in hospitals each year as a result of preventable mistakes.
The Journal of the American Medical Association examines the relationship that a Primary Care Providers practice caseload has on quality and performance measurement.
MHMC's own David White spurs an article by Gardiner Harris in the New York Times that discusses Maine's attempts to fix the healthcare system.
BAR HARBOR, Me. — When his car repair shop’s health insurance premiums doubled between 2000 and 2002, David White saw the problem as akin to a sputtering engine. So he got under the hood of the state’s health system and tried to fix it... Read More
Websites helps patients shop for medical services; cutting surgery by $3,000, says Anna Wilde- Mathews in this "Healthy Consumer" article.
"It's long been hard for health-care consumers to learn how much doctor visits or hospital stays will cost them. That's now beginning to change, as a growing array of Web sites try to lift the veil on pricing.
The online resources come from insurers, government agencies, Internet companies and medical-care providers. The sites aren't perfect: Unlike online retailers that sell products such as televisions, the health sites can't typically give exact prices for medical procedures and services. Still, consumers can get a rough idea of typical costs in their area, and that can help them choose doctors and hospitals, budget for medical costs and sort out disputed bills..." Read More
For the third year in a row, the quality of health care in the United States has not improved, according to the National Committee for Quality Assurance's 2009 report released Thursday.
The group surveyed more than 900 health care plans—that cover 116 million Americans—and determined that the quality of commercial health insurance, Medicare and Medicaid, has not improved. Read more.
The doors to the clinic had been locked for over an hour, and the last light in the sky was quickly fading when two eyes appeared in Teresa Moore's office window, followed by a sharp knock and a glass-muffled plea to be let in: It was a patient. Moore cares for modern patients. They're the people who come in with specific requests for medications and procedures. And oftentimes they get what they ask for, whether they need it or not. This consumer-driven health care is part of what's driving up costs across the country. Read more or listen.
Twenty-nine years old is pretty young for a hysterectomy. But in the mid-'70s in Lewiston, Maine, lots of women were getting them. The question, of course, is, why were so many women in the city of Lewiston having hysterectomies? Read more.
While other industries take as their focus such shallow concerns as the making of money, the health care profession prides itself on dealing with matters of life and death. But that’s not the only thing distinguishing health care from other industries: it is also unique in the extent to which it excludes consumers from important decisions. Read more.
The secret to fixing healthcare in the United States is to focus on value, a measure that takes into account both quality and cost, says Dr. Denis Cortese, president of the Mayo Clinic. To get healthcare moving in the right direction, Cortese argues for using currently available measurements to devise a "value score" that takes into account patient satisfaction, safety, cost and outcomes -- Did the patient get better? Read more.
Health and Human Services Secretary Kathleen Sebelius, along with Vermont Governor Jim Douglas and Director of the White House Office of Health Reform Nancy-Ann DeParle today announced an initiative that will allow Medicare to join Medicaid, and private insurers in state-based efforts to improve the way health care is delivered. Innovative models of delivering primary care around the country are examples of the types of programs that will be part of the President’s health reform plan. These are models that improve care for patients, give primary care providers better information about their patients and achieve greater value for the health dollars spent. Read more.
If I were magically given an hour to help Barack Obama prepare for his health care speech next week, the first thing I’d do is ask him to read David Goldhill’s essay, “How American Health Care Killed My Father,” in the current issue of The Atlantic. That essay would lift Obama out of the distracting sideshows about this public plan or that cooperative option. It would remind him why he got into this issue in the first place. Read more.
The modern hospital is a storehouse of technology and training unmatched in human society. But hospitals are also the black holes of the American health care debate. Eugene Litvak, now a professor of health care management at Boston University, looks at hospitals and sees systems that aren’t even trying to be efficient with people’s time or money. Over the past six years, Cincinnati Children’s Hospital, one of the country’s premier hospitals, has worked with Litvak to streamline the flow of patients from the emergency department waiting room to post-surgical recovery areas. The payoff has been dramatic. Read more.
A five-year ongoing study involving 10 large physician practices across the country has so far shown improved quality of care for chronic disease patients from the use of health information technology. The stud, named the Medicare Physician Group Practice Demonstration, was launched by the Center for Medicare and Medicaid Services to enable physician practices to demonstrate that proactive and coordinated care has the potential for larger revenue savings. It is the first Pay-for-Performance project to work directly with physician practices. Read more.
You go to a restaurant, peruse the menu, take your waiter's suggestions, and order a meal. But there is something odd: the menu has no prices and you have no idea what you will be required to pay until a few weeks later when the bill arrives in the mail. That, as it turns out, is analogous to what goes on in health care, where fees are hidden at the time of service. Read more.
The language is polite, but a new report by a coalition pushing for better preventive care says the congressional health overhaul effort is missing the mark when it comes to managing chronic disease and isn't doing enough to bend the health spending curve as a result. Read more.
There are two different problems to solve in health care reform. We hear a lot about one of them – covering the 47 million people who lack health insurance. But the second problem is important too, and, in fact, the two problems are connected. The second problem is that we have to lower the cost of health care if we hope to provide health care for all of us without going broke trying to pay for it. Read more.
By Atul Gawande, Donald Berwick, Elliott Fisher and Mark McClellan
We have reached a sobering point in our national health-reform debate. Americans have recognized that our health system is bankrupting us and that we have dealt with this by letting the system price more and more people out of health care. So we are trying to decide if we are willing to change — willing to ensure that everyone can have coverage. That means banishing the phrase “pre-existing condition.” It also means finding ways to pay for coverage for those who can’t afford it without help. Read more.
Ten years after the Institute of Medicine called for a crackdown on medical errors, federal analysts say the mistake rate actually may be increasing, according to a Hearst Newspapers report. The analysis found the medical community and governments have failed to take effective steps to reduce an estimated 98,000 deaths per year from preventable medical errors.
The Hearst Newspapers has created a website called “Dead by Mistake ” with a series of articles focused on preventable medical errors. The focus is on California, Connecticut, New York, Texas, and Washington (where their newspapers are based), and the website features an interactive data portal to get hospital-specific information. Read more.
Improving Chronic Illness Care has a guide to regional approaches to improving care. Maine's own Dr. Lisa Letourneau was interviewed for the second in a three-part series that summarizes the developing evidence base for regional healthcare improvement, shares stories from longstanding coalitions and proposes a framework to guide community improvement efforts. Click here and scroll down to find a link to Dr. Letourneau's 25 minute interview.
NBCH to Send Health Care Reform Letter to the President and Congressional Leadership
NBCH will go on public record with a letter to the White House and congressional leaders emphasizing the importance of health system reform through value based purchasing. NBCH believes that value based purchasing should be the centerpiece of any national health care reform strategy. NBCH’s health system reform letter does not commit to an employer mandate but simply suggests that the business community cannot consider the additional costs of universal coverage without having structural reforms that contribute to long-term savings. This message is clear but it needs to be better heard by the President and Members of Congress. To read the complete letter from NBCH CEO Andy Webber and all supporting documents, click on the links below.
Regarding the lack of progress in improving patient safety, we certainly should take a lesson from the National Transportation Safety Board’s successes and establish an independent agency charged with identifying and eliminating the causes of medical error, as Jim Hall, former chairman of that board, recommended. Read more of this Letter to the Editor by Karen Wolk Feinstein, Pittsburgh Regional Health Initiative
Maine Health Care Leaders Applauded Nationally For Efforts to Improve Cost and Quality
Maine health care leaders were invited to Washington, D.C. last week to represent the state as one of ten places in the nation that set an example for working together to provide low-cost, high-quality health for Medicare patients. The event, organized by the Institute for Healthcare Improvement, a nonprofit group based in Cambridge, MA highlighted Maine as a high-performer based upon per capita Medicare costs and federal hospital performance data and patient satisfaction data. The goal of the day long event was to build awareness among the public and policy-makers that successful models for achieving high quality care at significantly reduced Medicare costs exist in many regions and in many forms throughout the United States.
Report from the Oregon Healthcare Payment Reform Summit
On March 26, 2009, the Oregon Coaltion of Health Care Purchasers (OCHCP) hosted a one-day, invitation only Healthcare Payment Reform Summit. Primary guidance for and facilitation of the Summit was provided by Harold D. Miller, President of the Network for Regional Health Improvement (NRHI), who will also be moderating a reactor panel and facilitating MHMC's payment reform summit in October. Attached is the report of the summit. oregon_payment_reform_summit_report
President Obama says the primary goal of health reform is to rein in runaway spending, and he points to real-world examples in which doctors and hospitals have improved care and reduced costs. Making the leap from a handful of success stories to restructuring one-sixth of the nation's economy -- and writing it all in legislative language -- is a puzzle he has not solved. Read more.*
We tend to think of the Dartmouth Atlas as a series of maps, with high spending and low spending regions marked out in their respective primary colors. Yet the Atlas also represents a collection of stories, true stories, about good medical care and not so good medical care.
Some of the chief characters walked off the pages and into Washington this week with a message to policymakers and budget analysts: "We're fact, not fiction. Pay attention." Read more about the meeting that many representatives from Maine attended in Washington, DC.
The health care debate in Washington has basically deteriorated into a choice between raising taxes or cutting care. But "that's wrong," says Don Berwick of the Institute for Healthcare Improvement. "There's a third way: It's redesign." Read more.
Achieving comprehensive health reform has emerged as a leading priority of the President and Congress. President Obama has outlined eight principles for health reform, seeking to address not only the 45 million people who lack health insurance, but also rising health care costs and lack of quality. In Congress, a number of comprehensive reform proposals have been announced as the debate begins over how to overhaul the health care system.
This interactive side-by-side compares the leading comprehensive reform proposals across a number of key characteristics and plan components. Included in this side-by-side are proposals for moving toward universal coverage that have been put forward by the President and Members of Congress. In an effort to capture the most important proposals, we have included those that have been formally introduced as legislation as well as those that have been offered as principles or in White Paper form. This side-by-side will be regularly updated to reflect changes in the proposals and to incorporate major new proposals as they are announced. Read more and use the tool.
Maine is undertaking an experimental new way to deliver care to patients. A couple dozen primary care practices have signed up to be so-called "medical homes" in a pilot program. A medical home is not about bricks-and-mortar, but a model in which doctors spend more time coordinating their patients' care -- and get paid extra for their efforts. Read more and listen to the story.
From electronic bedside medication management and electronic prescriptions to a monitoring system that remotely links the sickest patients to a team of specialists in Portland, Franklin Memorial Hospital is wired. Read more.
The Economist Intelligence Unit, a division of he international magazine The Economist, issued a new report called “Doctor Innovation: Shaking Up the Health System.” Click below to read more.
McAllen, Texas, has the distinction of being one of the most expensive healthcare markets in the country. In 2006, Medicare spent $15,000 per enrollee, almost twice the national average. The income per capita is $12,000. In other words, Medicare spends $3,000 more per person here than the average person earns. The explosive trend in American medical costs seems to have occurred here in an especially intense form. Read more.
In an opinion piece in the Washington Post (5/31), cardiologist Harlan M. Krumholz wrote, "For most patients, the decision of where to seek care comes down to a recommendation based on hearsay." While "good reputation plays a role," research suggests "that just because you have a famous name doesn't mean that you're good." Krumholz argued that the lack "of information about medical performance not only makes it hard for patients to choose care. It also impairs our ability to improve care." Read more.
A new report by nonprofit publisher Consumers Union suggests that, despite an "initial flurry of activity" following the release of the Institute of Medicine's (IOM) 1999 "To Err is Human" report, the nation has since made limited progress against several of the IOM's recommended patient safety reforms, Reuters reports. Read more.
At Hospitals, More Intensive And Costly Treatment Does Not Bring Higher-Quality CareNew Study Represents One Of The First Nationwide Analyses Of Spending And Quality At Individual Hospitals Hospitals that provide more intensive and costly care do not provide better-quality care, as measured by the percentage of patients who are given evidence-based treatments, according to a study published today on the Health Affairs Web site. The study looks at care given to Medicare beneficiaries for three common conditions: acute myocardial infarction, or heart attack; pneumonia; and congestive heart failure. Read more.Source: Health Affairs
May 19, 2009
What 'Patient-Centered' Should Mean: Confessions of an Extremist
A seasoned clinician and expert fears the loss of his humanity if he should become a patient. By Donald M. Berwick.
Health care costs are going up across the board. This is also true for public employees such as teachers, state workers and University of Maine workers. How can we best manage health care for public sector workers.
Host: Christopher St. John
Guest(s): Christine Burke, MEA Benefits Trust, Frank Johnson, Maine Division of Health and Benefits; Thomas Hopkins, Human Resources, University of Maine
In repeated Kaiser polls, we see a divide between what experts believe and what the public believes about some of the key issues in health reform. They don’t disagree on everything; far from it. But there is a wide gulf on basic beliefs about what is behind the problems in the health care system and key elements of reform, especially delivery reform. Read more.
U.S. Senator Olympia Snowe (R) talks about her role in passing the "economic recovery" package and her opposition to the President's proposed budget. Also, cyber-security and bipartisanship. And, on the subject of health care reform - we sit in on one of the Senator's Maine "listening sessions" and hear what some of the stakeholders on this issue are telling her. Watch it.
Changing how the nation pays for health care is critical to improve value, achieve better quality, and slow cost growth. This report examines in greater detail key payment reform recommendations made by the Commonwealth Fund Commission on a High Performance Health System in its report, The Path to a High Performance U.S. Health System. The authors explore bundling payments to cover care over a specified period, revising fees to increase compensation for primary care, and offering providers financial incentives to serve as patient-centered medical homes. These strategies seek to encourage more collaboration among providers, accountability for patient outcomes, and efficient use of resources than exist in our current fragmented system of care. On a foundation of universal health insurance coverage and new systems to promote better decision-making and improve population health, these payment reforms could slow the growth of health spending by $1 trillion through 2020, compared with current projections. Read more.
Summary: A state employee health plan designated hospitals, and later primary care physician practices, that met certain performance criteria as "preferred" providers, and then gave employees incentives to use them. While this initiative appears to have improved the quality of care, its impact on costs has not yet been evaluated. Read more.
Four Local Hospitals Selected to Participate in National Quality Improvement Collaborative
Quality Counts announced today that Eastern Maine Medical Center, Redington-Fairview General Hospital, St. Mary's Regional Medical Center and Southern Maine Medical Center have been selected by the Robert Wood Johnson Foundation (RWJF) to participate in a new effort to improve the quality of care in hospitals. Click the link below to learn more.
Waiting to see his dermatologist about a skin rash, John Barnett heard the doctor sneeze loudly before he came into the exam room. The Seattle-area retiree says it took all his courage to ask, "Are you going to wash your hands before you examine me?"
Despite efforts by advocacy groups and others to empower patients, challenging a doctor or nurse on whether they are correctly doing their jobs remains downright intimidating. Read more.
Quality Counts, through the Robert Wood Johnson Foundation Aligning Forces for Quality (AF4Q grant), hosted a webinar about Large-Scale Change in Complex Systems featuring Paul Plsek, author of Appendix B of Crossing the Quality Chasm. You can listen to the webinar by clicking the link below.
Winter 2009 Edition - HealthLeaders Health Plan Analysis, New England
Maine, New Hampshire Look Toward Medical Home Pilots
As healthcare costs have continued to spiral upward nationwide, primary-care physicians have struggled with increasing demand for their services and fewer replacements coming into the profession. It is this troubling mix, however, that has helped usher in the medical home healthcare delivery model.
Please click the link below to read more of this article that starts on page 19. Thanks to Drs. Jeff Holmstrom and Lisa Letourneau for their participation.
Focusing on the need to dramatically reduce medical errors, many patient safety advocates have urged hospitals to implement computerized physician order entry systems. But so far, only about 8% of U.S. hospitals have implemented CPOE, the Leapfrog Group estimates. Read more.
As leaders in Congress and the Obama administration look to expand health-insurance coverage while controlling costs, they are considering changing the way doctors are paid for treating patients covered by Medicare. Read more.
In 10 years, at the current rate of cost increases, by some estimates the average American family will be spending almost half of its income on healthcare. Read more of the article by Dr. Erik Steele.
The Centers for Medicare & Medicaid Services last week finalized national Medicare coverage policies preventing the program from paying physicians, hospitals and other health care providers for certain serious surgical errors. Read more.
In honor of its broad-based efforts to improve the lives of the most vulnerable members of its community, St. Mary's Health System in Lewiston, Maine, is the recipient of the prestigious 2008 Foster G. McGaw Prize for Excellence in Community Service, one of the most esteemed community service honors in health care. Read more.
Watch this Fox News video about an experience at Johns Hopkins that cut the number of accidental deaths almost in half by using a nineteen point checklist.
A study that reexamined data from 10 clinical trials of care management programs for heart failure patients found that multidisciplinary teams and in-person communications led to fewer hospital readmissions and readmission days. Read more.
If employers want to reduce their health care costs by using value-based benefit designs, then they will have to teach their workers that expensive health care doesn't automatically mean quality care. Read more.
Six years ago, a relative of mine found out that she had rectal cancer and would need surgery, radiation and chemotherapy. She lives in a small town, and she consulted a local surgeon at a community hospital. It was tempting to think that she would receive first-rate treatment no matter where she went. Read more.
Ira’s story is a classic example of invasive cardiology run amok. For patients in the throes of a heart attack and those with crippling chest pain from even minor exertion, angioplasty and stents can be lifesaving, says Dr. Michael Ozner, a Miami cardiologist and the author of “The Great American Heart Hoax.” But, Dr. Ozner said in an interview, such “unstable” patients represent only a minority of those undergoing these costly and sometimes risky procedures. Read more.
Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative. Read more.
Call it the 'Partners Effect:' Elite hospitals are paid much more for care that is often no better than average. It is the best kept secret in Massachusetts medicine. Read more.
“What every Employer should know about healthcare quality and cost” was the topic at an EMHS Business Forum, November 14, 2008 in Waterville. Read more.
Most working Americans obtain health coverage through their employers – and neither presidential candidate is proposing to change that, although each of their plans, if enacted, would affect employers substantially. But over a third of US employers (almost exclusively small employers, with fewer than 500 workers) do not sponsor an employee health plan and one of the central questions of the reform debate is how they might be induced to do so. According to a major new employer survey on health care reform released by Mercer, the majority of these employers believe that, at its current price, employee medical coverage is far beyond their means. Read more.
Mainers who use high-quality doctors and hospitals are more likely to be satisfied with the care they get, and their employers are more likely to have healthy workers to show for their investment in health insurance, a health quality expert told local business leaders Friday. Read more.
Read and watch the news report from "Health Care Costs: Maine's Burning Platform - Can We Extinguish the Fire?" Over 275 individuals attended the thought-provoking event co-sponsored by MHMC and Anthem Blue Cross Blue Shield on Oct. 1, 2008.
Former NBA superstar Dominique Wilkins will be coming to Portland for 2010 Symposium on Payment Reform. Click HERE for more information!
Attention Physicians!
In our efforts to ensure that physician practice data
used to report results in the PTE program is accurate and up-to-date, we are
working to update demographic and contact information for physician practices. Please take a minute to fill out our brief provider database survey HERE .
Provider Ratings
Learn which physician practices and hospitals in Maine provide
safer, high-quality healthcare. Visit www.mhmc.info
