It’s the Price Stupid is the title of a seminal paper in Health Affairs that concluded that the United States pays more for health care and receives less than in other developed countries.
It is also a theme resurrected by Alec MacGillis in a Washington Post article last week.
The argument goes like this. The United States pays more for health care than anywhere else on the planet, as much as 50% more than the average for other developed countries.
Yet we get fewer services; fewer physician visits, fewer hospital admissions, fewer days in the hospitals. It doesn’t take a Ph.D. statistician to conclude that we are paying too much per unit of care.
A reader responded to my recent post about accountable care organizations with the question, “How do you measure quality in an accountable care organization?”
In other words, if a health care organization is accountable, what do you measure and how do we know that this organization is actually responsible for what is measured?
Vitality as performance
These are the two top challenges with the accountable care organization initiative. How does one define and measure the desired outcomes, and how does one define the group of practitioners that are responsible for those outcomes.
In my post I wrote the following:
The study first grouped physicians and patients around their primary hospitals. What it revealed is that when the hospital performed well, the physicians and physician practices affiliated with that hospital or hospitals also performed well.
Mortality – the ultimate performance measure
The reader appears to be asking: How do you know that a hospital is performing well and how do we know that the physicians are performing well? Continue reading →
Accountable care organizations. Patient centered medical homes. Episodes of care.
What do they have in common?
They each attempt to use payment incentives to encourage disparate practitioners to collaborate to achieve quality outcomes.
A common purpose
Socialized medicine is progress
The key word is collaborate. Countless research indicates that when doctors work in teams, they achieve better results at lower costs. It is this transition from doctor as solo practitioner to doctor as a member of a team that is the key challenge to reforming our health care delivery system.
This transition from solo craftsman to a member of a team is not new to the evolution of our economy.
It is how Karl Marx differentiated capitalism from the mercantilist economy that preceded it. He called it the socialization of work. It was this contradiction between the socialization of work and the private ownership of the means of production – capital –that was supposed to be resolved by the socialist revolution.
Karl Marx recognized that this socialization of work brought tremendous increases in productivity to the world economy. Continue reading →
The term medical home prompts associations with George Carlin and his comparison of baseball and football.
In baseball the object is to go home! And to be safe! – I hope I’ll be safe at home!
In football, we’re down in enemy territory
Reaching for the end zone
What would George offer as the medical counterpoint to “home”? End zone might be a bit extreme. But “homeless” could surely fit.
Can health care reform offer help for the medically homeless?
Safe at home
Medical home demonstration projectts
Shortly after the Patient Protection and Affordable Care Act was passed in March of this year, Mr. Vince Kuraitis, writing for the e-caremangement blog noted that the word “pilot” appears 80 times in the law, and the word “demonstration” is used 312 times
He might have also noticed that the term “medical home” appears 11 times, exactly the same as “accountable care organization” that I discussed last week. Continue reading →