Sunday, January 31, 2016

Adalja Lecture: Infectious Diseases and National Security

If you live in Colorado, you might be interested in this upcoming dinner lecture by Dr. Amesh Adalja: "Infectious Diseases and National Security" (March 12, 2016).  I've already purchased my ticket!

Here's the announcement and the link to register:

Hungry Minds Speaker Series

Food for the body. Food for the mind.

Infectious Diseases and National Security
This talk will discuss the intersection of infectious disease emergencies and national security, with special attention to the speaker’s experiences with the ongoing Ebola and measles outbreaks as well as bioterrorism and biowarfare. The talk will also address the field of public health, delineating the proper role of government as well as the role of experts in shaping policy and engaging with the public.

A Dinner and Talk featuring
Dr Amesh Adalja
Senior Associate, UPMC Center for Health Security
Clinical Assistant Professor, Department of Critical Care Medicine
Clinical Assistant Professor, Department of Emergency Medicine
Adjunct Instructor, Division of Infectious Diseases, Department of Medicine University of Pittsburgh Medical Center


Saturday March 12, 2016
5:00 – 9:00 PM

C.B. & Potts
6575 S Greenwood Plaza Blvd
Englewood, CO 80111

5:00 PM: Cocktails, Dinner (Cash)
7:00 PM: Announcements
7:15 PM: Talk with Q/A

Advance General Admission: $35 per person ($40 after 3/4)
At the Door General Admission: $40 per person
Seating at Head Table with Speaker (space limited): $75 ($80 after 3/4)
Please Note: Purchase does not include dinner; order directly at event
Online reservations through March 9, or at the door.

Monday, January 25, 2016

Hsieh Forbes Column on New Year's Resolutions

My latest Forbes piece is now out: "Are You Struggling To Keep Those New Year's Resolutions?"

I discuss "temptation bundling" and other techniques to keep your New Year's Resolutions. And the fact that sometimes it's ok to just break them!

Monday, January 18, 2016

Armstrong on Quality

Dr. Richard Armstrong asks (and answers) a critical question: "Who Determines Quality in Health Care?"

A couple of excerpts:
[E]verywhere you turn someone is measuring something or surveying something or requiring the reporting of metrics. Patients are flooded with satisfaction surveys, doctors are inundated with pay for performance reporting requirements, physician quality reporting systems and, soon on the horizon from the federal government, the new Merit Based Incentive System. It’s enough to make your head spin. So, just exactly what is going on?...

An estimated $3.5 trillion moves through our health care economy yearly. It should be no surprise that those who are purchasing health care would be concerned about the quality and value of their purchase. What is problematic is this…how do you measure it? Also, how can anyone be certain that they are measuring the “correct” things? 
To concretize the issue, Dr. Armstrong poses an example of a patient "Jack" who needs a hernia repair. As a surgeon, Dr. Armstrong will work conscientiously to do his best by Jack. But Armstrong notes:
[T]he doctor should be working for the patient. But what happens when a third party, a private insurance company or the government is the purchaser of health care on behalf of the patient consumer? We are experiencing that today in America and the confusion is becoming mind numbing for both patients and doctors...

Our “system” needs to focus clearly on producing high quality physicians and surgeons who understand why Jack and his family need quality care and that ultimately we are responsible to them, the patients. 

It is no surprise that those who are paying for the services expect quality and value. Maybe it would be wise for all of us to re-evaluate how we are paying instead of expanding ever more complex, confusing and expensive “quality assurance” processes. 
As Dr. Armstrong notes, piling on more regulations onto a flawed system based on third-party payments won't fix the underlying problem. I recommend folks read the whole piece for themselves, as I'm only scratching the surface of his discussion.

Interestingly, the New York Times recently published a piece by Dr. Robert Wachter with a similar theme: "How Measurement Fails Doctors and Teachers".  Wachter notes:
Avedis Donabedian, a professor at the University of Michigan’s School of Public Health, was a towering figure in the field of quality measurement. He developed what is known as Donabedian’s triad, which states that quality can be measured by looking at outcomes (how the subjects fared), processes (what was done) and structures (how the work was organized). In 2000, shortly before he died, he was asked about his view of quality. What this hard-nosed scientist answered is shocking at first, then somehow seems obvious.

“The secret of quality is love,” he said.

Our businesslike efforts to measure and improve quality are now blocking the altruism, indeed the love, that motivates people to enter the helping professions. While we’re figuring out how to get better, we need to tread more lightly in assessing the work of the professionals who practice in our most human and sacred fields.

By the way, there is lots more good commentary on health policy at the Docs4PatientCare Foundation website by Armstrong (pictured below) and others.

Thursday, January 14, 2016

Edison Vs. American Board of Pediatrics

Dr. Megan Edison has written an "Open Letter to the American Board of Pediatrics".

Here is the opening:
Dear American Board of Pediatrics:

On December 17 2015, at 3:01 in the middle of my busy day seeing patients, I voluntarily gave up my American Board of Pediatrics certification. I thought I should write this letter, hopefully preempting any more threatening emails warning me that I must pay up or lose my certification. This was not mere oversight on my part. This was purposeful...
She describes the numerous pointless "hoops" that pediatricians must jump through in order to maintain their certification (MOC), as well as questionable finances by the ABP leadership.  In her words:
I am sad about giving up my ABP certification. I remember the elation I felt when I passed my boards after residency. I really felt like I had accomplished something and that my certificate represented my professional  educational commitment to pediatric medicine. Now, after seeing the monster that board certification has ballooned into, I’m very happy to be off the MOC hamster wheel and no longer supporting a corrupt system that punishes very good doctors and pushes our most experienced pediatricians into early retirement.
Dr. Edison also offers concrete reforms that the ABP can adopt.  Let's hope the ABP chooses to listen to her.

Tuesday, January 5, 2016

Rising Interest in Health Care Ministries

The Wall Street Journal describes how "More People Turn to Faith-Based Groups for Health Coverage".

I very much like the idea of voluntary mutual-aid societies to share health costs. But some regulators don't.  An except:
Ministry officials say they aren’t offering insurance, don’t guarantee claims will be paid, and don’t need to be regulated. The nonprofits are well managed, according to ministry officials, with third-party audits and a sterling history of sharing members’ claims.

Ministries generally don’t allow members to sue and require disagreements to be settled by arbitration and mediation.

Some ministries say they cost about 30% less than private insurance. Monthly payments, or sharing, may range from about $75 for a single person under age 30 to $500 or so for a family.

State regulators also say health ministries disrupt the insurance market because they tend to attract healthier consumers, siphoning them from commercial plans that can be left with sicker or older customers. Most ministries don’t always share bills for certain pre-existing conditions, whereas the ACA requires insurers to cover anyone regardless of their past or current medical history.

“They [ministries] have the potential to destabilize the market by drawing off the good risk,” said Mike Kreidler, Washington’s state insurance commissioner.

Monday, January 4, 2016

Doctors Vs. Bureaucrats

Dr. Marion Mass asks, "When will more Doctors stand up for their Patients and Themselves?"

An excerpt:
Let’s get back to what really matters: the patient. At the moment I heard about not having crucial antibiotics for a sick infant, I snapped. I walked to the nearest phone and dialed the pharmacy, “Dr. Mass here. Why is patient x waiting for meds?”………(party line reply delivered)….”I see. You are going to mix up the antibiotics and get them to the ER in ten minutes. Otherwise, I will call the hospital CEO and tell him that I am going to tell the parents that their child is in danger because of hospital policy. I will not have some (un-publishable word) bureaucrat dictate my patient’s care. What? …Oh, thank you.” Coming clean to let you know how fun and liberating that moment was, as the ER staff stared at me in shock.

I don’t wonder why more physicians don’t complain; it takes time. We are knee deep in CME, MOC, state and hospital mandates, insurance company fights, on and on. No wonder patients say we don’t take enough time with them. Furthermore, 80% of physicians are hospital-employed. Buck the system, lose a job. If you aren’t hospital-employed, you are bogged down keeping your indie practice alive for the sake of the patients you love...
Read the whole thing. (Via Dr. Megan Edison.)