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Jan 01 2013

2013: The Year of Healthcare Emancipation?

By e-patients, healthcare industry, healthcare price transparency, participatory medicine

Hang on to your hats – this one might wade into controversy.

django lincoln caduceus imageAs I write this (3:30pm EST on January 1, 2013), I’m listening to a conversation on NPR about the Emancipation Proclamation, which was signed into law by Abraham Lincoln 150 years ago today. I’m also reflecting on a couple of movies I’ve seen in the last 45 days: Lincoln (over Thanksgiving weekend) and Django Unchained (on Christmas Day).

Is it time for an emancipation proclamation for patients? Or should we just saddle up and have a shootout at the plantation … um, hospital instead?

Too many healthcare transactions are still conducted over the patient’s supine form. Doctors, hospitals, and other entities in the “provider” column horse-trade with health insurers, including Medicare, in the “payer” column. That means that the patient winds up shackled. No say in how much something costs, no real voice (yet) in what happens next, little interest on the part of the two trading entities in clueing us in to what’s happening.

Some of my connections in the participatory medicine/e-patients movement use a driver-rider metaphor for transforming healthcare, with the patient moving from passenger to driver in healthcare. It’s a less controversial/confrontational metaphor than referring to patients as chattel on the medical plantation. However, I’m sticking with that plantation metaphor for the moment, because too many in the provider and payer camps are still viewing patients as meat puppets, not as full participants.

Does healthcare need an emancipation proclamation? Yes. Here’s where the metaphor shifts: let’s not wait for someone to proclaim us (patients) emancipated. Let’s break our own chains, and be our own liberators.

Let’s demand that the providers and the payers give us an equal seat at the table, and then let’s …

LEARN EVERYTHING WE CAN TO BE PRODUCTIVE CONTRIBUTORS TO THE HEALTHCARE SYSTEM.

That last statement is the core of what will emancipate healthcare: patients, providers, payers, caregivers, everyone. Shared decision making – along with “patient-centered”, that’s the new hot phrase in healthcare – can only exist if all parties are able to participate in sharing the decision-making. We must learn how to understand the language of medicine, including research statistics (by the way, many doctors aren’t great at that, either). We must learn to apply critical reasoning to what we see/hear/read in the media about risks and trends in health and disease. We need to work on getting a seat at the research table to give a hard shove in the direction of making clinical research less ivory-tower and more boots-on-the-ground.

Some recommended reading for those who’d like to emancipate themselves:

Society for Participatory Medicine blog

ePatient Dave

Susannah Fox

Dr. Ted Eytan

and our movement’s own Rosa Parks (or, dare I say it, our own Django?):

Regina Holliday

Let’s liberate ourselves, shall we?

Jan 01 2013

2013 Manifesto: short and salty-sweet

By healthcare industry, technology

Last year’s look-ahead for 2012 was a 5-point manifesto. Reviewing progress against that list, I see that I did pretty well, with only #2 falling a little short – which is not a bad track record.

This year, I’m keeping it tight. I’m going with a 2-rule manifesto.

Rule #1: Be accountable

We’ve all got metrics to measure ourselves against. Revenue, connections, sales, errors, accomplishments – all of those are important. The trouble comes when you focus too much on one area, which usually means that other important metrics wind up taking a back seat.

If you focus exclusively on incoming revenue, you might miss some mistakes that will cost you at least some of that revenue. If you concentrate only on building more connections in the industry, you might lose some long-term relationships that are just starting to ripen.

For me, accountability this year will be tied to two metrics: raising the revenue gained from the speaking side of my business, and widening my marketing net beyond the mid-Atlantic region. Tracking both will be easy, and each will challenge me to focus very tightly on activities and outreach that will move my game-plan forward. Accountability – at least here at Mighty Casey Media – will be baked in to the spreadsheet I’ll use to track that game-plan.

What accountability will you bake in to your 2013 goals? How will you track your progress? Who will you report to? That last one is a challenge for me, since I’m a solo-preneur. Stay tuned, since one of my accountability check-boxes will be reporting progress here, on the Mighty Mouth Blog.

Rule #2: Laugh more, bark less

That’s a purposeful scrambling of the “wag more, bark less” bumper sticker I see … everywhere. My version of wagging is laughter. If I’m laughing, there’s less risk that I’ll be screaming. Given that one of my core purposes in life is working to effect positive change in the healthcare industry, I can wind up screaming pretty easily if I don’t keep myself in check.

Barking = screaming in my world. We’re all about avoiding the screaming wherever possible. That does not mean that I’ll dampen my ferocity. Hell to the no. What it does mean is that I’ll find ways to wrap the bitter medicine in a big lump of maple sugar. “Bitter medicine” is hard truth about how healthcare has to shift from paternalism and a gold-rush mentality; the lump of maple sugar (and my biggest challenge) is finding the humor that will make that medicine go down … without resorting to barking.

Those are my Simple Rules for 2013.

Happy New Year.

Dec 24 2012

Immediate Jeopardy: I’ll take Medical Errors for $100,000!

By e-patients, healthcare industry, participatory medicine

Accountable care. That’s one of the central pillars of healthcare reform/Obamacare/the Affordable Care Act. Given that Obamacare is built on transforming Medicare, the payment system from which all Holy Billing Codes and the pricing attached thereto flow, Accountable Care Organizations (ACOs) would seem, given their name, to be about accountability for care, right?

Not so fast. The “accountable” in ACOs has more to do with accounting than accountability. An ACO is defined as a network of doctors and hospitals that shares responsibility for providing care to patients. In essence, that network agrees to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. The ACO is indeed accountable for providing care, yet that 5,000-Medicare-beneficiaries-for-three-years is as much about accounting as it is about patient care.

Real accountability in healthcare is an elusive thing. I’ve said many times that there are no guarantees in medicine, other than that there are no guarantees in medicine. That does not mean, though, that we should expect mistakes. Medicine is a human effort, with human failings embedded within it. We should help ourselves, and the medical-industrial complex, though, by taking advantage of the information available to us – patients, providers, all of us – to determine where to get the best and safest care.

jeopardy clue tileAccountability, in the accountable-actions definition, was codified in a California law that went into effect on January 1, 2007. That law gives the California Dept. of Public Health the power to fine hospitals up to $100,000 per event for what they call “immediate jeopardy”, which is defined thus: An immediate jeopardy is a situation in which the hospital’s noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient. A situation is an immediate jeopardy at the time it occurred.

Let’s play Immediate Jeopardy! I’ll take Medical Errors for $100,000! And the question is, “How much were California hospitals assessed in the most recent immediate jeopardy bitch-slap, Alex?” [the answer is in the blue tile]

Since the California law went into effect, 254 immediate jeopardy errors at 141 hospitals have been identified and fined, for a total of $10.4 million. $7.6 million of that has been paid. An article on Health Leaders Media gives the full story on the most recent round of errors, and the fines assessed. There’s also a link to the California Dept. of Health site, where all the incidents and fines since the law went into effect are available with just a few clicks. Some of those reports are truly alarming, even though they’re written up in very spare prose.

Here’s where becoming an e-patient delivers solid value: you learn how and where to look for reliable metrics on healthcare. Anyone can be an e-patient. Here’s how it worked in this instance, when I wanted some additional context for what I read in Health Leaders.

I read the article, and then, in a new browser tab, surfed over to a recent post on e-patients.net about the new Hospital Safety Score tool from The Leapfrog Group. I hunted up the safety scores – which run on an A through F scale, just like a school report card – for the 10 hospitals fined in the most recent round of Immediate Jeopardy. What I found was this:

  • Five of the fined hospitals were A-rated, yet one of them was fined at the highest level ($100K), twice, for repeated incidents
    Of the other five facilities, two had B grades, and three got Cs
  • What did I take away from this dive into the medical-quality-metrics pool? What I take away from each dive I make into the healthcare ocean: transparency in healthcare is still in its infancy, but it’s getting clearer and clearer every day. Will it ever be crystal clear, letting patients make choices that are 100% guaranteed to have a great outcome? Please re-read the 3rd graf of this post for the answer there (hint: it’s “no”).

What we – patients, providers, payers, all of us – can do to make healthcare as clear and careful as humanly possible is to continue to call for immediate reporting of problems, to participate fully in each transaction we have with the industry, to share lessons learned when outcomes don’t match reasonable expectations. By helping each other heal the system, we can help heal ourselves in the process.

Everybody wins.

Dec 18 2012

“How much is that?” = quest for VALUE

By healthcare industry, healthcare price transparency

healthcare money imageWhen you’re shopping for something, sometimes price is the only consideration. Yet think about the times when price matters, but you’ve already determined the only brand or brands you’re interested in buying.

Let’s say you’re buying a car. You’ve done plenty of research, using the criteria that are important to you. Fuel economy, vehicle safety statistics, passenger/cargo capacity, style, color – your vehicle-value-determining checklist. Only after you’ve built that list will you start to hone in on price, shopping around to find the dealers that have what you want in your price range. Value is only fully visible when you know what  you’re getting for the price.

Even in something as simple as grocery shopping, price isn’t always the #1 driver of purchase decisions. Sure, for some things generic Brand X at rock-bottom price is the way to go … on things like shop towels. However, ask any Coupon Queen what her quest is all about, and she’ll tell you that it’s about brands, then it’s about price. She’s not clipping coupons for generics, unless it’s a store brand that meets her quality metrics.

Price is important. Value is critical.

In the “how much is that?” campaign in healthcare, we’re as concerned about quality as we are about price. In healthcare there are quality metrics that far outstrip those for consumer products, but many of those healthcare quality metrics have been hard for consumers – patients – to find and use in assessing healthcare value. That’s changing with the rising availability of quality metrics like the Hospital Safety Scores from The Leapfrog Group released at the end of November. The US Department of Health & Human Services’s Agency for Healthcare Research and Quality – that’s a mouthful (and a massive amount of information on one site), let’s stick with HHS’s AHRQ, shall we? – has comprehensive info on healthcare quality and how to use it, and you paid for every byte with your tax dollars.

Here’s the challenge: start educating yourself about price AND quality when you’re buying healthcare services. Cruise the AHRQ information. Dive into the Hospital Safety Scores if you’re slated for a hospitalization. Ask “how much is that?” throughout the process. You might not get answers every time, but the more you ask, the faster the system will shift toward price transparency.

It’s up to us. Let’s roll.

Nov 29 2012

Comedy writer way-back machine: That ****ing tree

By Uncategorized

tree imageI spent 20+ years working for NBC at 30 Rock. When I started exploring stand-up comedy, the first bit I wrote was based on my experiences working in the building behind what has become “America’s Christmas Tree” – or, as I came to call it, “that fucking tree”.

Since the thing was lit last night, I know the hell my former colleagues are going through. Here’s the bit, in its entirety, with one update for 2012:

Who’s really jazzed about Christmas? Who’s excited beyond words at all the decorations and the hoopla?

Well, I know one thing about all of you. You don’t work in 30 Rock.

I do. That fucking tree.

Imagine that your commute, which normally means pinballing across at least one train platform and at least several crosstown blocks, now also includes hacking your way through a literal mob of tourists.

The mob grows by the minute. You’re trying desperately to get to your office. You can see the revolving doors across the plaza, but …

There’s the Stroller Army, who aim at your knees and ankles as they press their little angels closer to that fucking tree.

There’s the Double-Wides, who stand tall as they wave their arms, pointing … right into your eye … at that fucking tree.

You’ve got the tour group from Thailand, in scattered clumps around the skating rink, wai-ing that fucking tree.

So you make your best broken-field run across the heaving horde, focused on those doors and what’s beyond them – black coffee, toasted bagel, dry, and your work day – and you have to join in on a chorus of When the Saints Go Marching In (Gangnam style!) just to achieve the lobby.

I tell you, there’s nothing about that fucking tree that couldn’t be cured with a can of gas and a couple matches.

Nov 21 2012

Healthcare a passion of yours? Win an award!

By e-patients, healthcare industry

WEGO Awards logoWEGO Health is an online network of people from across the globe who use the internet and social media to connect around health and share health information.

WEGO calls us Health Activists, and they’ve  created a special awards program to recognize those Health Activists who are making a real difference in the online health community: click here to find out all about it. Health Activists are doctors, patients, caregivers, family members, any and all folks who care about their own health and the health of their families and communities.

I’ve signed up to be an Awards Ambassador – that means that I’m doing what I can to share the WEGO Health Activist Awards with my audience to make sure that all Health Activists are recognized for the efforts they make every day. Take a spin over to the nominations page and recognize your favorite health leaders. There is no limit to how many people you can nominate so make sure to recognize everyone that you follow, fan, or friend. WEGO Health has 12 different categories so everyone should fit somewhere!

Is there someone who inspires you to get and stay healthy? Is there someone whose online presence helps you manage a chronic condition? Is there a healthcare professional in your life who has guided you, your family, or your community toward better health with their work on the web? Nominate ’em!

There is no limit to how many people you can nominate so make sure to recognize everyone that you follow, fan, or friend.  WEGO Health has 12 different categories, so there’s a slot fo any kind of online Health Activist!

So go on – NOMINATE!

Jun 13 2012

The black box that caused the crash (of healthcare)

By healthcare industry, politics
healthcare money image

This week, NPR’s Marketplace aired a piece on what I have taken to calling the “black box of healthcare” – pricing. There is a committee, called the RUC, set up and run by the American Medical Association, that reports to CMS (the federal unit that runs Medicare and Medicaid) on relative value numbers for the thousands of medical procedures that wind up as billing codes in Medicare and your health insurer.

Those relative value numbers = PRICES. This isn’t considered price-fixing under anti-trust rules because the RUC reports to CMS, which then publishes the numbers on the Medicare reimbursement rate schedule. So the AMA isn’t publishing the prices, CMS is.

Fox, meet henhouse. Or, stated in another way: airplane, meet the black box that is making you crash and burn. The Marketplace page linked in the 1st graf has plenty of linkage to additional context for this issue. Read them, and weep.

How is it that an industry whose aggregate cost is now at close to 20% of US GDP gets to set its own prices, and then have them published by the federal government as The Official Price List?

It’s called effective lobbying, and it’s so effective that it’s essentially kept access to the pricing committee process a secret for decades. Which makes it pretty clear why so much of our GDP goes to healthcare, doesn’t it?

The sound bite in the story that I found the most hilarious was from Charlie Baker, the former CEO of the Harvard Pilgrim health plan in Massachusetts. His quote:

By having a process that for all intensive [sic] purposes isn’t a public process, and doesn’t appear to actually be accountable to much of anybody, I think that’s kind of un-American!

I find this hilarious because Harvard Pilgrim is a member of America’s Health Insurance Plans, the industry group that advocates (translation: lobbies) for health insurers, who also have their hands on the levers of healthcare pricing via reimbursement rates (granted, based on CMS’s published rates, which are based on the RUC’s relative value numbers). Which means that the very-American health insurance industry is a co-conspirator in this price-setting (-fixing?) game.

Healthcare pricing is such a black box that if a patient attempts to find out what something will cost before s/he has a medical procedure, s/he will be met with a blank stare, “I don’t know”, “nobody knows how to figure that out”, or some other version of “what?” that gets you no answer.

e-Patient Dave deBronkart has a terrific example of how shopping for healthcare can be done, even in the face of “what?” – click the link for the full story there. Patients acting on their own behalf to determine their economic exposure before they get medical care might begin to bend the healthcare cost curve IF they can get the price information.

Dave isn’t the only customer of the healthcare industry who’s looking for pricing, and answers to the variance in said pricing depending on who you ask. The LA Times had a piece in their May 27, 2012 business pages on how patients could negotiate cash prices at the hospital or in the doctor’s office that were far below insurance reimbursement rates IF they didn’t use their insurance.

As an industry, healthcare is deeply broken. Since the industry has been supported for decades by an economic model that hides pricing from its consumers – employer-based health insurance – the end users, patients, have no clear path to making informed choices based on quality and cost.

If you ran your business that way, you’d be out of business pretty quickly. It’s time to break the healthcare industry’s economic model – if ever there was a sector ripe for creative economic destruction, healthcare is that sector.

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