BLOG Medicine

Healthcare Cost, BIDMC and Strategy

A recent posting by Paul Levy, CEO, Beth Israel Deaconess Medical Center (BIDMC), Boston, on his blog asked some questions about strategic planning that I, and an enthusiastic number of others, responded to.  (Note to self: remember to better identify yourself, BLOG Medicine, or Maynard & Company, Inc., as appropriate, when commenting in blogs.)

What had prompted Paul's question was a recent post by Charlie Baker, President and CEO, Harvard Pilgrim Healthcare on his blog that would seem to reinforce the idea that payors reimburse based on market power rather than quality clinical outcomes.  A number of respondents, in their own way, mirror or support my own response, including, interestingly, that of Andrew Dreyfus, Blue Cross Blue Shield of Massachusetts.

Regardless of what payors may say, market power currently drives reimbursement and hospitals should plan accordingly.  Evolution of reimbursement methodologies that incorporates quality initiatives and healthcare transparency can be seen, but this change is slow and seemingly made only grudgingly.  Strategic plans, however, are a dynamic document and BIDMC can effectively incorporate none, some, or all of the suggested responses to increasing healthcare costs, decreasing revenue, and questionable clinical outcome reporting knowing that the plan will change again a year from now.■

Tennessee Hospitals Inform

The Tennessee Hospital Association went public 23 April 2007 with a web site telling patients, in advance, how much they'll pay.

The site, Tennessee Hospitals Inform, lists the median charges billed for the most common diagnosis-related groups at most of the state's 136 hospitals, using prices from hospital's most recent annual reports to the state.  HCA-owned hospitals prices aren't listed, but there are links to the company's own cost-of-care site.

The site also includes a link to the HospitalCompare, the US Departement of Health and Human Services site that maintains quality information backed by top health care experts and federal government agencies.■

AHIP Advances National Strategy to Improve Health Care Safety and Quality

America's Health Insurance Plans (AHIP) study, "Raising a Higher Bar," released 20 April 2007, calls for the creation of a new entity to compare the safety and efficacy of medical procedures and technologies, advocates steps to promote healthcare transparency and speed the adoption of best practices, and calls for the creation of a new patient-centered dispute resolution mechanism.

The AHIP plan advocates a 3-point program: creating a new public-private partnership charged with providing up-to-date and objective information on which health care services are most effective and provide the best value; assuring FDA authority to monitor long-term impact of new drugs, devices, and biologicals; and, adopting a national medical research agenda that closes gaps in knowledge and provides actionable information to patients and physicians.

The new plan to improve quality and safety follows a proposal to expand access to coverage released by AHIP in November 2006.  Because of the clear similarities to HHS Secretary Michael Leavitt's Value Exchange plan, unveiled late February 2007, it's unclear if the AHIP plan is a counter to the HHS plan, is meant to complement the HHS plan, or run parallel to the federal program.  It's also unclear how a new patient-centered dispute resolution mechanism is different than, or improves upon, the dispute resolution process advocated by the American Medical Association (AMA) in their "Model Managed Care Agreement," 4th edition, 2005.

What is clear is that healthcare reform remains a priority for everyone involved, but divergent agendas don't build consensus, and plans that purport to be new and visionary, but aren't, can only fail.■

HHS Value Exchanges to Report on Quality and Cost

On 28 February 2007, US Department of Health and Human Services (HHS) Secretary Mike Leavitt unveiled a plan for chartering local collaborative organizations that will assess the performance of local health care providers and publicly report the findings.  The plan would bring the local collaboratives into a nation-wide system, and use nationally recognized standards to measure and improve quality of care in their local areas.

HHS would charter select qualified regional collaboratives as Value Exchanges.  In such collaboratives, local area physicians, nurses, hospitals and other health care providers work with health plans, employers, unions, and other health care purchasers to achieve reliable public reporting on quality and cost of care.  As HHS-chartered Value Exchanges, they would continue to focus on quality improvement and would provide public reports on the performance of providers in their area.

The Value Exchanges would use nationally recognized standards developed through public-private efforts that also form the basis for ongoing Medicare quality and performance reporting.  The Exchanges could also pioneer new quality improvement strategies and share results through the Medicare Learning Network.

The HHS's Agency for Healthcare Research and Quality (AHRQ) will administer the new system, but providers will lead in the development of standards.

Leavitt said that the goal is to achieve both national coordination in developing standards and local control in applying them.■