At the Affordable Healthcare Conference at Virginia Mason
Dan Berwick spoke about using science as a basis for medical decisions looking out globally to see where US healthcare ranks, and learning
in large systems. Provost notes it is studies
that make it possible to learn and improve performance. Without feedback there is no
improvement. Knowledge begins and ends
in data, but there has to be some change in the middle to learn. Enumerative type studies are done when
conditions are stable whereas an analytic study is done to improve a
process.
VM’s CEO Gary Kaplan pointed out that most important outcome
is return to function and importance of also evaluating the patients experience. The Everett Clinic’s CEO Rick cooper spoke
of reducing cost by 25%, reaching 90% generic Rx, and the 49% rule is when you
don’t believe 49% of what you peddle.
And Group Health’s CEO Scott Armstrong spoke about the changing
incentive system. Mark Mora from GHC spoke
about the value of having patients actually make informed decisions after they
have watched a video. In American
medicine this is revolutionary.
Nobel prize winner Bernard Lown, MD has shown that half the
stents inserted are unneeded. Some
hospitals compete on quality and some on quantity.
We need to take the greed out of healthcare citing the
patenting of colchicine, payments for EPO. It is pernicious and worse than theft. The should be the minimum moral standard.
We heard that innovation
needs to prove itself. Washington State created an office to evaluate
new technology for effectiveness which was vilified in an editorial in the Wall
Street Journal for not approving a new technology which happened to kill people. Interestingly this office was
instigated by radiologists, who were threatened when the ENT docs were starting
to purchase MRIs to scan sinuses. Developers of new technology should have to prove its effectiveness
before they sell it.
Another problem in lowering costs is that the guilds are protecting
their turf, preventing health workers for working to their full capacity. In business jobs flow to the lowest skilled
ie. McDonalds. In healthcare that is blunted.
The discomfort with talking about caring for the poor,
talking about comparing our healthcare with other countries (Rwanda has 98% of its citizens
insured), discussing end of life care leads to a system which serves the medical
industrial complex but not its users.
Berwick says America needs to have a civil discourse. Calling
scientifically graded decisions government run medicine is priming which is meaningless in debate.
Speaking of government the Alaska Federal Healthcare
Network provides remote medicine throughout
the state of Alaska. The feds are so smart in Palin country.
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