Excerpt – The perception that practice variation signals quality deficiencies remains foundational to the pursuit of “high value” care. But if value is defined as quality divided by cost, measuring value faces all the same problems as measuring quality — flawed risk adjustment, metric gaming, omission of the many aspects of quality that defy measurement. So why do we continue to embrace these flawed constructs, particularly when it’s not clear that the current regulatory approach serves patients or clinicians? [president of the Commonwealth Fund David] Blumenthal offers international context: “The French, the Brits, the Swedes — they don’t torture their … Read More
All posts by Anupam
“The diagnostic process begins with gathering data. Key elements involve ascertaining the person’s current concerns; reviewing the medical history; performing a physical examination; evaluating findings from laboratory, imaging, and pathology studies; and exploring the inferences and plans of previous clinicians. In the modern era, much of this data gathering takes place through a review of the electronic medical record. While that is a valuable and efficient tool, physicians must continue to learn the value of listening to a person’s descriptions and accounts of their symptoms and concerns firsthand. [..] After gathering data, the next step is to determine which pieces … Read More
“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%. Reduce Expensive and Unnecessary Trips to the ER Reverse America’s Chronic-Disease Crisis – For members of large multispecialty medical groups such as Kaiser Permanente [KP], high blood pressure is a much more manageable problem [outside of KP, control rates hover around … Read More
“Berwick recognized that blaming workers for factors beyond their control quashes goodwill and encourages cheating. This insight accords with a foundational principle of the QI [quality-improvement] movement: most quality lapses reflect a faulty system rather than faulty people. To improve quality, we must fix the system. Some 30 years later, however, the fix is itself a massive system. As reimbursement models shift toward value-based payment, QI is no longer just about being better, but about documenting improvement to maximize payment. An entire industry has arisen to support the optimization and demonstration of performance. Though I could find no authoritative estimate … Read More
This piece was adapted from Ressa’s remarks at Disinformation and the Erosion of Democracy, a conference hosted by The Atlantic and the University of Chicago, on April 6, 2022. Maria Ressa is a contributing writer at The Atlantic, the CEO of Rappler, and a recipient of the 2021 Nobel Peace Prize. “really, this is like when 140,000 people died instantly in Hiroshima and Nagasaki. The same thing has happened in our information ecosystem, but it is silent and it is insidious. This is what I said in the Nobel lecture: An atom bomb has exploded in our information ecosystem. And … Read More
“There is an urgent need to improve diagnostic excellence in sepsis1. One potential solution is the development of a flexible, scalable, and interoperable data infrastructure to screen and identify sepsis patients across health systems using real-time, granular clinical data available within electronic health records (EHRs). Despite clinical data for millions of sepsis or pre-sepsis patients routinely collected in EHRs, the healthcare enterprise has accessed only a small fraction of these data to improve the clinical understanding of sepsis. The development of a sepsis data backbone could be extended to meet diverse needs, including sepsis translational research, clinical care delivery, machine … Read More
Excerpt – In 2001, I developed a checklist for health care workers to reduce infections from catheters, tubes that are widely used to deliver fluids and critical medicines to people who have been hospitalized. At the time, catheter infections resulted in approximately 31,000 deaths a year in the U.S, putting it in the top 15 leading causes of death. The checklist included measures such as washing hands and wearing masks. When tested at Johns Hopkins, where I worked at the time, and then adopted in Michigan, and overseen by a diligent nursing staff, use of the checklist eliminated almost all … Read More
“short of comprehensive reform by Congress, CMS may find it challenging to build value in Medicare over this decade if TM’s [traditional Medicare] scaffolding erodes [due to the rise of Medicare Advantage (MA)]. Much can be done under CMS’s existing authorities to promote efficiency and equity, but, under Medicare’s present configuration, that requires preservation of TM. Without substantive legislative reform on the horizon, regulatory policy will thus need to keep the long view in mind, lest several years of inertia set in motion an unalterable course to a lesser outcome. [..] MA has been clearly successful in managing utilization more … Read More
Excerpt – No public health decision is purely scientific, so the agency cannot avoid the small-p politics of health policy. No matter what we may yearn for, there is no ethereal scientific plane the CDC can ascend to. “The ‘politicization’ accusation implies that we should just isolate the CDC and let it do its work by itself,” said Gil Eyal, a sociology professor at Columbia University. “But I think that’s wrong. I don’t think we know of an obvious way to organize the relationship between science and politics.” That is, they are always intertwined, especially when it comes to the … Read More
“If we do want to change our relationship to technology, I think we’d have to do it intentionally. My basic thoughts are roughly: We should accept the premise that people will not run their own servers by designing systems that can distribute trust without having to distribute infrastructure. This means architecture that anticipates and accepts the inevitable outcome of relatively centralized client/server relationships, but uses cryptography (rather than infrastructure) to distribute trust. One of the surprising things to me about web3, despite being built on “crypto,” is how little cryptography seems to be involved! We should try to reduce the … Read More