“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
All posts in High-value Care
“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
“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
“In 2017, a total of 31% of Americans died at home, making it the most common site of death for the first time in decades. In the United States, we tend to believe that someone who died “peacefully at home, surrounded by family” (as the obituaries put it) has had a good death. Yet reality frequently diverges from this scenario. Unprepared family caregivers are routinely tasked with managing distressing symptoms (including pain, agitation, and dyspnea), administering medications, and providing intimate personal care (including bathing and toileting assistance) to bedbound patients. In other care settings, these tasks are performed by trained … Read More
“[Introduction] [..] Privileged US citizens—including thought and physician leaders—may tolerate this underperformance as applying to “others,” dismissing comparisons as mean values that do not reflect the quality of their own personal care. Privileged US citizens believe that their social connections and financial resources allow them to choose the best physicians and hospitals for their own care, thereby ensuring excellent health outcomes. One study showed that the wealthiest quintile receive 43% more health care than the poorest quintile and 23% more than middle-income US citizens. Privileged US citizens may believe that their resources ensure that they receive the world’s best health … Read More
“[Methods] [..] We included studies that reported LCS [lung cancer screening] adherence rates in the US and/or determinants of LCS adherence. We considered prospective or retrospective studies that screened adult patients at any risk level of developing cancer who opted to initiate LCS and continued to undergo additional screening after the first LDCT (low-dose computed tomography). [Results] [..] Fifteen studies (19 publications) involving a total of 16 863 individuals were included in this systematic review. [..] 12 studies (80%) did not have a follow-up time that was long enough to adequately assess periodic adherence beyond 1 year. All of the studies … Read More
“Enthusiasm for the potential impact of AI [artificial intelligence] on hospital operations is often based on its impact in other industries. However, non-health care companies invest in AI after having digitized and optimized their operations with a variety of older mathematical methods. In contrast, hospitals may invest in AI while still scheduling patient appointments using fax machines and allocating resources based largely on anecdotal experience. [..] For decades before the advent of modern AI, the operational management of capital, labor, and resources of large manufacturing, retail, airline, and most other large-scale industries were being designed and refined with rigorous methods … Read More
“[Introduction] The American Heart Association (AHA), American College of Cardiology (ACC), and the US Preventive Services Task Force (USPSTF) all recommend hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) for primary prevention of cardiovascular events in adults aged 40 to 75 years who have an elevated risk (most often defined as ≥7.5% risk of major adverse cardiovascular event [MACE] within 10 years). [..] Although the benefits of statins to decrease cardiovascular events such as myocardial infarction and stroke have been well documented for adults younger than 75 years, when these benefits occur is unclear. In contrast, the burdens of statins appear … Read More
“Skin cancers represent the most common malignant neoplasms in the United States and account for more than $8 billion of health expenditure annually. Because the US population is aging, the incidence of skin cancers is increasing. In addition to topical chemotherapy, procedural treatments for skin cancers include Mohs micrographic surgery (MMS), simple surgical excision, and shave excision as well as destructive modalities including laser surgery, electrosurgery, and cryosurgery. [Results] From 2012 to 2017, MMS services had the highest mean payment ($378.71; range, $41.24-$466.93) and shave excisions had the lowest ($70.99; range, $15.58-$135.24). During this period, payment rates declined for each … Read More