Archive for December, 2006

The Downside of Performance Measures

December 28th, 2006 by Melanie Matthews

The thing about performance measures is there can be a lot of caveats to the type of care given and the result – many of which can’t be reflected in a report card on the quality of care given at a hospital or by a physician.

Take for instance C-section rates. While the aim in labor and delivery is to have a low C-section rate, C-section rates can be influenced by patient risk factors (e.g., multiple pregnancy, previous C-section, greater than 36 weeks gestation, medical risk including hypertension, diabetes, etc.). However, most times, the reported C-section rates are not adjusted to reflect these factors, according to an article on the Michigan Hospital Association web site.

A woman I know had her first child this week. Weighing in at 10 lb. 2 oz., this baby spent its first two days of life in the NICU for problems related to a vaginal birth — problems that would have been avoided had a C-section been performed. The baby is also now going to physical therapy to hopefully fix an injury to his arm related to his birth.

This birth’s impact on the C-section versus vaginal birth rates would make the hospital’s quality ratings appear high, but a C-section would, indeed, have provided better quality care than this vaginal delivery.

Class-Action Lawsuit Highlights Importance of Healthcare Price Transparency

December 19th, 2006 by Melanie Matthews

A recent class action lawsuit in Seattle detailed in the November 16th USA Today is another example of the need for price transparency in the healthcare industry.

The lawsuit, filed against Virginia Mason Medical Center, stemmed from a patient name Lori Mill who was concerned about a possible toenail infection. She went to her doctor’s office in an outpatient clinic owned by the Virginia Mason Medical Center in downtown Seattle. Her doctor clipped off a piece of nail and sent it to the lab for a total cost to Ms. Mill of $1,133. Mill found out later that she could have paid hundreds less for the same thing had she gone to one of Virginia Mason’s seven other, more suburban, outpatient clinics, where her doctor also practices.

Her situation illustrates a practice that is legal and common, but little known to patients: Some medical clinics are considered “hospital-based” and charge additional fees for the same services, even if they aren’t inside an actual hospital.

The lawsuit argued that, under state consumer protection laws, patients should have been told in advance about additional fees.

Earlier last month, Virginia Mason settled the class-action law suit, agreeing to not only refund money to thousands of patients, but also to tell patients that it charges more at some clinics in its system than others and to find ways to help patients estimate upfront their costs for some outpatient procedures.

As consumers become more responsible for how their healthcare dollars are spent, it is only realistic that we ask for and are given the knowledge to make an informed decision. During “Meeting the Demands of Healthcare Transparency in Pricing and Quality,” an HIN audio conference on this transparency movement, Dr. Lou Diamond, medical director with Medstat and Paul F. Thompson, product marketing manager with Cigna, provided insight on healthcare cost and quality transparency.

In Ms. Mill’s case the facility fee was $418. I know put in her shoes, if I had been told of such a fee, I would have thought twice and sought an alternative to care in that particular clinic – I’m sure you agree.

Managing Transitions to Care for Medicare Patients to Avoid Costly Inpatient Admissions

December 14th, 2006 by Melanie Matthews

Miscommunication during the care transition puts elderly patients at risk for reduced quality of care, poorer outcomes and unnecessary procedures, according to Gregg Lehman, president and CEO of Inspiris. He defines the key players on the care transition team, suggests strategies for improving communications during this crucial phase and describes his organization’s approach to dual eligibles who find themselves at this healthcare crossroad. Click here to listen to Gregg’s comments. Lehman, along with Danielle Butin, director of health services at Oxford Health Plans, a United Healthcare Company, described how their organizations are coordinating the care of Medicare patients as they transition through the healthcare system to minimize costly episodes of care during a November 30th audio conference, Managing Transitions to Care for Medicare Patients to Avoid Costly Inpatient Admissions. For more information, please visit: Managing Transitions to Care for Medicare Patients to Avoid Costly Inpatient Admissions