Not All NICU Babies Should Get the Same Treatments
“Standardized work” in healthcare doesn't mean that every patient gets the same treatment. Care needs to be customized to provide the right value to the right patient, just as your car is customized to the features that you want and value.
From this story: 5 Things Your Baby Should Avoid In The NICU, they describe five treatments that are routinely given to babies in the NICU that might not be helpful or necessary, such as “daily chest X-rays for infants who are intubated, unless there's a specific problem that needs to be investigated.”
Unnecessary treatment increases cost and often harms outcomes (we see similar problems in the England NHS).
Of the five treatments:
“With newborns, there's very little evidence that routine use will improve the symptoms…” That's not to say that no infant should ever get these, [DeWayne Pursley, chief neonatologist at Beth Israel Deaconess Medical Center] says. “But our gripe, if you will, is their routine use.”
How can hospitals and physicians work to reduce unnecessary care? How much of that is due to habit, a mistaken view of “best practices,” or defensive medicine?
Shrinking and Cutting Isn't the Only Path for Hospitals
This piece really piqued my interest: “Expanding, Not Shrinking, Saves A Small Rural Hospital.”
Rural hospitals are under a lot of pressure recently. Far too many hospitals (large or small) think cost cutting, layoffs, and cutting service lines, are the only path to survival.
But what about trying to grow and provide MORE value instead?
“Then a key phone call and strikingly different strategy turned everything around. A doctor in the area called Jerry Cummings, who was then running a medical consulting business with his wife Cindy in central Missouri. Instead of closing its doors, Putnam County Memorial should expand, the couple advised.
The hospital could convert an unused 10-bed unit into a psychiatric wing to bring in new revenue, suggested the Cummings, and offer other medical services that Putnam County residents were driving hours away to get.”
“Our revenues went from $4 million to $22 million — a huge increase,” Jerry Cummings says. “Our average daily [patient] census, it was less than 1 patient per day. Our average daily census now is around 11 to 12 patients.”
They're keeping more local patients instead of losing them to further off big-city hospitals. Can more rural hospitals adopt this strategy?
More Expensive Cancer Drugs Aren't Always Better
Healthcare is still going through an awkward transition from being paid for activity to being paid for value and outcomes.
From this NPR story: “Doctors Plan Database On Cancer Drugs, Showing Effectiveness And Cost.” A group of physicians are developing a database of cancer drugs that “would include a score for each drug – basically how well the drug worked – and also right next to it, how much the drug cost.”
“scored a zero, meaning it didn't work any better than the standard treatment. And then there was the cost – 10 times more expensive than the standard treatment.”
The pharmaceutical maker pushed back that not all patients are the same (fair point):
“…questioning that score of zero and pointing out that the drug is intended for patients with a particular kind of lung cancer. Schilsky says that was a fair point, so his group put out an additional score for the drug's effectiveness on that subgroup of patients.
SCHILSKY: The net health benefit score was 16.
KESTENBAUM: Better than zero, but it's out of a total possible score of 130.
Society needs to come to terms with the idea that more expensive healthcare isn't always better healthcare… as with many things, it's easier to identify the problem than it is to come up with good solutions.
SCHILSKY: This is one of the real difficulties with the U.S. health care system is that the cost of almost any kind of treatment are largely invisible to either the providers of that treatment or the patients who are receiving that treatment.
KESTENBAUM: What should a patient do when there is one drug that is a little better but costs a lot more? That is a hard decision, but he says one worth having. David Kestenbaum, NPR News.
Getting Patients Involved in Choosing Better Care
I also heard this story: “More Health Plan Choices At Work: What's The Catch?” that talks about consumer-driven health plans (hear my interview with John Torinus on this subject).
The featured company is using a private insurance exchange to give employees choice, something only 3% of employers are doing right now.
It's easier to say “choose high quality, low cost care” than it is to actually do that if data isn't readily available.
“But shopping wisely for health care is almost impossible says Sara Collins from the Commonwealth Fund, a health policy research organization.
It's often difficult for consumers to find out how much a doctor visit or a particular procedure costs. And, Collins says, studies show that people with high-deductible plans often forgo care to save money; they'll even avoid free preventive care because they don't understand how their health insurance works.”
How do we improve the transparency of healthcare quality and cost data for employers and the general public?
The piece also highlights this ticking time bomb:
“It's called the “Cadillac” tax (meant to reduce health spending by discouraging luxurious health plans), but it is not as exclusive as its name implies. Towers Watson, a consulting firm, predicts that 48 percent of employers will have to pay the tax in its first year.”
What do you think about any of these stories? Leave a comment and have your say…