Insuring Resources Important Link:
I want to draw your attention to an important event that took place last week, on April 6th. Health care leaders from across the state met to discuss methods to improve health care payment methods to better reward health care quality and efficiency.
Please check this out:
http://www.createhealthcarevalue.com/blog/post/?bid=160
Here's an excerpt: "The Center has outlined what we think real health reform looks like. It boils down to three things: paying for value not volume, transparency of healthcare performance through public reporting, and redesigning the care delivery process to take out waste. We took a step closer to paying for value with the day long meeting in Pewaukee on (April 6th)." - Dr. Toussaint
Showing posts with label LEAN. Show all posts
Showing posts with label LEAN. Show all posts
Thursday, April 15, 2010
Wednesday, March 24, 2010
Lean Process in Practice
Insuring Resources Commentary:
I found the article included below on GE Healthcare's website. It details how Brigham and Women's Hospital in Boston, MA, implemented Lean tools in their clinical laboratory. These processes streamlined their laboratory operations and reduced wait times for lab tests.
The article states:
"The effort brought about rapid and significant improvements in key measures of quality and consistency. For example, in just six months, average wait times in phlebotomy decreased from 14-17 minutes to 4-5 minutes. In addition processing in the laboratory for specific tests (see table) now meets cycle time goals more than 90percent of the time."
This was accomplished by "Eliminating non-value-added tasks, such as duplicative sample container labeling, and "Reconfiguring one station that had been reserved for patients susceptible to fainting by installing a chair that can be used for all patients."
There's no information in the article about cost savings, but reduced wait times and elimination of non-value added tasks must achive some savings.
----- ------ ------ ------
LEAN TOOLS IN THE CLINICAL LABORATORY
Rapid-improvement events enhance laboratory performance
As plans advanced to automate the Clinical Laboratories, Brigham and Women’s Hospital faced growing specimen volumes in constrained space amid concerns about technician retention and recruitment.
The hospital staff worked with the Performance Solutions consulting group of GE Healthcare and the hospitals’ Center for Clinical Excellence as a part of a Lean Skills Transfer engagement to assess laboratory performance and design process improvements at all key steps in the value stream, from the time the patient arrives to provide a specimen until the lab report is complete.
The effort brought about rapid and significant improvements in key measures of quality and consistency. For example, in just six months, average wait times in phlebotomy decreased from 14-17 minutes to 4-5 minutes. In addition processing in the laboratory for specific tests (see table) now meets cycle time goals more than 90percent of the time.
“While our volumes were growing, we were also planning for laboratory automation,” says Dr. Milenko Tanasijevic, the Director of Clinical Laboratories. “We wanted to optimize workflow first, rather than automate suboptimal processes. Lean offered a unique set of tools that allowed our staff to break processes down into discrete steps to discern between non-value-added and critical, value-added steps.
“We achieved significant improvements in patient satisfaction, reduced wait times in
phlebotomy, streamlined processes and shortened laboratory turnaround time.”
Streamlining phlebotomy
A team made up of Clinical Excellence process improvement leaders, laboratory staff, and GE lean experts conducted a value stream mapping session in November 2007. Then they performed five kaizen rapid-improvement events over the next six months, each focusing on specific process areas.
One kaizen addressed wait times in the outpatient phlebotomy clinic, a small space with five drawing stations. Patients arrive without appointments and are seen on a first-come, first-served basis. Wait times were inconsistent: some patients were seen almost on arrival, but others waited 30 to 40 minutes, or longer.
The analysis found an imbalance between demand and staffing, especially early in the day. Patients arriving before the actual opening time caused a backlog that had a ripple effect lasting into the morning. To address that, the team decided to open the center 30 minutes earlier and increase staffing during the morning hours.
The kaizen also identified ways to manage patients’ expectations and improve patient flow. A “take a number” system allowed patients to anticipate their wait time. Those patients needing urine testing had their specimens collected in the interval between arrival and blood draws.
The team also introduced a flow coordinator role, responsible for escorting patients from the waiting area to the drawing stations, instead of having the phlebotomists walk to the waiting area and call for patients. The team also took several steps to make the phlebotomists’ work more efficient. These included:
> Eliminating non-value-added tasks, such as
duplicative sample container labeling.
> Reconfiguring one station that had been reserved
for patients susceptible to fainting by installing a
chair that can be used for all patients.
Improving laboratory workflow Four kaizens addressed various aspects of laboratory sample handling and processing workflow. The critical metrics included cycle time from logging of the specimen to entry of the result to the Laboratory Information System, measured for average time and percent compliance with cycle time goals.
The team made a variety of changes in staffing and procedures to eliminate issues that caused processing bottlenecks. Data gathered during the process made it possible to optimize staff levels to meet demand.
In addition, instead of having individual technicians perform all specimen processing steps, the Lean participants devised a team-based approach, reducing technician travel distance significantly. The group also reconfigured workspace layouts and co-located equipment for efficiency.
Sustaining momentum
Using lean tools to make processes more visible to staff and patients was a key tenet in working across the value stream. Surveys showed that phlebetomy patient satisfaction increased by more than 20 percentage points after the kaizen improvements.
The benefits of Lean and the kaizen have lasted well beyond the original engagement. For example, after the first 5S project, the hospital staff undertook two more such activities in other areas of the chemistry laboratory.
“Lean and the kaizens have enabled us to brainstorm solutions and actually go out and test them in a real-time mode,” says Tanasijevic. “It shortened the interval from issue identification and idea generation to trying out proposed changes in the laboratory.”
Dorothy Goulart, MS, RN, Director of Performance Improvement with the Center for Clinical Excellence, observes, “We have had success with facilitating design sessions
and involving staff and managers in problem solving, but we were challenged to consistently implement and sustain changes. By combining change acceleration, Lean and kaizen event approaches, we have been able to strengthen our institution’s ability to achieve tangible results while building new capabilities and knowledge.”
I found the article included below on GE Healthcare's website. It details how Brigham and Women's Hospital in Boston, MA, implemented Lean tools in their clinical laboratory. These processes streamlined their laboratory operations and reduced wait times for lab tests.
The article states:
"The effort brought about rapid and significant improvements in key measures of quality and consistency. For example, in just six months, average wait times in phlebotomy decreased from 14-17 minutes to 4-5 minutes. In addition processing in the laboratory for specific tests (see table) now meets cycle time goals more than 90percent of the time."
This was accomplished by "Eliminating non-value-added tasks, such as duplicative sample container labeling, and "Reconfiguring one station that had been reserved for patients susceptible to fainting by installing a chair that can be used for all patients."
There's no information in the article about cost savings, but reduced wait times and elimination of non-value added tasks must achive some savings.
----- ------ ------ ------
LEAN TOOLS IN THE CLINICAL LABORATORY
Rapid-improvement events enhance laboratory performance
As plans advanced to automate the Clinical Laboratories, Brigham and Women’s Hospital faced growing specimen volumes in constrained space amid concerns about technician retention and recruitment.
The hospital staff worked with the Performance Solutions consulting group of GE Healthcare and the hospitals’ Center for Clinical Excellence as a part of a Lean Skills Transfer engagement to assess laboratory performance and design process improvements at all key steps in the value stream, from the time the patient arrives to provide a specimen until the lab report is complete.
The effort brought about rapid and significant improvements in key measures of quality and consistency. For example, in just six months, average wait times in phlebotomy decreased from 14-17 minutes to 4-5 minutes. In addition processing in the laboratory for specific tests (see table) now meets cycle time goals more than 90percent of the time.
“While our volumes were growing, we were also planning for laboratory automation,” says Dr. Milenko Tanasijevic, the Director of Clinical Laboratories. “We wanted to optimize workflow first, rather than automate suboptimal processes. Lean offered a unique set of tools that allowed our staff to break processes down into discrete steps to discern between non-value-added and critical, value-added steps.
“We achieved significant improvements in patient satisfaction, reduced wait times in
phlebotomy, streamlined processes and shortened laboratory turnaround time.”
Streamlining phlebotomy
A team made up of Clinical Excellence process improvement leaders, laboratory staff, and GE lean experts conducted a value stream mapping session in November 2007. Then they performed five kaizen rapid-improvement events over the next six months, each focusing on specific process areas.
One kaizen addressed wait times in the outpatient phlebotomy clinic, a small space with five drawing stations. Patients arrive without appointments and are seen on a first-come, first-served basis. Wait times were inconsistent: some patients were seen almost on arrival, but others waited 30 to 40 minutes, or longer.
The analysis found an imbalance between demand and staffing, especially early in the day. Patients arriving before the actual opening time caused a backlog that had a ripple effect lasting into the morning. To address that, the team decided to open the center 30 minutes earlier and increase staffing during the morning hours.
The kaizen also identified ways to manage patients’ expectations and improve patient flow. A “take a number” system allowed patients to anticipate their wait time. Those patients needing urine testing had their specimens collected in the interval between arrival and blood draws.
The team also introduced a flow coordinator role, responsible for escorting patients from the waiting area to the drawing stations, instead of having the phlebotomists walk to the waiting area and call for patients. The team also took several steps to make the phlebotomists’ work more efficient. These included:
> Eliminating non-value-added tasks, such as
duplicative sample container labeling.
> Reconfiguring one station that had been reserved
for patients susceptible to fainting by installing a
chair that can be used for all patients.
Improving laboratory workflow Four kaizens addressed various aspects of laboratory sample handling and processing workflow. The critical metrics included cycle time from logging of the specimen to entry of the result to the Laboratory Information System, measured for average time and percent compliance with cycle time goals.
The team made a variety of changes in staffing and procedures to eliminate issues that caused processing bottlenecks. Data gathered during the process made it possible to optimize staff levels to meet demand.
In addition, instead of having individual technicians perform all specimen processing steps, the Lean participants devised a team-based approach, reducing technician travel distance significantly. The group also reconfigured workspace layouts and co-located equipment for efficiency.
Sustaining momentum
Using lean tools to make processes more visible to staff and patients was a key tenet in working across the value stream. Surveys showed that phlebetomy patient satisfaction increased by more than 20 percentage points after the kaizen improvements.
The benefits of Lean and the kaizen have lasted well beyond the original engagement. For example, after the first 5S project, the hospital staff undertook two more such activities in other areas of the chemistry laboratory.
“Lean and the kaizens have enabled us to brainstorm solutions and actually go out and test them in a real-time mode,” says Tanasijevic. “It shortened the interval from issue identification and idea generation to trying out proposed changes in the laboratory.”
Dorothy Goulart, MS, RN, Director of Performance Improvement with the Center for Clinical Excellence, observes, “We have had success with facilitating design sessions
and involving staff and managers in problem solving, but we were challenged to consistently implement and sustain changes. By combining change acceleration, Lean and kaizen event approaches, we have been able to strengthen our institution’s ability to achieve tangible results while building new capabilities and knowledge.”
Thursday, January 21, 2010
So What Happens Now--- Forecasting What's Possible
Insuring Resources Commentary:
Now that Senate Democrats have lost their Supermajority and only
have 59 votes they are quickly assessing the art of the possible to save face.
Here's my view of what we'll get:
These are definitely out
Public Option
Employer Mandate
I believe these might be in (Analysis follows)
Elimination of Pre-x exclusions
Individual Mandate
State Pilot Health Insurance Exchanges
Expand Medicaid in states at their option
Reduced tax on Cadillac Plans
Let's assess what I believe might be in from the list above:
Eliminate pre-x conditions- This is a must but insurers must have flexibility to deal with adverse selection of millions of uninsureds suddenly getting tremendous coverage for many for the very first time. Treatment costs may go through the roof and cost-shifting may be drastic upon the employer side.
Individual Mandate See above, but also what penalty will be set and will it be in proper balance to be both a carrot and a stick?
State Pilot Health Insurance Exchanges
I think we'll see Congress want to test this and not go with it nationwide. That will be a compromise both sides may be able to live with and I believe there will be employer "penalties" that they must pay if their employees access coverage through the HIE. Again, those penal;ties must be in the proper balance.
Medicaid Expansion
Ok' let's start with some state examples to set the stage.
Wisconsin: currently covers most adults and children up to 200% of the federal poverty level. Nebraska (which got the 'Cornhusker Kickback' thanks to Senator Nelson only covers up to 100% and the Senate Bill requires 133%. The House bill required 150%.
Louisiana I've heard is far below 100%.
I think the final bill will allow state's to experiment with some additional matching funds from the Feds. Currently most state Medicaid programs are 60% funded by the individual state and then they receive the remaining 40% from the feds. There are some nuances to this but that's the basics. I think the feds may sweeten that match within select pilots and allow a few states to experiment on a limited basis a la BadgerCare, except it might be a better financial deal for states to have waited.
But what about those with existing employer coverage?
I believe there will be a reduced tax on the so-called Cadillac plans as a compromise. Reform will probably include minimum required standard benefit plans which set a floor for the employer market. Employers may also be mandated to provide several options based on how many employees they have.
Employer size for inclusion in the Exchange will be interesting since I don't feel there will be a mandate if a compromise is found in the next few weeks. The impact on small businesses is perhaps the hardest issue to predict. If there's no mandate I think employees without coverage will be allowed in the Exchanges and the employer may face a fee because of that but what level of fee, what amount of payroll might be set for that. All these questions remain.
There also appears to be little impact on self-funded employer plans except in the areas of multi-state regulations, standard benefit plan offerings and a few other items that may or may not be included. If an employer's self-funded plan is deemed a Cadillac plan there may be a tax on the benefits.
What should happen but most likely won't
>Large Lean Efficiency pilots in multiple states- I won't harp on my pet issue again today.
Change health care reimbursement to episode of care basis, not fee-for-service.
-------------------------------------
Obama Weighs Options
1/21/10- The Wall Street Journal
Inside the White House, top aides to the president said Mr. Obama had made no decision on how to proceed, and insisted that his preference was still to win passage of a far-reaching health care measure, like the House and Senate bills, which would extend coverage to more than 30 million people by 2019.
On Capitol Hill, Democratic leaders said they were weighing several options. But some lawmakers in both parties began calling for a scaled-back bill that could be adopted quickly with bipartisan support, and Mr. Obama seemed to suggest that if he could not pass an ambitious health care bill, he would be willing to settle for what he could get. In the interview with ABC, he cited two specific goals: cracking down on insurance industry practices that hurt consumers and reining in health costs.
“We know that we need insurance reform, that the health insurance companies are taking advantage of people,” Mr. Obama said. “We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up, and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements to this bill.”
Republican Congressional aides said a compromise bill could include new insurance industry regulations, including a ban on denying coverage based on pre-existing medical conditions, as well as aid for small businesses for health costs and possible steps to restrict malpractice lawsuits. But as Mr. Obama noted on ABC, a pared-down package imposing restrictions on insurers might make coverage unaffordable, which is one reason he prefers a broad overhaul.
As the full Congress returned to Washington to start a new legislative year on the first anniversary of Mr. Obama’s inauguration options were limited and there were signs of a divide between the White House and Democrats on Capitol Hill. House leaders signaled that they had effectively ruled out the idea of adopting the Senate bill, which would send it directly to the president for his signature. Yet close advisers to the president said such a move was still on the table.
Mr. Brown’s victory in Massachusetts on Tuesday denies Democrats the 60th vote that they need to surmount filibusters and advance a revised health measure. Senate leaders said they would not risk antagonizing voters by trying to rush a bill through before Mr. Brown could be sworn in, and Mr. Obama agreed.
“People in Massachusetts spoke,” the president told ABC. “He’s got to be part of that process.”
Another option considered by Democrats would be to use the procedural maneuver known as reconciliation to pass chunks of the health care bill attached to a budget measure, which requires only a simple majority. But there appeared to be little appetite for such a move on Capitol Hill.
Senior Republicans showed little new willingness to collaborate with the Democrats. Asked where he might be willing to work across the aisle, the Senate Republican leader, Mitch McConnell of Kentucky, offered praise for Mr. Obama’s strategy in Afghanistan but not a single example on domestic policy.
Mr. McConnell was asked if the health care bill was dead. “I sure hope so,” he said.
Senator Susan Collins, Republican of Maine, said she was eager to work with Democrats in devising an alternative to the health care bill passed four weeks ago by the Senate on a party-line vote.
“What I hope the White House will do is start from scratch and, instead of pushing this bill through the House, work with a bipartisan group of senators to achieve a consensus bill that would have widespread support,” Ms. Collins said. “There are many provisions of the bill that have bipartisan support. And I believe the president would be wise to draft a new bill that he could get through both the House and the Senate with supermajority votes.”
Robert Pear contributed reporting.
Now that Senate Democrats have lost their Supermajority and only
have 59 votes they are quickly assessing the art of the possible to save face.
Here's my view of what we'll get:
These are definitely out
Public Option
Employer Mandate
I believe these might be in (Analysis follows)
Elimination of Pre-x exclusions
Individual Mandate
State Pilot Health Insurance Exchanges
Expand Medicaid in states at their option
Reduced tax on Cadillac Plans
Let's assess what I believe might be in from the list above:
Eliminate pre-x conditions- This is a must but insurers must have flexibility to deal with adverse selection of millions of uninsureds suddenly getting tremendous coverage for many for the very first time. Treatment costs may go through the roof and cost-shifting may be drastic upon the employer side.
Individual Mandate See above, but also what penalty will be set and will it be in proper balance to be both a carrot and a stick?
State Pilot Health Insurance Exchanges
I think we'll see Congress want to test this and not go with it nationwide. That will be a compromise both sides may be able to live with and I believe there will be employer "penalties" that they must pay if their employees access coverage through the HIE. Again, those penal;ties must be in the proper balance.
Medicaid Expansion
Ok' let's start with some state examples to set the stage.
Wisconsin: currently covers most adults and children up to 200% of the federal poverty level. Nebraska (which got the 'Cornhusker Kickback' thanks to Senator Nelson only covers up to 100% and the Senate Bill requires 133%. The House bill required 150%.
Louisiana I've heard is far below 100%.
I think the final bill will allow state's to experiment with some additional matching funds from the Feds. Currently most state Medicaid programs are 60% funded by the individual state and then they receive the remaining 40% from the feds. There are some nuances to this but that's the basics. I think the feds may sweeten that match within select pilots and allow a few states to experiment on a limited basis a la BadgerCare, except it might be a better financial deal for states to have waited.
But what about those with existing employer coverage?
I believe there will be a reduced tax on the so-called Cadillac plans as a compromise. Reform will probably include minimum required standard benefit plans which set a floor for the employer market. Employers may also be mandated to provide several options based on how many employees they have.
Employer size for inclusion in the Exchange will be interesting since I don't feel there will be a mandate if a compromise is found in the next few weeks. The impact on small businesses is perhaps the hardest issue to predict. If there's no mandate I think employees without coverage will be allowed in the Exchanges and the employer may face a fee because of that but what level of fee, what amount of payroll might be set for that. All these questions remain.
There also appears to be little impact on self-funded employer plans except in the areas of multi-state regulations, standard benefit plan offerings and a few other items that may or may not be included. If an employer's self-funded plan is deemed a Cadillac plan there may be a tax on the benefits.
What should happen but most likely won't
>Large Lean Efficiency pilots in multiple states- I won't harp on my pet issue again today.
Change health care reimbursement to episode of care basis, not fee-for-service.
-------------------------------------
Obama Weighs Options
1/21/10- The Wall Street Journal
Inside the White House, top aides to the president said Mr. Obama had made no decision on how to proceed, and insisted that his preference was still to win passage of a far-reaching health care measure, like the House and Senate bills, which would extend coverage to more than 30 million people by 2019.
On Capitol Hill, Democratic leaders said they were weighing several options. But some lawmakers in both parties began calling for a scaled-back bill that could be adopted quickly with bipartisan support, and Mr. Obama seemed to suggest that if he could not pass an ambitious health care bill, he would be willing to settle for what he could get. In the interview with ABC, he cited two specific goals: cracking down on insurance industry practices that hurt consumers and reining in health costs.
“We know that we need insurance reform, that the health insurance companies are taking advantage of people,” Mr. Obama said. “We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up, and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements to this bill.”
Republican Congressional aides said a compromise bill could include new insurance industry regulations, including a ban on denying coverage based on pre-existing medical conditions, as well as aid for small businesses for health costs and possible steps to restrict malpractice lawsuits. But as Mr. Obama noted on ABC, a pared-down package imposing restrictions on insurers might make coverage unaffordable, which is one reason he prefers a broad overhaul.
As the full Congress returned to Washington to start a new legislative year on the first anniversary of Mr. Obama’s inauguration options were limited and there were signs of a divide between the White House and Democrats on Capitol Hill. House leaders signaled that they had effectively ruled out the idea of adopting the Senate bill, which would send it directly to the president for his signature. Yet close advisers to the president said such a move was still on the table.
Mr. Brown’s victory in Massachusetts on Tuesday denies Democrats the 60th vote that they need to surmount filibusters and advance a revised health measure. Senate leaders said they would not risk antagonizing voters by trying to rush a bill through before Mr. Brown could be sworn in, and Mr. Obama agreed.
“People in Massachusetts spoke,” the president told ABC. “He’s got to be part of that process.”
Another option considered by Democrats would be to use the procedural maneuver known as reconciliation to pass chunks of the health care bill attached to a budget measure, which requires only a simple majority. But there appeared to be little appetite for such a move on Capitol Hill.
Senior Republicans showed little new willingness to collaborate with the Democrats. Asked where he might be willing to work across the aisle, the Senate Republican leader, Mitch McConnell of Kentucky, offered praise for Mr. Obama’s strategy in Afghanistan but not a single example on domestic policy.
Mr. McConnell was asked if the health care bill was dead. “I sure hope so,” he said.
Senator Susan Collins, Republican of Maine, said she was eager to work with Democrats in devising an alternative to the health care bill passed four weeks ago by the Senate on a party-line vote.
“What I hope the White House will do is start from scratch and, instead of pushing this bill through the House, work with a bipartisan group of senators to achieve a consensus bill that would have widespread support,” Ms. Collins said. “There are many provisions of the bill that have bipartisan support. And I believe the president would be wise to draft a new bill that he could get through both the House and the Senate with supermajority votes.”
Robert Pear contributed reporting.
Thursday, January 14, 2010
Fifteen states may sue over 'Cornhusker Kickback'
Insuring Resources Commentary:
Most backroom deals never asee the light of day, or at least not the immediate backlash this has received. Sen. Nelson secured a deal worth billions for Nebraqska's Medicaid program for his one vote which allowed the passage of the senate health care reform bill on Christmas Eve. Every other state should be suing over this, not just the 15.
One of Wisconsin's senators, Herb Kohl, in contrast tried and failed to get an amendment added that would create a demonstration program to implement and test Lean processes in health care which could SAVE billions in making health care more efficient. Priorities.
WASHINGTON (Reuters) - More than a dozen U.S. state attorneys general visited Washington on Wednesday threatening to sue the U.S. government if the so-called "Cornhusker Kickback," a special subsidy offered to Nebraska, is included in pen1ding healthcare reform legislation.
The subsidy, which was included in the Senate version of the bill, is "capricious and arbitrary treatment of Nebraska," said South Carolina's Republican Attorney General Henry McMaster, who has organized a group of 15 attorneys to pursue a lawsuit.
The group includes two Democrats, one from Oklahoma and one from American Samoa.
Many states are outraged by the caveat, which would have the federal government cover increases in Nebraska's obligations for Medicaid, the healthcare program for the poor jointly funded by the 50 states and federal government.
Medicaid already consumes large parts of states' budgets and would require even more funding under the reform plan, which would allow greater numbers of people to enroll in the program.
If the provision is removed they will not sue, McMaster said, but the attorneys are discussing where to file a suit and if the Supreme Court would have to hear the case.
McMaster wrote to Senate Majority Leader Harry Reid and House of Representatives Speaker Nancy Pelosi in December urging them to remove the provision as they hammer the bills into a single piece of legislation for President Barack Obama to sign into law.
He has yet to hear back from them. He has spoken to Sen. Bill Nelson, who represents Nebraska and who inserted the provision. Nelson has said he is fighting to ensure all states receive equal treatment to the Cornhusker State in the final law.
Meanwhile, the White House has said Obama is discussing how to handle Medicaid
and the states.
Removing that provision may not stop other lawsuits, McMaster warned. He has joined another group of attorneys general who are concerned that an "individual mandate," or requirement that citizens buy health insurance, violates a clause in the Constitution about regulating interstate commerce.
Most backroom deals never asee the light of day, or at least not the immediate backlash this has received. Sen. Nelson secured a deal worth billions for Nebraqska's Medicaid program for his one vote which allowed the passage of the senate health care reform bill on Christmas Eve. Every other state should be suing over this, not just the 15.
One of Wisconsin's senators, Herb Kohl, in contrast tried and failed to get an amendment added that would create a demonstration program to implement and test Lean processes in health care which could SAVE billions in making health care more efficient. Priorities.
WASHINGTON (Reuters) - More than a dozen U.S. state attorneys general visited Washington on Wednesday threatening to sue the U.S. government if the so-called "Cornhusker Kickback," a special subsidy offered to Nebraska, is included in pen1ding healthcare reform legislation.
The subsidy, which was included in the Senate version of the bill, is "capricious and arbitrary treatment of Nebraska," said South Carolina's Republican Attorney General Henry McMaster, who has organized a group of 15 attorneys to pursue a lawsuit.
The group includes two Democrats, one from Oklahoma and one from American Samoa.
Many states are outraged by the caveat, which would have the federal government cover increases in Nebraska's obligations for Medicaid, the healthcare program for the poor jointly funded by the 50 states and federal government.
Medicaid already consumes large parts of states' budgets and would require even more funding under the reform plan, which would allow greater numbers of people to enroll in the program.
If the provision is removed they will not sue, McMaster said, but the attorneys are discussing where to file a suit and if the Supreme Court would have to hear the case.
McMaster wrote to Senate Majority Leader Harry Reid and House of Representatives Speaker Nancy Pelosi in December urging them to remove the provision as they hammer the bills into a single piece of legislation for President Barack Obama to sign into law.
He has yet to hear back from them. He has spoken to Sen. Bill Nelson, who represents Nebraska and who inserted the provision. Nelson has said he is fighting to ensure all states receive equal treatment to the Cornhusker State in the final law.
Meanwhile, the White House has said Obama is discussing how to handle Medicaid
and the states.
Removing that provision may not stop other lawsuits, McMaster warned. He has joined another group of attorneys general who are concerned that an "individual mandate," or requirement that citizens buy health insurance, violates a clause in the Constitution about regulating interstate commerce.
Thursday, December 3, 2009
Dear Orszag: Please come to Wisconsin
Insuring Resources Commentary:
Perhaps Peter Orszag should take a visit to Wisconsin and witness what is happening daily at ThedaCare, Gunderson Lutheran, Group Health Coop and others. If 20 some health plans are already doing it why is it sooo hard that it will take 20+ years for others to catch on.
Visit www.createhealthcarevalue.com
or
http://www.healthcarevalueleaders.org/
Orszag knows these exist so why is his head in the sand?
-------------- -----------------
Orszag: Health Care Efficiencies May Take Decades Associated Press
Charles Babington
December 03, 2009
The White House budget director said Wednesday that it may take decades for America to have an efficient health care system even if Congress passes a major overhaul this year.
"It will be years to decades" before the nation has a properly working health care system that rewards quality over quantity, Peter Orszag told reporters. He said improving the quality of health care "is more like a lifelong nutrition or diet, not studying for an exam," but he added that continuous progress is a crucial goal.
Orszag is one of President Barack Obama's top aides in urging Congress to overhaul the U.S. health care system in the coming weeks. He acknowledged that many key elements of the pending House and Senate bills would not take effect for several years, but he urged Americans to embrace a gradual process.
The House-passed bill would bar insurance companies from denying coverage to sick people starting in 2013. A bill being debated in the Senate would do so in 2014.
The bills would create new government subsidies for buying insurance starting in 2014. Fines for individuals who refuse to buy insurance would begin in 2014, and increase in later years. Other provisions, such as subsidizing long-term care, also would be years away.
Orszag noted that some improvements to the health care system are already in the works. The economic stimulus bill enacted early this year included money to modernize medical record-keeping and to identify the most effective ways to address various medical needs. Both efforts should lead to better care, he said.
Orszag said the nation must move away from its long tradition of fee-for-service health care that tends to reward the number of procedures performed rather than the quality of care. The pending legislation includes pilot projects meant to reduce the number of patients who are quickly readmitted to hospitals, and to restructure payments to hospitals to discourage unnecessary procedures.
Orszag said limits on medical malpractice awards -- which many Republicans favor, but are not in the bills -- would do little to reduce health care costs.
Perhaps Peter Orszag should take a visit to Wisconsin and witness what is happening daily at ThedaCare, Gunderson Lutheran, Group Health Coop and others. If 20 some health plans are already doing it why is it sooo hard that it will take 20+ years for others to catch on.
Visit www.createhealthcarevalue.com
or
http://www.healthcarevalueleaders.org/
Orszag knows these exist so why is his head in the sand?
-------------- -----------------
Orszag: Health Care Efficiencies May Take Decades Associated Press
Charles Babington
December 03, 2009
The White House budget director said Wednesday that it may take decades for America to have an efficient health care system even if Congress passes a major overhaul this year.
"It will be years to decades" before the nation has a properly working health care system that rewards quality over quantity, Peter Orszag told reporters. He said improving the quality of health care "is more like a lifelong nutrition or diet, not studying for an exam," but he added that continuous progress is a crucial goal.
Orszag is one of President Barack Obama's top aides in urging Congress to overhaul the U.S. health care system in the coming weeks. He acknowledged that many key elements of the pending House and Senate bills would not take effect for several years, but he urged Americans to embrace a gradual process.
The House-passed bill would bar insurance companies from denying coverage to sick people starting in 2013. A bill being debated in the Senate would do so in 2014.
The bills would create new government subsidies for buying insurance starting in 2014. Fines for individuals who refuse to buy insurance would begin in 2014, and increase in later years. Other provisions, such as subsidizing long-term care, also would be years away.
Orszag noted that some improvements to the health care system are already in the works. The economic stimulus bill enacted early this year included money to modernize medical record-keeping and to identify the most effective ways to address various medical needs. Both efforts should lead to better care, he said.
Orszag said the nation must move away from its long tradition of fee-for-service health care that tends to reward the number of procedures performed rather than the quality of care. The pending legislation includes pilot projects meant to reduce the number of patients who are quickly readmitted to hospitals, and to restructure payments to hospitals to discourage unnecessary procedures.
Orszag said limits on medical malpractice awards -- which many Republicans favor, but are not in the bills -- would do little to reduce health care costs.
Wednesday, October 28, 2009
Examples of Lean Processes
The following appeared in the Oshkosh Northwestern:
by Lakshmi U. Tatikonda • for The Northwestern • October 27, 2009
The healthcare industry is in a mess, riddled with haphazard and outdated management systems, inefficiencies and waste, excess bureaucracy and costs, and greedy insurance companies. Waste is rewarded while innovation is ignored or penalized says Dr. John Toussaint, president and CEO of ThedaCare Center for Healthcare Value.
Lean methods (Toyota Production Systems) helped organizations reduce costs, improve quality and customer satisfaction. Critics say that healthcare is different from automobile industry, patients are not cars, and Lean methods don't apply to healthcare. This is not true. According to Dr. W. Edwards Deming, 80 percent of problems are process (system) related. Healthcare, like automobile industry, is a collection of processes and can gain from lean applications.
The causes of waste in healthcare are numerous:
Bureaucracy. Rigid adherence to policies and procedures costs U.S. residents $294.3 billion in healthcare and accounts for at least 31 percent of total U.S. health spending in 1999.
Overhead cost. Between the years 1970 and 2000 physician costs increased about 250 percent, whereas healthcare administrative costs increased by a whopping 2,500 percent.
Errors. The Institute of Medicine estimates that medical errors cost the United States $39.7 billion a year. Dr. Toussaint of ThedaCare, says that quality waste could be as high as 40 percent to 50 percent of costs. It is estimated that 44,000 to 95,000 people die every year from medical errors. Every year more than one million people in the United States suffer from preventable injuries caused by medical errors.
Excesses. One hospital found that 25 percent of the surgical supplies picked for use in operating rooms were never used and returned to the shelf requiring unnecessary re-sterilization.
Complexity. Medical billings cost hospitals $487 per person, and $561 for physicians. In my opinion, medical billings are not just complex, they are incomprehensible and unconscionable.
Overdoing. Ordering unnecessary tests, procedures and unnecessary brand name prescriptions, using many forms that are only slightly different, pharmaceutical companies spending more money on advertising than on R&D are like cracking a nut with sledgehammer.
Band-Aids. Failure to understand and identify root causes of waste, applying Band-Aid solutions, treating onetime special issues as normal occurrence.
Use of personnel. Using highly skilled and highly paid personnel such as an M.D. doing routine low level tasks that can be done by a qualified nurse practitioner.
Despite the many wastes there are success stories using Lean management methods:
Schaumburg, Ill.,-based Cancer Treatment Centers of America reduced the number of chemotherapy process steps from 32 to 16 and the amount of walking from the pharmacy to the chemo lab from 3,570 feet to 608 and increased the in chemotherapies delivered by 30 percent.
New York City Health and Hospitals Corp., once carried $10.2 million in inventory which included expired and useless items and 20 varieties of gloves. By reducing glove variety to two, they negotiated price per case from $58 to $28, saved about $4 millions a year, and realized a one-time gain of $5 million.
By improving its Cardiovascular Health Clinic, Mayo Clinic in Rochester, Minn., reduced process steps from 16 to six and wait time from 33 days to three.
EVirginia Mason Medical Center of Seattle, Wash., reduced staff walking distance by 60 miles per day.
St. Vincent Indianapolis Hospital reduced number of walking steps for emergency department nurses by 78 percent.
By implementing in-room devices for physicians in exam rooms, Virginia Mason reduced errors, lead time for documentation and cost of transcription per patient from $2.56 to $0.24.
ThedaCare cut cost of its in-patient care by 25 percent. "If all hospitals achieve similar results, $400 billion could be saved in Medicare and another $1.3 trillion on the non-Medicare side," says Dr. Dean Gruner, CEO of ThedaCare.
Healthcare cost is not just a political issue, it is also economic, competitive and moral issue. A 10 percent reduction in the $2.4 trillion spent on health care saves $240 billion, which can be used for improving schools, rebuilding roads, retraining unemployed workers and regaining our global competitiveness. Unfortunately, in today's convoluted political environment, the voices of reform are drowned by meaningless chatter.
The U.S. auto industry failed to accept deficiencies and make improvements to gain competitiveness. They acted like spoiled brats crying for candy and got government imposed sanctions, tariffs, quotas and domestic content requirements. You know what happened. Trying to reduce costs without eliminating root causes is like rearranging chairs on the deck of Titanic. Next bailout may be the healthcare industry.
by Lakshmi U. Tatikonda • for The Northwestern • October 27, 2009
The healthcare industry is in a mess, riddled with haphazard and outdated management systems, inefficiencies and waste, excess bureaucracy and costs, and greedy insurance companies. Waste is rewarded while innovation is ignored or penalized says Dr. John Toussaint, president and CEO of ThedaCare Center for Healthcare Value.
Lean methods (Toyota Production Systems) helped organizations reduce costs, improve quality and customer satisfaction. Critics say that healthcare is different from automobile industry, patients are not cars, and Lean methods don't apply to healthcare. This is not true. According to Dr. W. Edwards Deming, 80 percent of problems are process (system) related. Healthcare, like automobile industry, is a collection of processes and can gain from lean applications.
The causes of waste in healthcare are numerous:
Bureaucracy. Rigid adherence to policies and procedures costs U.S. residents $294.3 billion in healthcare and accounts for at least 31 percent of total U.S. health spending in 1999.
Overhead cost. Between the years 1970 and 2000 physician costs increased about 250 percent, whereas healthcare administrative costs increased by a whopping 2,500 percent.
Errors. The Institute of Medicine estimates that medical errors cost the United States $39.7 billion a year. Dr. Toussaint of ThedaCare, says that quality waste could be as high as 40 percent to 50 percent of costs. It is estimated that 44,000 to 95,000 people die every year from medical errors. Every year more than one million people in the United States suffer from preventable injuries caused by medical errors.
Excesses. One hospital found that 25 percent of the surgical supplies picked for use in operating rooms were never used and returned to the shelf requiring unnecessary re-sterilization.
Complexity. Medical billings cost hospitals $487 per person, and $561 for physicians. In my opinion, medical billings are not just complex, they are incomprehensible and unconscionable.
Overdoing. Ordering unnecessary tests, procedures and unnecessary brand name prescriptions, using many forms that are only slightly different, pharmaceutical companies spending more money on advertising than on R&D are like cracking a nut with sledgehammer.
Band-Aids. Failure to understand and identify root causes of waste, applying Band-Aid solutions, treating onetime special issues as normal occurrence.
Use of personnel. Using highly skilled and highly paid personnel such as an M.D. doing routine low level tasks that can be done by a qualified nurse practitioner.
Despite the many wastes there are success stories using Lean management methods:
Schaumburg, Ill.,-based Cancer Treatment Centers of America reduced the number of chemotherapy process steps from 32 to 16 and the amount of walking from the pharmacy to the chemo lab from 3,570 feet to 608 and increased the in chemotherapies delivered by 30 percent.
New York City Health and Hospitals Corp., once carried $10.2 million in inventory which included expired and useless items and 20 varieties of gloves. By reducing glove variety to two, they negotiated price per case from $58 to $28, saved about $4 millions a year, and realized a one-time gain of $5 million.
By improving its Cardiovascular Health Clinic, Mayo Clinic in Rochester, Minn., reduced process steps from 16 to six and wait time from 33 days to three.
EVirginia Mason Medical Center of Seattle, Wash., reduced staff walking distance by 60 miles per day.
St. Vincent Indianapolis Hospital reduced number of walking steps for emergency department nurses by 78 percent.
By implementing in-room devices for physicians in exam rooms, Virginia Mason reduced errors, lead time for documentation and cost of transcription per patient from $2.56 to $0.24.
ThedaCare cut cost of its in-patient care by 25 percent. "If all hospitals achieve similar results, $400 billion could be saved in Medicare and another $1.3 trillion on the non-Medicare side," says Dr. Dean Gruner, CEO of ThedaCare.
Healthcare cost is not just a political issue, it is also economic, competitive and moral issue. A 10 percent reduction in the $2.4 trillion spent on health care saves $240 billion, which can be used for improving schools, rebuilding roads, retraining unemployed workers and regaining our global competitiveness. Unfortunately, in today's convoluted political environment, the voices of reform are drowned by meaningless chatter.
The U.S. auto industry failed to accept deficiencies and make improvements to gain competitiveness. They acted like spoiled brats crying for candy and got government imposed sanctions, tariffs, quotas and domestic content requirements. You know what happened. Trying to reduce costs without eliminating root causes is like rearranging chairs on the deck of Titanic. Next bailout may be the healthcare industry.
Monday, October 26, 2009
More ammo: US healthcare system wastes at least $505 bln a year
The disease is Waste. The treatment method is implementation of LEAN processes on the surgical table of health care reform.
There is now pervasive evidence everywhere we turn. Is Congress paying attention?
Does your Member of Congress or Senator know this stuff? Isn't it your job to find out?
CALL THEM.
----------------------- --------------------------------
Article from Reuters News Service
The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.
The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters (TRI.TO), found.
"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.
"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.
"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."
One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending.
"It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.
Some other findings in the report from Thomson Reuters, the parent company of Reuters:
* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
There is now pervasive evidence everywhere we turn. Is Congress paying attention?
Does your Member of Congress or Senator know this stuff? Isn't it your job to find out?
CALL THEM.
----------------------- --------------------------------
Article from Reuters News Service
The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.
The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters (TRI.TO), found.
"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.
"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.
"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."
One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending.
"It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.
Some other findings in the report from Thomson Reuters, the parent company of Reuters:
* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
Thursday, September 24, 2009
Mandate Minus Price Controls may increase healthcare costs
This is what I've been blogging about since the beginning of Insuring Resources.
Congress has been debating health insurance reform, what we need even more is health care reform to fundamentally reduce costs. To do it we need provider incentives to implement Lean processes. See my other post from earlier today on ThedaCare for more details on how to reform HEALTH CARE.
--------------- ------------------- ---------------
With lawmakers reluctant to limit what insurers may charge, there's little to slow soaring premiums. Coupled with millions of new customers, that adds up to higher costs for taxpayers and consumers.
By Noam N. Levey and James Oliphant
LA times
September 24, 2009
E-mail Print Text Size
Reporting from Washington - In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years.
The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market.
"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive."
Soaring premiums coupled with millions of new customers forced to buy policies would likely mean higher costs for taxpayers to cover government subsidies for lower-income families and individuals.
They could also mean bigger bills for people who get benefits through work, as well as for their employers.
"I don't think there is any degree of confidence that our costs won't continue to go up," said Keith Ashmus, chairman of the National Small Business Assn.
If premiums continue to rise as quickly as they have over the last five years, the average annual cost of a family policy will exceed $24,000 in 10 years, up from $13,375 now, according to the nonprofit Henry J. Kaiser Family Foundation and the Health Research & Educational Trust.
"If the government is going to require people to buy an insurance policy, they have to guarantee it is affordable," said Jamie Court, president of Consumer Watchdog. "It is unconscionable not to."
Soaring premiums could eventually stir market forces, increasing competition and potentially restraining costs. But that would be a lengthy process, and potential competitors would face huge start-up costs.
Many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't.
All of the major healthcare bills would penalize people who do not get health insurance.
But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector.
As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.
"That would be a very substantial additional intervention in the marketplace," said Sen. Jeff Bingaman (D-N.M.), a member of a bipartisan group of lawmakers who worked with Senate Finance Committee Chairman Max Baucus (D-Mont.) on his healthcare bill. "I just don't think the support would be there for that kind of a change."
Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge -- a strategy used by several European countries to control healthcare spending.
In those systems -- some of which, like the United States, feature a blend of private insurers and government programs -- the government sets prices that providers charge to everyone.
"That is just too tough a row to hoe in America," said Peter Lee, executive director of the Pacific Business Group on Health, an association of large employers in California, many of whom are nonetheless concerned about how much they are getting charged for medical care.
Senior House Democrats have proposed the most far-reaching government regulation of the insurance industry.
Their bill, which is still being debated, seeks to control insurance premiums in part by limiting how much companies can spend on nonmedical expenses such as marketing and dividends to shareholders.
The House bill also features a new government insurance program -- or "public option" -- that advocates believe could offer consumers a lower-priced alternative to private plans and, in turn, pressure insurers to rein in premiums.
Congress has been debating health insurance reform, what we need even more is health care reform to fundamentally reduce costs. To do it we need provider incentives to implement Lean processes. See my other post from earlier today on ThedaCare for more details on how to reform HEALTH CARE.
--------------- ------------------- ---------------
With lawmakers reluctant to limit what insurers may charge, there's little to slow soaring premiums. Coupled with millions of new customers, that adds up to higher costs for taxpayers and consumers.
By Noam N. Levey and James Oliphant
LA times
September 24, 2009
E-mail Print Text Size
Reporting from Washington - In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years.
The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market.
"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive."
Soaring premiums coupled with millions of new customers forced to buy policies would likely mean higher costs for taxpayers to cover government subsidies for lower-income families and individuals.
They could also mean bigger bills for people who get benefits through work, as well as for their employers.
"I don't think there is any degree of confidence that our costs won't continue to go up," said Keith Ashmus, chairman of the National Small Business Assn.
If premiums continue to rise as quickly as they have over the last five years, the average annual cost of a family policy will exceed $24,000 in 10 years, up from $13,375 now, according to the nonprofit Henry J. Kaiser Family Foundation and the Health Research & Educational Trust.
"If the government is going to require people to buy an insurance policy, they have to guarantee it is affordable," said Jamie Court, president of Consumer Watchdog. "It is unconscionable not to."
Soaring premiums could eventually stir market forces, increasing competition and potentially restraining costs. But that would be a lengthy process, and potential competitors would face huge start-up costs.
Many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't.
All of the major healthcare bills would penalize people who do not get health insurance.
But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector.
As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.
"That would be a very substantial additional intervention in the marketplace," said Sen. Jeff Bingaman (D-N.M.), a member of a bipartisan group of lawmakers who worked with Senate Finance Committee Chairman Max Baucus (D-Mont.) on his healthcare bill. "I just don't think the support would be there for that kind of a change."
Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge -- a strategy used by several European countries to control healthcare spending.
In those systems -- some of which, like the United States, feature a blend of private insurers and government programs -- the government sets prices that providers charge to everyone.
"That is just too tough a row to hoe in America," said Peter Lee, executive director of the Pacific Business Group on Health, an association of large employers in California, many of whom are nonetheless concerned about how much they are getting charged for medical care.
Senior House Democrats have proposed the most far-reaching government regulation of the insurance industry.
Their bill, which is still being debated, seeks to control insurance premiums in part by limiting how much companies can spend on nonmedical expenses such as marketing and dividends to shareholders.
The House bill also features a new government insurance program -- or "public option" -- that advocates believe could offer consumers a lower-priced alternative to private plans and, in turn, pressure insurers to rein in premiums.
Health Affairs article on ThedaCare's Lean Processes
This is what I have been advocating from the start and now Health Affairs, the prestigious journal on health policy, has published an article on their practices.
The link-
http://content.healthaffairs.org/cgi/content/full/28/5/1343?ijkey=kECL9wF9SR8IE&keytype=ref&siteid=healthaff
This spells out the successes of ThedaCare and lessons for health care reform across America.
Below are small excerpts from the article
------------
Here's the abstract- U.S. taxpayers waste far too much money on health care that is merely average or worse. Some health care providers, including ThedaCare, a major Wisconsin health care company, are using the tools of lean manufacturing to eliminate millions of dollars of waste that obstructs the provision of effective medicine. ThedaCare studies care delivery processes to improve care and lower costs. Lessons from lean manufacturing and the Institute for Healthcare Improvement are lowering incidence of preterm births, improving heart attack response rates, and changing the way care is delivered in hospitals to a collaborative, team-based approach.
ThedaCare's results- Since Collaborative Care began with a pilot unit in 2007, we have cared for 2,400 people and recorded dramatic improvement in patient satisfaction, quality performance, and medication reconciliation (Exhibit 1). The cost of care in a Collaborative Care ward is 30 percent less than in a traditional ward. These data convinced ThedaCare board members to convert all hospital beds to Collaborative Care. This decision was projected to improve the buildings’ net present value by 63 percent, or more than $25 million.
Conclusion-
The changes we have described involve a fundamental shift in the way people think about and deliver care. It is not just about saving money or doing less with more. This is about returning to the core scientific principles of modern medicine.
We begin with a hypothesis that performance could be better. Then we change the process, measure it, study its effect, and incorporate it into daily work. Before we can convince other health care organizations to join us in radically improving performance, however, there must be some incentive. If we prove that lean health care will put more money in a hospital’s pocket, only to have Medicare take it out of another pocket, we will not enlist many converts. Similarly, if a national insurance plan continues Medicare’s rules, paying more money for inefficient health care, we will get a lot more inefficient care. Quality will only thrive when quality is demanded.
There is much more than money at stake. We must find a way to reward and encourage more efficient, better-quality health care, and that’s what we will get.
The link-
http://content.healthaffairs.org/cgi/content/full/28/5/1343?ijkey=kECL9wF9SR8IE&keytype=ref&siteid=healthaff
This spells out the successes of ThedaCare and lessons for health care reform across America.
Below are small excerpts from the article
------------
Here's the abstract- U.S. taxpayers waste far too much money on health care that is merely average or worse. Some health care providers, including ThedaCare, a major Wisconsin health care company, are using the tools of lean manufacturing to eliminate millions of dollars of waste that obstructs the provision of effective medicine. ThedaCare studies care delivery processes to improve care and lower costs. Lessons from lean manufacturing and the Institute for Healthcare Improvement are lowering incidence of preterm births, improving heart attack response rates, and changing the way care is delivered in hospitals to a collaborative, team-based approach.
ThedaCare's results- Since Collaborative Care began with a pilot unit in 2007, we have cared for 2,400 people and recorded dramatic improvement in patient satisfaction, quality performance, and medication reconciliation (Exhibit 1). The cost of care in a Collaborative Care ward is 30 percent less than in a traditional ward. These data convinced ThedaCare board members to convert all hospital beds to Collaborative Care. This decision was projected to improve the buildings’ net present value by 63 percent, or more than $25 million.
Conclusion-
The changes we have described involve a fundamental shift in the way people think about and deliver care. It is not just about saving money or doing less with more. This is about returning to the core scientific principles of modern medicine.
We begin with a hypothesis that performance could be better. Then we change the process, measure it, study its effect, and incorporate it into daily work. Before we can convince other health care organizations to join us in radically improving performance, however, there must be some incentive. If we prove that lean health care will put more money in a hospital’s pocket, only to have Medicare take it out of another pocket, we will not enlist many converts. Similarly, if a national insurance plan continues Medicare’s rules, paying more money for inefficient health care, we will get a lot more inefficient care. Quality will only thrive when quality is demanded.
There is much more than money at stake. We must find a way to reward and encourage more efficient, better-quality health care, and that’s what we will get.
Tuesday, August 25, 2009
ThedaCare touted as national model
This is from Fox News:
Maybe its because ThedaCare employs LEAN process adopted from manufacturing. Whatever the reason, FoxNews seems to understand one basic element of health care reform. Medical costs are driving the need for health care reform. Reforming the insurance side will not achieve the true savings that are needed. This is a lesson that has fallen on deaf ears so far on Democratic decision-makers despite this writer's repeated efforts, letters and phone calls to Congressional offices.
ThedaCare institued these measures to cut costs but amazingly they also IMPROVED patient health outcomes.
See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
Maybe its because ThedaCare employs LEAN process adopted from manufacturing. Whatever the reason, FoxNews seems to understand one basic element of health care reform. Medical costs are driving the need for health care reform. Reforming the insurance side will not achieve the true savings that are needed. This is a lesson that has fallen on deaf ears so far on Democratic decision-makers despite this writer's repeated efforts, letters and phone calls to Congressional offices.
ThedaCare institued these measures to cut costs but amazingly they also IMPROVED patient health outcomes.
See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
Tuesday, August 18, 2009
Reform without the Public Plan Option- It could look like this
What will reform look like?
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
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