Eight Days: A Health Care Diary

Posted on | July 17, 2008 | Comments Off on Eight Days: A Health Care Diary

Thought-provoking commentary from blogger Michael Millenson

Health Commentary guest blogger Michael Millenson has been on the road recently, covering health care events around the country. His summaries, posted at the Health Affairs Blog July 10, capture very well some of the key issues we face in trying to sort out our health care system problems. Read on…

EIGHT DAYS: A HEALTH CARE DIARY

By Michael Millenson

PAIN

(Chicago, June 19 – June 21) I sit down at a circular table in the high-ceilinged meeting room and conversationally ask the two women already there what brought them to this three-day conference. The first replies that she had a daughter die from a medical mistake. The other, a nurse, lost a son to medical error and later lost an elderly parent. Me? I write, speak, and consult on patient safety, activities whose significance seems quite small in the presence of these mothers’ losses.

A group of about forty providers and patients have gathered under the auspices of Consumers Advancing Patient Safety (CAPS). Here is partial list of what those in attendance had “consumed”: care that left a child dead from a preventable medical error. A child left brain-damaged. A parent dead. A parent left brain-damaged. A spouse dead. A spouse brain-damaged. The death of a child and death of a parent. The death of a spouse and brain damage of a child.

Story after story is briefly told, the commonplace ritual of stand-up-and-introduce-yourself slowly unfolding into a deeper communal sharing of terrible pain and unthinkable sorrow. Although we will roll up our sleeves and work to develop practical plans for change in the days that follow, that lies in the future. At the end of this first evening I cannot recall ever leaving a meeting with a heavier heart.

PRINCIPLES

(Las Vegas, June 23) “Quality” is the first of five principles set forth in a white paper released by the Healthcare Financial Management Association to mark the opening of its Annual National Institute (ANI). The white paper, Healthcare Payment Reform: From Principles to Action, declares: “Payments should encourage and reward high-quality care and discourage medical errors and ineffective care.”

It adds, “All stakeholder groups…strongly supported this principle.” That’s the good news. The bad news is that these same stakeholders “also pointed out a number of implementation challenges.”

Like deciding who gets more money and who gets less?

POSTURING

(Las Vegas, June 24) Steve Case, co-founder of AOL and founder and president of Revolution Health, is speaking to five thousand ANI attendees in a massive ballroom about the virtues of health care consumerism and personal responsibility. During the question period, I briefly describe the stories of mothers losing their children to medical error and then ask Case respectfully what he sees as the limits of medical consumerism. He barely pauses before launching into a slightly different version of his talking points about the general virtues of consumer responsibility and the consumer-empowering features of Revolution’s CarePages patient Web sites.

PAYMENT

(Las Vegas, June 24) In a display of wonkish wizardry, Ingenix analyst David Hochheiser has calculated how much money Medicare will actually save from its much-ballyhooed refusal to pay for certain “never events.”

Hochheiser, who repeatedly uses the word “exciting” to describe coding data, estimates Medicare will garner a grand total of $24 million annually by refusing payment beginning Oct. 1 for eight different never events, such as “foreign object retained after surgery.” Nine additional procedures proposed for the list add up to another $30.9 million in savings.

I look up the Medicare budget figures. In 2008, Medicare is expected to spend 130,000 million dollars ($130 billion) on inpatient hospital care.

Perhaps Medicare’s secret strategy is psychological warfare. If so, I’d like to offer the government a slogan: “Speak loudly and carry a small stick.”

PLAIN TALK

(Las Vegas, June 25) Richard Umbdenstock, president of the American Hospital Association, speaks with remarkable candor about the politics of health care reform and the need for all interest groups to be prepared to make trade-offs. He is equally plainspoken about the public preoccupation with cost. “Even when they talk about quality, it has a cost and affordability undertone,” he says; e.g., “You’d think that for all the money we spend, we’d get it right.”

And there’s this: because providing universal health insurance will not be cost-free, “85 percent see health care reform as a take-away.”

PROGRESS

(Las Vegas, June 25) Two senior executives of the Grand Rapids, Mich.-based Spectrum Health System are leading a breakout session that promises to provide the elusive “business case for quality.” They banter and joke together, but their charts and slides are dead serious, detailing the ways in which they saved money and lives while delivering safer, more evidence-based care. The thirty or so attendees are clearly impressed.

The financial exec stresses that Spectrum is committed to reducing costs without worrying whether the activities involved (e.g., eliminating unneeded blood transfusions) might theoretically be reimbursed at a tidy profit. Of course, Spectrum also owns a health plan.

Still, both men also slip in words like “moral” and “ethical.” This may explain why they have been given the coveted 2:30-4 pm slot in a far-away room whose front wall consists mostly of a garage door leading to the hotel’s loading dock.

PROVACATEUR

(Las Vegas, June 26) Management consultant Tom Peters became world famous for his co-authorship of the 1982 book, In Search of Excellence. Less known is that he has taken up the cudgel of the patient safety movement, both in speeches and in a blog on his Web site. With apologies for making his audience uncomfortable, the 65-year-old Peters (he notes that his age and various problems he catalogs make him a highly involved consumer) starts his presentation by focusing on avoidable deaths and injuries in hospitals.

He then recounts this anecdote from a visit to a new physician at a famous teaching hospital who was taking Peters’ medical history. The doctor asked what Peters’ mother died from. The response: “Too many specialists.”

POSTSCRIPT

The mother of Betsy Lehman, the Boston Globe columnist whose 1994 death from a medication overdose helped launch the patient safety movement, sent a letter years ago to a patient safety symposium run by CAPS’ sister organization. A passage from that letter tugged at me after spending seven out of eight days at conferences. Mildred Lehman wrote:

May I appeal to you to pause for a moment, if you will, in your important task. For in the wings outside your busy meeting rooms may be heard the murmurings of patients gone now due to fatal medical error, or harmed by a medical system they trusted. They are the ones absent…Among them is my young, brilliant daughter.

Patient safety must be utmost and constant, both ingrained into the system you seek to strengthen, and into caring hearts.

Mildred Lehman’s message still resonates. Yes, system change is critical (financial incentives, information technology, and all the rest), but so is a caring heart that remembers that sons and daughters, husbands and wives, mothers and fathers, not faceless “consumers,” are at the center of the health care drama.

As the Yiddish saying goes, “From your mouth to God’s ears,” Mrs. Lehman – and also to ours.