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Archive for the ‘health care reform’ Category

What’s right and what’s wrong with the U.S. health care system? Does it need a major overhaul or a few tweaks?

In a two part episode, I discuss the cost of the U.S. health care system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

Dr. Berenson describes how incentives need to change to get control of our medical costs.  You can hear both of these episodes and others on my online podcast radio program, Getting Better Health Care.

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Two judges have ruled the massive new health care law unconstitutional.  Two other judges have ruled that the law is constitutional.  What does this mean?

Dr. Mark Hall, Professor of both Law and Social Sciences & Health Policy at Wake Forest University explains the implications of these rulings, their underlying basis in constitutional law and what happens next in a wonderful article in the New England Journal of Medicine.

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President Obama’s 2011 State of the Union address was forward-looking. In the address, he mentioned the Internet six times, focusing much attention on American infrastructure, technology and our future economy.  The President said within the next five years, the next generation of high-speed wireless coverage will be deployed to 98 percent of all Americans.

At DrScore, we’re forward looking too.  Paper-based surveys of patient satisfaction are horse-and-buggy technology, expensive, time consuming and wasteful.  Online doctor rating has many advantages, including flexible, drill down survey methodology. As all Americans gain greater access and facility working online, the few barriers that remain to obtaining low cost, easy, high quality patient feedback through the Internet will quickly melt away.

DrScore is just one small facet of the future that President Obama shared with us: an economy that’s driven by new skills and new ideas.  Our success in this new and changing world will require reform, responsibility, and innovation.

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Pissed off patients aren’t the only ones who rate doctors — happy ones do, too.

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“You can cite all the statistics you want but I am telling you, that a pissed off patient is about 20 times more likely to post than a happy patient!”

I hear this type of comment quite often from doctors who think doctor reviews and online doctor rating are bad things.  However, I’ve run against the current on many issues in the past.  I don’t mind doing it.  My research found that tanning beds had addictive properties years before it became conventional to think so.  My research on how poorly patients used their medicine changed a lot of thinking in dermatology about how to best treat patients.  Some doctors still don’t believe me when I tell them online doctor rating is good for patients and for doctors.

Looking at individual ratings, on a 0-10 scale where 10 is the best score, the most common score a doctor gets on DrScore.com is a 10.  The next most common score is a 9.  The average score of doctors with 20 or more ratings is OVER 9 out of 10.  It amazes me that anyone familiar with these data believes that only unhappy patients rate doctors.

I can’t say that unhappy patients aren’t more likely to rate their doctor.  What I can say is that doctors have so, so many happy patients that doctors who have 20 or more ratings have an average score of over 9 out of 10.  Doctors shouldn’t be afraid of doctor reviews and online ratings; doctors should embrace online ratings and encourage all patients to rate their doctors.  Doctors have nothing to hide. Letting the public see a representative score of how doctors are doing will help the public see what a good job U.S. doctors are doing.

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Measuring medical center quality performance.

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I just attended a session on how a medical center can improve its health care performance statistics.  The session didn’t cover a single aspect of how to reduce infection rates, lower death rates, avoid wrong site surgery or anything like that.  The whole session was devoted to how to change how comorbidities are reported.

Here’s the thing: to evaluate the quality of health systems, things like death rates are reported.  But those death rates depend on how sick the patients are.  A system that takes care of sicker patients will have more patients die.  So when comparing quality measures like death rates across different hospital systems, it’s important to know how sick the overall patient mix is.

At this event, the speaker described how just changing how doctors document the various problems the patient has can dramatically change the score for illness severity, thereby changing the severity of patient mix, and ultimately changing the system’s overall score for quality compared to other hospitals.  I guess one way to look at this is that more accurate reporting will give more accurate quality results to compare one health system against others.  Another way to look at it is that it is just more attention on “how to play the game” rather than focusing on how to really improve quality.

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