National Committee for Quality Assurance report on The State of Health Care

The National Committee for Quality Assurance (NCQA)  has published a report on The State of Health Care.

The NCQA is devoted to measuring quality in order to improve health care.  The 162 page report is chock full of information.  Some of the highlights include:

• The report found no significant link between amount of health plan spending and the quality of care delivered (at least the measurable quality of care). The health plans that spend the most don’t always deliver the best quality.
• Vaccination rates have dropped for kids in private plans, while rates continue to rise for Medicaid children.

The decrease in childhood immunization rates is scary.  I guess people are forgetting how horrible these preventable childhood illnesses can be.  To read more about some of the key findings, click  here.

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Round-up of ‘Getting Better Healthcare’ programs

Make sure you check out the Getting Better Health Care Radio Program on webtalkradio.net. My latest interview is with Dr. Nancy Oriol, founder of the award winning Family Van program in Boston. She tells us about the barriers to accessing our health care system and how reaching out to the community can help reduce those barriers.

Want to reduce your health care costs? Don’t miss my interview with Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare.   She tells us how we can save money on preventive care, including information on which screening tests we need and which we don’t.

The previous show with David Coates talks about the politics of making needed changes in our health care system.

Another show not to be missed is the interview with Dr. Sandra Kweder, Deputy Director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research.  She explains what the FDA does to assure that marketed drug products are effective and safe.

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What’s to learn from malpractice?

In a July 14 blog, Medical Justice founder and malpractice protection champion Jeffrey Segal, MD, JD, explains why medical malpractice suits don’t help.

“If I touch a hot stove and burn my hand, I learn not to touch a hot stove again. Painful lesson, but lesson learned. How does this make our lives worse? When a person gets burned, whatever the reason, that person will naturally avoid that stimulus in the future. If that person is a doctor, and that stimulus is a frivolous lawsuit, the future behavior will be to avoid that stimulus (the frivolous suit) by ‘protecting themselves’ via defensive medicine.”

Dr. Segal makes a great point about frivolous lawsuits.  The resulting defensive medicine has been reported to cost us up to several billion dollars a year.

But what about the lawsuits that aren’t frivolous? Will patients and doctors learn from the mistakes that resulted in real harm to patients? Malpractice lawyer Patrick Malone offers advice in his blog to help people avoid putting themselves in situations that could result in a needless adverse outcome. Malone points out that step one is for patients to get and read their medical records.

I wonder how many problems would be averted if patients made a point to get, read and keep a file of their medical records. For some reason, it just isn’t a part of our culture. I have to admit, I probably keep a better file of records on the work that has been done on my car than I keep on my own medical care. This culture will change. It has to in order to better assure the quality of our medical care.

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Does board certification matter?

An August 2010 article in Physicians Practice magazine questions whether board certification of doctors is overrated. The article points out that board certification provides a guarantee of a certain level of knowledge and that recent board certified doctors are required to maintain that certification with periodic examination over time. The article also pointed out that studies have not found definitive evidence that seeing a board certified physician results in better outcomes than seeing a doctor who isn’t board certified.

No study will probably ever show a big difference between board certified and non-board certified physicians, perhaps in part because the great majority of U.S. physicians are board certified. We can almost take for granted that U.S. physicians practice within the scope of their training because of the existing certification system.

The American Board of Medical Specialties (ABMS) is a supervising board that oversees the board certification of 24 medical specialty boards. You can find out if a doctor is board certified at their Web site www.abms.org. You can learn more about board certification by listening to the conversation I had with Dr. Kevin Weiss, President of the ABMS , on Web Talk Radio.

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The World of Best Buy

As the holiday season kicks into full gear, I am always ready for a trip to Best Buy. What a great store! I could spend hours among the choices of sound systems, radios, telephones, electronic games, MP3 players, household appliances, cameras, video recorders, computers and computer peripherals.

Computers are my favorite. When I finished my dermatology training and joined the faculty of the Wake Forest University School of Medicine, I splurged and bought a state-of-the-art Gateway 486DX, 66MHz machine with 16MB of RAM. The cost at the time? $5,000.

By today’s standards, my beloved Gateway would be a dinosaur. A modern computer might have a 3.2GHz processor (over 50 times faster than the one in the old Gateway) and would have 250 times as much RAM. The modern computer would be smaller, lighter, have a bigger screen and would cost 1/10 what I paid for my old Gateway.

Over the past 15 years, the quality of computers has improved dramatically, and the cost has continued to decline. Why? There is tremendous competition driving more innovation and exerting pressure on prices. My nearest Best Buy competes with nearby Circuit City, Costco, Walmart, Sams, Target, Office Max and Office Depot — not to mention the Internet. Consumers shop prices when they are shopping for a computer. If Best Buy was the only game in town, it could certainly charge more.

But consumers are not only looking for the least expensive option — they are also looking for quality — faster computers, more gigabytes of memory, more megapixels of camera resolution, more features, etc. — as well as reliability. Consumers may choose to pay more for a brand name, basing that decision on the company’s strong reputation for good quality and good service. The consumer may choose not to go to a big box store to buy the computer; instead, he or she may go to a specialty store where the personnel has more experience and training, and provides more personal service.

Consumer experiences, such as purchasing a new computer, are basic to our everyday life in the capitalist world. The market can be an amazing system in which simple economic principles function. The direct interaction between buyers and sellers provides a system in which there are incentives to improve quality and to lower cost. Most buyers are careful to purchase products and services that they value and don’t waste money on things that provide little benefit to them.

This economic system makes food in the United States inexpensive and plentiful; provides an extraordinary array of housing and clothing choices; and underlies the availability of an incredible array of affordable goods, services and entertainment options.

However, this economic system does not underlie the economics of health care in the United States. There is very little direct purchase of health care services from physicians and hospitals — there is a third party, the insurer, involved.

Therefore, the motivation to improve quality and lower cost will never be as great as it is in the world of products at Best Buy, at least under our current system of insurance paying for health care.

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