December 2005, In This Issue:
HPCI is featuring successes using Lean in the health sector in this second in a series. Numerous health care providers in Iowa and elsewhere are now engaged in the Lean transformation with great results. Iowa successes are being featured along with those of others. Congratulations to all engaged in the Lean journey.
113 of the 116 hospitals in Iowa are participating in the Safe Practices Survey Initiative through the Texas Medical Institute of Technology (TMIT). Congratulations to all. This is a great step forward. HPCI recognizes and supports these efforts to utilize this web-based survey and resource to address the National Quality Forum's 36 Safe Practices. Also, the Iowa Health Care Collaborative, chaired by Thomas Evans, MD, is to be commended for its leadership.
The Leapfrog Group uses the same hospital survey and the same vendor (TMIT) in its national effort of informing choices, rewarding excellence and getting health care right. It is a public reporting vehicle for the National Quality Forum's 30 Safe Practices and is supported by the TMIT. It is hoped that now and/or over time hospital leaders and their respective Board of Trustees will share this information publicly to their customers and the general public using the Leapfrog Group's public reporting program. Over 1,000 U.S. hospitals are currently doing so and this number is growing all of the time.
Editor's note: HPCI is working with those Iowa hospital leaders who have expressed concern that variation may result in responses to the Leapfrog Hospital Patient Safety Survey due to differences in interpretation by those who are completing the survey. More information is available through HPCI.
The following highlights results of the 2005 survey conducted by David P. Lind and Associates:
Employer responses to rate increases in 2005:
Percent of Iowa Employers and Their Responses:
Possible employer responses to future increases in rates:
Percent of Iowa Employers and Their Responses:
For more information, download the 2005 Iowa Employer Benefits Study here.
HPCI recently joined other major stakeholders in Iowa and across the U.S. in supporting the adoption and implementation of the hospital CAHIPS Survey. HPCI emphasized that comparative information about hospitals' performance addressing critical domains of patients experience with hospital care is very important. These domains include: communication with doctors and nurses, responsiveness of hospital staff, pain control, communication about medicines, physical environment, and discharge information.
Making standardized patient experience data available will enable consumers and purchasers to make more informed hospital selection decisions. It will also support health care providers in their efforts to improve the care they provide. Hospitals are expected to begin using the form next year with data available to the public through HHS in 2007. More information regarding this initiative can be obtained through the HPCI office.
More Iowans and people through the U.S. are turning to the internet for health care information. How do you find accurate health information online? Studies found that from 20 - 90% of health information on the internet was incomplete or inaccurate. The Consumer Reports in its September, 2005 issue rated 20 health information websites with the most visitors, according to the internet research company, Nielsen//NetRatings. Websites categorized as Excellent included: Kidshealth.org, MayoClinic.com, MedicineNet.com, Medscape.com, National Institutes of Health (NIH.gov) and WebMD.com. Those listed as Very Good included: eMedicine.com, Healthology.com, HealthSquare.com, Intelihealth.com (Aetna), and RealAge.com.
Other websites included in the new HPCI/Iowa Health Buyers Alliance Consumers' Health Guide are: www.ahrq.gov/consumer, www.healthfinder.gov, www.wellnessiowa.org, www.CRBestDrugs.org, www.Leapfroggroup.org, www.Hospitalcompare.org, and www.kff.org/consumerguide.org.
Medicare receipts accounted for 48% of the inpatient discharges in Iowa's hospitals during the first quarter of 2005 according to the Iowa Hospital Association Data Bank Wellmark/Blue Cross subscribers accounted for 16.1%, Medicaid enrollees, commercial insurance, and all other insurance coverage accounted for the third, fourth and fifth highest inpatient utilization, respectively. The uninsured accounted for 4%.
The Medicare percent discount has substantially increased over time, staying above 40% since 1996 and reaching 59.1% during the 1st quarter according to the data from the Iowa Hospital Association. The Medicare payment discounts to Iowa hospitals are now at their highest level since implementation of the Medicare Prospective Payment System in 1983.
Government health care enthusiasts in the United States have long looked at Canada as the leading light of health care fairness and equity. From a distance, Canada seems to have it all: modern medicine and universal insurance. Up close, the story is quite different. In June of this year the Supreme Court of Canada called the system "dangerous and deadly, striking down key laws and turning the country's health system on its head."
Subsequently, the Supreme Court granted a one year stay on its ruling that it clear the way for private health insurance in Quebec, and potentially the rest of Canada. In its earlier decision the High Court ruled that long waiting times in Canada's universal public health care program, violated the rights of Quebec residents, who like those in most other providences, are forbidden from purchasing private insurance for services offered by the National Medicare System. Although this ruling only applied to Quebec, it is sure to bring similar cases to other Canadian providences and give impetus to a growing movement pushing for public and private care. Stay tuned. (Note: above summarized from media accounts).
Recently 23 hospitals, medical groups, and health plans in Wisconsin began reporting to the customers on their quality and charges using a quadrant analysis approach.
The quality score is a composite number that takes into account how well a hospital or medical group performed in giving the recommended care providing the best results for most patients with heart attacks and other conditions. The charges are risk adjusted to account for differences in patients such as the severity of illness and risk of death.
Health systems participating in this break-through are: Advanced Healthcare, Milwaukee, WI; Affinity Health System, Northeast, WI; Agnesian HealthCare, Fond du Lac, WI; Aspirus Wausau Hospital, Wausau, WI; Bellin Health, Green Bay, WI; Columbia St. Maryâ?™s, Milwaukee, WI; Dean Health System, Madison, WI; Franciscan Skemp Healthcare, LaCrosse, WI; Froedtert & Community Health, Milwaukee, WI; Gundersen Lutheran, LaCrosse, WI; Luther Midelfort â?" Mayo Health System, Eau Claire, WI; Marshfield Clinic, Marshfield, WI; Medical Associates Health Centers, Menomonee Falls, WI; Medical College of Wisconsin, Milwaukee, WI; Meriter Hospital, Madison, WI; Prevea Health, Green Bay, WI; ProHealth Care, Milwaukee, WI; Hospital Sisters Health System, Eau Claire, WI; St. Mary's Hospital Medical Center, Madison, WI; ThedaCare, Appleton, WI; UW Hospital & Clinics, Madison, WI; UW Medical Foundation, Madison, WI and Wheaton Franciscan Services, Milwaukee, WI.
This effort is sponsored by the Wisconsin Collaborative for Healthcare Quality (WCHQ). "The Collaborative is about building trust between providers, purchasers and consumers of health care. Even though we compete in the marketplace, we also can all work together through the Collaborative to improve the quality of healthcare in the state," said John Toussaint, MD, Chairman of the Collaborative and President/CEO of Appleton-based ThedaCare.
"Our patients have the right to know what kind of care they can expect from us, and this measurement will help us to continually improve the care we deliver," said Jim Ketterhagen, MD, Chief Quality Officer for Covenant Healthcare. "The best way to gauge improvement is to have measurable targets."
Check out the WCHQ at: www.wchq.org.
Recently, Mercy in Des Moines launched a public campaign to inform consumers of their standards of care and those key indicators that show how Mercy is doing compared to others in Iowa and across the U. S. Full page ads were published in the Des Moines Register during October and early November showing Mercy's performance in the treatment of heart attack, heart failure and pneumonia.
The importance of this initiative is that these reports were based upon standardized, comparable information publicly reported through Hospital Compare by the Department of Health and Human Services. This is the same type of information that will be included in the first Consumer's Healthcare Guide for Greater Iowa published by HPCI and the Iowa Health Buyers Alliance.
In announcing its launch, Dan Varnum, Vice President, Performance Improvement for Mercy stated, "We believe that patient access to quality information allows the public to make informed decisions about their health care. We welcome the opportunity to share our statistics and report quality information on a regular basis. We are very proud of the quality services delivered by the physicians and staff here at Mercy every day."
Note: From time to time various health organizations provide information on their performance. Generally, these reports are "back box" type information because they do not include standardized, comparable data. The above initiative is an example of a new beginning of transparency of information in the health industry.
Muda refers to any activity that adds cost, but no value to a process. Organizational scientists have defined five categories of Muda. According to the Institute for Healthcare Improvement (IHI), "there are plenty examples of each within the health care system":
Don Berwick, MD, MPP, IHI's President and CEO, theorizes that 30-40% of the total "cost of production" is waste: wasted supplies, wasted space, wasted time, wasted (never opened, never used) medical records, and so forth. Iowa Lean practitioners estimate this number may be as high as 60%.
Dr. Berwick states that the problem is hidden, untracked and unexamined. In part, Dr. Berwick says, this is because waste is a politically sensitive topic. "The policy agenda," he explains, "is not about finding resources within an institution; it's about convincing insurers to pay us more; convincing Congress to increase Medicare funding, so there is very little self- interest at the organizational level for public disclosure or discussion about waste."
He believes that this situation must change, that the search for waste is vital. "We have to find an honest, accurate and aggressive strategy to find muda," he says, "We have to be willing to look at ingrained habits, rules and beliefs about our systems and processes." And the assessment should focus on the front-line, Berwick says: "We need a culture in which staff know that they can report on the waste they see, call it by name, without breaking the rules."
"The seriousness of the problem lies in the cost," he says. "The consequences of muda go beyond daily frustrations of clinicians and patients; waste eats up vast amounts of resources, and squandered funds are a luxury that our health care system cannot support."
John Wennberg, MD, MPH, a Dartmouth Medical School expert in geographic variation in health care delivery, has uncovered substantial evidence of waste based on overuse - unwanted, unneeded health care. In one analysis, for example, he found that, despite a lack of discernable improvements in health in the higher-spending locations, 70 percent of the children who grew in Stowe, Vermont had tonsillectomies by age 15, but only 10 percent of the children from Waterbury did. Similarly, some 50 percent of men in Portland, Maine, had prostate surgery by age 85, compared to about 10 percent of the men in Bangor. And twice as many people had heart surgery in Des Moines, Iowa, as in Iowa City.
Dr. Berwick concludes that "if we have the collective courage to address our rampant muda, we can begin to eliminate it, and move closer to the Lean health care delivery system that we would all be proud to represent."
Deere & Co. will sell its managed health care business to the nation's second-biggest medical-insurance provider in a deal that would triple UnitedHealth Group's presence in Iowa.
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