The Collaborative Forum

In the healthcare reform debate, hospital pay-for-performance has received plenty of discussion—how it could impact health outcomes, how it could promote efficiency, how it could change care coordination. In 2013, we’ll see the first step toward hospital pay-for-performance: hospitals will have some revenues withheld by Medicare and then returned if they meet specific clinical targets.

According to a new study published in the Journal of Public Library of Science, there are economic and human resource issues that may hinder some hospitals from meeting those pay-for-performance targets. And if that happens, the study’s authors are concerned that funding will be taken away from hospitals that provide care in poor and underserved communities.

The study’s lead author, Jan Blustein, MD, PhD, a New York University professor of health policy and medicine, analogizes hospital pay-for-performance with the “No Child Left Behind“ initiative for education that was started several years ago. In an interview earlier this month with HealthLeaders, Dr. Blustein said, “’One of the problems is we know very little about what helps and what works.’ In education, schools are told to do better—‘but there is no science there.’”

Dr. Blustein goes on in the interview, “’And the same thing is true in healthcare. We know a lot about what works to improve a patient’s health, but we really don’t know about what works to improve organizational performance.’”

And this is where I part ways with Dr. Blustein and her colleagues. Read the rest of this entry →

A recent study published in the Archives of Internal Medicine (from McGill University in Montreal) examined patient medication adherence and concluded that a physician’s medical management and communication skills influenced whether a patient stuck with the regimen. Given the significant impact medication adherence has on healthcare quality, costs, and outcomes, we all have a stake in figuring out what makes patients adhere to doctors’ treatment recommendations.

The study found doctors with strong communication skills had the lowest noncompliance levels and concluded that these findings are significant because they point to possible steps providers and healthcare organizations could take to improve medication adherence by educating and training physicians. Researchers felt that the more communicative physicians may have had better results “either because they followed up with their patients more effectively, or their patients were more motivated to report problems.”

Communication is key!  This study bears out the importance of communicating effectively, to get better outcomes. We know that and see that all of the time. Read the rest of this entry →

I am sure you have seen the reports, including the 2009 article in the New England Journal of Medicine (Jenks, et al), that highlight the cost and prevalence of 30, 60 and 90 day hospital readmissions. I think it’s safe to say that we all agree that this is a major issue that our healthcare system needs to address.

Where we don’t all agree is how to get there. Organizations across the country are looking for effective initiatives and innovations to reduce these costs. In their quest, some organizations are looking for easy solutions, such as the simple scheduling of follow-up visits post discharge.  However, as detailed in a new study from the Mayo Clinic, published in the Archives of Internal Medicine, siloed, quick-fix initiatives, while very important, alone will not provide the true behavior change needed for measurable reductions in avoidable hospital admissions and readmissions. Read the rest of this entry →