Managed Care Losing Ground on Containing Hospital Costs

From a recent reseach study published by Inquiry ($$) using California data. A little wordy but worth a read:

Our findings show that manged care appears to have lost its ability to significantly reduce the rate of increase in hospital costs at least in the more competitive markets in which it was most effective at holding down costs in the early to mid-1990s. Our results from the early 1990s are consistent with both theory and prior evidence showing the combination of more competitive hospital markets and high managed care penetration resulted in price competition that effectively held down costs. Our more recent data reveal that these relationships changed in important ways since the managed care backlash. High managed care penetration no longer is associated with lower cost growth — and may even be associated with higher cost growth — in the most competitive markets, indicating that the synergistic effect between managed care penetration and hospital competition to hold down hospital cost inflation no longer exists.

We are witnessing a shifting of the battle ground over the cost of health care. Not sure whether anyone but scholars and health care wonks realize the growing impact of this change in the market’s ability to deliver effective economic checks and balances in the private health care sector.

Zemanta Pixie

iPhone Health Apps — The New EMR for the MobileMe Gen?

A medical record folder being pulled from the ...Image via Wikipedia

Julie Deardorff of the Chicago Tribune writes on the the new health and fitness apps for the iPhone:

These programs can literally put all your health records—including digital images such as ultrasounds and echocardiograms—into the palm of your hand. Or they can administer eye exams or keep track of your calories and exercise.

We’ve talked about this before (here and here) but now the question is, will the the new ‘mobileme’ generation push the demand for the adoption of electronic medical records (EMRs) and personal health records (PHRs)?

Zemanta Pixie

Virtual Books and “This Intimacy Across Time”

A painting of God watching as an angel and a d...Image via Wikipedia

In the introduction to The Love of Books: The Philobiblon of Richard De Bury, Matthew Battles writes that “It is this continuity — this intimacy across time — that Bury held to be one of the chief merits of the book.” This was the phrase that stopped me — this intimacy across time - and started me thinking about virtual books and what our attachments would be overtime to our new emerging historical electronica.

But first, let’s for a minute appreciate the beauty in Bury’s 12th century expression of his love for books.

In books I find the dead as if they were alive; in books I forsee things to come; in books warlike affairs are set forth; from books come forth the laws of peace. . .

For the meaning of the voice perishes with the sound; truth latent in the mind is wisdom that is hid and treasure that is not seen; but truth which shines forth in books desires to manifest itself to every impressionable sense. It commends itself to the sight when it is read, to the hearing when it is heard, and moreover in a manner to the touch, when it suffers itself to be transcribed, bound, corrected and preserved.

What accounts for this intimacy, this love and affection? Does the physicality of a book, the touch and feel, so closely identified with the embedded ideas, establish an emotional framework for our attachment to those ideas? Books in De Bury’s time were elaborate physical affairs, engineered constructions for words, truth, vision, science and, of course, the afterlife. So do electronic books  deploy the same kick in the ontological gut that drives this kind of intellectual intensity?

Bury claimed allegiance to ideas: “Now truth is chiefly maintained and contained in books - nay, they are written truth itself, since by books we do not mean the materials of which they are made.”

But he also speaks as a book, in the first person, as though it were a living, breathing, sentient thing  — as in the complaints which books harbor about the ways they are treated, the injuries and treacheries they suffer, at the hands of humanity:

. . . new authors’ names are imposed upon us by worthless compilers, translators and transformers, and losing our ancient nobility, while we are reborn in successive generations, we become wholly degenerate; and thus against our will the name of some wretched stepfather is affixed to us, and the sons are robbed of the names of their true fathers. . .

Oftentimes we have had to endure barbarous interpreters . . .

And hence it is that we have to mourn for the homes of which we have been unjustly robbed; and as to our coverings, not that they have not been given to us, but that the coverings anciently given to us have been torn by violent hands, insomuch that our soul is bowed down to dust, our belly cleaved unto the earth. . . we are diseased with jaundice.

My god man, will we ever find the depth of that sentiment to our electronic writings? Can one love virtual books in the same way? Bury is the voice of the unread, unkempt and unappreciated books that mock you from your bookshelf. How will virtual books fill that role with their voices hidden and buried in the miscellaneously organized electronic universe? Will they only nag us through the machinations of our search engines?

Alas, this is a lamentation that will soon be history itself. There is just too much to be gained, to be opened up, in the new virtual world. But let’s at least recognize the pain that comes along with the ride.

Zemanta Pixie

Why Emergency Rooms are “Error-Prone” Environments

Painting of Henriette BrowneImage via Wikipedia

More reasons why not to visit an emergency room when you don’t need to. From a Medscape conference report on emergency medicine.

As in all organizations, there are system errors and intrinsic errors in the ED (Emergency Department). System errors pertain to design, both physical and process design. The physical design of the ED, because of the varying patient loads, is necessarily imperfect. Design of specific equipment may not match every need at every moment. Adequate lines of vital supplies depend on managers with whom individual physicians may or may not have any direct contact. Further, all of these factors may occur in the context of ED overcrowding and boarding, unpredictable patient surges, high noise levels (acoustic and otherwise), and inadequate staffing. These issues, only some of which are even minimally correctable, are inherent to the practice of emergency medicine, and many errors can be traced back to the working conditions and environment in the ED. For those issues that can be addressed, protocols and proactive management can help move toward their resolution.

Within the disorder of a busy ED, and the potential for system errors, physicians must also deal with the potential for intrinsic errors. These sources of error include:

· High levels of diagnostic uncertainty;

· “Decision density,” or the volume of decisions that are made in a given amount of time;

· A high amount of cognitive load needed to process a large volume of data;

· Narrow time windows for patient assessment;

· Multiple care transitions for any given patient; and

· A multitude of interruptions and distractions throughout the thought process.

This list is compounded by “surge phenomena” (unpredictable sharp increases in patient volume), physician fatigue, and sleep cycle disturbances as well as novel and unpredictable conditions, such as unplanned illnesses or absences that reduce staffing or hospital disasters, including chemical exposures or unforeseen contaminations within the hospital.

Zemanta Pixie

Fire in the Hole: Health Care Reform - Acts One and Two

Health care reform Act One, circa 1993: In the battle over Clinton’s Health Security Act we witnessed the formation of an extraordinary number of special interest groups. Many of these groups were advocating for the inclusion of a variety of medical providers under the act, or coverage for specific medical conditions, tests, drugs or technologies. These groups also began building strong roots to local organizations to push their political agendas through state legislatures in light of the failure of national reform. The result of this amazing health care reform political formation was a proposed standard benefit package that was extremely rich, comprehensive and, of course, economically unsustainable.

Health care reform Act Two, present day: To all of the above, add the Internet or gasoline to a smoldering fire.

Zemanta Pixie

“Welcome to the Youniverse” - Lee Siegal’s Rage Against the Machine

Lee Siegel’s book, Against the Machine: Being Human in the Age of the Electronic Mob, is a difficult book to read if you are in any way a web 2.0 enthusiast. But read it we must, just as we must read Andrew Keen’s work and others who are trying to unpack the internet experience and it’s impact on American culture and politics. Siegel has his own controversial blogging history and he takes few prisoners in his critique, taking to task a number of icons of the internet culture.

Siegel sums up his arguments on blogging, for example, by exposing a number of “open secrets” such as:

  • Lust for recognition rules the blogosphere.
  • The individual news blogger’s lack of an institution’s ethical framework encourages the mutation of rumor into fact.
  • The most popular and prestigious bloggers comprise an elite technocracy.
  • Most prominent bloggers rush to join the mainstream media as soon as it beckons.

And he offers up five open “supersecrets” as well:

  • Not everyone has something meaningful to say.
  • Few people have anything original to say.
  • Only a handful of people know how to write well.
  • Most people will do almost anything to be liked.
  • “Customers” are always right, but “people” aren’t.

Siegel comes across as a harsh task master who suffers few fools. And to a certain extent, we’ve heard much of it before. But give a listen to Siegel’s unsettling insight into popular culture’s aspiration to “full viewer participation” and his understanding the “resentment against the authority of glamour” that lies behind blogs.

But driving the rebellion against authoritative images is a hatred of any kind of cultural authority, whether it is a hollow, pumped-up star or a talented actor who has worked hard at his craft. And driving the gospel of popularity is an appeal to each one of us to replace the inflated icons with an inflated sense of ourselves — whether or not we have talent and discipline or not. Web culture’s hatred of the famous figure often comes down to an indiscriminate mania for access to what other people have and we don’t. It’s not the gaseous star we dislike; it’s the fact that he possesses a status and authority that we feel we deserve. In this sense, the cult of popularity, which celebrates “you”, is instilling in everyone an impulsive impatience with anyone and anything that is not you.

Ouch. I hear the voice of the parent in these words, instructing the narcissistic and unruly adolescent to cast a critical eye to influence his peer group. It is a thankless, often fruitless, but nevertheless necessary exercise.

Zemanta Pixie

More Sobering Thoughts on Innovation

Dionysos mask, found in Myrina (now in Turkey)...Image via Wikipedia

Here are a few more gems from Scott Berkun’s book The Myths of Innovation. Seems I just can’t put this down.

Every great idea in history has the fat red stamp of rejection on its face.

The secret tragedy of innovators is that their desire to improve the world is rarely matched by support from people they hope to help.

No matter how amazing an idea is, until proven otherwise, its imagined benefits will pale in comparison to the real, and nonimagined , fear of change.

The future never enters the present as a finished product, but that doesn’t stop people from expecting it to arrive that way.

Talent is only as good as the environment it’s in.

Good managers of innovation recognize that they are in primary control over the environment, and it’s up to them to create a place for talented people to do their best work.

The difference betwenn success and failure is most often relentlessness, not talent or charisma. . .

And my favorite,

The best ideas don’t always win . . .

Zemanta Pixie

Innovation Quote of the Day

From Scott Berkun’s excellent book The Myths of Innovation:

This is the magic double-secret principle: innovative ideas are rarely rejected on their merits; they’re rejected because of how they make people feel. If you forget people’s concerns and feelings when you present an innovation or neglect to understand their perspectives in your design, you’re setting yourself up to fail.

This is a must-read.

Freeman Dyson Quote of the Day

From Freeman Dyson’s Imagined Worlds:

Successful technologies are pulled along by the needs of the buyers, and not pushed along by the ideologies of the sellers.

And this is true no matter how current, attractive or hip that ideology may be. But what about when ‘ideology’ and buyers combine forces on a technology? Is there an ideology alive and well living in the core of the Apple?

Zemanta Pixie

Taking a Lesson from WALL-E

Scene from the 1966 television adaptation of

Image via Wikipedia

Matthew Battles, writing on the Britannica Blog, compares the new movie WALL-E to E.M Forster’s tale “The Machine Stops” saying,

In both stories . . . humanity has grown fat and sessile thanks to automated systems that serve their every need. Whisked from screen to screen in automated chairs, they’re unable to interact with the world without electronic mediation. And in both stories, the systems break down.

Sessile? I admit I had to look that one up. In biology, it refers to, say an organism, that is fixed in one place, immobile. For us internet junkies we may want to think about this a little more and spend a bit more time off the grid and go direct to the experience — whatever that may be.

Just a thought.

Zemanta Pixie