IHBA News
HPCI News: Accountable Care Organizations and earlier HPCI initiatives
To: HPCI and IHBA members and others
From: Paul
The attached article was published by the Business Record in December. It outlines efforts to develop new Accountable Care Organizations in Iowa and describes earlier initiatives by HPCI (see page 3). Have a great new year! It promises to be an interesting and important one.
Paul M. Pietzsch, MPH
HPCI - IHBA Office
6165 NW 86th Street
Johnston, IA 50131
515-252-2530
Health Exchanges and Qualified Health Plans - HPCI and IHBA Involvement
To: HPCI and IHBA members and selected others
HPCI and IHBA were two of twenty-three organizations (23) signing on to a letter to CMS regarding the final rules for establishing exchanges and qualified health plans. These are created under the national Patient Protection and Affordable Care Act.
Our work through the Consumer-Purchaser Disclosure Project is aimed at improving quality and affordability of health care through the use of performance information to inform consumer choice, payment and quality improvement. I hope you will take the time to read at least the two page cover letter attached.
Paul M. Pietzsch, MPH
HPCI - IHBA Office
6165 NW 86th Street
Johnston, IA 50131
515-252-2530
Iowa Health Buyer's Alliance Statewide Conference Health Care Reform:
A Broader View
Wednesday, October 12th, 2011
The Hotel at Kirkwood Center in Cedar Rapids
The Iowa Health Buyers Alliance will hold its 5th statewide conference at the Hotel at Kirkwood Center in Cedar Rapids. Plan to join us and learn the latest on private and public efforts to improve health and get better value.
Topics will include:
- National and Iowa reform
- Employer/purchaser led efforts to improve health care and value
- Iowa Health Insurance Exchange
- Private sector Health Insurance Exchanges
- The Greater Iowa Leapfrog Group
- Health Information Technology and "Meaningful Use"…what will it mean to consumers and purchasers?
- Employee/consumer engagement: demand side innovations in health care…labor and management working together
Featured speakers include:
- Suzanne Delbanco, Catalyst for Payment Reform
- Susan Voss, Iowa Insurance Commissioner
- Dana Chapman, Senior VP; Aon Hewitt
- Becky Dunk, Senior Manager; Health and Welfare Benefits; Transamerica
- Ray Werntz, Senior Consultant; HPN Worldwide
- Danny Homan, President; AFSCME Council 61
- Bonnie Pisarik, Benefits Manager; City of Cedar Rapids
- Susan Brown, Telligen HIT Regional Extension Center
Availability of Data for Performance Measurement is Key
To: Members and Supporters
From: Paul
HPCI and IHBA were two of 38 signing on to a recent letter supporting availability of Medicare data for performance measurement. These 38 are a growing collaboration of leading consumer, labor, and employer organizations committed to improving quality and affordability of health care through the use of performance information to inform consumer choice, payment, and quality improvement.
As you may know, Medicare in Iowa accounts for almost one-half of all medical claims and thus it is the dominate payer. Included in the letter, which is attached, is the following key set of ideas:
"We strongly support making Medicare data available so that reports on provider performance can be compiled. Greater transparency of provider performance is necessary to improve the quality, safety, and cost of health care and give consumers much needed information to make decisions. In addition, reports on provider performance give health plans and others information to guide contracting, tiering, benefit design, andpay-for-performance programs. Other industries provide comparative information on performance to enable consumer decision-making and stimulate market improvements. Health care should be no different. In fact, in health care, there is an even greater imperative to make useful information available because patients' lives and well-being are at stake."
Paul M. Pietzsch, MPH
HPCI - IHBA Office
6165 NW 86th Street
Johnston, IA 50131
515-252-2530
Reporting Medical Errors Critical to Patient Safety
July 10, 2011 issue of the Cedar Rapids Gazette
Read Article
Modern Healthcare Magazine on Gauging Quality, State Snapshot Reports
To: Members and Supporters
From: Paul M. Pietzsch
I thought you might find the attached article of interest. These are important and useful reports. I hope you will review them and use them for improvement and accountability. HPCI and IHBA are planning to do so and help move Iowa's health care quality from good to great. Please join us.
Paul M. Pietzsch, MPH
HPCI - IHBA Office
6165 NW 86th Street
Johnston, IA 50131
515-252-2530
Iowa Leapfrog Group Rollout for 2011-2012
To: Iowa Leapfrog Group Project Supporters
From: Paul
Attached is a sample of the letter and The Leapfrog Group Fact Sheet that were recently mailed to hospital CEO's as part of the 2011-12 rollout. A total of 44 hospitals in greater Iowa were included in this mailing and are being requested to participate this year. They represent over 80% of the hospital costs in greater Iowa.
I want to give a special thanks to Becky Dunk for chairing the Iowa Leapfrog project this year and to those who signed-on to these letters. Your names are shown at the bottom of the letter.
We had a breakthrough this year. Grinnell Regional Medical Center was recognized as a top hospital and their CEO stepped-up in support of the Leapfrog Group. Todd Linden is encouraging other Iowa hospital CEO's to report. See paragraph six in the attached letter. Recognition and support of Leapfrog is increasing all the time.
Thanks again for your interest and support. If you would like more information, please let me know.
Paul M. Pietzsch, MPH
HPCI - IHBA Office
6165 NW 86th Street
Johnston, IA 50131
515-252-2530
Affordable Care Act One Year Anniversary:
Message from the Consumer-Purchaser Disclosure Project
To: HPCI and IHBA Members
From: Paul
See below and attached for good update and timeline.
Dear Colleagues:
As we approach the first anniversity of the Patient Protection & Affordable Care Act, we at the Consumer-Purchaser Disclosure Project (CPDP) believe it is important to reflect on our progress to date, thank our members for all their hard work, and consider the opportunities that lie ahead as we continue our efforts to improve the quality and affordability of health care in the United States.
To this end, we have developed Advancing the Consumer and Purchaser Advocacy Agenda for Better Quality, More Affordable Care ("Timeline") that highlights key CPDP accomplishments and resources, and identifies future opportunities for collaboratively building a high performing health care system.
With the support and hard work of our diverse membership, during thispast year the Consumer-Purchaser Discloseure Project has engaged in many advocacy efforts to strengthen how our health care system measures and reports performance data in a meaningful way to consumers and purchasers. Together with our members and partners, we haveengaged in numerous successful actions including:
- Ensuring that the rules for meaningful use of electronic health records are strong;
- Mobilizing consumer and purchaser voices in policy-making venues to shape the direction of major stategic initiatives, including Accountable Care Organizations, Medicare Physician Compare, and Health Insurance Exchanges;
- Writing and submitting more than twenty comment letters related to health reform implementation activities since the law was signed.
In the months and years ahead, there will be myriad other opportunities to make a difference. Our diverse coalition will remain highly engaged, including:
- Continuing to make sure consumers and purchasers shape the design of new payment stategies, public reporting, and ACOs and other new models of care;
- Supporting Health Insurance Exchanges that foster high quality, affordable and accountable care for consumers and small employers;
- Supporting consumers and purchasers in the multi-stakeholder process that will advise the HHS Secretary on priorities for public reporting and provider payment programs.
We invite you to review the attached Timeline, and share it with your colleagues. The Timeline provides an overview of the major steps in health care reform implementation as well as numerous opportunities to advocate for improvements in quality measurement and payment reform. It also reflects our members' hard work to dateand their continued commitment to building a quality, affordable health care system.
We hope that you will find the Timeline informative and inspirational: there is much work ahead of us and we look forward to your continued commitment, voice and partnership. Should you have any comments or questions about the Timeline or suggestions for improvement please contact Jennifer Eames Huff (jeames@pbgh.org).
Sincerely,
- Bill Kramer
Executive Director for National Health Policy
Pacific Business Group on Health
Co-Chair
Consumer-Purchaser Disclosure Project - Debra L. Ness
President
National Partnership for Women and Families
Co-Chair
Consumer-Purchaser Disclosure Project
Boeing making health care lean and efficient
To: HPCI and IHBA Members
From: Paul
The presentation below is excellent. It points out the importance of several items we are working on and how they relate to each other: 1) Lean production system; 2) The Leapfrog Group; 3) labor and management working together; and 4) recognition of health provider improvement and excellence (in this case Virginia Mason in Seattle, which was just named "Top Hospital of the Decade" by The Leapfrog Group). While this presentation was given sometime ago, I hope you agree it is worth reviewing. Happy New Year!
Paul M. Pietzsch, MPH
HPCI - IHBA Office
6165 NW 86th Street
Johnston, IA 50131
"Making health care lean and efficient"
Seattle, Washington
As both a private citizen and a representative of a corporate citizen, The Boeing Company, I want to thank the people of the Robert Wood Johnson Foundation, the Puget Sound Health Alliance and the Aligning Forces for Quality participant organizations here tonight. And I want to thank you especially for stepping up and taking on one of the most important issues America is facing today.
A strong, effective, high-quality and well-managed health care system is vital to our country's well-being, our prosperity and our strength.
There is a personal dimension to your work as well. When people like you come together to identify and to implement solutions that will improve the quality and delivery of care, you are touching lives -- millions of lives -- and making them better in a very profound and personal way. That has to be among the highest callings one has the privilege to undertake. So I applaud you for this great work.
The reason that this work is so important is that the beneficiaries of an improved health care system are our own families, our friends and our neighbors.
At Boeing, we have an enormous interest in a successful health care system. Before I tell you about some of our efforts and the partnerships we have forged to make that vision a reality, I want to tell you a little bit about the company itself.
I think the scale of our operations and the kind of work we do have some interesting parallels to the health care field.
Boeing began right here in the Puget Sound area. Our founder, Bill Boeing, had been a lumberman. In 1910, he ventured south to Dominguez Hills, California, to an air show, fell in love with the technology, came back up here and on the shores of Lake Union, just north of downtown Seattle, and founded the Boeing Company in 1916. So we're 91 years old.
Over the years, we have become the world's leading producer of commercial and military aircraft. Our heritage encompasses the entire history of flight, from our first wooden World War I training aircraft to the 7-series of commercial jet aircraft to the International Space Station.
Our history is a history of innovation and of exciting new ideas, going all the way back to Bill Boeing and that day in 1910 when he marveled at manned flight.
As we speak, that history of innovation is being taken to new heights. A little after midnight today, the first 787 Dreamliner was rolled out of our large facility in Everett, Washington, and across the freeway to a paint hangar, in anticipation of the Premier. We have one of these product rollouts about every 12 or 13 years, so they are a very big deal. The 787 Premier will happen on Sunday, July 8,, 2007. Get it? See, the marketing people are really smart. 7-8-07.
I know you are finding that a little bit funny and a little bit interesting. But when you think about the millions of parts that have to come together to get this ready for a certain date set years in advance, the logistics and the planning are not exactly easy tasks. We've got a lot of bright people who are working diligently night and day, literally, to pull this off.
In the 1990s, we undertook a series of strategic mergers and acquisitions to broaden our portfolio and flatten some of the ups and downs of this highly cyclic aerospace industry. These included McDonnell Douglas, the space and defense business of Rockwell International, and Hughes Space and Communications, one of the world's leading satellite producers. And so today, Boeing finds itself an extremely broad, global business and the aerospace leader.
We have more than 155,000 employees in 48 states and 70 countries. More than 70 percent of our employees are located in three states -- of course, here in Washington; in Missouri, where McDonnell Douglas was founded; and in California, where the Douglas Aircraft, the Rockwell firm and Hughes were established.
84,000 members of our team have college degrees, including nearly 29,000 advanced degrees. Boeing is an engineering company. We're a technology leader, and our bread and butter is innovation and we do that through the brains and brawn of our engineering and technical team. These degrees are in virtually every business and technical field from almost 3,000 colleges and universities worldwide.
Now, 36 percent of our employees are represented by labor unions. Here in the Seattle area, two-thirds of the roughly 55,000 employees are represented by labor. So as Margaret said, bringing the labor unions into this dialogue and into this discussion is critically important to our success. And they, like we, are very interested in the quality and cost of health care.
We are one of the largest exporters in the United States. We have customers in more than 90 countries, and 37 percent of our revenue comes from international sales.
Total company revenues last year were $61.5 billion. And in 2006, we spent $1.9 billion of that on health care. Three out of every $100 of revenue is spent on health care for our employees, families and retirees. So this is a very, very significant line item.
As I said earlier, health care benefits go beyond dollars and cents. Yes, we are concerned about the effect of health care on our bottom line, as is every other employer offering this type of benefit to date. But we are mindful of the fact that without a high-quality, effective, efficient health care system, our employees and their families are at risk.
And at Boeing, we know something about risk. That's the nature of our business.
Our airplanes have to perform flawlessly. If we make mistakes, if our processes are ill-defined and sloppy, if we don't design and build our products properly so that they perform as they should, we put all of you and the entire flying public at risk.
It's very simple. In our business, our tolerance for defects is zero. We think the health care industry should adopt the same standard.
We are pleased that our industry delivers an extremely safe and reliable product. The chance of a flight fatality on a U.S. commercial airplane is three in 10 million. But that's not good enough. And so, every single day, we strive to make it better.
Now compare that to the chance of becoming injured while you are a hospital patient. You are twenty thousand times more likely to be injured in a hospital than to be injured on a commercial airplane.
The commercial airplane industry safety record isn't the result of luck. It is the result of some very serious quality initiatives and careful analysis of processes to eliminate risk. It is the result of working closely on quality issues with our customer airlines, with regulators and with thousands of suppliers around the world.
We'd like to see some of the strategies that we use and that work in our industry take hold in the health care sector.
One concept that we are particularly attached to and particularly excited about and that we've embraced in a big way at Boeing -- and that we think has terrific potential in the health care area -- is the creation of a Lean production system.
Lean manufacturing is the foundation of the world's best production system -- the Toyota production system -- used in the factories in Japan and the United States to build what are probably the highest-quality cars in the world.
Interestingly, before the world's attention turned to Toyota, a lot of those same techniques were used by Boeing here in Seattle during World War II. We built the B-17 bomber, known as the Flying Fortress, just south of downtown at what we call Plant 2 and adjacent to Boeing Field. And of course, the B-17 was critical in helping the Allies win World War II.
In those days, a team of highly motivated employees in the factory -- almost half women, working in industry for the first time -- analyzed the work they were doing, redesigned their processes for maximum efficiency, and ended up with a manufacturing miracle, producing about 15 airplanes a day. These airplanes rolled out the factory doors and across the street to what is now called Boeing Field, where they flew off to war at a rate of 1.6 per hour.
Lean focuses on eliminating waste, whether from errors, or inefficiency from a production process. Wasted money, wasted space, wasted time.
In a Lean system, the people who do the work analyze how they are building, assess how they should be building and then squeeze all the waste out of the processes.
Sometimes that means eliminating steps in a process, reconfiguring a work space or making sure supplies are delivered to a production line just when they are needed. The idea is to create a smooth workflow, reduce the time it takes to build the product and eliminate rework.
Besides increasing efficiency and lowering cost, Lean reduces defects. Defects cause rework, and if you don't catch them, they become a threat to quality. Lean thinking requires that every abnormality be addressed immediately. Work is stopped and the defect is addressed in real time.
The exciting thing about Lean is that it's grounded in creating a culture of continuous improvement. The journey never ends. There is always opportunity to eliminate more waste and lean out processes. In this culture, every employee shows up every day obsessed with one thing: improving the processes, even, as at Toyota today, targeting taking seconds out of a process.
So you can go to a Toyota plant and to a General Motors plant, and you will think you are seeing the same thing. There really is very little difference when observed by an untrained eye. The companies use the same robotics, the same moving lines and very similar production processes.
The difference is that Toyota has trained its work force and embedded them in this culture of continuous improvement. So every day the hearts and the minds of the employees are focused on improving the process.
People will come to Toyota and look at the production system and say, "Seems like we can do that." They go back home and try, and fail, and they ask themselves why. And the reason is that the employees aren't grounded; a culture hasn't been created where the hearts and minds of everybody involved in the process are focused on one thing -- and that's continuous improvement.
After World War II, Boeing led the world into the jet age. But with minimum competition. Then, during the prosperous fifties, we began to forget our Lean ways.
Decades later, when our business became extremely competitive with the advent of a European competitor called Airbus, we really had to focus on lowering cost and improving quality. We focus on that today, and we'll focus on that tomorrow, and we'll focus on that for the rest of our existence. We began to implement the Toyota production system in our commercial airplane factories.
Amazingly enough, the Lean philosophy still works, decades after we first started using it, in the 1940s.
Many of you probably arrived at this event on a 737 built by Boeing -- the most popular commercial airplane in history. It is built down at the south end of Lake Washington in Renton.
In 1999, we were struggling to produce 17 737s a month. We were operating three separate assembly lines, which required nearly 7 million square feet of covered space for the production facilities and related offices and equipment. Then we readopted Lean principles.
Since then, we've reduced our floor space in Renton by 35 percent. We've sold 118 acres of land. We went from operating three 737 assembly lines to one and a half.
And most importantly, and this is the key -- we've nearly doubled the number of airplanes we're delivering to customers each month.
So this is what Lean delivers: doubling production, using half the assembly space. That's the type of productivity gain that creates the revenue that allows us to continue to invest in innovation and keeps us in the game for decades to come.
But the story can't stop there. The market wants even more 737s. So we've got to find a way to do that, to create capacity in the production system so that our customers buy from us and not from the competition.
That's the beauty of Lean. The improvements never end. We have an obsession with always being better tomorrow than we are today.
Now we are working to implement Lean beyond the manufacturing areas, in the office areas in particular.
We think these principles can be used in any environment, on any process, including those used in the hospital environment and in the health care clinic environment.
Lean does two things really well that are vitally important to improving our health care system: It improves quality and it lowers cost.
The Boeing executive who led the Lean effort on the 737 is a very talented leader by the name of Carolyn Corvi. Carolyn is also on the board of Virginia Mason hospital here in Seattle, which has been recognized as a national leader in quality improvement. Virginia Mason has officially embraced Lean thinking and is applying Lean principles in its day-to-day operations, with some very impressive results.
At Boeing, we've used Lean to address and prevent defects such as a bolt that hasn't been torqued properly, or a wrench that gets left behind and sealed into the compartment of the airplane, which could pose a safety hazard or just drive the customer nuts by rattling around.
When you are paying tens of millions of dollars for products, you expect them to be perfect, right? Our customers will crawl all over these airplanes before we deliver them and will find the smallest item -- they call it FOD or foreign object debris -- that's left in the airplane. And they get all over us if we fail to deliver a perfect aircraft.
Here in the Seattle area, a number of great medical institutions -- Group Health, Virginia Mason and others -- are using Lean principles and using them very effectively. At Virginia Mason, Lean is being used to eliminate defects such as an accidental puncture, an infection, or a foreign object left inside the human body as opposed to the body of an airplane.
When we implemented Lean thinking, we used a medical metaphor: Our highly skilled mechanics were to be treated like surgeons. We wanted to make sure they had everything they needed when they needed it so they could focus on producing a high-quality product for our airline customers. And we had to make sure that the processes that they used were designed to avoid defects and rework.
In short, we wanted to make sure that those mechanics, those very skilled mechanics, were operating in the type of environment that most patients would expect doctors to be operating in. We think it makes sense to do the same thing for real doctors and real operating rooms, which, as many of us know, could benefit from becoming leaner and more efficient.
A big part of Boeing becoming Lean was working with thousands of independent suppliers, in almost every state and on every continent, who deliver millions of parts that come together to make commercial airplanes.
In partnership with us, they focused on standardizing processes across the industry, reducing defects and improving productivity, thus lowering cost. And they got as excited about Lean as we did. They took on the principle of continuous improvement themselves. So we have assurance that tomorrow they'll be doing their work even better than they are doing it today.
If thousands of independent companies in the aerospace industry can standardize practices, become more efficient, lower cost and increase quality, it would seem to us that doctors, clinics, insurance companies and other segments of the health care industry can do the same thing. It's in the best interest of your customers, the patients, and it will make your industry more productive and more competitive.
We expect that will be the result of a new Boeing health care program that we're offering to employees who require intensive outpatient care. We developed this new approach to health care in conjunction with Regence, our insurance provider, and three local health care providers: the Everett Clinic up north, Virginia Mason here in Seattle, and Valley Medical, which is down in Renton, south of Seattle.
Patients who choose this approach are assigned a physician-led specialized care team that will supplement -- not replace, but supplement -- the care being provided by the primary care physician. The team comprises a doctor, nurses and other team members who provide help through e-mails, phone calls and in-person visits.
This program is just getting started and we're tracking it to see how it improves health, reduces emergency room visits, lowers costs and provides better prescription drug management and, ultimately, better patient satisfaction. It's Lean because it eliminates unnecessary treatment, which is the goal. It's Lean because it delivers evidence-based medicine efficiently, lowers costs, improves quality and provides for continuous improvement through a feedback loop that measures results.
One reason gatherings such as these are so vitally important is that they provide us with the opportunity to share ideas and successes. And by us, I mean representatives of the health care sector, companies that purchase health care services and others that are so instrumental in the success of this industry.
Our national health care system is high on the Boeing agenda. It has to be. It's a huge budget item for us. As I mentioned, as a health care customer, we're spending almost $2 billion a year on health care for employees, retirees and families. To stay competitive, we have to be able to control that expense if not reduce it.
We have to work for public policies and industry improvements that deliver quality health care at a reasonable and stable cost. We have to work as partners with health care suppliers to ensure that our employees are getting high-quality health care and that costs are contained.
The Puget Sound Health Care Alliance has embraced this idea and is taking a collaborative approach to identifying and implementing best practices based on national standards.
And collaboration is the key. We do the same thing with our thousands of global suppliers around the world who provide us with the millions of components that we integrate into our aircraft. We engage in Lean activities with them, helping them smooth out their processes so they can deliver us high-quality, zero-defect parts, on schedule and at low cost.
And so our suppliers have come to share our passion for continuous improvement that must become ingrained in the business culture once Lean principles are understood and embraced. By working with suppliers in this way, we are making their businesses stronger and more competitive.
Just as our suppliers can lower cost by using standard forms and standard software, so can health care providers lower costs by working toward those same standards.
Although cost is certainly a big concern to us, as it is to all of American industry, we are also very concerned about quality -- the quality of every medical experience our employees and their families have. That means we are concerned about safety and efficiency.
We believe we have the best employees in the world. They are engaged and excited about what they do, they love the product, they love the company and they are proud to be Boeing employees. We want them to be healthy and productive. We don't want them to be worried about care they and their families receive. And we don't want them to be at risk when they are receiving medical care.
So we've made this clear to our health care suppliers. And we are working together with them and with union leadership to ensure that our employees get the best from our health care suppliers. We expect our health care suppliers to be committed to continuous improvement and to work toward zero-defect health care delivery.
Our efforts also go beyond the specific needs of our own company.
As corporate citizens, we are advocates of public policy reform at the national level and in our largest markets. We believe that the private sector is the best way to deliver a high-quality health care system, but the present system needs change to make it better.
We are involved in projects to initiate such change through coalitions and alliances with organizations that share our point of view. One of these alliances is the Leapfrog Initiative. Like the Aligning Forces for Quality project, Leapfrog also enjoys the support of the Robert Wood Johnson Foundation.
Leapfrog is a coalition of more than 150 public and private organizations, including key employers like Boeing, General Motors and General Electric, representing 37 million covered patients.
Leapfrog is promoting computerized physician order entry. We know this works because we've discovered that computerized work orders on the factory floor have drastically reduced errors resulting from illegibility and lost paperwork. Leapfrog also promotes evidence-based referral, getting patients to the hospitals offering the best performance. Again, we have been managing our supply chain this way for years.
We also believe in getting the right people to do the right job, for example, reducing mortality risk in intensive care units by increasing staffing with specialized doctors.
We were one of the first groups of employers to join Leapfrog, back in 1999. It was easy for us to see the value of Leapfrog because of our own Lean thinking, our own risk-management strategies and our own zero-defect philosophy.
Leapfrog was formed as an initiative to address the fact that up to 98,000 Americans die every year from preventable medical errors in hospitals. As someone who has spent most of his career in the aerospace industry, I find that number unacceptable.
The world's airlines conduct nearly 44,000 flights a day, more than 16 million flights a year, carrying more than 2 billion passengers, 75 percent of them on Boeing aircraft.
In 2005, the last year for which worldwide statistics are available, there were 20 accidents and 1,035 fatalities. We work with the entire industry, including our competition, to strive to reduce that number year over year over year.
If commercial air travel had the safety record of U.S. hospitals, we might be out of business. And deservedly so.
The large numbers of preventable deaths in hospitals illustrate why the work you're involved in is so critically important.
Like all of you, Boeing will continue working on many fronts to address this issue. On policy, on process, on our patients, with our employees, families, friends and neighbors.
We realize that improving our health care system is a huge challenge.
We build very complex products and we integrate millions of parts from all over the world. That's a huge challenge. To meet that challenge, we have to develop innovative solutions. We have to make dreams, like the dream of flight, a reality.
We know that complex problems can be solved by people committed and passionate about their work and by strategic partnerships. You are the people who are dreaming of making our health care system, which, throughout the years has generated so many miracles, even better. You are the people whose dedication will make this dream a reality. That's yet another reason why an event like this is so important and so useful.
So on behalf of Boeing, I want to thank you again for the great work you are doing. We are committed to working with you, taking this journey with you and helping you in any way we can.
We wish you the very best as you come together to continue to find solutions and renew your commitment and your passion for improvements in the health care system, which we so drastically need, and which we will attain through great work like this.
I want to thank you again on behalf of the company for having us. And I applaud your efforts, I applaud your commitment and I applaud your passion.
So keep at it. Thank you.
Doug Kight
Vice President
Human Resources
Commercial Airplanes
Grinnell Regional Medical Center Receives National Recognition for Outstanding Achievement in Patient Safety and Quality Care
Sixty-five (65) Named "2010 Top Hospital" by The Leapfrog Group
Read Press ReleaseOur presentation to Iowa Insurance and Information Exchange Workgroup of state health reform commission
To: Members and supporters
From: Paul
The presentation I made to the Iowa Insurance and Information Exchange Workgroup this week was very well received. See attached. It includes new information on quality of care in Iowa and four recommendations to further transparency and public reporting of health provider performance in Iowa. We will keep working on this priority with the legislative health reform commission and others. Thanks for your support. Should you have questions or if I can be of other assistance please let me know.
Iowa Health Buyers AllianceNational Institute for Health Care Reform
To: Members and supporters
The attached is a very good overview on employer wellness efforts. It points-out the importance of communication and financial incentives among other factors.
National Institute for Health Care ReformSeptember 7, 2010
HEALTH INSURANCE PREMIUMS INCREASE 13% IN IOWA
2010 Press Release on Iowa Employer Benefits StudyAugust 19, 2010 IHBA Presentation:
Value-Based Health Care Reform Workgroup Legislative Health Care Coverage Commission
IHBA Presentation Document Reforming Health Care Payment:
Accountable Care Organizations (ACO) Promise and Issues
To: Members and Supporters:
Iowa will soon have a new form of managed care or HMOs. The new Federal health reform law, the Patient Protection and Affordability Act (PPACA), contains many policies for delivery system reform. Accountable Care Organizations (ACOs) is one of many policies for reforming payment. Under ACO's providers are held accountable for total spending and quality of care for a defined population. ACOs would consist of primary care physicians, specialists, and at least one hospital.
ACOs "Done Right" have promise for improved quality and affordability. The attached identifies four big issues:
- Are ACOs delivering on their fullest potential?
- Beware of emerging cartels
- Alignment between public and private sectors
- Patient-centered provisions are in place
Transparency and full public disclosure are essential for the success of ACOs to serve in the best interest of patients, consumers, and purchasers.
Lansky ACO Intro 5-25-10Health Care Changes
Summaries of the New Health Reform Law and Changing Delivery & Changing Care:
The Leapfrog Group Response to the Iowa Healthcare Collaborative
October, 2009
The Iowa Healthcare Collaborative (IHC) is advising Iowa hospitals not to respond to the Leapfrog Group annual hospital patient safety survey. Four points are listed in the IHC position. We shared this information with The Leapfrog Group who assisted us in preparing this response. Below please find each of IHC’s four points followed by our combined response in italics.
The Iowa Health Collaborative has significant reservations about the value of Iowans of reliance on proprietary surveys or quality measurement tools, such as Leapfrog. It therefore does not endorse such proprietary products. IHC and Iowa hospitals’ experience with TMIT, the precursor to the Leapfrog survey, leaves significant hospital to hospital scoring reliability questions, which, in our view, dramatically weakens validity and usefulness of the Leapfrog data.
First, the Leapfrog Group is a not-for-profit patient safety advocacy organization sponsored by employers and healthcare purchasers, and is not proprietary. The Leapfrog Hospital Survey materials are transparent to all users and consumers and the survey is offered to hospitals at no charge. The results of the survey are made available to all website users and we never charge for consulting or other activities related to the survey.
Second, the Leapfrog Group treats TMIT as it does other experts from across the country. We do not provide financial support to them, nor do we endorse their services. We have been the recipient of materials from them, as we have from other research entities.
IHC endorses the National Quality Forum’s 30 Safe Practices and prefers to focus on evidence-based metrics that promote quality and safety improvement.
We respect your preference. However, your customers are asking for this public reporting and greater accountability. There is growing consensus in Iowa and nationally that driving health care improvement will be: (1) consumers using performance information to choose providers and treatments, (2) purchasers building performance expectations into their contracts and benefit designs, and (3) providers acting on their desire to improve, supported with better information.
The Leapfrog Group includes 13 of the Safe Practices in its survey, but urges healthcare providers to address all 30 in their quality improvement activities. Originally, the Leapfrog Group had included all the safe practices in our survey, but feedback from hospitals regarding the burden of reporting resulted in reducing the number to 13.
Consumers are increasingly gaining access to better, reliable, quantifiable data describing healthcare provider performance. The IHC reports publicly on CMS measures, AHRQ and through the HAI Reporting Initiatives.
We would not expect Leapfrog data to serve as a substitute for the quality reporting of collaborative entities like Iowa’s, but Leapfrog is an important supplement since it measures issues of direct concern to consumers and purchasers. For example, to address this same issue, the Wisconsin Healthcare Collaborative includes Leapfrog measures in its reporting. (Note: The measures the IHC mention such as CMS are already in the public domain. Thus, IHC is reproducing this publicly available data.)
The IHC has become an unprecedented focus of engagement of Iowa’s healthcare provider community in initiatives to improve the quality and safety within our healthcare delivery system. It has accomplished this by involving providers in the selection of evidence-based metrics with the goals of public transparency, statewide quality and safety measurement, and improvement. Iowa’s healthcare providers are already very engaged in patient safety and quality improvements as evidenced by the work of the Collaborative.
It is disappointing that IHC is not interested in responding to Leapfrog, the consensus quality evaluation tool used by consumers, employers and purchasers nationally and within Iowa. As a participant in the IHC, you may want to encourage Iowa hospitals to reconsider their approach. According to a significant body of peer-reviewed literature, hospitals that report to Leapfrog are higher quality, and those that decline to report tend to have higher mortality rates. Declining to respond to purchaser requests for Leapfrog data thus sends messages we are sure are unintentional: an implication quality may not be competitive, and a message of disregard to employers and consumers.
Our intention in this document is to clarify the issues so we hope that all Iowans take this in the spirit of open and candid dialogue. The Leapfrog Group is intended to serve as a constructive tool and is used by many hospitals not only as a means of responding to the inquiries of consumers and purchasers, but also as a quality improvement instrument that Leapfrog believes--and many thought leaders concur-- is second to none. We would be glad to put interested persons in touch with any of the hospitals that gave The Leapfrog this feedback. The IHBA and HPCI hope to see Iowa hospitals more present on the state and national healthcare quality reporting landscape in the future.
Letter to State on Health IT
Dear Dr. Newton:
The work of the Iowa e-Health Project is very important. Thank you for your leadership. The use of health information technology (HIT) holds much promise to improve health care while driving out cost and increasing quality and transparency. It may be as revolutionary or more so in health as information technology has been in the banking and finance industry.
As you know there is now a major push underway across the U.S. to deploy this technology triggered by the American Recovery and Reinvestment Act. National health reform, in all of its current options, contains emphasis on HIT as well. With such a major push to deploy the technology, there is a risk of overlooking a key piece of the overall strategy. Standardization is much easier to achieve at the onset of a technological shift than later when there are many installed systems in place that require retrofitting.
Health information technology has many dimensions in terms of its promise for improvement as well as in its application. While the initial application may be through health care providers, it is very important to involve all major stakeholders from the beginning and to create a vision with goals that encompass the full potential and use of health information technology.
Given the above, we want to communicate important priorities and issues we have determined so far as representatives of Iowa consumers and purchasers. While the initial focus is rightly on health providers and their systems, it is essential that all dimensions and interests be included in the planning process now and as deployment moves forward.
From our research there are three dimensions of HIT necessary in order to unlock its potential and all three should be planned for now as Iowa moves forward:
- Electronic health record (EHR) systems used by health care providers.
- Personal health record (PHR) for each patient with the essential goal of one PHR for each person across all health care providers so a complete record is available, and that record should be owned by that person (the consumer). We recommend that the State explore the concept of Health Banking to accomplish this goal.
- A layer of infrastructure and standards (such as regional health exchanges) to enable population level analysis which supports implementation of evidence-based medicine, helps reduce costs, enhances transparency and supports CQI. All three are key components and are interrelated. Only through cost and quality transparency will we be able to tap into the power of the consumer and realize real health transformation.
In addition, we want to point out the following key priorities/issues:
- Assure patient confidentiality, privacy and security.
- Enable patient access to their health information.
- Allow patients to contribute key information to their health record.
- Realize the potential of patient-centered care.
- Support CQI and evidence-based medicine.
- Increase provider performance measurement and public reporting (transparency).
We encourage and recommend that the State of Iowa include theses dimensions and priorities as the State Plan is updated and in the work of the e-Health Project. We stand ready to be of assistance.
Consumers' Guides on Consumers Union Website
The most recent two consumers’ health guides produced by IHBA and HPCI are now on the Consumers Union website under “Research and Reports”.
IHBA Announces Consumer Health Guide Series and “Ask Your Doctor” Cards Avaliable to the Public via this Website
The Iowa Health Buyers Alliance (IHBA) uses data from various public sources to produce Iowa reports of health care provider quality, patient safety and cost/efficiency... Data sources include the Center for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Health Care Organizations, The Leapfrog Group, AHRQ, and the Dartmouth Atlas of Health Care. Various reported and guides are prepared by IHBA based upon this data. The primary audiences for these reports are consumers, patients and their families as well as public and private employers.
Consumer Health Guide Series
- Consumers’ Health Reference Guide
- Heart Health Guide with Scorecard, Heart Centers in Greater Iowa
- Iowa Report Card, What Patients Say About Their Experiences with Hospital Care in the Greater Iowa Area
- Iowa Report Card, Ranking of Hospitals for Chronic Care, Greater Iowa Area, with What You Can Do to Get Health Care Right?
"Ask Your Doctor" Cards
The Guides and Cards are made available to members, employers, unions and others for use on their intranet sites, lunch and learn sessions and in other ways.
Hospital Performance Measures Released
The Wisconsin Collaborative for Healthcare Quality recently updated its hospital performance results based on data from the Centers for Medicare and Medicaid Services (CMS), The Leapfrog Group, and the Joint Commission for heart care and pneumonia. This is an excellent example of meaningful information to enable better consumer and provider decision-making. Iowa should follow their lead.
To view the updated hospital performance results, click here and look for the measures that are labeled "Updated".
Hospitals Should Report to the Public
The Cedar Rapids Gazette 01/11/2009, Page A06
Hospitals Should Report to the Public
By Garth Bowen
Congratulations to St.Luke's Hospital and its team of nurses, doctors and other staff for recently being recognized as one of 13 "highest value" hospitals in the nation. More than 1,200 hospitals were reviewed in the annual Leapfrog Hospital Survey. This achievement is especially important for consumers, patients and their families, as well as purchasers. It is based upon high quality and efficient use of resources. The award was presented by The Leapfrog Group, a national independent organization of employers and consumers.
Consumers and purchasers are demanding quality and cost effectiveness. St. Luke's demonstrates that it is possible to deliver quality health care and keep costs lower by using expensive health care resources efficiently. We think other Iowa hospitals might be doing well too, but we can't tell since most have chosen not to publicly report to The Leapfrog Group.
The Leapfrog Group is the first national quality organization to evaluate and identify hospitals that provide excellent quality and at the same time demonstrate appropriate uses of resources for specific procedures. The hospitals were designated "highest value" based on efficiency scores — a combination of their quality and resource utilization scores — for coronary artery bypass graft, percutaneous coronary interventions, treatment of acute myocardial infarction and pneumonia care.
The Leapfrog Group focuses on patient safety, informing choice, rewarding excellence and getting health care right. It was founded in 2000 by the Business Roundtable and is supported by its members, the Robert Wood Johnson Foundation, The Commonwealth Fund, the U.S. Agency for Healthcare Research and Quality and other sources.
As a regional rollout leader for The Leapfrog Group, the Iowa Health Buyers Alliance invited 41 greater Iowa hospitals to publicly report their quality and patient safety information.
So far, 10 have reported. In addition to St. Luke's, others reporting are Genesis Medical Center in Davenport; Mayo Clinic Rochester-St Mary's, Rochester, Minn.; Mayo Clinic Rochester; Methodist, Rochester, Minn; Olmsted Medical Center Hospital in Rochester, Minn.; Austin Medical Center in Austin, Minn.; Gunderson Lutheran Medical Center in La Crosse, Wis.; and the University of Wisconsin Hospitals and Clinics in Madison. Wis.
Area hospitals that so far have declined to report their quality and safety scores include Cedar Rapids Mercy, the University of Iowa Hospitals and Clinics, Mercy Iowa City and three hospitals in Waterloo/Cedar Falls: Allen Hospital, Covenant Medical Center and Sartori Memorial Hospital. They should be encour aged to report to the customers and community they serve.
There are four Leapfrog Leaps in hospital quality, safety and affordability. First, computer physician order entry. It has been shown to reduce serious prescribing errors in hospitals by more than 50 percent.
Second, evidence-based hospital referral. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds, research indicates that a patient's risk of dying could be reduced by 40 percent.
Third, intensive care unit physician staffing. Staffing intensive care units with doctors who have special training in critical care medicine has shown to reduce the risk of patients dying in the ICU by 40 percent.
Fourth, national quality forum — 30 safe practices that, if utilized, would reduce the risk of harm.
Consumers, patients and their families can view the quality results by individual hospital for each of the 1,220 or so hospitals reporting by going to www.leapfroggroup and clicking on "for consumers." Click one more time and you can compare hospital performance by city, state, zip code or by hospital.
Become an educated and informed consumer on where to get your care. Quality does matter. There is variation in quality, outcomes of care and mortality between hospitals.
Check out this information.
Also, encourage your hospital to publicly report its quality scores to The Leapfrog Group so it can be compared with other hospitals in the area and region. The time has come.
Garth Bowen of Cedar Rapids is a member of the United Steelworkers International Union and is labor chair of the Iowa Health Buyers Alliance ( www.ihbaonline.org ), an association of health care customers (consumers and purchasers) for a patient-centered health system, improved quality, wellness and increased transparency and public disclosure.
St. Luke's Hospital Recognized by the Leapfrog Group
One of Nation's "HIGHEST VALUE" Hospitals
Leapfrog Highest Value Hospital Awards will be presented at the Leapfrog Annual Meeting, at the Palomar Hotel in Washington, DC, December 12, 2008. The award is sponsored by Aetna, CIGNA, and Wellpoint.
The Leapfrog Group uses its members' collective leverage to initiate breakthrough improvements in the safety, quality, and affordability of health care for Americans. The Leapfrog Group was founded in November 2000 by the Business Roundtable and is supported by its members, the Robert Wood Johnson Foundation, The Commonwealth Fund, the Agency for Healthcare Research and Quality and other sources.
The Iowa Health Buyers Alliance (IHBA) and the Health Policy Corporation of Iowa (HPCI) are the Leapfrog Group Regional Rollout Leaders for greater Iowa. IHBA is an association of health care customers (consumers and purchasers) working together for a patient centered health system, improved quality, wellness, and increased transparency and disclosure. The HPCI, formed in 1982, develops and supports initiatives which relate to cost containment, quality and access of health services in Iowa.
National Quality Forum Priorities Report
NQF has released its new report on Priorities and Goals for the US health care system.
You can read it HERE.
RWJ has a new report on paying for quality care. Read it HERE.
Patient Information Bill Criticized
The Des Moines Register described it
The article below entitled "Hospitals, regulators in battle over rules" may help explain, at least in part, why Iowa is so far behind other states in meaningful health care transparency... and heading in the wrong direction with this pending legislation. The Iowa hospital and medical industry lobbyists are strong and at work...unfortunately not in the public's best interest. Unless something changes, they will continue to get their way. The Director of the Iowa Department Inspections and Appeals is stepping up for the public. Where are the Director of the Department of Public Health and our other state officials?
Note: Pay special attention to the readers' reactions to the story above at the end of the article.
Healthcare Reforms
Require Reporting of Errors, and Other Measures of Quality
It will promote public reporting of quality performance measures and create public awareness to educate consumers on smart health-care choices..."
Read Garth Bowen's complete article, which appeard in the March 25th Des Moines Register, by clicking here
Iowa State Legislative Briefing
Iowa Health Buyers Alliance, 2008
Numerous state initiatives are underway across the U.S. aimed at improving health care quality, patient safety, and the overall value of health care. Efforts focus on measuring and reporting to the general public quality and efficiency results of both hospital and physician performance. This type of public information is important for patients and their families, employers and other buyers. Since taxpayers pay a hefty chuck of costs through Medicare and Medicaid, hospitals and other providers should be held publicly accountable for the care they deliver. Requiring publication of quality and efficiency measures provides additional incentive for hospitals and other providers to implement practices that can reduce errors and otherwise improve quality and drive-out cost. There are many state efforts underway in the area of provider performance measurement and publication many of which support The Leapfrog Group. The Leapfrog Group is a national organization driven by health care buyers who are working to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans.
Summary of state purchasing and public reporting efforts:
Minnesota: 1) Minnesota’s Smart Buyers Alliance which MN’s Governor has endorsed since 2004 is a coalition of public and private purchasers demanding quality and efficiency in health care. The State of Minnesota has joined private business and labor groups to drive quality improvements and efficiencies in the health care delivery system. The Governor also recently initiated Q-care which lays out hospital quality improvement and reporting benchmarks and factors in Leapfrog measures among other performance measures. 2) Minnesota adopted legislation in 2004 on public reporting of Adverse Health Events Reporting (“Never Events”). Minnesota was the first state to publicly report these results.
Maine: The State of Maine implemented an employee benefit program designed to encourage their covered people to choose Leapfrog-reported hospitals.
Massachusetts: The Massachusetts Group Insurance Commission (CIC) leads a Regional Roll-Out for Leapfrog; has a pay-for-performance program in place with its contracted health plans to encourage Leapfrog reporting; and posts Leapfrog data on its Website. The CIC lead in value-driven purchasing has informed the state’s recently enacted health care reform legislation.
Florida: The State of Florida leads the nation in public reporting of health care information to residents. Their website provides information on costs, quality and errors in hospitals. Florida adopted mandatory hospital infection reporting in 2004. In November 2005, Florida became the first state to publicly report infection and mortality rates in each hospital.
Pennsylvania: The Pennsylvania Health Care Cost Containment Council recently reported on the high costs of infections in both dollars and lives. Also, Medicaid in Pennsylvania has a hospital pay-for-performance program in place that incorporates some of Leapfrog measures.
Ohio: By the middle of 2007, consumers will be able to go to the Ohio Department of Health’s website to compare Ohio hospitals costs and quality of care. Governor Taft signed legislation to force hospitals to provide more information about the quality of medical care they provide and how much it costs (about 15 states have approved similar legislation); the State also leads Regional Roll-out for Leapfrog in Columbus.
Washington: Washington leads a Regional Roll-out for Leapfrog.
Connecticut: Connecticut adopted ”never events” legislation.
Indiana: Indiana initiated a new medical errors reporting requirement with its hospitals and cited Leapfrog.
The following states adopted mandatory reporting of hospital infections: California, Colorado, Illinois, Maryland, Missouri, New York, New Hampshire, Pennsylvania, Rhode Island, South Caroline, Tennessee, Virginia, and Vermont.
New Jersey: The state of New Jersey adopted “never events” legislation and is an active member of The Leapfrog Group.
Wisconsin: The Wisconsin Department of Employee Trust Funds is very active with the Leapfrog Roll-Out and has a pay-for-performance program in place with its contracted plans incenting them to encourage Leapfrog reporting.
Recommended Iowa Actions
- Iowa Quality Purchasing Program Establish an Iowa quality purchasing initiative involving the State of Iowa as a purchaser and other public and private purchasers.
- Four Cornerstones of Value-Driven Heath Care The State of Iowa through the Department of Administrative Services and the Department of Human Services (Medicaid) adopt and use the common set of RFI/RFP questions included in the HHS Four Cornerstones of Value-Driven Health Care, Version 1.0.
- Support The Leapfrog Group and Co-sponsor Iowa Leapfrog Group Roll-Out The Leapfrog Group is a national initiative driven by organizations who buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of health care for all Americans.
Currently there are over 1,200 U. S. hospitals publicly reporting to The Leapfrog Group’s Hospital Quality and Patient Safety Survey. Only one (1) Iowa hospital reports, Genesis Medical Center in Quad Cities. The bordering states of KS, MO, MN, IL, and WI all include formal roll-outs of The Leapfrog Group survey. Leapfrog fields a voluntary online hospital quality and safety survey and states across the country are playing their part to encourage hospitals to report to the survey and other public reporting initiatives.
The Leapfrog Group measures are becoming main-stream as they are now endorsed by the National Quality Forum (NQF) and recently included in the U. S. Department of Health and Human Services Four Cornerstones of Value-driven Health Care’s RFI. Many states have led the way or have provided leadership in Leapfrog Regional Roll-outs. It’s time for Iowa to join-in on this important effort. - Enact Adverse Health Events Reporting (“Never Events”) Legislation Minnesota adopted legislation in 2004 under which its Department of Health is required to track and report on the occurrence of 28 serious medical errors that should never happen. These “never events” include leaving medical instruments in patients, surgery on the wrong body part, and a range of other events. It is being saluted as a major step forward to improve the quality of care for all Minnesotans.
While Minnesota is the first state to take action and actually report publicly on these standards developed by the National Quality Forum (NQF), they are being joined by others including New Jersey and Connecticut. Many other states are considering such action. Iowa should do so as well. - Enact Health Infection Reporting Legislation Hospital infections are the fourth leading cause of death in the United States according to the National Center for Disease and Prevention (CDC). Based on information from the CDC, the Consumers Union reports that every year two million Americans develop infections while in the hospital and an estimated 90,000 die as a result. The remainder often endures prolonged hospital stays and sometimes suffers lasting health problems. Recently, treatment of healthcare-associated infections has become more complex due to an alarming rise in antibiotic resistance.
The Iowa Healthcare Collaborative is working on a proposal for action: Healthcare Associated Infections (HAI). Their strategy is to employ a provider led voluntary exercise in self-reporting and clinical process improvement to accelerate the spread of best practice in Iowa.
Iowa legislation could recognize and couple these efforts with mandatory public reporting.
The Importance of Quality, Patient Safety and Transparency
Information about Iowa health care providers’ quality and patient safety performance, price and other information is essential. Transparency of this information has proven to be an important catalyst for improvement in health care. It is also important for consumers, patients and their families. Listed below are some examples of quality, patient safety and waste in health care issues:
- Rand:Only 50% chance of getting the right care when visit the doctor's office.
- Institute of Medicine (IOM):98,000 preventable deaths in hospitals each year. In 2004 Health Grades reported this number to be 195,000 people, almost twice the number from the 1999 IOM report.
- Center for Health Transformation:You are 2,000 times more likely to die in the hospital from a mistake than in an airplane.
- The Leapfrog Group:The 1st three Leaps can save 58,300 preventable deaths, multiple times this # of disabilities, 522,000 medication errors, and at least $ 9.6 billion per year.
- Juan Institute/Midwest Business Group on Health:30%+ of health cost due to poor quality/ineffective care.
- Consumers Union:Every year, two million Americans develop infections while in the hospital and an estimated 90,000 die as a result. The remainder often endure prolonged hospital stays and sometimes suffer lasting health problems.
- John Toussaint, MD, CEO of ThedaCare:"About 70% of what we do is non-value-added (waste)." (Institute for Health Care Improvement (2-16-05). Note: Lean experts estimate 60% waste in health care.
- The Institute of Medicine:"Between the care we have and the care we could have lays not just a gap, but a chasm. The current care systems cannot do the job. Trying harder will not work. Changing the systems of care will." (Institute of Medicine's: Crossing the Quality Chasm)
- Pennsylvania Governor Rendell Launched a new program in January, 2008 through the Department of Public Welfare to identify and stop payments for care related to preventable hospital errors. The state also will prohibit hospitals from charging patients for such errors.
- Pennsylvania Health Care Cost Containment Council: During 2005 the sates hospitals reported 19,154 cases in which patients contracted hospital-acquired infections. The hospitalizations resulting from these infections amounted to 394,129 days and $3.5 billion in hospital charges. The average hospital charge for patients with hospital-acquired infections was $185,268 while the average charge for patients without hospital-acquired infections was $31,389. The average length of stay for patients with hospital-acquired infections was also longer at 20.6 days, compared with 4.5 days for those who didn’t contract hospital infections. Most telling, though, was the figures on patient deaths. The report said that while 2.3% of patients who didn’t acquire infections died, the mortality rate for those who did contract infections was 12.9%--- more than 5 ½ times higher.
Treating Heart Disease, Heart Attack, and Stroke - The Antiplatelets
For most people who need a blood-thinning drug to help prevent a first or repeat heart attack or stroke, aspirin is the drug of choice, according to the latest report from the Consumer Reports Best Buy Drugs project.
Aspirin is one of four drugs in a class of medicines called antiplatelets. The medicines decrease blood clotting, which evidence now shows is intimately tied to heart attack and stroke risk. As a result, the use of aspirin and other antiplatelets has skyrocketed in recent years.
The Best Buy Drugs Report evaluates the effectiveness, safety, and cost of the four drugs in varying clinical circumstances — aspirin, Aggrenox (a combination of aspirin and the drug dipyridamole), Plavix (clopidogrel) and Ticlid (ticlopidine).
The report discusses in consumer-friendly language the fast-moving changes in cardiology that impact the use of antiplatelets. Several major studies have underscored the effectiveness of these medicines and when angioplasty and stents are needed. Central to these developments is distinguishing between people who have so-called stable versus unstable angina — chest pain due to artery narrowing and/or blockage.
Consumer Reports Best Buy Drugs now has free reports on 17 categories of medications, including:
- Statins for high cholesterol
- ACEI drugs, beta-blockers, and calcium channel blockers for high blood pressure
- Menopause drugs
- Antihistamines for allergies, hay fever, and hives
- NSAIDs for arthritis pain
You'll also find new shoppers guides with advice on how to save money on your medications.
Improving Quality and Value in Health Care
Community Leaders Seeking Collaboration
Last month the US HHS Secretary Mike Leavitt recognized Iowa Health Buyer's Alliance and Health Policy Corporation of Iowa as Community Leaders. We are sending you this special note today because your suggestions matter to us.
Two Groups Recognized as Community Leaders
Iowa Businesses Commit to National Initiative for Improving Quality and Value in Health Care
In a meeting today in Des Moines with HHS Secretary Mike Leavitt, executives from area businesses signed statements of support for a national initiative aimed at improving health care quality, information and cost-effectiveness for employees and their families. The Secretary recognized Iowa Health Buyer’s Alliance and Health Policy Corporation of Iowa as Community Leaders at the event.
Altogether, more than 600,000 people will benefit by implementation of this initiative in Iowa. Employers signing on include the American Republic Insurance Company; AmerUs Group; David P. Lind and Associates; Des Moines University; Health Policy Corporation; Iowa Association of Business and Industry; Iowa Bankers Insurance & Services; Iowa Foundation for Medical Care; Iowa Health Buyers Alliance; Pella Corporation; Principal Financial Group; Rockwell Collins; City of Ames; City of Cedar Rapids; City of Des Moines; Iowa State Education Association; and State of Iowa Department of Management.
The executives pledged to provide quality and price information about doctors, hospitals and other medical providers for all enrollees in their health care insurance programs. This information will help employees choose health care providers based on the quality of care they deliver and the prices they charge.
In addition, the employers will support health information technology by encouraging the use of recognized interoperability standards in the health IT products used by their health plans. They also pledged to develop incentives for achieving better value in health care, including incentives for high quality care and for more active involvement by employees in choosing their health care services.
President Bush committed federal health programs to the four cornerstones through an Executive Order last August. In November, Secretary Leavitt invited all employers, in both the private and public sectors, to take these same four steps. By committing to these goals, Secretary Leavitt said, “Our individual actions will be aligned toward reaching the common national goal of better health at lower costs for all Americans. Today, purchasers in Iowa are joining with the federal government in adopting the four cornerstones of value-driven health care.”
“I am proud that leading Iowa employers are choosing to support these four cornerstones to achieve better health care and better value for employees and their families,” Secretary Leavitt said. “Until now, it has not been possible for patients to learn in advance about the quality of care they can expect to receive from a provider, or the cost of the services they will incur. By making this information available, employers can help their employees get better care and better value in health care.
“With the commitment that Iowa employers like these are now making, I expect many changes in health care,” Secretary Leavitt said. “Patients will come to expect quality and performance information about health care providers. They will expect to have price or cost information in advance to make good value decisions about their care. They will use this information to improve health care value for themselves and their families. And the choices they make will help improve value and health care quality across the health care sector.”
Secretary Leavitt recognized the Iowa Health Buyer’s Alliance and Health Policy Corporation of Iowa as Community Leaders, a designation bestowed to organizations who agree to support the cornerstones at the local and regional level. Recognition of the two groups represents a step in building a national network of regional organizations that bring together local stakeholders to improve health care while holding costs down.
More information on Value-Driven Health Care is available at here. For a full list of companies who have signed statements of support, including those signing in Iowa today, visit: this link.
Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.
Please Join Secretary Mike Leavitt
U.S. Department of Health and Human Services
and Iowa Association of Business and Industry
Health Policy Corporation of Iowa
Greater Des Moines Partnership
Iowa Health Buyers Alliance
At a special Iowa event to discuss the transformation of our health care system through transparency and value-driven healthcare purchasing:
Friday, March 9 Noon-1:30pm Renaissance Savery Hotel Des Moines, Iowa Cost: $30
Secretary Leavitt will discuss the work of the Department of Health & Human Services to encourage support and widespread adoption of four strategies to improve health care quality and affordability.
Cornerstones of Value-Driven Healthcare:
- Quality Transparency
- Price Transparency
- Interoperable Health Information Systems
- Incentives that Recognize and Reward Value
Leaders of Iowa businesses and other organizations are invited to sign a Statement of Support during the event. If you would like to join in the signing, please make your interest known to ABI by March 6, 2007 For more information go to www.iowaabi.org or call 515.280.8000.
What Health Care Needs to Be About
Main article: A Dose of Transparency
One expert’s views
Elizabeth Teisberg
Elizabeth Teisberg visited Governing’s office a few weeks ago to talk about what’s wrong with the U.S. health care system and what role Web sites that provide cost and quality information play in the drive to reform a dysfunctional system. Teisberg is co-author with Michael E. Porter of “Redefining Health Care: Creating Value-Based Competition on Results,” (published by Harvard Business School Press) and an associate professor at the University of Virginia’s Darden Graduate School of Business.
Here are some of her observations:
- The health care system needs to be about health and care, but so much of it is about reimbursement and access and payment. Pay for performance, evidence-based medicine and managed care are powerful ideas for reform that got morphed into different ideas. They end up specifying processes, and we then pay for compliance. But our understanding of the right processes changes. And, when we specify a process doctors have to perform, we get into administration and management.
- It seems like every time we focus on reducing costs, we increase them. The goal of health care reform is not cost-cutting. It’s to improve value — the quality of outcomes for money spent. So we need to focus more on results. If you want to make sure you’re doing something right, measure results and report them.
- Doctors need measures. We assume all doctors provide excellent care with small variations. The truth is, there are large variations. Our ties to results and science and state-of-art practice are not as strong as we believe. It’s important to see how we’re doing and why and to use multiple measures of results.
- The U.S. health care system is more competitive than any system but it’s still dysfunctional. What people compete over is how to shift costs — make sure costs don’t land on them. That doesn’t create value. The right kind of competition should create value and multiple winners. Why don’t we have the right kind of competition? It’s at the wrong level: It’s among health plans and hospital systems. Hospitals compete over doing the most procedures instead of driving to improve results.
- Consumer-directed health care can’t succeed. Consumers have very little choice. They’re captives of physicians. Doctors are competing. They don’t want to show up at the bottom 25 percent. The importance of reporting results is not just to enable patients to get information but for physicians to improve.
- Web sites about hospital costs and quality of care are providing information at the wrong level. A hospital’s infection rate is important, but you need it at the medical-condition level — results for specific conditions. It doesn’t matter if a hospital is good at X or Y if the condition you have is not either of those.
- Patients can’t make sense of piecemeal prices on some of the Web sites. It’s like giving me prices for the components of a car and asking me which pieces I want to buy. The point of reform is not to put the consumer in charge but to drive quality and efficiency simultaneously. And in most industries that’s what happens. But it requires competition at the right levels.
- We have to enable outcome measurement. We should require it. The gold standard is what the federal government has for transplants: universal collection of outcomes measures, publicly reported and peer reviewed. In other areas of care where we have outcome data, we see dramatic improvement in results. New York State requires heart-bypass data. And what they’ve found is a 50 percent reduction in the death rate for patients who go to high-rated places. But patients don’t pay attention to the data.
—Penelope Lemov
Americans With Insomnia May Be Relying Too Heavily On Sleeping Pills
Americans with insomnia may be relying too heavily on sleeping pills instead of trying safer non-drug remedies, according to a new free report from Consumer Reports Best Buy Drugs. If you take sleeping pills, you should discuss their use with your doctor, and take them for the shortest period possible because of the risk of side effects and misuse.
The latest Best Buy Drugs report on insomnia examines four heavily promoted drugs -- Ambien, Lunesta, Sonata and Rozerem -- for their effectiveness, side effects and price. Although the drugs are effective, the report finds these medicines are not necessarily better than older, less expensive drugs for many people who need a sleep aid for a few nights.
All sleeping medicines have side effects, including daytime sleepiness, dizziness and rebound insomnia. They also can cause dependency and even worsen insomnia if misused or taken
too often.
The report stresses that people with mild or occasional insomnia may be relying too heavily on pills. It suggests first trying behavioral therapy to improve sleep habits, and suggests methods
to correct them.
The insomnia report is one of 14 in a series comparing the effectiveness and cost of prescription drugs to treat a range of illnesses and conditions. All the reports are available to consumers free at Consumer Reports Best Buy Drugs.
Four Steps to Help you Prevent Cancer!
These simple steps can add up to big changes in your health and may help reduce your risk of getting many kinds of cancer. For more cancer prevention tips, visit the American Cancer Society at www.cancer.org or call 1.800.ACS.2345. (Note: The cancer survival rate is climbing. The five-year survival rate is 3 in 5 or 64%.)
- Maintain a healthy weight throughout your life.
- Eat five or more servings of a variety of vegetables and fruits each day.
- Be physically active for 30 minutes or more at least five days a week.
- Do not use tobacco products.
STROKE: Remember The First Three Steps
Stroke Identification:
During a BBQ, a friend stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm, Ingrid passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don't die. They end up in a helpless, hopeless condition instead.
It only takes a minute to read this...
A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.
Recognizing a Stroke
Thank God for the sense to remember the "3" steps, STR . Read and Learn! Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say a bystander can recognize a stroke by asking three simple questions:
- S *Ask the individual to SMILE.
- T *Ask the person to TALK, to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. It is sunny out today)
- R *Ask him or her to RAISE BOTH ARMS.
NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue... if the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke. If he or she has trouble with ANY ONE of these tasks, call 911 immediately and describe the symptoms to the dispatcher.
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Consumer Health Guide Series and "Ask Your Doctor" Cards
Consumer Health Guide Series
- Consumers’ Health Reference Guide
- Heart Health Guide with Scorecard
Heart Centers in Greater Iowa - Iowa Report Card, What Patients Say About Their Experiences with Hospital Care in the Greater Iowa Area
- Iowa Report Card, Ranking of Hospitals for Chronic Care, Greater Iowa Area, with What You Can Do to Get Health Care Right?
"Ask Your Doctor" Cards
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- U.S. Department of Health and Human Services Hospital Compare
- The Joint Commission
- Consumer Reports Health
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