The Article the For-Profit Healthcare Sector SERIOUSLY Doesn't Want You (or Anyone) to Read

[TygrBright]

The Hot Spotters

...Besides looking at assault patterns, he began studying patterns in the way patients flowed into and out of Camden’s hospitals. “I’d just sit there and play with the data for hours,” he says, and the more he played the more he found. For instance, he ran the data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years—than any other in the city, resulting in almost three million dollars in health-care bills. “It was just this amazing window into the health-care delivery system,” he says.

So he took what he learned from police reform and tried a Compstat approach to the city’s health-care performance—a Healthstat, so to speak. He made block-by-block maps of the city, color-coded by the hospital costs of its residents, and looked for the hot spots. The two most expensive city blocks were in north Camden, one that had a large nursing home called Abigail House and one that had a low-income housing tower called Northgate II. He found that between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million.

Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.

...Could anything that dramatic happen here? An important idea is getting its test run in America: the creation of intensive outpatient care to target hot spots, and thereby reduce over-all health-care costs. But, if it works, hospitals will lose revenue and some will have to close. Medical companies and specialists profiting from the excess of scans and procedures will get squeezed. This will provoke retaliation, counter-campaigns, intense lobbying for Washington to obstruct reform.

A truly revolutionary idea: Save money by doing GOOD health care, rather than NO health care. But it would reduce or eliminate profit margins for a lot of people getting rich off of providing bad health care and no health care now, so what are the odds that anyone will actually learn from this work?

Let's just say that if it were a horse at Pimlico, I'd definitely box it in an exacta with the favorite. And then kiss my money good-bye...

pessimistically,
Bright

[ejpoeta]

1. i guess it depends what the goal is. because we are now 'customers' instead of paitients

it is obvious that the goal is to make money. that is what I have figured from the cost of pharmaceuticals and the government refusing to and even making it so they can't negotiate for medications. if you go into the hospital as your main source of medical care, then the odds are you are getting fast tracked out of there. in fact, i would say that the system is set up to pretty much do that to almost everyone who isn't rich or in congress. in and out like a mcdonald's drive up window. so what if your order is wrong.... they have it set up so it's harder to go in and complain or you won't even notice before you get home and by then you aren't coming back. then they can charge you inflated prices and how many are going to fight it?

[Ron Green]

2. My 3-part model for health care:

1) Single payer; everybody in, nobody out.
2) Public policies that encourage good eating, exercise and mental health.
3) A realistic awareness of death as life's natural end.

[FormerDittoHead]

4. COMMIE! How can any system be fair unless unlucky people suffer? n/t

It's not like medical care is some "necessity".

:sarcasm:

[patrice]

5. I hope you will consider a 4) Autonomous, self-renewing, accountable commitments to professional

standards respective to each professional field.

[Ron Green]

7. Excellent! (Although that might be included in a comprehensive

single-payer system.)

The idea of "competition" driving quality, as it's supposed to in the automobile or shampoo business, is just pathetic when Free Market Morons apply it to a medical care system. The high quality of medical science in this country ought to guarantee that we can have peer-reviewed standards that are second to none.

[patrice]

8. I like the sorts of things that Edward Deming created for this.

His quality assurance models were rejected by the American auto-industry, so he took them to Japan and the rest is a significant part of our economic history.

I think his ideas could be adapted so that health care staff, and administrations, study themselves and develop and apply THEIR OWN knowledge bases. Health care consumers could go to aggregated professional indexes to evaluate the resources that they are using.

[midnight]

23. I like this idea because it focuses on quality assurance...

Something that is sorely missing in our Health care delivery model... And for some reason when I'm in a hospital with a family member, the doctors ask who am I instead of introducing who they are...I'm not so much a fan of treating family like they are busy bodies who need to be removed.

[BobbyBoring]

10. Oh Yeah??

You're gonna tell people what to eat? What about FREEDOM!:sarcasm:

[MedicalAdmin]

16. That is not what he said.

At all.

[GTurck]

17. HURRAH!!

That is the most common sensical list on health care that I have ever seen. Wish you were in some sort of power position.

[patrice]

3. Another aspect of the costs is related to staffing shortages & the stratification of "care".

Non-conformists (Whistle-blowers) in such a culture, whether they are right or wrong, get terminated in various ways and replaced. The churn alone affects the quality of care, not to mention that functional adaptations are never tested and identified and implemented if they are in fact good for the quality of care. Everything keeps just stumbling forward, because of the shortages; whoever gets terminated (maintenance, CNAs, CMAs, and Nurses), as long as they don't have any felony in their backgrounds, can go anywhere in the country and be re-employed IMMEDIATELY. Once re-employed, any potential effect, whether it could be positive or negative, just gets churned back into the systems all over again. It's one big vicious circle driven by staffing shortages.

[patrice]

6. And the ones who ARE stable, the ones who don't get churned, have a major incentive to

go along to get along.

[patrice]

9. And the staffing shortages are driven by pressures on the quality of care. nt

[hootinholler]

11. Kick for tonight. n/t

[Scuba]

12. A simple "meals on wheels" program for the elderly....

...would eliminate gobs of malnutrition which results in extremely costly hospital stays.


An ounce of prevention....

[fasttense]

13. So fix the stairs already.

"He ran the data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years—than any other in the city."

Sound to me like there are structural problems in that building. Maybe they need an elevator or something. If falls are that prevalent, then there is a problem in the building's design.

[supernova]

14. Lotta building code violations

it sounds like. Sounds like a slum lord who isn't up to code.

That would be the first thing I'd think about with date like this. GMTA.

[catrose]

20. Code? In Massachusetts? New England?

The old buildings have some kind of grandfather clause that lets them out of code. I saw many faulty wiring fires in MA. And the nightclub in RI where so many died was another example of an old out-of-code building, with contributing factors like setting off fireworks inside under a phosphorescent ceiling.

[supernova]

15. Wow, I'd want to work for someone like this

:applause:

This is an excellent, neigh superior, use of data mining. You're using it to find the people who need the most help then at least offering it to them.

Thanks for the article.


edit: I remember working with end-stage cancer patients, one of the first things I learned was that cancer was just one of a series of problems. Some people were middle class and on top of their issues, but others were really struggling and having cancer on top of it didn't help matters. As an admin, I was constantly referring them to services in the community, like Meals on Wheels, mentioned previously. I really wondered how we could better coordinate the many pieces of these people's lives that needed monitoring. I remember being annoyed at the social workers who didn't seem to know either. (hey, I was young and didnt' realize how overworked they are.) It is gratifying to see that someone is finally paying attention to the bigger puzzle picture.

[NothingRight]

18. Sounds like European model, go figure

Brilliant article and brilliant work by the people who truly realize how health care should be delivered. Should it be a shock to us that the same morons who believe top down is the way to fix the economy believe top down is the way to handle health care?

As someone who has spent over 17 years working in healthcare, specifically senior healthcare, I see on a daily basis how the unaffordable routine care creates a burden of larger costs in hospitals.

The insurance companies themselves promote this concept. If you go have an MRI done at an outpatient radiology clinic, you are likely to pay more out of pocket than you will for an ER visit, during which they will run all sorts of tests, at a substantially higher cost.

You then take these at risk patients and charge them higher premiums than they can afford reasonably and guess what? More cutbacks on primary care or preventative care. Now they want to offer what amounts to crisis medical insurance. This coverage won't cover routine medical items, but when you do finally crash, it will cover some of what you will incur at the hospitals to be "treated and streeted" until your next crash.

Care coordinators, doctors who will actually make sure the gang of specialists people are sent to these days work in harmony with one another toward a successful outcome would be such a huge improvement over the current system of each doctor working as an independent contractor.

The author is right, hospitals may indeed close if we actually fix the system, but more primary care clinics will be needed. Clinics that will be consistently busy with people who are there to do what seems to have been lost in our current system........stay healthy.

[onethatcares]

19. one patient with 324 admissions in five years equals fraud

jeez, I'm a carpenter and can see that from a mile away. It's like having your car stolen every third day and the insurance company paying for a new one each time.

For some reason, I believe that patient is on Medicare or Medicaid.

But those are just my opinions.

[999998th word]

21. Blame the perp- not the program-

If someone is defrauding Medicare-Medicaid, they need to be found and prosecuted.

Lets not make it seem as though those programs are to blame.

[supernova]

22. Data is inconclusive

on the reasons for that particular person's story. As the article points out, in any given area you have a definable set of people with lots of problems that must be looked after and presently they aren't getting their problems addressed. It's possible the person with 324 admissions/5 years is in chronic, albeit real trouble. The point is, a healthcare professional should get in touch with them to see what their story is. That's the whole point of the org in the article.