Stephen C Schimpff's Page

In appropriating funds for the new Walter Reed National Military Medical Center and the new Fort Belvoir Community Hospital, Congress determined that the military should receive only “world class healthcare” but did not define the meaning of the term. When the Health Systems Advisory panel of the Defense Health Board described in the previous blog was assembled, it decided that its first order of business was to establish a benchmark for world class. After much discussion, research and debate, a… Continue

A very important reason for medical care cost escalation has to do with our own personal behaviors. We are a country of people who are overweight --one-third are overweight and one-third or more are frankly obese --, under-exercised, poorly fed from a nutritional perspective and highly stressed. And it gets worse each year. Even children have progressively declining physical activity from about three hours per day at age nine to less than an hour by age fifteen. And this will correlate to obesit… Continue

Last fall I was asked by Maryland Senator Benjamin Cardin to join a group evaluating whether the new Walter Reed National Military Medical Center [WRNMMC], when completed in a few years, would be “world class.” The group, a subcommittee of the Defense Health Board, met multiple times to learn about the plans and develop a report for Congress. The report is now available at http://www.health.mil/dhb/meetings/NCR%20BRAC%20HSAS%20Report%20-%20Final.pdf . Here is a brief summary. The Base Realignmen… Continue

The switch from acute to complex chronic diseases and the wide variation in care patterns are closely related. It is the complex chronic diseases that need the most attention and hence are most expensive to treat. But as a country we have long had the tradition of the independent, autonomous practioneer in the community taking care of us. This was fine for acute illnesses. The physician could either treat you him or herself or else would refer you to a particular specialist for needed care. Mayb… Continue

Recently Conrad Cyburn posted a note about the approach of Kaiser to keep costs down while quality high. They do a good job of avoiding the variations in care that exist across the country and which are part of thereason that caare is both expensive and not as good as it could or should be. There are wide variations in care expenditures from geographic region to region. One might assume that those regions with higher expenditures reap better health but that is simply not the case. Unfortunately,… Continue