All Blog Posts Tagged 'care' (46)

“Protocol Medicine” – It Is Time For Doctors To Recognize Its Value

We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.

Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to obtain, chemotherapy drugs, steps to prevent infection, prevent kidney…

Continue

Added by Stephen C Schimpff on February 9, 2011 at 3:25pm — No Comments

Leadership In Medicine – New Expectations, Time to Rethink What Leaders Should Be Doing

What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.

Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added admissions. A dean might be expected to develop new research programs by building new… Continue

Added by Stephen C Schimpff on November 10, 2010 at 4:45pm — No Comments

The Implications of Chronic Disease

I have written frequently about the importance of chronic illnesses. Most of us are just not aware that their incidence is rising - and rapidly. We tend to think instead about acute illnesses and injury but chronic illnesses are now not only common but last a lifetime once developed and are inherently expensive to treat. On top of that there are enormous losses in quality of life, personal productivity and economic impact on the individual and society.

The Milken Institute quantified some… Continue

Added by Stephen C Schimpff on October 19, 2010 at 2:57pm — No Comments

Time to Rethink How We Pay for Medical Care and Healthcare

Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare. In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, hospitals, drug and device companies, others) get paid for a unit of activity –… Continue

Added by Stephen C Schimpff on July 10, 2010 at 5:22pm — 3 Comments

Today’s Health Insurance Has Perverse Incentives

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality. In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care physician feels underpaid for routine visits but nevertheless we basically… Continue

Added by Stephen C Schimpff on July 1, 2010 at 8:47am — No Comments

A Disease Industry vs. A Healthcare System

Today America does not have a true healthcare system that focuses on wellness and disease prevention. Rather it focuses on disease diagnosis and treatment paid for on a unit basis. Each visit, each procedure, each test, each drug, each hospitalization is charged for. The result is more and more units of care are given rather than a focus on how to give good preventive care and how to coordinate the care of those with complex chronic illnesses. As long as we have a disease industry – driven by… Continue

Added by Stephen C Schimpff on June 24, 2010 at 5:36pm — 3 Comments

Turbulence Ahead in Health Care

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.

But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or diagnostic device in a clinical laboratory – to create any return on the investment before a new or… Continue

Added by Stephen C Schimpff on June 10, 2010 at 4:26pm — No Comments

Further Disruptive Trends in Medicine

Generally we prefer calm seas but often they don’t get us anywhere. We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change. Here a few more disruptive changes or refinements that are leading to disruptions of the old ways.… Continue

Added by Stephen C Schimpff on May 4, 2010 at 7:39am — No Comments

Disruptive Changes Are Coming to the Delivery of Medical Care

The following was an invited post on Harvard Busines Review web site last Friday.

We have grown accustomed to scientific research producing major medical advances such as those I wrote about in The Future of Medicine — Megatrends in Healthcare. But there are now some very disruptive changes coming in how medical care will be delivered by your doctor or hospital.

Some examples:

Team-based care for chronic illness. The combination of an aging population and… Continue

Added by Stephen C Schimpff on April 25, 2010 at 4:42pm — No Comments

Teamwork Can Help Avert the Pending Cost Crisis in Health Care

The following was posted by me at Harvard Business Review yesterday. http://blogs.hbr.org/cs/2010/04/teamwork_can_help_avert_the_pe.html

Most health care money in the United States goes largely for the care of people with complex chronic illnesses such as diabetes, heart failure, cancer, lung disease, and the like. We will soon see many more individuals with these illnesses because of two factors: the… Continue

Added by Stephen C Schimpff on April 13, 2010 at 11:08am — No Comments

Misconception - Primary care physicians do not deal with the expensive aspects of medical care so they can have little impact on reducing medical expenditures.

Two major reasons for cost escalation are lack of good care coordination of those with complex chronic illnesses and inadequate attention to prevention and screening. PCPs are key to both of these but they have too little time per patient and are not paid for either activity. About 5% of all healthcare expenditures go to PCPs but they can have a major impact on the other 95%, especially with good care coordination of chronic illness and with a focus on prevention.

To fix this, PCPs… Continue

Added by Stephen C Schimpff on January 14, 2010 at 5:19pm — No Comments

Misconception – Healthcare reform will fundamentally improve how we receive care going forward.

This is also not at all likely except for those who do not now have medical care insurance. For the rest of us, medical care delivery will change but it will change not because of reform but because of some fundamental societal and demographic reasons along with a marked change in the types, severity and chronicity of illnesses that is occurring right now. The combination of an aging population and our non-healthy lifestyles (obesity, poor nutrition, lack of exercise, stress and smoking) are… Continue

Added by Stephen C Schimpff on December 21, 2009 at 2:12pm — No Comments

Misconception - “Health care reform” will improve the delivery of care and offer us better care opportunities.

In fact, healthcare reform is not about healthcare; it is mostly about paying for medical care for the uninsured and only somewhat about the rising costs of medical care. I use the term medical care here to emphasize that today American “healthcare” is all about treating disease and injury and very little about promoting wellness and preventing illness. The reforms being proposed are about addressing the financing of medical care but not the quality, the safety or the way that healthcare will… Continue

Added by Stephen C Schimpff on December 12, 2009 at 3:41pm — 2 Comments

Common Misconceptions About Healthcare Reform

American medicine must change - and the change will be both substantial and difficult to achieve but change is critical if we are to have a well functioning healthcare system that affords all of us safe, quality care at a reasonable cost in a customer-focused manner. Today there are many misconceptions about healthcare reform - misconceptions about who will have access, how much it will cost, who will pay the bills, whether it will benefit those who currently have insurance, whether there will… Continue

Added by Stephen C Schimpff on December 9, 2009 at 10:01am — 3 Comments

Guest Blog: Do 297 hospitals really use social media? Should you?

Colleagues,

Interesting guest blog from Roberta Rochman, RN, MBA in Examiner.Com on the spreading use of Health 2.0 tools by top flight medical institutions such as Johns Hopkins, Mayo Clinic and Duke University...

ENJOY!

CC

------------------------------------------------------------------------------------

Yes, indeed, 297 hospitals use some form of Social… Continue

Added by CC-Conrad Clyburn-MedForeSight on August 8, 2009 at 11:30am — 1 Comment

Personal Behoviors and the Costs of Medical Care

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… Continue

Added by Stephen C Schimpff on July 31, 2009 at 9:08am — No Comments

World Class Health Care at Walter Reed

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… Continue

Added by Stephen C Schimpff on July 26, 2009 at 3:23pm — No Comments

Lack of Care Coordination Hinders Care Quality and Escalates costs

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.… Continue

Added by Stephen C Schimpff on July 20, 2009 at 10:00am — 1 Comment

Medical Care Varies By Geographic Region

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.… Continue

Added by Stephen C Schimpff on July 16, 2009 at 10:13am — No Comments

Complex, Chronic Illnesses That Last a Lifetime and Are Expensive to Treat

I appreciate the comments to my earlier post on the state of America's health care delivery system. We have incredible medical advances, of the type often referred to on MedTecIQ, but if they cannot be dellivered to the right people at the right time, then they are not being fully utilized to best advantage. One pressing need is to recognize the marked shift in disease prevalence from acute illness to chronic illnesses that has occured over the years; it is a real… Continue

Added by Stephen C Schimpff on June 29, 2009 at 2:14pm — No Comments