Seven years ago, Massachusetts mandated that hospitals report on a public database how often they perform minimally invasive heart procedures to open blocked arteries—like angioplasty and stenting—and their death rates from these procedures. That was meant to reduce unnecessary procedures and to lower death rates, but new research from the Harvard School of Public Health and two Boston hospitals indicates that the public reporting system might also be leading to fewer angioplasties in patients who need them the most: those in the throes of a heart attack.
Monday, October 1, marked a date hospitals knew was coming since March 2010: the beginning of federal fiscal year 2013, and the initiation of the CMS Readmission Reduction Program. When the penalties rolled out consistent with the original concept, readmissions topped the agenda of hospital executive team meetings across the nation. It will be imperative to understand how hospitals—safety net and otherwise—move from a baseline of high readmissions to expected or lower-than-expected readmissions; the field is still nascent in hospital-wide results. It will also be important to study how hospitals that primarily serve underserved populations adapt and extend their partnership base with community health centers, community agencies, Medicaid payers, and other stakeholders to more effectively address the complexities of the social, economic, and behavioral drivers of hospital utilization.
At Beth Israel Deaconess Medical Center in Massachusetts, health reform means testing out new payment models and delivery systems. It also means changing the socks that patients wear. About six years ago, the health care system set a goal: It would aim to end preventable harm in its hospitals by 2012. It has just now released the results of that effort, which included "hundreds" of small changes–such as having patients wear socks with treads that could prevent falls. While the hospital has not eliminated preventable harm, it has seen such incidents cut in half–and might have a few lessons for hospitals elsewhere in the country. "There are a hundred things were doing differently. It’s really not so much about each individual project," says Beth Israel CEO Michael Tabb. "It's about a wholesale change in culture. And we think constantly about how do we improve our quality of care and how do we reduce any kind of harm to our patients."
The demise of St. Vincent's Hospital in Greenwich Village two years ago has led to a struggle for health care supremacy in some of New York's most distinctive neighborhoods, offering a glimpse, in the process, at what might be the future of urban medicine. Without building a hospital, one large chain, Continuum Health Partners, is establishing a beachhead by connecting with outpatient clinics, trying to dominate the market and create a feeder network for its hospitals in other neighborhoods. It is joining forces not just with traditional clinics but also with newer experiments like doctors working out of drugstores. A competitor, NYU Langone Medical Center, is expanding its physician practices downtown, and like Continuum, it has hired dozens of stranded St. Vincent's doctors.
Health care delivered in the emergency room is often derided as expensive and inefficient, the source of our health spending woes. Physician Robert O'Connor has a different way to describe emergency medicine: An incredibly good deal. O'Connor chairs the department of emergency medicine at the University of Virginia School of Medicine. As an emergency room doctor, he is not unbiased in defending the work he and his colleagues do. He's also pretty tired of all the rhetoric about emergency rooms as the health spending culprit. He says that ERs only account for 2 percent of all health care spending—and argues that patients actually get tons of bang for their buck.
Bigger is thought to be better in these days of health care consolidations and partnerships. Size brings the bargaining power—and the range of patient service—needed to drive down costs and to better coordinate care, improving quality. So goes the mantra uttered time and time again as hospitals and physician practices that once operated independently seek the protection of deep-pocketed partners. But whether this trend will translate into lower cost—particularly for patients—is theoretical at best, experts say. "Have you ever seen costs go down in health care? Anywhere? For anything?" said Glenn Melnick, a health economist at the nonpartisan RAND Corp.