Corporate Research Group’s Weblog

I missed this study from October: According to the Assn. of American Medical Colleges (Washington), first-time applicants to medical schools reached an all-time high in 2011 at 32,600 — up nearly 3% from last year.  Total applications also rose 3% to nearly 44,000.

Says AAMC chief executive Darrell Kirch, M.D.:

U.S. medical schools have been responding to the nation’s health challenges by finding ways not only to select the right individuals for medicine, but also to educate and train more doctors for the future.  However, to increase the nation’s supply of physicians, the number of residency training positions at teaching hospitals must also increase to accommodate the growth in the number of students in U.S. medical schools.  We are very concerned that proposals to decrease federal support of graduate medical education will exacerbate the physician shortage, which is expected to reach 90,000 by 2020.

McKinsey Quarterly has an interesting Q&A with Hal Wolf, COO of the Permanente Foundation, the umbrella organization for Kaiser Permanente’s medical groups, highlighting some of the unintended positive consequences of integrated information technology.  Says Wolf:

Our IT system was originally designed to provide information about individual patients, but our physicians quickly realized that real value could be derived from aggregating the patient data into disease registries. Cardiovascular disease and diabetes were among the first registries we created. Today, we have more than 50 registries. These registries enable all team members to determine how well their patients are doing in comparison with other KP patients, as well as how well their patients’ outcomes stack up against national and international benchmarks.

When we started these registries, we began by tracking outcomes and co-morbidities. Over time, however, the registries have grown more sophisticated. We can now determine how even small changes in care pathways can have a significant impact on outcomes, and we can study patients with specific combinations of co-morbidities to identify the best treatment approaches for them.

Time magazine’s Scott Haig, M.D., says in a recent article that to fix healthcare we need to streamline regulation and billing, “computerize everything,” and find a better way of sanctioning bad practices without the threat of malpractice litigation.

On managed care, he writes: “It costs the typical doctor about 10%, right off the top, to collect our fees from the HMOs and other insurance companies we have to deal with.  This is due to the ultra-complex set of rules and regulations those companies have established to ‘control costs’ (read: to pay us less while their executives take home more) and the billing staffs we have to hire to deal with them. This money does nothing for patients….It could easily be eliminated with simple, intelligent, centralized payment rules.”

I always wondered what was up with all those workers shuffling papers in my doctor’s office.

The toll on human life by preventable medical errors in the U.S. (and elsewhere) is unbearable and unacceptable. We are told that some 100,000 patients die annually from hospital errors alone, and an untold number of patients suffer complications and morbidity, adding to the already high burden of health-care costs. 

Some errors in written communications (e.g. spelling errors, wrong doses) or drug interactions have received a lot of attention, mostly because they could be fixed by technological solutions.  Another factor mentioned often is human fatigue, usually the result of long hours of in-hospital on-calls by more junior staff.

The 800 pound gorilla in this story is more insidious and related to the knowledge and attitude of practicing physicians.  One of the major differences between physicians today and those 30 years ago (when I first practiced medicine) is today’s excessive reliance on technology and too little reliance on information supplied by the patient or her family. 

This is a tough problem to solve, because technology is here to stay, and the system is unlikely to reward physicians for spending more time with patients (and thus forcing them to see smaller number of patients). 

There are some ways to indeed use low-tech for improving outcomes: What if every interaction between health giver and patient (or patient’s family) is recorded?  This will, at the very least, avoid debates and misunderstandings as to who said what and when. But this may not suffice.  Our lives, and those of our families, are too important to be left totally to the control of tired and overworked medical staff.

 A new type of healthcare provider (or intermediary) must enter the picture: an advocate for the family who will make sure the physician’s orders are properly executed, the IV is running properly, correct medicine is given at the right time, and the risk of a potential in-hospital “error” is drastically reduced. 

Finally, the family of a patient who is a victim of medical errors (assuming they find out about it) should not have to pay any bills.  Of course, many issues need to be resolved before these can be implemented, but it is important to explore any new idea that might just work. Even a single avoidable death of a patient due to medical error should not be tolerated.

Maybe we need a hobby, but we can’t help following the ups and downs of neonatal intensive care provider Pediatrix—the last reminder of our days covering the now-defunct physician practice management industry. 

Shares are down 30% this year, the most recent falloff coming this week after the company lowered its earnings projections because of falling neonatal intensive care patient volume and a shift in reimbursement mix from commercial to lower-paying government payers.

What’s interesting is that last month, we reported on an initiative by UnitedHealth that has dramatically reduced NICU admissions in its southwest market.  Is there a correlation between payer NICU efforts and falling volume?  Pediatrix officials say no, blaming the shortfall instead on a decline in births in the hospitals in which it operates.  NICU admissions as a percentage of births remain steady, officials said.

So what can we conclude from all this?  A struggling economy is pushing more people into Medcaid, and we’re not making much progress in preventing NICU admissions?  Maybe.  But we’re not alone in wondering whether payers really are starting to make some progress in NICU admissions prevention?   

Pediatrix’ bottom line aside, we hope it’s the latter.