The document discusses quality management in anesthesia practices. It introduces the Anesthesia Incident Reporting System (AIRS), which allows providers to anonymously report unintended events or "near misses" that did not harm patients but had potential to. Near misses provide teaching opportunities at morbidity and mortality conferences. Mature practices encourage self-reporting of near misses through online forms or other methods. Reported cases are reviewed to identify those with educational value for discussing key decision points with the goal of improving patient safety.
Incident decision tree following james reasonDigitalPower
The document describes the development of the Incident Decision Tree by the National Patient Safety Agency in the UK. The tool was created to provide guidelines for NHS managers on determining a fair course of action, like suspension, for staff involved in patient safety incidents. It encourages considering systems failures rather than individual blame, as research shows the majority of incidents stem from systems issues. Initial findings found the tree robust and adaptable across healthcare environments and professions. It aims to standardize the approach and encourage open reporting of incidents.
The document summarizes the key points from a panel discussion on solving America's workers' compensation crisis. The panel identified four main changes needed: 1) Eliminate unproven therapies in favor of accurate diagnosis and evidence-based treatment; 2) Identify at-risk workers early and invest in wellness programs; 3) Embrace innovative treatment solutions currently not covered by insurance; and 4) Advocate for changes to public policy to alleviate financial motivations that drive up costs. The panel agreed comprehensive reform is needed across the entire workers' compensation system to improve outcomes and reduce costs.
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides 3 key points:
1) The PCMH model emphasizes primary care-led, coordinated, and comprehensive care centered around the patient. It aims to improve access, outcomes and reduce costs through care coordination and an emphasis on prevention.
2) Studies show PCMH interventions can reduce hospital and ER use by over 30% each and lower total costs by 9% while maintaining or improving outcomes.
3) Successful PCMH models require health IT and data sharing to facilitate care coordination, population health management, and quality improvement. They also rely on payment reforms that appropriately recognize the added value of the medical
This is an old article (2007) on the dangers of oversaturation of paramedics vs. EMTs. Well written, timely , and evidence based. Written by Matt Zavadsky. The original website, www.emsnetwork.org, is now defunct so I repost it so it doesn't get lost forever.
The Arizona Crisis Now Model: AHCCCS OutcomesDavid Covington
In 2016, the National Action Alliance for Suicide Prevention published “Crisis Now: Transforming Care is Within Our Reach.” Alignment with these practices cuts cost of care substantially, reduces the need for psychiatric hospital bed usage, ED visits and law enforcement overuse; resulting in better health and declines in suicide rate, justice system involvement/ incarcerations and psychiatric boarding. These challenges are simply greater than previously acknowledged, but the Washington State supreme court ruling on the unconstitutionality of boarding, the suicide death of Virginia State Senator Creigh Deeds’ son, the insistence of hospitals nationwide about the costs and safety and the series of violent incidents from Columbine forward are changing the expectations. These innovative approaches pioneered under the leadership of Arizona Medicaid are now being replicated throughout the US.
- The document summarizes the benefits of implementing a patient-centered medical home (PCMH) model, including reduced costs, improved outcomes, and better care coordination.
- Studies show PCMH practices have significantly reduced costs, especially inpatient costs, and utilization for high-risk patients. They have also improved outcomes such as reduced hospital days and emergency room visits.
- Transitioning to a PCMH model focuses on proactive, coordinated care through a team-based approach rather than episodic care during office visits. This emphasizes prevention, chronic disease management, and tracking of tests and follow-ups.
In 2016, the National Action Alliance for Suicide Prevention published “Crisis Now: Transforming Care is Within Our Reach.” Alignment with these practices cuts cost of care substantially, reduces the need for psychiatric hospital bed usage, ED visits and law enforcement overuse; resulting in better health and declines in suicide rate, justice system involvement/ incarcerations and psychiatric boarding. These challenges are simply greater than previously acknowledged, but the Washington State supreme court ruling on the unconstitutionality of boarding, the suicide death of Virginia State Senator Creigh Deeds’ son, the insistence of hospitals nationwide about the costs and safety and the series of violent incidents from Columbine forward are changing the expectations. These innovative approaches pioneered under the leadership of Arizona Medicaid are now being replicated throughout the US.
The document discusses quality management in anesthesia practices. It introduces the Anesthesia Incident Reporting System (AIRS), which allows providers to anonymously report unintended events or "near misses" that did not harm patients but had potential to. Near misses provide teaching opportunities at morbidity and mortality conferences. Mature practices encourage self-reporting of near misses through online forms or other methods. Reported cases are reviewed to identify those with educational value for discussing key decision points with the goal of improving patient safety.
Incident decision tree following james reasonDigitalPower
The document describes the development of the Incident Decision Tree by the National Patient Safety Agency in the UK. The tool was created to provide guidelines for NHS managers on determining a fair course of action, like suspension, for staff involved in patient safety incidents. It encourages considering systems failures rather than individual blame, as research shows the majority of incidents stem from systems issues. Initial findings found the tree robust and adaptable across healthcare environments and professions. It aims to standardize the approach and encourage open reporting of incidents.
The document summarizes the key points from a panel discussion on solving America's workers' compensation crisis. The panel identified four main changes needed: 1) Eliminate unproven therapies in favor of accurate diagnosis and evidence-based treatment; 2) Identify at-risk workers early and invest in wellness programs; 3) Embrace innovative treatment solutions currently not covered by insurance; and 4) Advocate for changes to public policy to alleviate financial motivations that drive up costs. The panel agreed comprehensive reform is needed across the entire workers' compensation system to improve outcomes and reduce costs.
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides 3 key points:
1) The PCMH model emphasizes primary care-led, coordinated, and comprehensive care centered around the patient. It aims to improve access, outcomes and reduce costs through care coordination and an emphasis on prevention.
2) Studies show PCMH interventions can reduce hospital and ER use by over 30% each and lower total costs by 9% while maintaining or improving outcomes.
3) Successful PCMH models require health IT and data sharing to facilitate care coordination, population health management, and quality improvement. They also rely on payment reforms that appropriately recognize the added value of the medical
This is an old article (2007) on the dangers of oversaturation of paramedics vs. EMTs. Well written, timely , and evidence based. Written by Matt Zavadsky. The original website, www.emsnetwork.org, is now defunct so I repost it so it doesn't get lost forever.
The Arizona Crisis Now Model: AHCCCS OutcomesDavid Covington
In 2016, the National Action Alliance for Suicide Prevention published “Crisis Now: Transforming Care is Within Our Reach.” Alignment with these practices cuts cost of care substantially, reduces the need for psychiatric hospital bed usage, ED visits and law enforcement overuse; resulting in better health and declines in suicide rate, justice system involvement/ incarcerations and psychiatric boarding. These challenges are simply greater than previously acknowledged, but the Washington State supreme court ruling on the unconstitutionality of boarding, the suicide death of Virginia State Senator Creigh Deeds’ son, the insistence of hospitals nationwide about the costs and safety and the series of violent incidents from Columbine forward are changing the expectations. These innovative approaches pioneered under the leadership of Arizona Medicaid are now being replicated throughout the US.
- The document summarizes the benefits of implementing a patient-centered medical home (PCMH) model, including reduced costs, improved outcomes, and better care coordination.
- Studies show PCMH practices have significantly reduced costs, especially inpatient costs, and utilization for high-risk patients. They have also improved outcomes such as reduced hospital days and emergency room visits.
- Transitioning to a PCMH model focuses on proactive, coordinated care through a team-based approach rather than episodic care during office visits. This emphasizes prevention, chronic disease management, and tracking of tests and follow-ups.
In 2016, the National Action Alliance for Suicide Prevention published “Crisis Now: Transforming Care is Within Our Reach.” Alignment with these practices cuts cost of care substantially, reduces the need for psychiatric hospital bed usage, ED visits and law enforcement overuse; resulting in better health and declines in suicide rate, justice system involvement/ incarcerations and psychiatric boarding. These challenges are simply greater than previously acknowledged, but the Washington State supreme court ruling on the unconstitutionality of boarding, the suicide death of Virginia State Senator Creigh Deeds’ son, the insistence of hospitals nationwide about the costs and safety and the series of violent incidents from Columbine forward are changing the expectations. These innovative approaches pioneered under the leadership of Arizona Medicaid are now being replicated throughout the US.
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
Healthy Analytics - Prevention through PredictionBenjamin Ashkar
The document describes the process of preparing heart failure patient data for predictive modeling to reduce readmission rates and costs. Key steps included data cleansing, profiling, de-duplication, segmentation, aggregation, and fuzzy matching to identify heart-related procedures. Final data sets with 544 records were created to model predictors of above average charges and effective treatments leading to lower readmission.
This document presents research on the impact of weekly work hours for health employees on patient satisfaction. The researchers gathered data from 2008 on average weekly work hours, hospital cleanliness, employee salaries, and noise levels to create a regression model testing the hypothesis that more work hours leads to lower patient satisfaction. However, the results did not provide a clear conclusion as none of the coefficients were statistically significant. The researchers believe using different data sources and arbitrary cutoff values for control variables weakened the analysis. Overall, the study was unable to determine the effect of weekly work hours on patient satisfaction.
Whitepaper - Attitudes Toward Patient Harm And Hospital FinancesWilliam Andrews
Patient safety leaders believe that reducing harm improves both patient outcomes and financial performance. However, the survey found that while hospital executives agree on this, less than half of safety leaders believe their organizations have clear plans to achieve zero preventable errors. Most safety leaders also report not having full support and resources. Respondents indicated that new initiatives require business cases to receive funding. Recent research demonstrates adverse events negatively impact profits by over $1,000 per incident on average, representing a potential $63 billion annual cost to the healthcare system. This provides strong evidence that improved safety measurably benefits both patients and financial outcomes.
Learn how Methodist Richardson Achieved Fastest Total Patient Treatment Time ...EmCare
Methodist Richardson Medical Center (MRMC) and the Richardson Fire Department (RFD) were recognized by the American Heart Association for having the fastest total combined patient treatment time for cardiac events for the first quarter of 2011 for the state of Texas.
The dental practice of Dr. Hart and Dr. Stern began using an antioxidant scanner to measure patients' antioxidant levels. This was well-received by patients and increased business for the practice. It generated scan fees and led some patients to purchase supplements. The scanner helped promote the practice as preventatively-focused and brought in new patients. It also motivated staff through bonus incentives. Within two months, scans and supplement sales increased, generating over $4,000 in revenue for the practice. The scanner received positive publicity that attracted interest from other dental offices.
Making Healthcare Waste Reduction and Patient Safety Actionable - HAS Session 6Health Catalyst
Multiple studies have estimated that at least 30% of US healthcare expenditures are wasteful. But how do you identify and reduce that waste? In this session, we will share with you a three-part framework for understanding, measuring and addressing waste reduction. In particular, we will highlight the importance patient safety and injury prevention, framing the importance of shifting from a system of incident reporting (which creates a culture of blame and guilt) to a system in which patient injury is regarded as a process failure rather than a person failure. To make that transition, health systems will need to 1) define process flows and metrics for each major type of patient injury; and 2) create a learning environment in which team members are engaged in process redesign to prevent process failure and injury. A leading health system in patient safety and quality will also share their best practices in how they have created a culture of patient safety and quality.
Why a Patient-centric Approach Is Best: Stories from a PhysicianHealth Catalyst
This document discusses the importance of taking a patient-centric approach in healthcare. It describes stories from the author's experience as a physician where focusing first on the patient led to better outcomes. It discusses how the author's mentors emphasized connecting with patients as people rather than just their diagnoses. One story describes how thoroughly documenting a finding in a patient's chart led to the discovery of an aortic aneurysm and a life-saving surgery. The author advocates working together as a team with the primary focus always being on improving patients' lives.
MMS State of the State Conference: Elliott Fisher - Rethinking Health Care - ...Frank Fortin
The document discusses rising healthcare costs and declining quality in the US healthcare system. It argues that the current system rewards more treatment and increased capacity, rather than value and outcomes. It proposes moving towards accountable care organizations that are accountable for overall costs and outcomes, comprehensive performance measurement, and payment reform to reward high-value care rather than volume of services. Massachusetts could lead the way by fostering the development of accountable care organizations.
What is possible in a hospital getting to zero harm cincinati childrens story...Proqualis
Apresentação de Stephen Muething durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
For a complete podcast interview on this topic with Jim Kean, visit: http://rebootedbody.com/006/
Check out wellnessFX: http://rebootedbody.com/wellness/
And find more information on sustainable health, nutrition, fitness, and psychology at http://rebootedbody.com
The document summarizes information about patient-centered medical homes (PCMHs) and healthcare transformation efforts at the University of Utah and elsewhere. It discusses how PCMHs have led to reductions in emergency room visits, hospital admissions, and specialty care visits while improving outcomes for patients. The document also outlines the key principles of the PCMH model and how it can improve coordination of care, access, and overall population health while lowering costs.
The document discusses laws and initiatives aimed at improving healthcare quality in the United States. It notes that Congress passed several laws establishing new quality programs in response to consensus around the importance of quality improvement. Key laws and initiatives discussed include the Medicare Prescription Drug, Improvement and Modernization Act of 2002, the Affordable Care Act of 2010, and the establishment of the Center for Medicare and Medicaid Innovation in 2011 to develop and test new payment models. The document also discusses the development and goals of value-based purchasing programs and accountable care organizations.
Quality improvement is important in ensuring continuous development in service delivery, design or staff education hence a continuous improvement in patient outcome. Patient satisfaction begins in the ED, service delivery in the ED should be exemplary to ensure a better reputation for the hospital in the community and among patients. Quality improvement in the ED will improve patients’ outcomes, the process of care and reduce mortality due to ED delay.
Pediatric Adverse Drug Events PresentationJordan Gamart
This document summarizes a webinar on pediatric adverse drug events hosted by the Patient Safety Movement Foundation. The webinar featured presentations from Dr. Anne Lyren on Children's Hospitals' Solutions for Patient Safety and Dr. James Broselow on eBroselow. Dr. Lyren discussed strategies to reduce pediatric adverse drug events through programs, checklists, and technology. Dr. Broselow discussed how assistive technologies can help standardize and simplify drug administration in pediatrics to reduce errors through features like dose verification and guidelines. The webinar provided an overview of initiatives and tools to help hospitals improve pediatric safety.
Telehealth offers convenient virtual care that can reduce costs while improving outcomes. It allows patients to access care remotely through video or phone instead of visiting physical offices. This saves money by reducing unnecessary emergency room visits and tests. It also improves productivity and wellness by making care more accessible. Telehealth is highly satisfactory to patients and can help prevent medical issues by facilitating preventative care. Its 24/7 availability makes telehealth a valuable option for employers and insurers to include in health plans.
This document provides an overview of Dr Foster Intelligence's annual audit of hospital quality and performance in England. Some key findings include:
- 95% of trusts have reduced mortality rates over the past 5 years, with fewer trusts performing poorly and less extreme outliers.
- All trusts performing coronary artery bypass grafts have mortality rates within the expected range, though there is up to a 4-fold variation.
- Six trusts had above expected mortality for fractured neck of femur.
- Waiting times are falling but challenges remain for orthopaedics and diagnostics to meet 18-week targets.
- There is significant variation in following best practices and clinical guidelines across trusts and regions.
- Effective measures of patient safety
This annotated bibliography provides an overview of literature relevant to exploring representations of the McRobies Gully landfill site in Tasmania. The literature is divided into three sections: geographies of waste, aesthetics and ecological relations, and making landscapes. Key sources discuss waste as dependent on human culture rather than an inherent quality; critique linear understandings of waste in favor of complex networks; and analyze landscape as encoding political power and shaping human relationships with place over time through complex interrelations. Gaps in the literature regarding non-human animals' relationships with waste are also noted.
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
Healthy Analytics - Prevention through PredictionBenjamin Ashkar
The document describes the process of preparing heart failure patient data for predictive modeling to reduce readmission rates and costs. Key steps included data cleansing, profiling, de-duplication, segmentation, aggregation, and fuzzy matching to identify heart-related procedures. Final data sets with 544 records were created to model predictors of above average charges and effective treatments leading to lower readmission.
This document presents research on the impact of weekly work hours for health employees on patient satisfaction. The researchers gathered data from 2008 on average weekly work hours, hospital cleanliness, employee salaries, and noise levels to create a regression model testing the hypothesis that more work hours leads to lower patient satisfaction. However, the results did not provide a clear conclusion as none of the coefficients were statistically significant. The researchers believe using different data sources and arbitrary cutoff values for control variables weakened the analysis. Overall, the study was unable to determine the effect of weekly work hours on patient satisfaction.
Whitepaper - Attitudes Toward Patient Harm And Hospital FinancesWilliam Andrews
Patient safety leaders believe that reducing harm improves both patient outcomes and financial performance. However, the survey found that while hospital executives agree on this, less than half of safety leaders believe their organizations have clear plans to achieve zero preventable errors. Most safety leaders also report not having full support and resources. Respondents indicated that new initiatives require business cases to receive funding. Recent research demonstrates adverse events negatively impact profits by over $1,000 per incident on average, representing a potential $63 billion annual cost to the healthcare system. This provides strong evidence that improved safety measurably benefits both patients and financial outcomes.
Learn how Methodist Richardson Achieved Fastest Total Patient Treatment Time ...EmCare
Methodist Richardson Medical Center (MRMC) and the Richardson Fire Department (RFD) were recognized by the American Heart Association for having the fastest total combined patient treatment time for cardiac events for the first quarter of 2011 for the state of Texas.
The dental practice of Dr. Hart and Dr. Stern began using an antioxidant scanner to measure patients' antioxidant levels. This was well-received by patients and increased business for the practice. It generated scan fees and led some patients to purchase supplements. The scanner helped promote the practice as preventatively-focused and brought in new patients. It also motivated staff through bonus incentives. Within two months, scans and supplement sales increased, generating over $4,000 in revenue for the practice. The scanner received positive publicity that attracted interest from other dental offices.
Making Healthcare Waste Reduction and Patient Safety Actionable - HAS Session 6Health Catalyst
Multiple studies have estimated that at least 30% of US healthcare expenditures are wasteful. But how do you identify and reduce that waste? In this session, we will share with you a three-part framework for understanding, measuring and addressing waste reduction. In particular, we will highlight the importance patient safety and injury prevention, framing the importance of shifting from a system of incident reporting (which creates a culture of blame and guilt) to a system in which patient injury is regarded as a process failure rather than a person failure. To make that transition, health systems will need to 1) define process flows and metrics for each major type of patient injury; and 2) create a learning environment in which team members are engaged in process redesign to prevent process failure and injury. A leading health system in patient safety and quality will also share their best practices in how they have created a culture of patient safety and quality.
Why a Patient-centric Approach Is Best: Stories from a PhysicianHealth Catalyst
This document discusses the importance of taking a patient-centric approach in healthcare. It describes stories from the author's experience as a physician where focusing first on the patient led to better outcomes. It discusses how the author's mentors emphasized connecting with patients as people rather than just their diagnoses. One story describes how thoroughly documenting a finding in a patient's chart led to the discovery of an aortic aneurysm and a life-saving surgery. The author advocates working together as a team with the primary focus always being on improving patients' lives.
MMS State of the State Conference: Elliott Fisher - Rethinking Health Care - ...Frank Fortin
The document discusses rising healthcare costs and declining quality in the US healthcare system. It argues that the current system rewards more treatment and increased capacity, rather than value and outcomes. It proposes moving towards accountable care organizations that are accountable for overall costs and outcomes, comprehensive performance measurement, and payment reform to reward high-value care rather than volume of services. Massachusetts could lead the way by fostering the development of accountable care organizations.
What is possible in a hospital getting to zero harm cincinati childrens story...Proqualis
Apresentação de Stephen Muething durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
For a complete podcast interview on this topic with Jim Kean, visit: http://rebootedbody.com/006/
Check out wellnessFX: http://rebootedbody.com/wellness/
And find more information on sustainable health, nutrition, fitness, and psychology at http://rebootedbody.com
The document summarizes information about patient-centered medical homes (PCMHs) and healthcare transformation efforts at the University of Utah and elsewhere. It discusses how PCMHs have led to reductions in emergency room visits, hospital admissions, and specialty care visits while improving outcomes for patients. The document also outlines the key principles of the PCMH model and how it can improve coordination of care, access, and overall population health while lowering costs.
The document discusses laws and initiatives aimed at improving healthcare quality in the United States. It notes that Congress passed several laws establishing new quality programs in response to consensus around the importance of quality improvement. Key laws and initiatives discussed include the Medicare Prescription Drug, Improvement and Modernization Act of 2002, the Affordable Care Act of 2010, and the establishment of the Center for Medicare and Medicaid Innovation in 2011 to develop and test new payment models. The document also discusses the development and goals of value-based purchasing programs and accountable care organizations.
Quality improvement is important in ensuring continuous development in service delivery, design or staff education hence a continuous improvement in patient outcome. Patient satisfaction begins in the ED, service delivery in the ED should be exemplary to ensure a better reputation for the hospital in the community and among patients. Quality improvement in the ED will improve patients’ outcomes, the process of care and reduce mortality due to ED delay.
Pediatric Adverse Drug Events PresentationJordan Gamart
This document summarizes a webinar on pediatric adverse drug events hosted by the Patient Safety Movement Foundation. The webinar featured presentations from Dr. Anne Lyren on Children's Hospitals' Solutions for Patient Safety and Dr. James Broselow on eBroselow. Dr. Lyren discussed strategies to reduce pediatric adverse drug events through programs, checklists, and technology. Dr. Broselow discussed how assistive technologies can help standardize and simplify drug administration in pediatrics to reduce errors through features like dose verification and guidelines. The webinar provided an overview of initiatives and tools to help hospitals improve pediatric safety.
Telehealth offers convenient virtual care that can reduce costs while improving outcomes. It allows patients to access care remotely through video or phone instead of visiting physical offices. This saves money by reducing unnecessary emergency room visits and tests. It also improves productivity and wellness by making care more accessible. Telehealth is highly satisfactory to patients and can help prevent medical issues by facilitating preventative care. Its 24/7 availability makes telehealth a valuable option for employers and insurers to include in health plans.
This document provides an overview of Dr Foster Intelligence's annual audit of hospital quality and performance in England. Some key findings include:
- 95% of trusts have reduced mortality rates over the past 5 years, with fewer trusts performing poorly and less extreme outliers.
- All trusts performing coronary artery bypass grafts have mortality rates within the expected range, though there is up to a 4-fold variation.
- Six trusts had above expected mortality for fractured neck of femur.
- Waiting times are falling but challenges remain for orthopaedics and diagnostics to meet 18-week targets.
- There is significant variation in following best practices and clinical guidelines across trusts and regions.
- Effective measures of patient safety
This annotated bibliography provides an overview of literature relevant to exploring representations of the McRobies Gully landfill site in Tasmania. The literature is divided into three sections: geographies of waste, aesthetics and ecological relations, and making landscapes. Key sources discuss waste as dependent on human culture rather than an inherent quality; critique linear understandings of waste in favor of complex networks; and analyze landscape as encoding political power and shaping human relationships with place over time through complex interrelations. Gaps in the literature regarding non-human animals' relationships with waste are also noted.
Hi speed video toepassingen in de industrie 20120615-sWouterdestecker
These are the slides as used during the presentation for the Dutch Maintenance association NVDO in december 2011. All the high speed movies are available via the youtube channel "Cyclocam".
ICA is a consulting firm that provides services related to foreign direct investment (FDI) including location selection and optimization. It has developed LocationSelector, a software tool with four modules that allows users to benchmark and analyze the competitiveness of over 200 countries and 350 cities based on over 400 factors. LocationSelector provides visualizations and rankings to help multinational companies and governments evaluate potential locations for investment projects and portsfolios.
El documento resume la reflexión de Ana Marisol Gonzales Pérez sobre el Módulo IV. Describe sus conocimientos previos sobre organizadores gráficos como mapas mentales y cómo ha adquirido nuevos aprendizajes sobre la herramienta Mindmeister para elaborar mapas mentales. Planea utilizar estos conocimientos en su labor docente con estudiantes. Su participación en el módulo fue activa a través de lecturas, elaboración de actividades y comentarios en el foro.
The document provides 70 sales tips and motivational quotes intended to help sales professionals focus on their goals and improve their skills. Some of the key tips include preparing thoroughly for each sales call, listening to customers without interrupting, asking questions to understand their needs and pain points, exceeding expectations to build trust, and persisting through obstacles and rejections. The overall message is that sales success requires passion, focus, resilience and a willingness to constantly learn and improve.
Intangibles make up 70% of the value of the average transaction and company. This presentation provides a primer on how to incorporate intangibles into your mainstream management. Maximize the performance and value of intangibles including human, relationship and structural capital. For more information, please visit www.i-capitaladvisors.com
Improving RDF Search Performance with Lucene and SIRENMike Hugo
This document discusses improving the performance of semantic web applications by indexing RDF datasets with Lucene, SIREn, and RDF. It begins with an overview of SPARQL and its limitations for querying large datasets. It then introduces Lucene as a way to index and search text fields from RDF triples for improved query performance. Finally, it discusses how SIREn can be used to extend Lucene indexing to support semi-structured data from RDF triples beyond just text fields.
1) General practice is under pressure due to increasing patient populations, consultations, complexity of cases, and costs while receiving decreasing relative funding and workforce.
2) The needs of patients are changing as more have multiple long-term conditions requiring holistic and ongoing care rather than occasional acute issues.
3) To meet changing patient needs, general practice will need to move away from the traditional model of GPs as gatekeepers and work more collaboratively within integrated systems using a broader workforce.
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Going Beyond Genomics in Precision Medicine: What's NextHealth Catalyst
Precision medicine processes, while involving genomics, are not confined to working with data about an individual’s genes, environment, and lifestyle. Precision medicine also means putting patients on the right path of care, taking into consideration other individual tolerances, such as participation and cost. Precision medicine processes incorporate data beyond the individual, pulling in socio-economic data, as well as relevant internal and external data, to create an entire patient data ecosystem. With reusable data modules, this information is processed within a closed-loop analytics framework to facilitate clinical decision making at the point of care. This optimizes clinical workflow, thus leading to more precise medicine.
The document discusses how Canada's healthcare system can be improved through adopting a value-based model and increased use of technology. It notes that Canada's system scores below average on key indicators and is fragmented with siloed administration and funding. Implementing value-based healthcare, which focuses on patient outcomes and bundles all costs of a patient's journey, could lower costs and improve quality by breaking down these silos. Emerging technologies also offer opportunities to provide better care and save lives at lower costs, but the current system does not always embrace these due to its compartmentalized structure.
PCPCC on the Patient-Centered Medical Homedebronkart
The document discusses transforming primary care practices into patient-centered medical homes (PCMHs) through collaboration between large employers, employer coalitions, and primary care providers. The key points are:
1) Establishing long-term patient-doctor relationships and comprehensive primary care focused on patients' needs can improve health outcomes and reduce costs.
2) The current healthcare system fails to support primary care adequately through funding and incentives.
3) Transforming primary care practices into PCMHs through collaborative efforts between employers and providers can help fix these issues by improving care coordination and shifting reimbursements to support comprehensive care.
The document compares healthcare systems in the UK and US, identifies problems with both, and proposes solutions. It finds that while both systems provide generally good care, neither is optimal. The US system is overly expensive and not truly a free market. The NHS is underfunded and rationing is becoming covert. Both generalist care and informed consumers are lacking. Incremental reforms toward universal coverage, transparent pricing, and incentives for high-quality care are needed.
Pharmanex HCP presentation, Provo, Utah 03 Louis Cady, MD
This is the slightly trimmed version of "The Gathering Storm, The Breaking Dawn" talk I previously gave in California, dealing with the failing financial and physical health of the American public (other than the much talked about "1%") as well as the medical care system which is in danger of imploding. The Pharmanex Biophotonic scanner, its validation, and the rationale behind the LifePak supplement line is reviewed.
The document discusses the challenges of uncertainty for doctors in general practice and family medicine. It defines uncertainty as being at the core of medicine due to a lack of complete information about patients' past, present, and future conditions. Doctors must cope with uncertainty in medical histories, diagnoses, potential outcomes, and impacts of interventions. How doctors and patients communicate and cope with uncertainty has implications for medical ethics, referrals, prescribing practices, and overuse of services. Uncertainty is an inevitable part of medicine that doctors and patients must learn to acknowledge and manage together.
Don Berwick offered 10 tips for improving the NHS in his speech:
1. Put patients at the center of care by customizing care to individuals and involving patients in their own care.
2. Stop restructuring the NHS to provide stability for improvements.
3. Strengthen local community health systems as the core unit for leadership, management, and care coordination.
4. Reinvest in general practice and primary care, which are the foundation of the healthcare system.
This document discusses the benefits of Medical Follow-Up, a program that provides sound medical advice and periodic follow-ups from world-leading specialists, no matter their location. It allows patients to ensure their diagnosis and treatment are in line with the most recent medical advancements. The program offers top-level second medical opinions and follow-ups to increase access to specialists, improve outcomes, and reduce costs for insurance companies and employers providing healthcare. Real-life cases demonstrate how second opinions identified more effective treatments no longer considered standard. Timely input from experts can significantly improve recovery times and long-term outcomes.
The future of general practice - how can the PM Challenge Fund help?Robert Varnam Coaching
A presentation to GPs in Worcester, reflecting on the challenges facing general practice, presenting the emerging evidence about successful GP federations and suggesting ways in which GP practices can take their destiny in their hands and release more of their potential.
The document summarizes key issues facing the U.S. healthcare system including rising costs, an increasing number of uninsured and underinsured Americans, and poor health outcomes compared to other developed nations. It attributes these problems partially to the for-profit insurance model which incentivizes denying claims to maximize profits. This leads to high administrative waste as hospitals must employ large staffs to deal with insurance bureaucracies. The majority of healthcare spending is shouldered by the government through programs like Medicare and Medicaid, yet the U.S. still spends over twice as much per capita as other countries without achieving better population health.
The document summarizes several myths that impede effective management in healthcare. It discusses that (1) healthcare systems are often not failing as believed but are instead succeeding expensively, (2) complex social engineering solutions from detached experts usually do not work as well as changes developed by engaged clinicians, and (3) treating healthcare more like a business has not improved the high administrative costs and mediocre quality outcomes in the United States compared to countries with less business-oriented models. The document argues for reframing healthcare management to be more collaborative, adaptive, and recognize the system as more than just the sum of its parts.
This document summarizes lessons learned from reviewing 1,889 health news stories based on 10 criteria of quality. The most common flaws found were exaggerating effects, failing to provide absolute risk values, using causal language for observational studies, and relying on single sources without independent analysis. Proper risk communication requires stating absolute rather than just relative risk. Framing of health news stories on the same topics can differ dramatically depending on whether independent expert perspectives are included that provide necessary context.
doctors and nurses can be differentiated in an effortless manner. Doctors study and cure disease, while nurses study and heal people. Too know more visit: https://at.tumblr.com/medicalsaffairsusa/what-can-nurses-do-that-doctors-cannot/31c42h37gaen
This is a ppt. presentation for an audience of professionals who contacts within their own place of business as well as networking contacts with other businesses. It is design to generate interest in hosting a wellness workshop in a workplace.
Similar to Post-Election Health Policy - Impact on Physicians (20)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
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Post-Election Health Policy - Impact on Physicians
1. Post-Election Health Policy:
Impact on Physicians
Bruce S. Auerbach, MD
President
Massachusetts Medical Society
•No stakeholder group in health care is more aware of the problems in
health care than physicians.
•We have no monopoly on this, but we experience its strengths and
weaknesses every day, in a very direct, almost intimate way.
•Physicians are both Republican and Democrat – maybe more
Democrat here in Massachusetts.
•But regardless of how we vote, where we live or where we work, we
are fundamentally conservative people – we need to feel assured
something new will work, before we use it.
•We’re not likely to take a chance on something new, just because it’s
new, because peoples’ lives are at stake. This applies to technologies,
and it applies to health policy too.
1
2. •Physicians tend to fall into 3 camps.
•A small group that wants us to go back to the good old days
•Another small group that wants us to leap into a full-blown single
payer system
•Then, there is a vast middle ground of physicians who believe
that while the health care system has its good elements, it is
somewhat dysfunctional too. They looking for the areas to
improve what’s dysfunctional without harming what works.
•Three different approaches, but what we have in common is we all
want change.
•We know that costs cannot keep rising like this forever.
•We know that while the quality of our care is higher than ever, it could
be a lot better.
•In the past, we did not embrace the imperative to control costs. But that
is changing.
•In the past, we did not embrace the quality imperative as well as we
could have. But that is changing, too.
•You could argue that we should have come to this point sooner – and I
may not argue with you – but the point is, we’re here at the table. We
want to work with you to make health care better.
2
3. Starting Points
• Reduce variation
• IT adoption
• Payment reform
• Transparency
• Performance measurement
– Scientific validity
• Cost control
•We accept the stipulation that reducing unnecessary variation in health
care is critically important. It will save costs, improve outcomes, and it
may save lives.
•We accept the idea that full scale adoption of information technology –
in big hospitals and small practices – will help get us there very quickly.
•We accept the assertion that reimbursing hospitals and doctors solely
on the volume of work they do is not applicable in all settings. We need
payment reform.
•We accept the transparency imperative. We’re not afraid of having our
outcomes available for the public to see. It’ll keep us on our toes, and it
will reinforce the trust that must be present between every doctor and
patient.
•We accept the notion that at least some of our compensation should be
based on how well we do our jobs.
•This could be where many of us in this room may part ways.
•We insist that such performance measurement systems – and
performance based payments – must be scientifically valid.
•We do not accept badly designed systems that are literally worse
than the problem itself.
•We have proven that we will do what it takes to fight badly
designed systems. We have gone to court to correct a particularly
bad system that its sponsors have been unwilling to change on
their own.
•We don’t think it has to be perfect before it’s rolled out. You do
have to start somewhere, as my friends among the health plans
are fond of saying. But wherever we start must be scientifically
valid – and we have published detailed explanations of what that
means. They’re available on our website.
•We accept that we bear some responsibility for controlling costs. But
we don’t have as much control over costs as some would have you
believe.
•There’s an old saying that most of medicine flows from the pen of the
doctor – or at least the modern equivalent of the pen. But that’s a gross
oversimplification of why health care has become expensive.
3
4. Schroeder S. N Engl J Med 2007;357:1221-1228
•According to Michael McGinnis in a very famous article published in
Health Affairs six years ago, our health care system has only a limited
ability to reduce premature death and improve overall well-being.
•Put another way, if every American were to receive timely, error-free
medical care tomorrow, the number of early deaths in America would
not be reduced by very much.
•The top factors by far -- behavior and genetics – have seven times the
impact on health status over medical care alone.
•At our Shattuck Lecture a year ago, Steve Schroeder asked, if that’s
the case, why do we spend so little on health prevention? Good
question – we could spend days answering that.
•Since I only have 20 minutes today, I can short-cut that discussion by
telling you that if the new administration were to bestow its blessing
today on a massive funding of preventive care, the physician community
would be one of the first in line to support it.
•Not just prevention, either.
4
5. •Chronic disease management - asthma, diabetes, high blood
pressure, obesity.
•Let’s look at diabetes alone: Simply ensuring that a diabetic has timely,
regular H1aC tests, and timely eye exams, would reduce blindness,
hospitalization, cardiac events, stroke, amputations, and the list goes
on.
•However: our system rewards heroic, episodic care above all.
Preventive care gets little, and frequently, no funding.
•Our system has devalued primary care so much that many of our
young doctors don’t want to become internists, or family practitioners –
even if they were inclined to do when they started medical school.
•There are enough pediatricians – for now – but if things don’t change,
maybe we’ll see a crisis in that specialty too.
•It has gotten so bad that there is a terrible crisis in the shortage of
primary care physicians – here and across the country. More than
higher costs, this shortage threatens the terrific gains we made in
Massachusetts to insure everyone.
•If it happens here, with our medical legacy, imagine what would
happen if this experiment is exported to other states, where their
health care infrastructure isn’t like ours. It would be a disaster.
•Preventive care is actually more expensive in the short run. I can’t list
any studies proving that this will save money in the long run, but it’s
worth the gamble. And – even if we do spend more – it’s for the right
reason. To keep you out of the hospital.
5
6. Physician Workforce Study
• Internal medicine
• Family medicine
• New: Oncology, neurology,
and dermatology
• Continuing:
– Emergency medicine
– General surgery
– Neurosurgery
– Orthopedics
– Psychiatry
– Urology
– Vascular surgery
www.massmed.org/workforce
•There is a long punch list of things physicians want addressed in the
new administration.
•We are very worried about the condition of the physician workforce –
not just here in Massachusetts, but across the country.
•For years, we have seen predictions of a severe shortage of physicians
by the middle of the century. That is now coming true.
•For the last seven years, our medical society has conducted a
comprehensive study of the physician workforce in our state. We survey
practicing physicians, chiefs of hospital medical staffs, and others,
about their ability to retyain and recruit physicians in Massachusetts.
•Every year, we identified between 6 and 12 physician specialties with
labor shortages. Three years ago, we identified an emerging crisis in
the primary care labor force. Today this “emerging” crisis is here, it is
now front and center.
•But as you can see here, it is only two of the 12 specialties that are
under stress. That is why a workforce strategy targeting only primary
care will fail. This goes beyond primary care – it goes to some of the
core specialties in medicine.
•The causes are very complex, and the answer may NOT be simply
adding more physicians. That could be a never-ending spiral. We need
to look at systemic reforms that make the best use of our resources,
and encourage the marketplace to allocate our resources more
equitably.
6
7. Medicare
•Medicare is an example of what works, and doesn’t work, about our
health care system.
•Medicare successfully made health care accessible to every senior
citizen in America.
•By its sheer size, Medicare brings the flaws of health care system in
very sharp focus.
•One problem is rising costs. If left unchecked, Medicare could bankrupt
our federal budget and our society.
•So for the last 8 years, Congress has tried to control the growth of
Medicare spending by using a detailed formula that has stipulated a cut
in physician payment rates by about 5% each year, since the beginning
of the decade.
•These cuts are based on faulty, outdated assumptions, and would be
devastating to physician practices nationwide. The problem needs
delicate micro-surgery, but instead we had an attempted amputation.
•In every year but one, Congress intervened at the last minute –
sometimes after the last minute – to block the payment cut. Because of
federal “pay-go” rules, the cut didn’t go away, it was deferred until a
date in the future.
•This has happened year after year, and the day of reckoning was
pushed deeper and deeper into the future. And the size of that future
cut grew each time.
•This past year, the payment cut was delayed 18 months (instead of 6
months or 12 months). Finally, Congress has plans to develop a long-
term fix to this Medicare payment problem in the new administration.
•Physicians are very supportive of this effort, and we expect to be at the
table helping Congress and the administration develop a system that
will work.
7
8. Defensive Medicine
•Another thing we can look at to control costs is the cost of defensive
medicine.
•Tomorrow, our medical society will release a report on the cost of
defensive medicine in Massachusetts. Conventional wisdom is that
malpractice reform will make only a small dent in controlling costs.
•Our report states that defensive medicine wastes between 8% and
15% of the health care dollar. It’s a huge proportion of our spending,
and it’s more easily corrected than some of the other approaches we’re
discussing.
8
9. Stand-Alone Solutions
• Capitation • PMPM rates cannot
keep up with costs
• Global • Administrative cost
Capitation shifting
• Rate Setting • Re-regulation?
• Single Payer • Systemic paradigm
shift, but which
system?
• DON • Stifles competitive
marketplace
•That brings us to overall health care payment reform.
•There is considerable interest in the physician community in examining
a new way to compensate providers for the care they provide – and a
new way for the nation to pay for it.
•Standalone solutions have been proposed in the past, and each has
been problematic.
•The problem with capitation was that PMPM rates could not
keep up with costs. The theoretical incentive to under-treat was
more than our society could tolerate.
•If you remember, the Institute of Medicine says that poor quality
in health care comes in three forms – misuse, overuse, and
underuse of care. Capitation encourages underuse.
•Global capitation doesn’t reduce costs … it shifts administrative
costs to physician practices, which are probably the LEAST
equipped entity in health care to deal with the issue. We think that
cost-shifting increases overall costs, worsens health status by
reducing access, or both.
•Rate setting at a global level introduces re-regulation … the top-
down control of health care has its own problems.
•Single-payer would cause a systemic paradigm shift, but would
we want or tolerate the system we would get from that shift?
•Determination of Need (DON) processes are cumbersome,
overly political and stifle competition and innovation.
9
10. Prometheus Payment
Evidence Informed Case Rate Model – A single risk adjusted payment
across inpatient and outpatient settings to care for a patient with a
specific condition
• May improve quality, • Only 10 ECRs developed
reduce administrative • Only in the modeling
burden, enhance stage
transparency • Limited data available to
• Patient centered, build ECRs
Consumer driven • Development time
• Performance based – Still looking for pilot sites
withholds
– Prometheus Scorecard
– Claims activity
Evidence-Informed Case Rates: A New Health Care Payment Model, , Francois de Brantes,; Joseph A, Camillus, April 2007
Commonwealth Fund Publication No. 1022
Some of the most interesting solutions are comprehensive payment
models that try to combine evidence-based medicine with aligned
incentives and reasonable cost control.
Some examples include:
the Prometheus Payment Model, promoted by Francois
DeBrantes and published by the Commonwealth Fund in 2007.
This is a single risk-adjusted payment across inpatient and
outpatient settings to care for a patient with a specific condition.
10
11. Blue Cross and Blue Shield MA
Global capitation proposal for doctors and hospitals. Will consist of a
flat fee per patient per year, age and sickness adjusted, with a bonus
for improved care.
• Quicker access to care • Details (Improved care?)
via technology • May restrict patient
• Home visits by nurses choice
• Better coordination of • Physicians responsible
care for costs they do not
• Better care for chronic control
illness • Increased administrative
burden for physicians
– Claims administration
New therapy for old woes, Alice Dembner, 01/22/08, The Boston Globe
•A global capitation proposal from Blue Cross Blue Shield of
Massachusetts, introduced last year, but with little uptake so far.
It’s essentially a flat capitated rate, with additional bonuses for
improved care.
•It has drawbacks, including the possibility of restricting
patient choice, penalizing physicians for costs they do not
control, and increasing administrative burden on physicians
and hospitals.
11
12. The Advanced Medical Home
Based on the principles of the Chronic Care model, uses evidence
based guidelines and information technology to demonstrate use of
“best practices”
• Relationship based • Potential for gaming of system
• Uses evidence based over or under utilization
guidelines • Potential for less provider
• Propose a fee for primary care access
management • A variation of capitation
• Purports to reduce wasteful • Potential for primary care
spending on unnecessary physician shortage
medical expenditures
• Similar to successful European
models
The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care; Michael Barr, MD, MBA, Vice President, Practice
Advocacy & Improvement; Jack Ginsberg, Director, Policy Analysis & Research. A Policy Monograph, American College of Physicians, 2006
Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care; Alan H. Goroll, MD.; Robert A.
Berenson, MD.; Stephen C. Schoenbaum, MD.; and Laurence Gardner, MD, 2006, Society of General Internal Medicine
There’s a lot of talk about the advanced medical home. This
vision of care, based on the model of chronic care management,
is intuitively attractive to many people, because it appears to
promote prevention, chronic disease management, collaboration,
and communication. It appears to align the incentives of patients,
payers and providers better than other systems in existence, or
under development.
At least a half-dozen pilot medical home projects are
underway, or about to begin, in the area. Some are being
developed by physicians, many by health plans. There are
so many different approaches to this concept, and many of
them are dramatically different form each other.
I suspect that it will be a year or so before this new idea
becomes more tangible; before we have a model that can
be implemented.
That’s just a few approaches… there are many more.
12
13. Post-Election Health Policy:
Impact on Physicians
Bruce S. Auerbach, MD
President
Massachusetts Medical Society
•These comprehensive models may not be the magic solution. But they
offer the good chance at addressing what we’re talking about today:
•Reducing costs without cost-shifting
•Improving quality
•Promoting prevention
•Promoting stability
•And most important, improving health
•The key point I want to leave you with:
•Physicians are ready to step up and participate in these discussion.
We are ready to help lead our health care system into the new era.
13