Second Opinion http://www.secondopinionblog.com/ en Copyright 2008 Thu, 13 Mar 2008 13:59:20 -0500 http://www.sixapart.com/movabletype/ http://blogs.law.harvard.edu/tech/rss Your Doctor’s Guidance: Fact vs. Opinion Empowered Patient column informed parents when pediatricians’ recommendations are merely opinions and not based in medical fact. In the article “When it’s OK to question your pediatrician’s advice,” Elizabeth Cohen highlights five parenting issues “where there’s plenty of room to disagree with the pediatrician.” These areas are: 1. Don’t pick up your baby in the middle of the night 2. Baby should be at home with mom 3. Don’t give your baby “triple nipple confusion” 4. Your baby must eat solid foods by 6 months 5. You must take the pacifier away Dr. Robert Needlman, co-author of the latest edition of Dr. Spock's Baby and Child Care, states, “If you're not sure if you're getting fact or opinion, ask. You can challenge your pediatrician along the lines of saying, 'That advice you gave me doesn't feel comfortable to me. Can we talk about some other options?’" ]]> http://www.secondopinionblog.com/2008/03/your_doctors_guidance_fact_vs_opinion.html http://www.secondopinionblog.com/2008/03/your_doctors_guidance_fact_vs_opinion.html Communication baby; pediatrician; consumer engagement; empowered patient; patient; communication; healthcare quality; health care quality Thu, 13 Mar 2008 13:59:20 -0500 You the Patient and Dr. Right “Empowered Patient,” and one recent article entitled “Five ways to find Dr. Right” highlights the similarities between the relationship with one’s significant other and that of one’s physician. Both are extremely intimate personal interactions, so why would we choose to be with the person who isn’t “the one?” Dr. Vicki Rackner, a professional patient advocate, states: "I consider the doctor-patient relationship to be as intimate as a life partnership. There are lots of nice people out there, but you would not want to marry most of them." Below are the five ways to find Dr. Right: 1. Date before you get married. Schedule a time to just talk with a new doctor, or go with a problem of limited scope. 2. Check them out on the Internet. There are many web sites that share objective information on doctors – state licensure boards, independent non-profits, health insurance plans, etc. 3. Check out the family. A doctor is sometimes only as good as his or her office staff, physician assistants, etc. It’s vital that you feel comfortable with everyone in the office. 4. Ask your friends to fix you up. Ask a friend who thinks like you do who he or she recommends. 5. Go with your gut. If a new doctor makes you feel uneasy, trust your instincts. You need to have full trust in the person who is responsible for your health. Please visit the full article, as it offers lengthier explanations for each of the five above suggestions. We all deserve “the one.” ]]> http://www.secondopinionblog.com/2008/02/you_the_patient_and_dr_right.html http://www.secondopinionblog.com/2008/02/you_the_patient_and_dr_right.html Communication Tue, 19 Feb 2008 08:54:14 -0500 Quality Improves, But Unexplained Variations Cost 75,000 Lives Each Year The State of Health Care Quality, NCQA concludes that the quality of care delivered by the 141 health plans who voluntarily report data has improved for an eighth consecutive year. But the rate of improvement has slowed leading President Margaret O’Kane to say “We must redouble our efforts to understand the value yielded by the $2 trillion we invest in health care.” The report provides over 80 pages of trended HEDIS and other quality measures, but one of the most telling statistics is in figure 10 of the executive summary where it is noted that the NCQA’s “examination of the top 10 percent of health plans shows what our health care system is able to achieve. If the entire health care system could perform as well as the top achievers, NCQA estimates that as many as 75,000 lives could be saved each year and our national bill for hospital care would be reduced by as much as $3.7 billion.” ]]> http://www.secondopinionblog.com/2008/02/quality_improves_but_unexplained_variations_cost_7_1.html http://www.secondopinionblog.com/2008/02/quality_improves_but_unexplained_variations_cost_7_1.html Quality Sat, 02 Feb 2008 07:33:18 -0500 Maine’s Health Reform Efforts Examined In A New Study and Cyber Seminar Cyber Seminar on February 1, 2008 (12:00 pm – 1:30 pm EDT) for a Cyber Seminar hosted by HCFO, the Commonwealth Fund's State Innovations program and RWJF's State Coverage Initiatives (SCI) program. ]]> http://www.secondopinionblog.com/2008/01/maines_health_reform_efforts_examined_in_a_new_stu.html http://www.secondopinionblog.com/2008/01/maines_health_reform_efforts_examined_in_a_new_stu.html Wed, 23 Jan 2008 20:18:32 -0500 Less Value, More Disparity In U.S. Health Care Health Affairs reports that “despite being the most prolific health care spender, the United States is falling farther behind its peer nations in overall health system performance, as measured by what the authors term “amenable mortality.” The United States places last among 19 leading industrialized countries when it comes to deaths that could have been prevented by access to timely and effective health care.]]> http://www.secondopinionblog.com/2008/01/less_value_more_disparity_in_us_health_care.html http://www.secondopinionblog.com/2008/01/less_value_more_disparity_in_us_health_care.html Quality Value Based Purchasing Mon, 14 Jan 2008 19:53:48 -0500 Consumer Engagement in Healthcare – Not Just for Consumers? Dale Shaller’s article in the October issue of The American Journal for Medical Quality ,he explores this topic by asking whose responsibility it is to make sure that consumers are engaged in managing their healthcare.
"For consumer engagement to become a reality, and not just the latest catchphrase in the ongoing litany of health care reform rhetoric, we will need to see concerted aggressive action on the part of multiple stakeholders that are in a position to help consumers and patients assume the wide range of personal responsibilities increasingly expected of them."
Of course there are some substantial upsides to consumers taking on the challenge of managing their own healthcare. No one has a more intimate knowledge of the patient’s health than the patient. The consumer knows things in a way that a provider often cannot. Certainly no one has a more vested interest in a positive outcome than the patient. In an ideal world, a consumer assumes a collaborative role with providers to successfully drive positive health outcomes. However, the current reality requires the consumer to shoulder the majority of the weight, and the current environment makes the load nearly impossible to bear. The system needs change. Shaller suggest employers should play a key role, and cites several good examples of ways employers have creatively engaged employees to effect better outcomes. But most of these are large employers - what about the employees of small organizations? What about the unemployed? Shaller suggests the physician will need to be a key player if this transformation is to occur. Clearly, more efforts need to be made in getting all stakeholders to work together. ]]> http://www.secondopinionblog.com/2007/09/consumer_engagement_in_healthcare_not_just_for_con.html http://www.secondopinionblog.com/2007/09/consumer_engagement_in_healthcare_not_just_for_con.html Advocacy advocate collaboration engagement Thu, 20 Sep 2007 12:19:06 -0500 The Role of the Healthcare Advocate “Five must-do’s when a loved one is ill”, Elizabeth Cohen summarizes the five most important things an advocate must do:
  • Don't be afraid to intervene
  • Ask questions until you understand the answer
  • Remember that you know things the doctors don't
  • Temper your loved one's enthusiasm for quick fixes
  • Scope out the nurses
The article contains much more valuable advice, but the bottom line is that an advocate must be persistent, understand the loved one’s condition, and find allies within the healthcare system. ]]> http://www.secondopinionblog.com/2007/09/the_role_of_the_healthcare_advocate.html http://www.secondopinionblog.com/2007/09/the_role_of_the_healthcare_advocate.html Advocacy advocate caring for others engagement health care Thu, 20 Sep 2007 12:06:52 -0500 Collaboration and Transparency are the Keys to Success Houston Business Journal reported recently that “In response to last year's controversial decision by some major health insurers -- including industry giant Blue Cross Blue Shield of Texas -- to rate and rank doctors based on several criteria, the Harris County Medical Society has launched a survey that allows doctors to publicize their opinions of insurance companies.” Dr. Michael V. Kelly II, president of the Harris County Medical Society, states that, "The goal of this initial survey is to recognize the areas of good performance and uncover issues that need to be addressed by the health insurance companies." This development is huge – physicians have spent years at the mercy of insurance companies who tell them what tests they can run on their patients, and how much they’ll be compensated for their services. But what is really important here? The message is really that collaboration, negotiation, and transparency are three elements (certainly not all) that are needed for a successful outcome, because no one likes things being done TO them without their consent. “Doctors are up in arms not because they are being rated, but because they don't know what the ratings are about”, says Dr. Michael Speer, a neonatologist at The Methodist Hospital and former Harris County Medical Society president. “One physician will get a terrible rating from one company and a glowing rating from another company," he says. "Physicians want their data out there, but they want it to be accurate.” In the blog hospital impact, Nick Jacobs in his entry “Marketing” states “we hear, everyday, the little whispers about skill level. Perception is reality, and unless or until total and complete transparency becomes the guiding light of health care, we will be in the same boat that we were in before "Consumer Reports." “Bring on open communication, just don't let some of the major, existing evaluators take the lead. They are from a different paradigm, a world where, many times the twisted, interpreted detail is the basis for a pronouncement that has no bearing on the reality of the care.” Collaboration and transparency will ultimately benefit all stakeholders – physicians, insurance companies, hospitals, and most importantly consumers – and improve the system. Until then, caveat emptor – “Let the buyer beware.” ]]> http://www.secondopinionblog.com/2007/09/collaboration_and_transparency_are_the_keys_to_suc.html http://www.secondopinionblog.com/2007/09/collaboration_and_transparency_are_the_keys_to_suc.html Communication collaboration communication transparency Tue, 11 Sep 2007 16:10:56 -0500 States Are Expanding Coverage, Value Based Purchasing, and Getting Consumers Involved review of Value Based Purchasing efforts in Massachusetts, Minnesota, Washington, and Wisconsin suggests that tiered premiums, pay-for-performance measures, and the designation of high-performance providers as "centers of excellence" are paying off. The research, sponsored by the Commonwealth Fund, examines the current and potential role of state and local governments, as well as public–private coalitions, in promoting value-driven health care. Massachusetts Health Reform posted lots of numbers this past week and the suggest a few key lessons/insights from the numbers. Number 1: the MassHealth “surge” from Chapter 58 is over, and the impact is a net gain of 47,000. Click here for their other observations. Also, the Los Angeles Times reported September 1 that Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nuñez are “fashioning a high-stakes strategy focused on expanding medical coverage to nearly all of the 4.9 million Californians without it. The plan would require all Californians to have insurance and would give subsidies to those unable to afford coverage. It would also address the problems of the private insurance market and require healthcare providers to reveal the costs of their services to foster competition.” The Legislative session ends in mid-September.. ]]> http://www.secondopinionblog.com/2007/09/states_are_expanding_coverage_value_based_purchasi_1.html http://www.secondopinionblog.com/2007/09/states_are_expanding_coverage_value_based_purchasi_1.html Value Based Purchasing Mon, 03 Sep 2007 11:21:42 -0500 Discussing Drug Side Effects With Doctors Touches A Nerve Reuters headlined the story “Docs often write off patient side effect concerns” and explained that the UC San Diego research suggests that doctors will very often dismiss their concerns when patients feel they might be having an adverse drug effect. Dr. Beatrice A. Golomb of the University of California at San Diego told Reuters Health: "Physicians seem to commonly dismiss the possibility of a connection. This seems to occur even for the best-supported adverse effects of the most widely prescribed class of drugs...Clearly there is a need for better physician education about adverse effects, and there is a strong need for patient involvement in adverse event reporting." The Consumers Union prescription drug blog picked up the story, as did MSNBC. The related MSNBC Health message board titled “Felt dismissed by your doctor?” begins to show that there is a lot of frustration on the part of consumers. While complaints are more likely to surface in such a forum, it is not surprising to see the robust reaction if the percentages found in the study hold for other physician/patient interactions regarding side effects (only 39 percent said their physicians said such a connection was possible.) ]]> http://www.secondopinionblog.com/2007/09/discussing_drug_side_effects_with_doctors_touches_1.html http://www.secondopinionblog.com/2007/09/discussing_drug_side_effects_with_doctors_touches_1.html Communication Safety Sun, 02 Sep 2007 08:27:02 -0500 Consumer Education Drives Success of Consumer-driven Health Plans in Wisconsin some companies and communities have reported failed attempts at gaining employee acceptance of these, enrollment in CDHPs is increasing in the Milwaukee area. The secret of success? According to The Business Journal of Milwaukee, employees must be educated about the health plans and given some incentive to enroll. “The key to achieving higher enrollment is making sure employees understand how the plan works,” according to Kristine Seymour, president of Louisville, Ky.-based Humana’s Wisconsin market. Various tools are used to educate consumers about CDHPs. An on-line instrument allows people to determine which plan works best for their family. Additionally, people are taught how to become educated healthcare consumers. As our return blog readers know, consumer engagement frequently is highlighted as a major focus, and is a major aspect of healthcare reform. Some companies offer incentives, including contributing to the savings accounts. This technique is especially useful if companies want to steer their employees to CDHPs when they are also offered more traditional plans such as PPOs. According to Clark Slipher, a consulting actuary for Milliman Consultants & Actuaries, states “Employers who have stuck with the plan tend to see increased enrollment over time as employees learn more about it. Clients that see higher enrollment are generous with their contributions to spending accounts and have provided good education.” The future of consumer-driven health plans remains to be seen, but what is certain is that consumers, employers and providers need to work together to improve the value of healthcare. ]]> http://www.secondopinionblog.com/2007/08/consumer_education_drives_success_of_consumer-driven_health_plans_in_wisconsin.html http://www.secondopinionblog.com/2007/08/consumer_education_drives_success_of_consumer-driven_health_plans_in_wisconsin.html Communication Consumer-driven health plans employee education high deductible health plans HRA HSA Thu, 16 Aug 2007 08:21:25 -0500 Questions Are the Answer “Questions are the Answer” campaign, the Agency of Healthcare and Research Quality has created two public service announcements (PSAs). You may have already seen one of the musical reminders during the commercial break of your favorite show. If not, you can watch now . From the Questions are the Answer site you can also obtain a list of questions to ask your healthcare provider and a helpful guide for preparing for a doctor’s visit. There’s even an option to customize your own list of questions. These new tools from AHRQ may just be the answer for people who want to manage their own health better.]]> http://www.secondopinionblog.com/2007/08/questions_are_the_answer.html http://www.secondopinionblog.com/2007/08/questions_are_the_answer.html Tools consumer consumer engagement resources Mon, 13 Aug 2007 09:27:28 -0500 Improving the Quality of Healthcare – What Do You Want Me to Do? Familydoctor.org, which has some great information and advice for preventing medical errors. There’s also the Agency for Healthcare and Research Quality, which has countless, easy-to-use tools available. On this site, you can find an easy reference guide featuring 20 tips for preventing medical errors , among many other items. Perhaps you’re the type that learns better with something visual? That’s OK too, because there are videos available that can help you learn more about the role you can take to become more involved with your own healthcare. Remaking American Medicine created an excellent four-part TV series for PBS last fall, which can be purchased directly from its website . And, of course, if you want immediate gratification, don’t forget about the video referenced in an earlier entry on this blog in which a Maine Cancer patient tells her story. The role this woman takes in managing her treatment is phenomenal – and likely has a huge impact on her successful outcome. ]]> http://www.secondopinionblog.com/2007/08/quality_healthcare_what_do_you_want_me_to_do.html http://www.secondopinionblog.com/2007/08/quality_healthcare_what_do_you_want_me_to_do.html Tools consumer engagement Consumer Issues quality resources Thu, 02 Aug 2007 14:25:42 -0500 IT and Quality – correlation, but not necessarily causation Information technology infrastructure and improved quality have been shown to be correlated in a study by Hospitals & Health Networks. Four quality measures – mortality rates, the Agency for Healthcare Research and Quality’s patient safety measures, the Joint Commission’s Core Measures and average length of stay – had better outcomes in the 100 “most wired” facilities. How did these facilities do it? The article details the ten lessons learned from the top hospitals in the study. Critics are quick to point out that although IT and quality are correlated, advanced IT function does not necessarily cause the benefits of improved quality. Mike Alverson, acting CIO of Texas Health Resources in Arlington states that, “These initiatives are a combination of people, process and technology, not just technology alone.” If integrated IT is an accurate measure of quality, it would be logical for consumers to review the list of hospitals and health systems to determine which in their geographic area ranks highest and patronize these facilities when in need of care. Yet another indicator of quality healthcare and resource for consumer empowerment. ]]> http://www.secondopinionblog.com/2007/07/it_and_quality_correlation_but_not_necessarily_cau.html http://www.secondopinionblog.com/2007/07/it_and_quality_correlation_but_not_necessarily_cau.html Quality activation consumer engagement consumers health care health care quality Hospitals quality quality care Wed, 25 Jul 2007 10:29:55 -0500 Study Reports that Higher Quality Equals Saved Lives recent study published in HealthDay quantified the number of lives improved quality care would save. According to the study, “if the lowest ranked hospitals had the same death rates as top-ranked hospitals, 2,200 fewer older Americans would die each year from heart attacks, congestive heart failure or pneumonia.” This report truly brings to light the reasons why quality matters. As Dr. Ashish Jha, an assistant professor of health policy and management at Harvard School of Public Health, stated: “These findings are really a confirmation of the value of these quality measures for predicting outcomes.” While there are other research findings (Dr. Jha’s work among them) that would contradict the article’s assertion that “a hospital’s level of care is probably not tied to its treatment of any one condition but reflects an institution-wide commitment to quality care,” the content of the study nonetheless reinforces the notion that quality varies and consumers can and should make an educated choice when selecting a hospital. To find quality rankings for your local hospitals, visit national sites such as Leapfrog and Hospital Compare , or check with other local resources.]]> http://www.secondopinionblog.com/2007/07/study_reports_that_higher_quality_equals_saved_lives.html http://www.secondopinionblog.com/2007/07/study_reports_that_higher_quality_equals_saved_lives.html Quality consumer engagement Consumer Issues healthcare Hospitals quality quality care Quality Comparisons Mon, 23 Jul 2007 15:14:11 -0500