Another Year of Lessons learned

2012 Closed with drama and 2013 will be filled with more as Obama care provisions roll out- So What did we learn in 2012 to help us go forward?
1. Quality and appropriateness will drive sustainability as much as volume. What seems obvious but it will be tricky are the transition to move volume out that "doesn't benefit the patient and keep some in that just may". For instance, will we see some longer lengths of stay as we assure a decrease in re-admissions. I think it makes sense.  It is a clear paradigm shift.
2. Will we get smart enough by allocating more support in the form of PT/ OT and other paraprofessional support to manage and keep expensive seniors and high cost folks well. It seems to me that we ought to apply the public health philosophy of good prenatal care  from the 1960s and 1970s to an senior model to avoid the trauma expenditures and focus on preventive elder care  - end of life care for the living end of lifers!  It reminds you of the world war posters reminding people to stay strong and resilient.
3."Mind the GAP" - the Brits subway speaker cautions one to Mind the Gap every time you enter or exit a train.  We need to mind the gap to make sure that people are not falling through the cracks in the healthcare system and manage the gap assuring that they have alternative is they are.
4.  Drug costs:  the users of public vs private health care will be drawn by two things: quality and access to providers, especially primary care providers with access to teritary or emergency and discount or paid pharmeceuticals.  The biggest line in the ED are those off their meds - can't afford them or can't understand them. 
5. Change is not going to come to all healthcare but data driven management of the top 20% of healthcare access drivers is going to be important.
6. Managing risk is like nothing else -  it is way more difficult and expense than people think and requires strong IT, clinical analysis, clinical management and structures to support primary care.
7.  IT and staff for primary care that are integrated into hospitals and all levels of care will be essential to creating successful pirmary care proactices.

Not enough focus on patient safety and quality outcomes

It really is amazing that a decade after the "To Err is Human"  report that major hospitals are still not adequately focused on safety and quality.  A colleague today pointed out that 5 or 6 quality FTEs is the equivalent of the aerospace industry moving forward with no safety engineers.  The complexity of patient safety issues both (as the old Catholics said about sin) the errors of omission as well as commission - is just as painful and deadly.  They are all costly in terms of human capital and waste - and it is so extremely underreported.

How many hospitals are challenging the types, severity and outcomes of surgery?
How many hospitals are challenging the variation in Internal Medicine orders and outcomes?
 How many hospitals challenge CT or MRI rates, Mammograms, biopsies and their outcomes in terms of longevity, quality of life and mordidity. 

I would say that 1% are focused on the change that we need in healthcare outcomes, followup and choices; a larger percent on creating access to services, and an even larger percent on profitability of the system.  To me that is not a sustainable change model.


How do we really incnetivize the change. 
More importnatly will it come from the upstarts or the old guard....I am guessing like IBM, we will see the Microsoft, Apples and Facebooks lead the change that is needed.  I don't think I like it but it is inevitable!