22. January 2012 · Comments Off · Categories: Health Trends · Tags: ,

Apparently asking for a second opinion is now recommended, particularly for diagnoses involving benign musculoskeletal pain, skin lesions, and pneumonia, among others.  The Wall Street Journal today reported that a recent study demonstrated that final correct diagnoses for initially misdiagnosed patients included cancer and coronary artery disease.  A revealing aspect of the article?  A growing number of cancer centers are now requiring an “internal second review” of pathology results to prevent misdiagnosis. It sounds obvious, but these changes take time.  The issue will be balancing the costs versus the results, or the expense of a biopsy versus the danger of improper surgery.

17. January 2012 · Comments Off · Categories: Health Law · Tags:

It’s not a stretch to suggest that years ago, in the dark ages of our health care system (say circa 1960′s and 1970′s), non-physician citizens joined non-profit hospital boards of trustees simply because other respected members of their communities asked them.  Certainly most if not all were civic-minded in their inclinations and generous in the nature of their participation.  But the era was itself simpler and less daunting, primarily because less money was involved and less investment was at stake, among other differences.  I’m reminded of the Curious George story where the famous chimp breaks his leg and needs an extended stay in the local hospital.  Being curious, George ends up on a run-away cart and makes a mess right in the middle of a tour that the hospital’s governing body is giving the Mayor.  Everything works out just fine, but the image of the hospital group as a convivial go-along-to-get-along group is one that really cannot and does not exist [okay, call me strange but that's one of my takeaways from the story!].


Central to successful board membership is the need to stay engaged with the trends and the view from 30,000 feet.  For a smart, sophisticated person, in this age of reform and transparency, the task appears daunting, but perhaps one way of thinking about hospital board memebrship is to compartmentalize the issues.  Board members should not be micro-managers, not even managers, of their institutions, so day-to-day operations are not where the focus should be.  In contrast, compartmentalization involves oversight of management, finance, quality of care, and the rather broad category of “strategy.”  Members need to participate where their talents, and their interests, best fit.  No one should be on a board for its prestige alone.  Rather, as an active participant, new board members should be prepared to take on and study new areas.  It’s called homework, and doing it will result in stronger non-profit hospitals and other non-profit providers.

10. January 2012 · Comments Off · Categories: Health Law

Okay, while is not a blog solely devoted to cycling, a recent NEJM (New England Journal of Medicine) article encapsulates two topics of interest.  James Walker, M.D., and Aaron McKethan, Ph.D. make a sound comparison between a cyclist and her actual bike, and the structure and organization of an ACO and the care delivery organizations that will work through that structure and organization.  The operation and structure of the ACO is merely the platform by which the care delivery organization, as a whole, demonstrates its efficiency, nimbleness, power, and ultimately, stamina (my words).  Here’s in part what they say:


If an ACO were a bicycle, its wheels, spokes, and gears would be the criteria used by payers such as Medicare to determine providers’ eligibility, the methods used to assign patients to a given ACO, and the manner in which financial bonuses are calculated. These and other key operational issues are important and have accordingly attracted close scrutiny in the past year. Yet the success of ACOs — like the usefulness of bikes — depends on whether they can compel and equip the athletes riding them to improve their performance. It’s not merely about the bike.


Just as riding skills, physical conditioning, and race-day effort are critical to winning races, care delivery organizations will need to build a largely new set of core competencies in order to deliver accountable, high-value care. Unless careful attention is paid to these competencies, organizations meeting the administrative and operational definition of ACOs will nevertheless not achieve their potential.


I also would add that, over time, I expect we will see a wide variety of ACOs in the healthcare landscape, just as there are many different types of bicycles for many different kinds of riders.