Next Things First

Beyond the Partners Health Article: Looking at the Bigger Picture (From Howard Luks, MD) by charlottegee
November 19, 2008, 4:46 pm
Filed under: innovation, quality, wellness | Tags: , ,

The recent article in the Boston Globe regarding the perceived inequity of payments to the Partners system by local payors serves as notice on where the press and perhaps the public is going to come down on this issue. In the article, the authors assumed their conclusion and skewered Partners. I believe the authors missed a huge opportunity to explore the bigger picture. One of the more glaring problems I have with the article is that the authors begin with the assumption that institutional compensation (in medicine) is linked to quality.

Health care (medicine) is big business, the largest the world has ever known. The “average” successful hospital’s margin is 2%-2.5% at best. The payors are only interested in managing shareholder value and revenues and the effect of reimbursement on their valuation. How can the authors of the article find fault with Partners and their ability to negotiate from a position of strength, while they note that other local institutions are struggling and running in the red even prior to the enormous cuts that will come down from the state over the next quarter? How can they fault Partners’ quest for a profit to fund the next generation of technological advances, capital improvements and to fund care for the indigent and under-insured? Another interesting consideration is how the reporters gained access to the fees paid to institutions. There is NO transparency in this space. Confidentiality agreements between payors and institutions are SOP—which leaves one to imagine who wanted this article published in the first place.

The bigger picture that was not explored by the reporters is measuring quality and somehow tying quality measures to compensation. Measuring “quality” is a burgeoning practice (industry) that is trying to define and align itself in this highly fragmented and well-entrenched space. The definition of *success* and *quality*is the first of many roadblocks that exist. Is it a length of stay issue? Complication rate issue? Quality of life issue? Mechanical issue (healed rotator cuff in a patient who remains in pain)? Which of the overlapping systems are we referring to: the environmental level, the level of the health care organization, or the interface between clinicians and patients? There are numerous opportunities that exist within existing industry standards and industries that are just starting to emerge to enhance/streamline/incentivize (and profit from) the focus on *quality*.

A small, but certainly not exhaustive list of opportunities that exist are in various areas of the health care system:

Enabling rapid advances in health care: The need for federal, state and local governments to come together and guide reform platforms.

Health care delivery redesign: In order to provide safer, more reproducible, higher *quality* care, the environment in which health care is delivered needs to change. This will need to address, amongst other issues, management practices, workforce capability, work design and organizational safety culture.

Furthering measurement: Unfortunately this will be driven by CMS and other federal agencies and will likely take a long time to develop and put an onerous burden on physicians and hospital. Take ICD-10 for example…The compliance, coding and billing industry will blossom after implementation of ICD-10 due to its sheer complexity.

Encouraging information technology implementation: Significant technological advances will be necessary to drive health care forward and enable fulfillment of the mission of improving *quality* measures. The next generation EMR, reverse engineered from the clinical encounter to an operational platform, will improve adoption minimizing useless functions by aiding in data collection, by improved processes and increased office throughput.

Telemedicine and use of Bluetooth-enabled or wireless biometric devices will significantly improve our ability to monitor chronic disease states and identify the patient at risk prior to decompensation. This will present opportunities for companies to read, interpret data and inform the MCO or physician when a trend is obvious. This will also require a change in the reimbursement decisions made by the MCOs to incentivize the PCP to receive these data.

Preventing medication errors

Wellness and preventative medicine: As one of the emerging leaders states, “By focusing on cost reduction, traditional wellness companies miss the mark. They focus on a small number of people with significant health risks or chronic conditions, and nag them into becoming ‘less of a risk.’”

In our current system, preventative care focuses on the sick and elderly. The ship has already sailed in many of these cases. This emerging industry has data to support their claim that they can directly influence health care expenses in the companies they serve by keeping their *healthy* patients healthy.

As the focus on healthcare trends further toward quality issues, numerous opportunities will emerge to assist the industry to define and implement the strategies necessary. Because of their net profit, Partners will be able to implement these technologies as they present themselves. Those institutions that are underfunded will not. What will The Globe have to say about that???

Submitted by Howard J Luks, MD

Editor’s Note: The online version of the article on already has received over 200 reader comments as of this posting.


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