Love to a fault: How the best of intentions is hurting care for Americans who live in rural areas

Ensuring that Americans who live in rural areas have access to health care has always been a policy priority.  In healthcare, where nearly every policy decision seems contentious and partisan, there has been widespread, bipartisan support for helping providers who work in rural areas.  The hallmark of the policy effort has been the Critical Access Hospital (CAH) program– and new evidence from our latest paper in the Journal of the…

Did Massachusetts Healthcare Reform Hurt Access To Care For the Previously Insured?

In 2006, Governor Mitt Romney signed Chapter 58 of the Acts of 2006 entitled “An Act Providing Access to Affordable, Quality, Accountable Health Care.”  It has been described by many names, including Massachusetts Healthcare Reform (MHR), Romneycare, or simply, as the template for the Affordable Care Act.  The goal of the act was straightforward: to ensure near-universal access to health insurance for citizens of the Commonwealth of Massachusetts.  The bill…

The 30-day Readmission Rate: Not a quality measure but an accountability measure

Should we hold hospitals accountable for what happens after a patient leaves the hospitals’ doors?  A year ago, I thought the answer was no.  A hospital’s job was to take care of sick patients, make them better and send them on their way.  With more thought and consideration, I have come to conclude that I was probably wrong.  It may be perfectly reasonable to hold hospitals accountable for care beyond…

Getting Pay-For-Performance Right

Over the past decade, there has been yet another debate about whether pay-for-performance, the notion that the amount you get paid is tied to some measure of how you perform, “works” or not.  It’s a silly debate, with proponents pointing to the logic that “you get what you pay for” and critics arguing that the evidence is not very encouraging.  Both sides are right. In really simple terms, pay-for-performance, or…

Healthcare: The Journal of Delivery Science and Innovation

Healthcare: The Journal of Delivery Science and Innovation, a new journal promoting cutting edge research on innovation in health care delivery, has launched. The questions is, do we really need yet another journal? The short answer is yes. The longer answer is, absolutely yes. Here’s why. The Need for New Knowledge on Healthcare Delivery There is an urgent need to improve our mess of a health care system. Healthcare will consume about $2.8 trillion in…

Trust But Verify: Why CMS Got It Right On EHR Oversight

Yesterday’s New York Times headline read that “Medicare Is Faulted on Shift to Electronic Records.”  The story describes an Office of Inspector General (OIG) report, released November 29, 2012, that faults the Centers for Medicare and Medicaid Services (CMS) for not providing adequate oversight of the Meaningful Use incentive program. Going after “waste, fraud, and abuse” always makes good headlines, but in this case, the story is not so simple. For…

Is the Readmissions Penalty Off Base?

I’ve been getting emails about the New York Times piece and my quotation that the penalties for readmissions are “crazy.”  It’s worth thinking about why the ACA gets hospital penalties on readmissions wrong, what we might do to fix it—and where our priorities should be. A year ago, on a Saturday morning, I saw Mr. “Johnson,” who was in the hospital with a pneumonia.  He was still breathing hard but…

Can quality be on India’s healthcare agenda? Should it be?

Currently, India spends about $20 per person per year on healthcare and spending more once seemed like a peripheral concern, taking a back seat to basics like food and sanitation.  However, in the past decade, as the Indian economy has grown and wealth followed, Indians are increasingly demanding access to “high quality” healthcare.  But what does “high quality” mean for a country where a large proportion of the population still…

Weighing the risks and benefits: what health policy can learn from clinical medicine

A few months back, we admitted a patient we’ll call Mr. Jones to the hospital for a severe gastrointestinal bleed.  We had discharged him two weeks earlier after he had come in with a heart attack and made sure he was on aspirin to prevent future cardiac events.  He dutifully took his aspirin and on the day of the readmission, had a massive bleed.  He made it to the hospital…

Safdarjung Hospital: Volume and efficiency but little time for quality

I visited Safdarjung Hospital in New Delhi today – an institution with  1,531 beds and 145% occupancy rate.  Yes, 145%.  You do the math.  A lot of bed sharing and asking families to bring in cots.  It’s right across the street from the All India Institute of Medical Sciences (AIIMS), the premier public healthcare institution in India.  While both AIIMS and Safdarjung are run by the federal government, only AIIMS…