Judging Health Systems: Focusing on What Matters

Austin Frakt and Aaron Carroll recently approached me about a New York Times UpShot piece aiming to rank eight healthcare systems they had chosen: Australia, Canada, France, Germany, Singapore, Switzerland, the United Kingdom, and the United States. This forced me to think about a pretty fundamental question: what do we want from a healthcare system? What Does an Ideal Healthcare System Look Like? I would argue that most people want…

Our latest JAMA paper: teaching hospitals and thinking about conflict of interest

How much does it matter which hospital you go to? Of course, it matters a lot – hospitals vary enormously on quality of care, and choosing the right hospital can mean the difference between life and death. The problem is that it’s hard for most people to know how to choose. Useful data on patient outcomes remain hard to find, and even though Medicare provides data on patient mortality for…

Correlation, Causation, and Gender Differences in Patient Outcomes

Our recent paper on differences in outcomes for Medicare patients cared for by male and female physicians has created a stir.  While the paper has gotten broad coverage and mostly positive responses, there have also been quite a few critiques. There is no doubt that the study raises questions that need to be aired and discussed openly and honestly.  Its limitations, which are highlighted in the paper itself, are important. …

Do women make better doctors than men?

About a year ago, Yusuke Tsugawa – then a doctoral student in the Harvard health policy PhD program – and I were discussing the evidence around the quality of care delivered by female and male doctors. The data suggested that women practice medicine a little differently than men do. It appeared that practice patterns of female physicians were a little more evidence-based, sticking more closely to clinical guidelines.  There was…

ACO Winners and Losers: a quick take

Last week, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations.  Here’s the tweet from Andy Slavitt, the acting Administrator of CMS: NEW ACO RESULTS: physicians are changing care, w better results for patients & are saving money. Over $1B. https://t.co/FEfe3QErb5 — Andy Slavitt (@ASlavitt) August 25, 2016 The link in the tweet is to a press release.  The link in the press release…

Readmissions, Observation, and Improving Hospital Care

Reducing Hospital Use Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The motivation behind HRRP is simple:  the readmission rate, the proportion of discharged patients who return…

Consumer Reports accompaniment to “Hospital Rankings Get Serious”

Guest post by John Santa, MD MPH, accompanying Hospital Rankings Get Serious Including Consumers In the Safety Journey For more than a decade, those in health care have known that serious safety problems were present in our health systems. Many of the country’s most prominent health care leaders have done their best to make safety improvement a priority. Patients and families have shared their stories, pleading for more attention to the…

Leapfrog accompaniment to “Hospital Rankings Get Serious”

Guest post by Leah Binder, accompanying Hospital Rankings Get Serious Here’s some stories from my summer reading list. In one story, a woman is stopped by security at the airport when the metal detector goes off. Security guards can find no cause for this and eventually let her board the flight. But this makes her wonder, so she calls her doctor. Later an X-Ray shows a metal retractor in her abdomen,…