News&Views

September 28, 2007

Public-Private Disconnect?

Filed under: — mlazoff

Yesterday’s Slate article, Where’s My Free Wi-Fi? Why municipal wireless networks have been such a flop, describes the failure of many free citywide Wi-Fi systems, particularly those based on private/public partnerships in cities like Philadelphia and San Francisco. “The result, as this summer has made clear, has been telecom’s Bay of Pigs—a project the government wanted to happen but left to underqualified private parties to deliver…The deeper problem is economics… Private municipal wireless networks have to compete against competitors with better infrastructure who paid off their capital investments years ago…Today, the limited success stories come from towns that have actually treated Wi-Fi as a public calling. St. Cloud, Fla., a town of 28,000, has an entirely free wireless network. The network has its problems, such as dead spots, but also claims a 77 percent use rate among its citizens. Cities like St. Cloud understand the concept of a public service: something that’s free, or near-free, like the local swimming pool.” Ignacio Valdes, MD, creator of the wonderful open access software news blog LinuxMedNews, noted in today’s entry that the failure of several citywide Wi-Fi projects “may shed some light on the failings of RHIOs.”  (For example, see Requiem for an HIE Dream in last month’s News&Views.)



September 11, 2007

In memoriam

Filed under: — mlazoff

The Wall Street Journal’s Health Blog offers an off-topic but reflective page on the World Trade Center: Past and Planned.



The Eyes Have It

Filed under: — mlazoff

An interesting opinion piece by medical resident Michael Hochman, MD, posted today on Boston.com, Eyes Shift From Patient to Keyboard reviews some of the benefits and limitations to physicians in using computers in patient encounters. Benefits include: speed of chart review, increased access to key medical history information, and at least one study that found ”after the introduction of a computer in the office, patients were more likely to feel that their doctors were familiar with their history.” On the other hand, two studies found that a sizeable minority of patients experienced computers as interfering with their time with, and attention from, the doctor. In particular, lack of eye contact between physician and patient is discussed, along with possible remedies, such as acknowledging the distraction to the patient beforehand, and closing each session with a face-to-face review of the visit. Another option not discussed: arranging the monitor so that both patient and physician can see what’s on the screen, as when the patient sits alongside rather than across from the physician’s desk. 



September 6, 2007

P4P’s peek into the future of medical charting

The Leapfrog Group, a powerful group of major company and other large private and public healthcare purchasers known for supporting quality and cost-control incentives, promotes the results of this year’s Pay for Performance (P4P) and Consumer Incentive Survey of 75 “purchasers, government agencies, and health plans”. Conducted biannually since 2003, this year Leapfrog partnered for the first time with the P4P specialty software company Med-Vantage. The actual results are not online, only the press release, which describes several statistics: a nearly four-fold increase in the number of P4P programs to a current 148; a cost savings noted by about a third of respondants; and that provider performance was made publicly available by over 30% of respondants. 

An article posted earlier this week on the Web site of magazine Modern Healthcare Online commented on this press release: “Even as payers issue glowing news releases about the expansion of their programs’ scope and the millions of dollars in physician rewards they’re dispersing, government officials, research organizations and physicians are questioning the motivation and methodology of current pay-for-performance programs.” The above Leapfrog/Med-Vantage survey is contrasted with a report on P4P among commercial insurers released several weeks ago by PriceWaterhouse, which describes significant differences among these programs’ structures, performance metrics and rewards structures. 

The Modern Healthcare article quotes a surgeon/attorney who describes P4P as, “an attempt to control prices—but not for the benefit of the patient or the benefit of the doctor.” From elsewhere in the article: “Meanwhile, the physician-ranking programs [used by over 30% of respondants to the Leapfrog/Med-Vantage survey] under consideration for use by insurers Aetna, Cigna HealthCare and UnitedHealth Group have come under scrutiny by New York State Attorney General Andrew Cuomo, who expressed concern that the rankings may be used to steer patients toward less-expensive rather than higher quality providers.”

HIT is the elephant in the P4P room. According to the Modern Healthcare article, “In the end, the one industry segment that may truly be happy with pay-for-performance programs are health IT vendors who can persuade providers that their electronic systems are absolutely necessary for the data management that require such programs.” The article closes with a comment by a Pricewaterhouse director who believes that wider IT adoption would “‘pave the way for standardized measures,’ mak[ing] it easier to validate physician data and reduce the administrative costs of the programs.” The Leapfrog/Med-Vantage press release agrees: ”Advanced P4P programs are now developing tools to measure improvements in outcomes and eligibility for rewards directly from medical charts.”



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