Speaking of Boston, the latest edition of Health Wonk Review is hosted by Tinker Ready at Boston Health News and it has has a terrific collection of posts on the latest activity in health policy.
There are a significant number of very good posts this week but one that interested me personally was a very nice and timely post by Dr. Roy Poses at Health Care Renewal. In it, he discussed HealthSouth’s digital hospital that was touted as the solution to all of our health care woes.
The hospital’s “shell” (it was never completed and is now slated to serve as office space) was plopped right alongside US HWY 280 in south Birmingham and every time I pass the beautiful edifice, I wonder about its lessons for health reform.
Dr. Poses sums it up pretty well when he states:
So we have gone from "the hospital model for the world," with great "promise," which "could save lives," proclaiming the "era of cyber hospitals," to a "pipe dream," just the shell of half-finished building.
So I wonder, if one were to identify every highly hyped, rapidly spun, magic new "innovation" promising to revolutionize patient care, and follow them forward in time, how many would even marginally improve health care, or provide benefits that marginally out-weighed their harms? How many would never come to be, or prove to be unworkable, useless, or even harmful?
But the short-term incentives for leaders of health care organizations push them to announce innovation after innovation, collect their bonuses and perks, and be somewhere else by the time their wondrous innovations prove to be not so good.
Keep in mind that some heavily promoted innovations, such as new pharmaceuticals, must be subject to randomized controlled trials and government approval. Yet, as perusing Health Care Renewal will show, many pharmaceutical companies have managed to make their glitzy innovations appear more efficacious and less hazardous by lavish, shrewd, and sometimes deceptive marketing, and by manipulating clinical research, and sometimes suppressing results. Medical devices are not subject to as much scrutiny. Health care information technology, and programmatic innovations by hospitals, health systems, managed care and health insurance companies can appear without any research evidence to support them.
This is why we all should be extremely skeptical of whatever new "innovations" our multi-million dollar health care CEOs are hawking these days.
As we work to improve health care, it is helpful to remember that technology is only one very helpful tool in our toolbox and focusing on it too intently without considering the other components of the health care system is like building a bookshelf with only a hammer.
Yes, digital hospitals could possibly reduce the cost of care per admission by reducing things like medication errors (which are still shockingly high) but they would not have an incentive to prevent admissions in the first place.
That is why it is so important that we reorient ourselves to look at the desired outcome, which is improved health and then continually adjust and improve our use of different tools to continually improve public health measures.
For example, Medicare makes various adjustments to hospital and other provider payments that account for local cost differentials. These differentials largely support a continuation of the wide variation that exists today in costs and their inverse relationship to quality (see excellent New Yorker article by Atul Gawande). But imagine what a difference it would make if Medicare phased-out these local cost differentials over time and phased-in local health improvement differentials. That means all Medicare payments to a hospital would be partly tied to their ability to improve the health of their local community. Now we're talking real change and alignment of incentives.
Fact is, digital hospitals will not save the day. But digital hospitals that are less concerned with combative insurer negotiations, unnecessary expansions, and marketing to attract more commercial patients and more concerned with serving as a vital cog in a larger public health system that is incentivized to improve health…that is something that could be very special. ~BAA