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Healthcare Best Practices in...Green Bay?

The cost of healthcare affects us all. The current effort to make more effective changes needs to be weighed carefully, with apples compared to apples. And not Lutheran hospitals compared to county hospitals.

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By Carolyn Allen, Editor

The news story took me by surprise...President Obama is pointing out the high quality of health care and low cost in Green Bay, WI. Well, my father was actually born in Green Bay...and those Germans have their own way of dishing up the meat and Polish you can imagine my surprise with this story.

However, it piqued my interest. Here's a quote from the Washington Post about that hidden American treasure of Green Bay healthcare...

What Obama is likely to hear in Green Bay is testimony to the value of digital records, physician collaboration, preventive care and transparency, say those most involved in Wisconsin's innovative approach.

"There's been a fairly steady progression of quality" in areas such as diabetes care and cancer screening, said Chris Queram, executive director of the Wisconsin Collaborative for Healthcare Quality, which publishes statewide performance measures. "Every physician believes he is doing the very best for their patients, but when they see data that their group is not practicing at the same level as across the state, it's a real positive motivator to improve."

The federal Agency for Healthcare Research and Quality gives Wisconsin high scores on 100 measures, ranging from the treatment of heart disease to childhood asthma.

But it is the findings of the Dartmouth Institute for Health Policy and Clinical Practice that have generated the most excitement in the Obama administration, all the way up to the Oval Office. For more than a decade, the New Hampshire researchers have documented and mapped wide variations in the cost and types of care given to American seniors through the Medicare program, concluding that spending more on health care has not resulted in better health.

So who are these resources?

Wisconsin Collaborative for Healthcare Quality

The Wisconsin Collaborative for Healthcare Quality (WCHQ) is a voluntary consortium of organizations learning and working together to improve the quality and cost-effectiveness of healthcare for the people of Wisconsin.

What They Collaborate To Do

  • Develop performance measures for assessing the quality of healthcare services.
  • Guide the collection, validation and analysis of data related to these measures.
  • Publicly report measurement results for healthcare providers, purchasers and consumers.
  • Share the best practices of healthcare organizations that demonstrate high-quality service, enabling all providers to adopt successful methods.

Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving quality, safety, efficiency, and effectiveness. As 1 of 12 agencies within the Department of Health and Human Services (HHS), the Agency for Healthcare Research and Quality (AHRQ) supports health services research initiatives that seek to improve the quality of health care in America. AHRQ's mission is to improve the quality, safety, efficiency, effectiveness, and cost-effectiveness of health care for all Americans.


Dartmouth Institute for Health Policy and Clinical Practice

In the final two years of a patient's life, for example, they found that Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.

Dartmouth Atlas Project

For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians.

These reports, used by policymakers, the media, health care analysts and others, have radically changed our understanding of the efficiency and effectiveness of our health care system. This valuable data forms the foundation for many of the ongoing efforts to improve health and health systems across America.

This website provides access to all Atlas reports and publications, as well as interactive tools to allow visitors to view specific regions and perform their own comparisons and analyses.

Their Benchmarking tool allows you to compare rates in selected areas or hospitals to each other or the national or state average. What if rates in the comparison areas or hospitals were equal to rates in selected benchmarks? There are six steps to creating a table using the Benchmarking tool.


Institute of Quality Improvement

Much of the evidence suggests that the more doctors, more drugs, more tests and more therapies given to patients, the worse they fare -- and the unhappier they become, said Donald Berwick, president of the independent research group Institute of Quality Improvement.

Get the latest on the Improvement Map, including news about the tool IHI is prototyping. You can also become a Charter Member of Passport, their new membership program to help hospitals make the most of the Improvement Map.

During the 100,000 Lives and 5 Million Lives Campaigns, health care providers told IHI they wanted help making sense of the many complex and competing demands hospitals face. In response, IHI is developing the Improvement Map, an online tool that distills the best knowledge available on the key process improvements that will lead to better outcomes for patients.


End of Life Care

Persuading patients to sign medical directives and using electronic medical records to alert doctors and nurses, for example, the health system has dramatically reduced the intrusive, expensive end-of-life procedures that often drive up costs but rarely stave off death for long.

"At the end of life, what most people want is for their wishes to be respected, not to undergo an aggressive battery of tests and treatments" says an executive at Gundersen Lutheran Health System in La Crosse, Wis.

Ah, yes. Lutherans. I grew up as a Lutheran. And those Missouri and Wisconsin Synod Lutherans are paragons of discipline. Seriously. I can understand the top-down approach to "persuasion" that was implemented -- probably much like the top-down approach to implementing financial policies in China. Very efficient, very thorough, very persuasive. Very disciplined. And very ethnic group-centric. The Lutherans also have a very extensive network of hospitals and have honed their management strategies over more than a century. They have an extensive network of volunteers from their neighboring churches and I'm sure that wasn't factored in adequately.

And yes, I know about those volunteers because my best friend was a volunteer flower arranger for a Lutheran hospital (turned public in the last decade or so) for over 20 years. Their little band of volunteer flower arrangers made bouquets for the gift shop all those years and raised many thousands of dollars for the hospital. And those figures weren't really acknowledged by the hospital to my knowledge. And they were just one small band of volunteers among many.

Religious hospitals aren't exactly like urban hospitals or county hospitals. The metrics are different.

Richard Cooper, professor of medicine at the University of Pennsylvania, says he thinks the variations identified by the Dartmouth researchers -- due primarily to enormous hospital expenses -- are often related to patients' socioeconomic status. States such as Wisconsin have lower medical costs because they are predominantly white and middle class, he said.

Ah, yes, poverty. Another virtue of the Lutherans is that they are hard workers and are as ashamed of poverty as they are of ostentatious wealth. So salaries are probably more moderate than in many public and private hospitals driven by high-paid leaders.

And that's a strong motivator. Those Lutherans are rebels...and never forget it. Healthcare, here comes the standard bearers of Martin Luther's rebellious nature! Reform! 99 Theses! Intelligent discipline. Service to mankind! America will never be the same!

Edited by Carolyn Allen
| healthcare | governance | science |


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