Tuesday, November 15, 2011
There's No Such Thing As a Free Lunch
The White House on Monday announced it would free up as much as $1 billion in grants to help groups, doctors, and communities hire and train health care workers as a way both to create jobs and improve health care. (Quinton, 2011) Okay, on the face of it this looks like good news. I mean, a “grant” means to “transfer or convey” (Dictionary.com, 2011) . If I “grant” you $1 billion, then I am transferring to you the sum of $1 billion. That is not the way the government sees it – trust me, I worked there for 28 years, and I know how they think.
A “grant” from the Federal government means, “the government is going to convey a sum of money to you with certain conditions, codicils, and provisos. In this case, the “grant” is to “hire and train health care workers “ (Quinton, 2011) for the purpose of lowering the cost of healthcare. Now let me see if I have this straight. If I hire and train more healthcare workers with “grant” money, then when the money runs out I still have to pay these workers, which I have to charge the patients for, or I have to lay off the new healthcare workers which increases the unemployment rolls.
“Today’s grants can be a catalyst for the kind of innovation we need,” Health and Human Services Secretary Kathleen Sebelius said at a news conference. (Quinton, 2011) . Excuse me? I always thought necessity was the Mother of invention.
“When I visit communities across the country, I continually see innovative solutions at the very ground level—a large health system working with community partners to decrease the risk of diabetes with nutrition programs or a church group that sends volunteers to help home bound seniors so they can live at home,” Centers for Medicare and Medicaid Services Administrator Dr. Donald Berwick said in a statement. (Quinton, 2011)
To which Secretary Sebelius added, “By bringing national attention to these projects, we can help them spread to other communities,” (Quinton, 2011) . Bring attention to them, yes. Laud them and get Congress to award Medals of Freedom to their instigators and innovators, yes. Throw money at them, no.
Look, there is no such thing as a free lunch. When the Feds give you a grant, there are always strings attached; and when the grant is done, the cost of maintaining the level of service you started is on you, and your patients.
Works Cited
Dictionary.com. (2011). Dictionary.com. Retrieved November 15, 2011, from Dictionary.com: http://dictionary.reference.com/browse/grant
Quinton, S. (2011, November 14). Yahoo News. Retrieved November 15, 2011, from White House Announces $1 Billion in Health Care Grants: http://news.yahoo.com/white-house-announces-1-billion-health-care-grants-114848156.html
Labels: grants, healthcare, Sebelius
Sunday, November 13, 2011
The Question of Maturity?
So the question becomes have we really matured when it comes to healthcare information technology? The initial talk about healthcare IT was about reducing cost and providing better care. I believe we have put to rest the notion that healthcare IT is going to save anyone money. At the same time, we have not quite solidified the notion of better care through IT. News services such as the Huffington Post Investigative Fund have discovered disparities in healthcare IT. Some of these have led to serious errors in health care and shown that a total reliance on IT can result in serious complications or even death.
When it comes to the abundance of information concerning healthcare IT there is certainly no lack of availability. A search on YouTube for Healthcare Information Technology gives over 7,700 hits running the gamut from testimonials, to sales pitches, to infomercials. A similar search on Google results in over 21 million hits. While the increase of information and exposure of information technology in healthcare is certainly welcome, has it led to a process of maturation, or merely a process of oversight?
President Reagan said, “The most terrifying words in the English language are: I'm from the government and I'm here to help”. With the advent of government oversight on healthcare information technology, can a process of maturation take place? Without government oversight, would the advances of information technology in healthcare be safe?
The resultant debate should center on how to use information technology to commoditize healthcare. Only then can we truly lower the cost of healthcare for the American, or the World consumer. We have seen this in recent years, but have not recognized it as such, or have not touted it as such. The availability of flu shots at your local pharmacy, over the counter pregnancy tests, home glucometers and even automated blood pressure monitors are all advances that have been made by making a trusted medical procedure into a commodity. This has given the trained medical professionals the ability to work on those cases where there is no standard answer, no standard diagnosis, and to use the education for which they strived and paid. The use of information technology in healthcare should be focused on more access to healthcare – more commoditized healthcare – not more government oversight which will only stifle innovation and stagnate commoditization.
Works Cited
Reagan, R. (2011). Ronald Reagan Quotes. Retrieved November 13, 2011, from Brainy Quotes: http://www.brainyquote.com/quotes/authors/r/ronald_reagan_4.html
Labels: healthcare, maturation
Sunday, May 15, 2011
Disrupting Medical Education
One of the things that we need to tackle as a nation is what to do about healthcare. The last big grab bag by Congress was not what many Americans wanted; while a lot said, it was better than nothing. There is truth to both sides. The problem is, there is no such thing as a “quick fix” when it comes to healthcare reform. If reform is going to be lasting and sustainable, then it must be disruptive. We do not pretend to have all the answers, but we do have some ideas, and that is where this whole blog got started in the first place.
People know we are a big fan of Clayton Christensen, so we want to merge a couple of his books, in the broadest sense, to provide some fodder for the ideas arena on disruptive measures concerning healthcare. To that end, we want to look at Disrupting Class and The Innovator's Prescription. There is a joke, which is quite true, if not humorous that goes, “What do you call the guy who graduates medical school with a D?” The answer is, “Doctor”. Hopefully, and most probably, this is the person who gets weeded out during the rigorous internship process. But what about the educational process that allowed him to graduate in the first place?
In Disrupting Class, Christensen brings up two different training techniques comparing one of the Big Three in Detroit and the Toyota plant in Canada. We will not belabor the points here, but the Toyota plant training was to start with Step 1. When you had mastered Step 1, you were granted the privilege of going on to Step 2 and so forth. If Step 1 took you one minute, then in one minute you would move on to Step 2. If Step 1 took you a day, then tomorrow you would move on the Step 2. The attitude here is that it does no good to teach you step two, if you have not mastered step one. Any yet, the American education system continues to move people through Steps (Grades) 3, 4, 5, and on before they have mastered the current level of work.
In The Innovator's Prescription, Christensen talks about the training of doctors and other medical professionals, and brings in some of the main points, and that is what we want to concentrate hereupon. How can we implement student-centric education, first with our nurses (LPN, RN, etc.) and then with our physicians? I do not think there is anything that will substitute for the hands-on clinical experience that each class of professionals go through at the end of their classroom education. So let's focus on the classroom education.
This needs to be student-centric; and by that, I mean the student should control the pace, the place, and the time. Even with “distance learning” from today's educational institutions, there is still a time-line that has to be met. You have the option of doing your classwork around your schedule, but it still has to be done in the allotted amount of time. For the purpose of argument, what would happen if each healthcare student who arrived for internship had mastered every class in every field they had taken? Would not, then, the internship process be much more profound and rewarding for both the budding professional and the patient alike?
Student-centric learning, with the latest technology, whereby a student does not move on to Step 2 until they have mastered Step 1, is the disruptive step we need in medical education. This will promote higher quality, less critical shortages, and eventually lower prices.
