The Future of Medicine is Now: Can We Afford It?

“Imagination is more important than knowledge. For knowledge is limited to all we know and understand, while imagination embraces the entire world, all there ever will be to know and understand.” ~ Albert Einstein

Writing about healthcare public policy is never far removed from contention and conflict. It just comes with the territory. So it’s a treat on occasion to share something that can be appreciated and enjoyed without being debated (that being said, stand by). But first, please enjoy these two videos – in order, starting in the late 23rd century with the original crew of Star Trek.

“What is this, the Dark Ages?”

Now fast forward back to the twenty-first century.

InSightec is an Israeli-based company that has pioneered MR guided Focused Ultrasound, which provides a personalized non-invasive treatment that can replace invasive procedures and offer therapeutic alternatives to millions of patients with serious diseases. Jackob Vortman, PdD, the President of InSightec, shares the remarkable advancements he and his colleagues are achieving.

Future of Noninvasive Outpatient Surgery

Policy Implications

The future of medical technology is indeed exciting. As with many innovations over the course of history what once was only imagined is now becoming a reality. At the same time medical technology is recognized as a fundamental driver of healthcare costs and, in turn, affordability. From a social and political perspective what makes this driver so acutely felt today is the demographic impact on escalating demand for core primary care.

Invoking Star Trek again, the relative merits of individual versus social needs pervade several film episodes with the key line being, “the needs of the many outweigh the needs of the few – or the one.” Of course pragmatists will recognize that’s really more a matter of perspective than any metaphysical reality: i.e., depending on whether you are the one or the many and your personal belief system.

To put a finer point on the issue: how can we possibly continue to fund the types of advancements of organizations like InSightec here in the US and allocate sufficient resources to provide a baseline level of care for a dramatically aging population while not being more direct, more candid and more transparent in how medical care is rationed?

There has always been rationing of care. But it has always been a de facto situation that is for better or worse woven into the fabric of our care delivery system. Can we continue that way without anticipating some real tragedies?

Cheers,
  Sparky

The Virginia Mason Experience

Prospering by Standardizing Processes and Improving the Patient Experience by Andis Robeznieks, Modern Healthcare.

Dr. Gary Kaplan, chairman and CEO of the Virginia Mason Medical Center in Seattle Washington was recently interviewed about his experience of integrating Lean manufacturing process improvement at VMMC. Paul Plsek, a management consultant, has also written a new book about that experience: Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience.

Below are a few excerpts from the interview:

On Organizational Change Management
Change is very, very hard in healthcare. We have learned a lot about change management. Not everybody wanted to come along. There were perhaps 10% who were early adopters, 10% who were very resistant to any kind of change and probably 80% of the people—and I’m talking about physicians, nurses and others—in the middle, just sort of saying we’ll see what happens and this too will pass.

I think we surprised people with our perseverance. Today, we’re possibly the furthest along of anybody in healthcare who’s consciously deployed a management method for more than a decade. But the most significant accomplishment is understanding that the pathway to improving quality and safety is the same pathway to lowering cost, and that involves relentlessly taking waste and unnecessary variability out of our processes. This creates a much higher quality, better patient experience.

It creates an opportunity for people to be empowered to use their best thinking to redesign their work. Our staff, who are closest to the work, are the ones who redesigned the work and in so doing reduced the burden of work.

On Physician Resistance
Traditionally, physician autonomy has been thought to be the sine qua non of professionalism, and that only we know what’s in the best interests of our patients. At Virginia Mason, we’ve been able to move from that approach and we understand that healthcare is impeded, not facilitated, by the notion of physician autonomy. Our physicians are actively engaged in supply-chain initiatives that standardize prostheses. One of our early rapid-cycle improvement events in 2001 was standardizing laparoscopic cholecystectomy trays, enabling us to save $700-$800 for every case by getting all the surgeons to realize that customized setups were unnecessary. We found is that if we eliminated nonvalue-added variation, the result is we create time for the value-added variation that differentiates individual physicians from each other and for patient preferences.

On Measurable Improvement
One of the things I’m most proud of is we’re the only hospital in the U.S. to be named by Leapfrog a top hospital in every year that designation has been given. We reduced cumulative nurse walking distance in the hospital by 750 miles per day, which freed up more than 250 hours of time for direct patient care.

On Measuring Outcomes
Outcomes measures have eluded us in healthcare for a long time. We’re getting better, but it’s a challenge. The entire continuum of care is a challenge to measure, given that we have patients coming in for care from Alaska, Montana and across Washington state, and Walmart and the Pacific Business Group on Health send patients here for heart and spine and total joint care. So it becomes quite difficult at times to measure the entire continuum of care.
One of the interesting things we’ve learned is that standardizing processes is really important even when there is no incontrovertible double-blinded study evidence. The standardization in itself allows us to measure and then it allows us to eliminate defect-prone situations. If a team of people do things nine different ways, that creates opportunities for defects to occur, and that’s what we want to eliminate.

On the Impact of Healthcare Reform
We welcome the changes that are here and are coming. More transparency is critical, and it plays right to our sweet spot. If we are able to improve quality and safety and lower costs, that’s going to allow us to succeed in a marketplace that’s more driven by value than volume. We see reform as a catalyst to accelerate our work, and it’s going to help move the entire industry in ways that will improve quality and lower cost.

Policy Issue
VMMC’s process improvement initiative was launched before and thus independent of the influences of the Affordable Care Act. But of course it was not launched in a free market vacuum independent of industry regulatory influences. Dr. Kaplan welcomes the future impact of healthcare reform as an inducement – or at least catalyst – for change at healthcare organizations that don’t have the predisposed wherewith all to affect the kinds of change accomplished at VMMC.

Others are going to disagree. They will argue that innovation and performance improvement flourish best when individuals’ inherent incentives to act in their best interests are rewarded by market-driven rewards. But is that even remotely possible to achieve in an industry that is already so heavily regulated that market-driven incentives are but a myth that stand in the way of collaboration and coordination?

Cheers,
  Sparky

WARNING: Rough Waters Ahead

This is a self-promotional blog post, but the connection to healthcare public policy is clear enough.  Just this morning Erskine Bowles and Alan Simpson released a new plan that seeks to find some balance between the polar opposition of the Republican and Democratic parties over fiscal management.

Their approach would cut $600 billion from Medicare and Medicaid and raise $600 billion in new tax revenue from ending or curbing deductions and tax breaks. It would also include $1.2 trillion in cuts to discretionary spending, along with cuts in cost-of-living increases for social security, farm program and civilian and defense retirement programs. 

The Obama Administration has discussed supporting $400 billion in cuts to Medicaid and Medicare, while the House GOP considers any new revenue a nonstarter.  The self-serving political intransigence of the two parties is unlikely to abate any time soon.  But the metaphorical swirls of focus and attention, like water in a sink flowing toward the drain, are clearly zeroing in squarely on further Medicare and Medicaid cost containment.

Healthcare providers are going to have to double down on lowering expenses while concurrently reacting to market and regulatory forces that are driving demands for improved outcomes, higher safety and better quality.  In reaction to this tremendous challenge, Artower Advisory Services has partnered with StrategyDriven Enterprises to create a new product offering that can accelerate the efforts of healthcare providers to meet these challenges.

The Value-Driven Performance Improvement Model© leverages StrategyDriven’s knowledge and expertise developing and implementing performance improvement models in the nuclear power industry to give healthcare providers the tools they need to improve efficiency, enhance production and improve outcomes while lowering costs (i.e., increase patient value).

Please take a moment to read our new White Paper, which describes the V-D PIM in detail (just click on cover page, below).

Cheers,
  Sparky

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