Money, Medicine and Metrics

A colleague of mine shared and article from the New England Journal of Medicine called "Money and the Changing Culture of Medicine" by Pamela Hartzband, M.D., and Jerome Groopman, M.D. The gist of the article is that the practice of medicine had both communal and market characteristics and that currently the balance is skewed towards the market end of things. For example, physicians are pushed by pay for performance, payors and medicare/medicaid to focus on the cost of care. There is currently no carrot for collaboration with peers or even patients. Additionally the article points out that studies have shown that the introduction of financial rewards into almost any situation tend to reduce willingness to collaborate. Scary!

Perhaps change is in the air though. Word on the street is that the National Quality Forum is considering different kinds of metrics. Metrics that measure things like patient engagement in their own care. Not that traditional quality metrics like the SCIP measures will go away but perhaps pay for performance will start to focus on actually changing the culture of healthcare. This is exciting!

We should be careful though. Just as paying physicians based on efficiency alone doesn't necessarily deliver the right outcomes, encouraging physicians who find the right ways to engage their patients to hold those techniques as strategic advantages may be less likely to share what worked. So I hope NQF successfully finds a way to reward and encourage the sharing of such best practices, among doctors and hospitals alike.

Back in the (Blogging) Saddle

After a week and a half of intensity at work and intensity at home I'm about to get back in the saddle again. If you have for some reason followed my twitter posts recently they are mostly about bread and chicken coops. The work-life balance tipped away from work for a while and it's been nice. I find that once I refuel like this my mind starts looking up and around again vs the heads down daily grind that can come after intense periods of work.

Work has been intense. Strategy development, team building, infrastructure projects and new technology evaluations abound. I like to get deep into a topic, obsess about it and know as much as I can in the time I have. I then come back up for air and a reality check and figuring out how much of each is needed to keep the momentum going requires more art than science right now.

So a colleague of mine gave me a few articles to read recently and I took the opportunity in a longish large meeting to scan them and it spawned a few ideas.

• An article on the effect of compensation on collaboration (negative in most cases) got cross pollinated with what I'm learning about the National Quality Forum's likely future direction on hospital metrics.
• Build vs buy on the Business Intelligence front in payor organizations. What are the lesson's learned for providers and how does that relate to emerging trends on data aggregation vendors as opposed to traditional Business Intelligence vendors.
• The economic recovery legislation and it's impact on adoption of EMRs and even more importantly the execution of those projects.

Today was a good reminder to stop, pay attention to everything going on around me and not just focus on the next steps and the plan. If you don't stop and smell the roses then you might just miss something important...

(Not) Lost in Translation

Today I was given a fine compliment and told that I was a translator. After writing about having to "traverse the stack" and Business Intelligence as a bad word it felt good to hear evidence that bridging the gap between the technical world and the healthcare world is doable by mere humans. Like many things in our culture this talent isn't nurtured early enough and it seems that the school of hard knocks is the primary teacher. For example, how many computer science programs emphasize non-technical writing, non-academic presentation and business skills? It's been a while since I got my Bachelors Degree but I don't see the core of these programs doing a good job in this area.

There are a few ways to try and get there faster. A double major in business management, communications or an MBA. In fact many of the best and most effective translators I know got their MBAs early in their careers and I admire their grace. In a pinch though an organization can help this happen by cultivating these skills internally, not slaying people for making mistakes and committing to the development of their people. These things will evolve into part of a hard-wired culture of learning and culture definitely eats strategy for lunch!

Back to sharpening the saw...