Category Archives: Quality Measures

Top 10 Orthopedic Hospitals by Procedure

Last year, Christmas Eve, to be exact, I wrote a short post about the top ten hospitals for total knee replacement under $50,000.

This year, I’d like to expand on that and discuss the top ten orthopedic hospitals outside of the US for such procedures as Arthroscopy (knee or shoulder), Disc Replacement, and Rotator Cuff Repair.

The website I linked to in my post last year, Archimedicx.com, is the same website I used now to illustrate the difference between costs in the US and elsewhere in the world.

This website is by no means the definitive source of such information. There are other websites that provide similar prices and are only ballpark figures, not actual quotes, or firm prices. Archimedicx’s website will give you a quote once you have chosen from among a list of hospitals you searched for, depending on what procedure you want to have.

I have limited the discussion here to only the three I mentioned above, as arthroscopic procedures for both knees and shoulders, resulted in the same hospitals being displayed.

The price range column indicates those hospitals who charge the amount stated or less, as the website allows an individual to choose the price range they want.

In the table below, the quality score is the ranking algorithm that generates a unique quality score for each procedure in each analyzed hospital (on a scale of 1 to 5). For the sake of clarification, a certain hospital can have different quality scores, depending on the procedure or treatment in question.

 

Table – Top Ten Orthopedic Hospitals by Procedure

top-ten-ortho-hosp

For each procedure examined, there were at least a few hundred other hospitals that one could look at, but I only wanted the top ten, as you see, ranked by quality scores. There are no doubt other hospitals on the website that may score better on other websites, or can provide these procedures for far less than they do.

The idea here is to point out that the US is more expensive than others, and as the following chart shows, we are dead last in terms of care.

nhs-best-system

But it is sad that Americans do not realize this and do what the other countries in that chart have done, provide health care to all.

It is also sad that our system for treating on the job injuries also does not allow people to seek medical care outside of their states or the country. Only two states do that, Washington, and Oregon, but as I’ve said before, there have been exceptions.

Now with a new administration seeking to destroy the social safety net and the ACA, we may see more case shifting and more crowded ER’s and not enough medical personnel to treat them.

And for what?  The commodification of health care for those who can afford it, and for the profit of those who pay for it.

A Simple Friday Morning Health Care Philippic – (With Apologies to Simon & Garfunkle)

Health Affairs blog today posted an article about the new rules CMS released on Wednesday that would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These policies were established by the latest, permanent ‘doc fix,’ the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

My writing this morning is not about the proposed rule, the Quality Payment Program, the Merit-based Incentive Payment System (MIPS), or the Alternative Payment Models (APM’s).

But rather, it is about something I first encountered during my first MHA class on Health Care Quality. Reading the assigned readings in the one textbook we were given, I noticed that throughout the last several decades, CMS has released and created many rules, programs, models, and whatnot, that made my head spin. No doubt that is what the good folks at CMS intended, because these rules, programs, models, schemes and “solutions” have only seemed to make the American health care system more complex, confusing, bureaucratic, wasteful, idiotic, and expensive.

When supporters of the current challenger in the Democratic Party presidential primaries say that their candidate will give them free health care, do they really understand and realize how much of a house of cards the entire system is, and one that will collapse if given enough time?

How so, you ask? Well, if you know of any other human-devised system that is so top-heavy, so convoluted, and so complex that the sheer weight of its rules, regulations, laws, programs and models will cause it to collapse, let me know, because the US health care system is the only one I see.

What those who advocate Medicare for All don’t realize (I am one too, but I realize what is at stake), is that even with all of this complexity, people are profiting from the ever continuing releasing of proposed rules, programs and models, and that to simply do away with them is equally as bad as letting it collapse, but at least when it does collapse, we can start all over again and provide the single payer system they want.

Yet, if we scrape it now, those who just got health coverage will lose it, those who never had it will never be able to afford it, and the entities that profit from it will work day and night to prevent the scraping of their “golden goose”.

I don’t have all the answers, but I know this, too many rules, programs, incentives, models, schemes, etc, etc, and so forth, only makes things worse, not better. I don’t remember learning about other nations’ health care systems being so top-heavy and so complex, and maybe, in the final analysis, is why their systems work, and ours does not.

When an American citizen goes abroad and needs medical care in a country such as France (I read one person’s account of what they experienced), the bill they received after treatment was only a few dollars, not hundreds or thousands. Why is that? Maybe because they don’t have a CMS screwing it up.

Maybe it’s because their doctors don’t wave expensive watches in the faces of their patients, or describe their recent safaris where they shot some endangered species in Africa because they were wealthy and believe they have the right to do so, as a Midwestern dentist did last year to a prized lion.

I also remember that during the run-up to the enactment of the ACA, many senior citizens demanded that the government keep its hands off of their Medicaid, and that they did not want some government bureaucrat to make health care decisions for them and their families. Who do they think makes these decisions in health insurance companies? Do they know any corporate “bureaucrats”, or do they think that because they work for a private company, that they are not part of a bureaucracy?

I’ll end this philippic here, but it makes me wonder why we haven’t gotten wise to the fact that too many cooks, too many rules, etc., only make things worse, not better. We need to wake up and join the rest of the industrialized world.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

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Ten Facts About Medical Travel

Maria Maldonado has put together a list of ten facts about medical travel that people in the workers’ comp world should know about.

While it is true that there have been serious medical issues abroad, the same medical errors can and do occur right here at home. One particular one that stuck in my mind some years ago was a patient at a hospital in Tampa who had the wrong body part removed.

Also, there may be some who question whether the JCI’s accreditation is sufficient enough to justify patients going abroad, but absent any other reputable institutions, the JCI will have to suffice as a starting point or floor to which any such future institutions will have to better.

Here is the link to Maria’s post:

https://www.linkedin.com/pulse/10-things-you-should-know-medical-tourism-maria-maldonado?trk=hb_ntf_MEGAPHONE_ARTICLE_POST

Sluggish Hospital Improvement

Modern Healthcare published the following article that stated that there was sluggish improvement in patient safety in the nation’s hospitals.

Here is the link to the article:

http://www.modernhealthcare.com/article/20151028/HOLD/151029895/leapfrog-hospital-improvement-sluggish-despite-some-stars?utm_campaign=socialflow&utm_source=twitter&utm_medium=social

Still believe we have the best hospitals in the world, or just the most expensive?

It’s your choice, poor quality and high cost, or low cost and better quality somewhere else.

Or maybe the injured workers should make that choice.

Infographic on Patient Experience: US versus Non-US Hospitals

My good friend, Elizabeth Ziemba, who I met last year in Reynosa, Mexico when I spoke at the 5th Mexico Health & Wellness Travel Show, published the following infographic on patient experience from The Beryl Institute.

It is called, “State of Patient Experience 2015: A Global Perspective on the Patient Experience Movement”.

US hospitals are designated in blue, non-US hospitals in light green.

The following is an excerpt from the infographic. The entire infographic can be seen here:

https://t.e2ma.net/webview/tueam/63af6d0bbad8f609f4e4de367af49924

Patient Experience

Patient Experience1

Patient Experience2

Patient Experience3

Patient Experience4

So the next time anyone says that the US has the best health care, or that medical care abroad can’t be better than it is here, or that the very idea of wanting to give injured workers access to the better medical care that these patient respondents said was better in non-US hospitals than in US hospitals, and is a stupid or ridiculous idea, show them this infographic.

Addendum

A connection of mine asked if there was a breakdown of the non-US hospitals. I looked at the research paper, and found none, but what I did notice was that there was slight differences in some measures between US and non-US hospitals, with the non-US hospitals slightly better than their US counterparts. What that tells me is that medical travel destination hospitals need to do a better job in those areas so that they outshine their US counterparts. Then they will see greater numbers of foreign patients.

Challenges Remain in Physician Payment Reform

Following up on my post yesterday about shared savings, John O’Shea writes today in the Health Affairs blog, that challenges remain with regard to physician payment reform, now that President Obama has signed the Medicare Access and CHIP Reauthorization Act (MACRA) in April.

MACRA repeals the Sustainable Growth Rate (SGR) mechanism of updating fees to the Physician Fee Schedule (PFS).

The SGR has been blamed for causing instability and uncertainty among physicians for over a decade, and that led to 17 overrides of scheduled fee cuts, at a cost of over $ 150 billion.

The passage of MACRA, O’Shea wrote, raises new questions about where the US health care system is headed in the post-SGR world of payment and delivery reform.

Yet, before MACRA was signed into law, HHS Secretary Burwell announced a major initiative calling for 30 % of Medicare payments to be value-based through the use of alternative payment models (APMs) by 2016, and 50% by 2018.

HHS also set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016, and 90% by 2018.

O’Shea reported there are reasons for caution. These policy changes, following calls to move from the current volume-based, fee-for-service (FFS) system to a value-based system that pays for patient outcomes, rather than for individual services, present major challenges to achieving the goal of value-based health care, the goal of any real health reform initiative.

One of the APMs O’Shea discussed is Value-based purchasing (VBP), which is the concept behind APMs, includes a broad set of performance-based payment strategies that attempt to use financial incentives to influence provider performance, such as the Shared Savings Program mentioned yesterday.

Another APMs is the Merit-Based Incentive Payment System (MIPS) [don’t you just love how the government comes up with these abbreviations?], a modified FFS system, which is basically a Pay-for-Performance (P4P) program.

The overall early results of these initiatives, as well as possible flaws, make the long term viability of these models uncertain.

With regard to P4P programs, a 2014 RAND report looked at 49 studies examining the effect of P4P on process and intermediate outcome measures, and found that the overall results were mixed, and that any identified effects were relatively small.

According to the lead author of the study, Cheryl Damberg, “The evidence from the past decade is that pay for performance had modest effects on closing the quality gap.” A basic flaw in the model is the reality that meaningful patient-centered outcome measures remain elusive.

ACOs, as I wrote about yesterday, are another APM; and O’Shea reported that their ability to generate savings to share with participants is so far not encouraging. He points to early results from the Pioneer ACO program that determined that of the 23 ACOs that participated in 2013, only 11 earned any shared savings, which totaled about $41 million. Six ACOs lost a total of $25 million. The results from a similar study in 2014 showed improvement, but the long-term outlook is still unclear.

What is the impact on the practice of medicine?

What O’Shea found was that physicians currently labor under an increasingly burdensome and often meaningless number of reporting requirements that take time away from patients, and fail to help them improve quality of care.

Accordingly, a commentary O’Shea cited from the New England Journal of Medicine said that, “the quality-measurement enterprise in US health care is troubled.”

A recent CMS report, O’Shea mentioned, said that 40% of Medicare providers will face 1.5% cuts for failing to submit data to the Physician Quality Reporting System.

Because of this, many public and private payers are tying larger amounts of provider payments to a growing number of largely meaningless measures.

O’Shea said that there are two areas of concern, given the plethora of payment and delivery reform initiatives: the administrative burden on physicians, and the push towards greater consolidation.

Nearly half, or 46% of doctors who reported said that they felt burned out in 2014. A main reason cited by the physicians was the increasing administrative burden.

What does the mean?

Well, having slogged through an online Health Care Quality course as part of my MHA degree program, the myriad abbreviations mentioned in Mr. O’Shea’s article does not surprise me. CMS and HHS has for years developed all kinds of initiatives and programs to influence and alter behavior of all stakeholders in our health care system.

As “Uncle” Walter Cronkite once said, “America’s health care system is neither healthy, caring, nor a system.” And that was before the passage of the ACA.

But for the purposes of this blog, and in keeping with the point of the last article where it was said that what happens in health care affects workers’ comp. then I think you can agree that these initiatives and programs, while well-meaning, may make things worse in the future, but not because the idea behind the ACA or the law itself is bad, but because we Americans cannot do anything right until we try everything else, a la Winston Churchill.

If that is the case, then believing that by doing the same things over and over again, that by following everyone else off the cliff of unregulated, employer-based, multi-payer health care, and by not opening the workers’ comp system to real alternatives, especially for surgery, then nothing will ever change.

We will continue to see more new initiatives and programs from CMS, and the results will be dismal, and the impact on workers’ comp will be felt eventually. That is, unless you open up your minds to new ways of thinking.

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I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

New report on growth of medical tourism

As reported last week on Medicalsea.org, a new report by Research and Markets.com, entitled “Medical Tourism Market – Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2013 – 2019“, analyzes the medical tourism industry and singles out several major medical tourism destinations such as India, Thailand, Singapore, Malaysia, Mexico, Brazil, Taiwan, Turkey, South Korea, Costa Rica, Poland, Dubai and the Philippines.

The report is available online for between $4,795 and $10,795 US, depending on user size: single user, 1- 5 users, or enterprise-wide.

Health care is globalizing, and to deny it, or to avoid it, is foolish, expensive and dangerous to your bottom line. Quality measures are better, costs are lower, and training in Western medical schools mean that more and more physicians are being trained on the same equipment and with the same knowledge Western doctors are trained on.

Health care no longer stops at the water’s edge, so open your eyes and go see for yourself.

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Richard