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Quality metrics need fixing, doctors unionize to protect practice and patients, and pharma recruits patients to peddle drugs

January 21, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Features:

Hitting the targets, but missing the point. That’s what Robert Wachter, MD, interim chair of the department of medicine at the University of California, San Francisco, had to say about doctors and teachers in relation to the new metrics in health care and education. In  The New York Times this week, he said the requirements in the two fields, though based on good intentions, often lead these professionals to distractions from the core of their work—educating and healing. In medicine, it’s measurements of outcomes and processes that are key; in education, it’s test performance that counts, even when it may be at the expense of nixing subjects like music and phys ed in preparing for the test. While measurements can help with improvements, Watchter said, “we need to tone down the fervor and think harder about the unanticipated consequences.” Among those consequences are physician and educator dissatisfaction— “blocking the altruism,” says Wachter, “indeed the love, that motivates people to enter the helping professions.”  We need to find the right measurements for assessing performance, perhaps based on Care That Matters, and include what professionals are saying about the metrics that are currently in play, especially now when we know from physician surveys and teacher surveys that work dissatisfaction is so widespread.

 

The administration at PeaceHealth Sacred Heart Medical Center in Springfield, Oregon, recently made a decision that many hospitals have been making in the past 10 years: to outsource its 36 hospitalists to a management company. The decision, presumably, was the result of “growing pressure on hospitals to measure quality and keep people healthy after they are discharged,” writes Noam Scheiber in The New York Times. Hospitalists and other clinicians are increasingly encouraged to promote hospital efficiency and help their employer reach performance targets—by seeing more patients, working more shifts, discharging patients sooner… “We’re trained to be leaders, but they treat us like assembly line workers. You need that time with the patient,” said Dr. Brittany Ellison, a hospitalist at Sacred Heart. This time, however, the Sacred Heart hospitalists revolted. Their main concern: being forced to see more patients in the same amount of time and the potential harms to patients and physicians that can result from burnout. A third of Sacred Heart hospitalists sought employment elsewhere, and those who stayed formed a union. In response, the hospital’s administration agreed to reverse its decision.

 

A piece this week on Philly.com finds that one quarter of U.S. cancer patients are receiving so-called “precision therapies,” which dominate cancer drug spending. According to the NCI, targeted therapy “is a type of cancer treatment that targets the changes in cancer cells that help them grow, divide, and spread.”  As drug costs across the board continue to rise, and as patients look to ways to make ends meet, some patients consider working for the very companies that are profiting from their illness. Hemophiliacs, whose needed drugs are among the costliest, are being hired by the pharmaceutical industry to serve as salespeople for their hemophilia drugs, recruiting others who suffer from the disease to use their drugs. Andrew Pollack of The New York Times asks whether such approaches, which pay huge commissions, don’t create conflicts of interest, effectively obscuring the lines between patients and drug peddlers. In one instance, the mother of a hemophiliac earned 45 percent of the profit that pharma made on each new patient she recruited to take their drug. While this practice is not limited to hemophilia, hemophiliacs (and their families) are particularly affected because drugs can cost from $30,000 to hundreds of thousands of dollars a year per patient. Pollack writes, “More and more, manufacturers of hemophilia drugs and their specialty pharmacies that dispense the medicines are hiring patients and their relatives to gain an inside track and access in selling their products.”

 

Announcements:

 

  • Just in: We’ve extended early bird registration until Sunday, January 31 for the 4th Annual Lown Institute Conference at the JW Marriott Chicago, April 15-17. Join us for what promises again to be a great conference. Hear from our renowned speakers: Jeffrey Brenner, MD; Gordon Guyatt, MD; John Ioannidis, MD; Joanne Lynn, MD; and Rita Redberg, MD.  Register now. Space is limited.

 

  • Be part of our second annual RightCare Vignette Competition. We are seeking clinical vignettes written by trainees that describe harm or near harm caused by medical overuse. To learn more or to submit a vignette, visit our RightCare Vignette Competition page.

 

Headlines:

 

Overuse

 

End of life

 

Patient engagement/empowerment

 

Safety

 

Drugs

 

Tech & innovation

 

Maternal and child health

 

Business of health

 

Practice

 

Guns

 

Opioid crisis

 

Public health

 

Research

 

Transparency

 

Primary care

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.