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‘Escape Fire’ leaves out IT, ultimately disappoints

I finally got the opportunity to catch the documentary film “Escape Fire,” a good 15 months after it went into limited theatrical release and became available in digital formats. I thought it would be an eye-opening exposé of all that ills the American healthcare industry, particularly for those who somehow believe we have the greatest care in the world. I excitingly ran this graphic when I first mentioned the movie on this blog back in October 2012:

The well-paced, 99-minute film interviews some notable figures in the fight to improve American healthcare — safety guru and former CMS head Dr. Don Berwick, journalist Shannon Brownlee, integrative medicine advocates Dr. Andrew Weill and Dr. Dean Ornish — as well as some lesser-known people trying to make a difference. It goes through a laundry list of all the culprits in the overpriced, underperforming mess of a healthcare system we have now, and examines approaches that seem to be producing better care for lower cost.

I expected the movie to have a liberal slant, but it really stayed away from the political battles that have poisoned healthcare “reform” the last couple of years. About the only presence of specific politicians were clips of both President Obama and Senate Republican leader Mitch McConnell both praising a highly incentivized employee wellness program at grocery chain Safeway that reportedly kept the company’s health expenses flat from 2005 through 2009, a remarkable achievement in an era of escalating costs.

However, filmmakers Matthew Heineman and Susan Froemke did discuss all the lobbyists’ money presumably buying off enough votes in Washington and at the state level that has helped entrench the status quo. They even scored an interview with Wendell Potter, the former top media spokesman for Cigna, who became a public voice against abuses by health insurers because his conscience got the better of him. As Brownlee noted in the film’s opening, the industry “doesn’t want to stop making money.”

Other reasons given for why healthcare is so expensive, ineffective and, yes, dangerous include:

  • direct-to-consumer drug advertising leading to overmedication;
  • public companies needing to keep profits up;
  • fee-for-service reimbursement;
  • the uninsured using emergency departments as their safety net;
  • lack of preventive care and education about lifestyle changes;
  • a shortage of primary care physicians;
  • cheap junk food that encourages people to eat poorly; and
  • severe suffering among the wounded military ranks.

The filmmakers also kind of imply that there isn’t much in the way of disease management or continuity of care. Brownlee described a “disease care” system that doesn’t want people to die, nor does it want them to get well. It just wants people getting ongoing treatment for the same chronic conditions.

One physician depicted in the movie, Dr. Erin Martin, left a safety-net clinic in The Dalles, Ore., because the work had become “demoralizing.” The same people kept coming back over and over, but few got better because Martin had to rush them out the door without consulting on lifestyle choices, since she was so overscheduled. “I’m not interested in getting my productivity up,” an exasperated Martin said. “I’m interested in helping patients.”

Another patient in rural Ohio had received at least seven stents and had cardiac catheterization more than two dozen times, but never saw any improvement in her symptoms for heart disease or diabetes until she went to the Cleveland Clinic, where physicians are all on salary and the incentives are more aligned than they were in her home town. As Berwick importantly noted, “We create a public expectation that more is better.” In this patient’s case, she was over-catheterized and over-stented to address an acute condition, but not treated for the underlying chronic problems.

The film also examined how the U.S. military turned to acupuncture as an alternative to narcotics because so many wounded soldiers have become hooked on pain pills. One soldier, a self-described “hillbilly” from Louisiana, got off the dozens of meds he had become addicted to and took up yoga, meditation and acupuncture to recover from an explosion in Afghanistan that left him partially paralyzed and with a bad case of post-traumatic stress disorder. The only laugh I had in the movie was when he told the acupuncturist at Walter Reed Army Medical Center in Washington, “Let’s open up some chi.”

I kept waiting and waiting for some evidence of information technology making healthcare better, but I never got it. After leaving the Oregon clinic, Martin took a job at a small practice in Washington state where she was seen toting a laptop between exam rooms, but, for the most part, I saw paper charts, paper medication lists and verbal communication between clinicians.

What really bothered me, however, is the fact that there was no discussion of EHRs, health information exchange or clinical decision support, no mention of the problem of misdiagnosis, no explicit discussion of patient handoffs, continuity of care, medication reconciliation and so many other points where the system breaks down. You can’t truly fix healthcare until you address those areas.

 

January 21, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Is this Cisco commercial reflective of the real world?

Cisco Systems is running this commercial about the “Internet of everything,” with a focus on connected healthcare.

 

It all sounds great, but how much of this is grounded in the real world today and how much is wishful thinking? I mean, connected medical records? It sounds so idealistic.

May 19, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Anthem’s California plan turns to Google Maps to reduce ER costs

Remember back in February when I cut my face open at the HIMSS conference and needed medical assistance while 1,000 miles from home? I blogged then about how I used Google Maps to find an urgent care clinic close to the convention center instead of riding to a hospital emergency room in an ambulance? I’m guessing that course of action saved me at least $1,500, money that would have come out of my pocket because, as a self-employed individual, I was only able to qualify for an afford an insurance policy with a high deductible.

Though most Americans still aren’t engaged as consumers when they seek healthcare services, there are tens of millions of uninsured people and a smaller number of people like me with high-deductible plans that would face the same conundrum when they have a non-life-threatening condition: go for “traditional” ER care and pay through the nose, or take a few minutes to seek out lower-cost alternatives.

Now, insurers are trying to encourage the same kind of behavior, because they usually are the ones on the hook for high-dollar ambulance transport and emergency care, even if the condition isn’t a true emergency. Last week, Anthem Blue Cross in California announced a new program to encourage members to seek out non-emergency care—walk-in retail clinics and urgent care centers—when their regular physicians are not available.

“When your five-year-old is crying with a fever at 7 p.m. on a Friday because she has a sore throat or an ear ache, what do you do?” Anthem Medical Director Kurt Tamaru, M.D., said in a press release. “It’s important people know that they have options for less serious ailments other than an ER, such as retail health clinics and urgent care centers that provide quality care and cost them significantly less.”

According to Anthem Blue Cross, an ER charges an average of $641 treat strep throat, something that would cost about $70 at an urgent care center and just $27 at a retail health clinic. This does effect patients directly, too, because Anthem requires a $150 co-pay on average for a ER visit, but just $10 to $40 for care delivered at a walk-in clinic or urgent care center.

The technology driving this program? Google Maps and its brethren.

Just go to Google, Yahoo or Bing and type in “Anthem and urgent care,” and you will be directed to an Anthem educational site (or visit the site directly at http://www.anthem.com/ca/eralt). There, you will find a Google map showing ER alternatives within Anthem’s California network.

Members can sign up for educational e-mails explaining the types of conditions that don’t usually require emergency care, and the potential costs savings by seeking an alternative. Anthem also will make automated phone calls to members who recently had a costly ER visit that could have been avoided.

Anthem cited a study that proved the efficacy of such as an approach. Hopefully, the statistics are accurate and Anthem has success with its program. It worked for me because a lot of money was on the line. Likewise, Anthem members now face higher out-of-pocket expenses if they choose the expensive option rather than the right option. And all it takes is a simple, proven piece of technology called Google Maps.

 

July 15, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.