Justin still teaches us all, thanks to Dale's generous spirit

Dale Ann Micalizzi started Justin's Hope Project in memory of her 11-year-old son who died as a result of medical errors.  It took her nine years to learn why.

Dale now gives scholarships so that young people involved in pediatric care can attend the IHI Annual Forum and learn more about quality and safety and be among thousands of other people who likewise are committed to these ends.

Here's a video she recently produced that tells her story.  It begins, "The code blue was called," and then the story unfolds.  The video has already prompted some lovely comments on Facebook and is being shared on that platform, and now here (with Dale's permission).

Jim Conway noted: "So tragic, powerful and beautiful. An exceptional lever for change. Our gratitude only grows, Dale."

Indeed.

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Mixed feelings

On the one hand, kudos to Lenox Hill Hospital’s Chair of Urology Dr. David Samadi, who highlighted the importance of early screening and prevention by performing prostate exams live on NBC Today Show anchors Matt Lauer and Al Roker. Helping people understand the ease of this screening test is a public service.

On the other hand, this is the same Dr. Samadi who permitted himself to appear in a testimonial video produced by Intuitive Surgery (posted on August 28, 2013) to support its marketing campaign for use of the daVinci robotic surgery machine, specifically by playing on men's fear of impotence and incontinence. His statement--"There's a huge benefit to patients when they go through the daVinci prostate surgery"--is not supported by scientific inquiry. This video was posted in the midst of numerous reports and concerns about the use of this technique.

Recall this report by Citron Research, on December 19, 2012:

Imagine a medical company with a single product — one which lacks any clinical data proving medical efficacy superior to other conventional treatments.

And another particularly damning report from Citron in October 2013:

In over 12 years of publishing probative stock research, Citron is most proud of the work we published on Intuitive Surgical (NASDAQ:ISRG) starting last December. Not because the stock suffered a decline of over 30% amidst a record- setting bull market, but rather because we helped raise to the forefront of public awareness the undisclosed dangers of robotic surgery and the subsequent dilemma: what happens when medical best practices collide with unbridled thirst for profits.

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What you can't do directly . . .

. . . you do indirectly.

The country's labor unions tried hard to exempt themselves from the "Cadillac" tax on expensive (and generous) health insurance policies when the Accountable Care Act was being debated.  Whatever you might think about that tax, Congress wisely decided that labor unions were no different from companies on this matter.

But now Jay Hancock at Kaiser Health News reports that the unions may getting their way, through quiet, back-door administrative changes:

Buried in rules issued last week is the disclosure that the administration will propose exempting “certain self-insured, self-administered plans” from the law’s temporary reinsurance fee in 2015 and 2016.

That’s a description that applies to many Taft-Hartley union plans acting as their own insurance company and claims processor, said Edward Fensholt, a senior vice president at Lockton Cos., a large insurance broker.

Insurance companies and self-insured employers that hire outside claims administrators would still be liable for the fee, which starts at $63 per insurance plan member next year and is projected to raise $25 billion over three years.

Unions, a key Obama ally, have increasingly criticized the Affordable Care Act as threatening the generous medical plans held by many members.

Eliminating the reinsurance fee was one of several resolutions adopted at the AFL-CIO’s September convention.

Although it’s too early to tell whether the Department of Health and Human Services will give union plans all of what they want on the fee, last week’s language “is how HHS often breaks controversial regulatory news,” benefits lawyer R. Pepper Crutcher, Jr. wrote last week. It's not known when the administration will put out a new regulation on reinsurance. 

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Another chance to vote

No, I'm not suggesting that you vote "early and often," but I am requesting you to vote on one more ballot.

My friends and colleagues Gilles Frydman and Roni Zeiger explain:

We are Smart Patients, a new online community of cancer patients and caregivers, for the era of molecular medicine. Our mission is simple; improve medicine, one story at a time.

We're here to help people get optimal care by sharing with other informed patients everything they need to know about any aspect of their disease.To do so, we have created a new platform, designed to tear down silos that have stopped people from sharing with others who know the answer to their particular question. 

This great duo is competing to get a grant from Chase Mission Main Street.  They need 250 votes to be considered for this grant, although more votes than that are even better. As I write this, they have 65, but I bet we can all get that number to go up pretty quickly.

That's where you come in. Please go to this site and vote. No muss. No fuss. Although you must first connect with you Facebook account, no one stores or shares your information. Then, just vote, and know that you have helped these great guys get one step closer to a better world.

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Focus on ambulatory care on WIHI

Madge Kaplan writes:

The next WIHI broadcast — Improving Safety and Satisfaction in Ambulatory Care — will take place on Thursday, November 7, from 2 to 3 PM ET, and I hope you'll tune in.

Our guests will include:

• Gordon Schiff, MD, Associate Director, Brigham Center for Patient Safety Research and Practice, Brigham and Women's Hospital
• Nicholas Leydon, MPH, Director, PROMISES Project, Massachusetts Department of Public Health
• Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement (IHI)
• Damian Folch, MD, Family Practice and Lifestyle Medicine (Chelmsford, MA)

We don’t typically associate the ambulatory care setting with serious lapses in quality that threaten patient safety. Much of the improvement in recent years targeting outpatient care has focused on access, waiting times, communication, and coordination of care. But these areas ripe for change have often obscured others that, if not handled well, can have even more dire consequences: the ordering of tests, the timely handling and communication of results, and the overall process of making a diagnosis in response to a patient’s symptoms or complaints, including making referrals to specialists. 

With these issues in mind, we invite you to join the next WIHI on November 7, 2013: Improving Safety and Satisfaction in Ambulatory Care. On the program, we’re going to find out what’s been learned from a three-year initiative known as PROMISES, charged with reducing malpractice risk in the ambulatory setting by making care safer, more efficient, and more reliable. 

The WIHI panel will be headed up by the lead researcher for PROMISES, Dr. Gordon Schiff, who’s also the lead author of a recently published article in JAMA Internal Medicine ("Primary Care Closed Claims Experience of Massachusetts Malpractice Insurers") that found that the lion’s share of malpractice claims in Massachusetts primary care practices relate to allegations of misdiagnosis stemming, in part, from dropped balls with test results. This finding matches national trends, which is why the work of PROMISES, centered on making improvements at 16 sites, should resonate with many. Dr. Damian Folch worked on improvements at his practice in Chelmsford, MA, and he and other sites were coached by Improvement Advisors, including Nicholas Leydon. Because it’s rarely a matter of one thing that’s been missed or that can go wrong, IHI’s Frank Federico will help us understand why a systems approach is critical to managing the many things that transpire in the ambulatory setting, including careful tracking of prescribed medications.

This WIHI on PROMISES promises to be rich with results and real-world experience, and it will offer you ways to get involved to help shape and spread further change. Could your team use a PROMISES Patient Safety Curriculum? Would you like to explore becoming a Primary Care Patient Safety Innovator? Find out how and join the discussion on this next WIHI on Nov 7. Host Madge Kaplan and her guests are looking forward to your questions and hearing about your experiences.

I hope you'll join us! You can enroll for the broadcast here.

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It's time for NHS Change Day 2014 to begin.

What happens when the third largest organization in the world decides to change? We'll see in a few months.

Today starts the countdown to NHS Change Day, set for March 3, 2014.

This is a grass roots approach to change, not something ordered from the top down.

How it works is remarkably simple and engaging.

First, you make a pledge and post it for all to see.

All you need is an idea of what you could do to make a positive difference. Then you make a pledge - a simple promise to yourself and others that you will act on that idea and become a 'changemaker'.

If a pledge inspires you, you hit "like."

The more likes you give, the more you'll inspire others.Tell other people you like it too by sharing it on your social networks.

Join someone else's pledge.

Find a pledge that inspires you and if you think you can do it too, hit Join!

This is the second year. Last year saw 189,000 pledges to make things better. This year the goal is for 500,000.The organizers summarize:

Anyone can make a pledge. We ask everyone to embrace the energy of Change Day and to PLEDGE, SHARE, DO and INSPIRE. To make the NHS the best is can be. Let's do something better and courageous together. It's time for NHS Change Day 2014 to begin.

Here's a picture of the kick-off with three of the organizers, Jeremy Tong, Helen Bevan, and Sebastian Yuen, where Helen noted, "We're doing this because it fits with our values."  Jeremy advised the assembled crowd: "Listen to what people say... they'll be able to tell you the problems... but also act on what you hear."

From this side of the pond, I say, "Bravo!"

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Dammit, take credit for the good!

Many of us who support the primary goal of the Affordable Care Act--to provide access to insurance for many more Americans--get frustrated by the inability or unwillingness of the administration to create a powerful narrative for the law.  A story earlier this week in the New York Times provides an unfortunate example.

The headline is a winner: Under Health Care Act, Millions Eligible for Free Policies.

The lede is more qualified:

Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs. 

We can't blame the administration for the reporters' choice of words, but in the second paragraph they start to dig themselves into a hole:

Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.  

What is this paternalism? We are reluctant to tell people about plans that can help them because the plans may not help them as much as plans they can't afford?

In contrast, the advocates understand that something important is being made available:

Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available.

But then we get this "no comment" from the administration:

Officials at the Department of Health and Human Services would not comment on the McKinsey analysis, saying in a statement that the goal of the health law was to provide a range of options for people with differing needs and budgets.

In a unattributed statement?   Luckily someone else is out there who is willing to be quoted:

The availability of zero-premium plans may make the deal especially enticing to the healthy young people the marketplace needs to succeed, said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School. “This is such a good deal that you’d have to believe you were immortal not to really pick it up,” he said.

I wish the administration would likewise learn to claim victory on these matters.

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