Sewage Leaks in DC Hospital Operating Rooms

The next time you are tempted to think, "all hospitals are equally safe," stop and think of this story about sewage leaks in the operating rooms at MedStar Washington Hospital Center. These leaks are cited as a cause of patients acquiring infections while in the hospital and the cause of the death of a woman from Northern Virginia. 

Leapfrog Hospital Safety Grade assigned Washington Hospital Center a safety grade of a D the last four times safety was evaluated.  The results clearly show they scored below average in infections. Sibley Memorial Hospital is just six miles away and it earned a B. Knowing this, where would you choose to seek care? 

I understand people put a lot of trust in their doctors and generally go wherever their doctors recommend, but it's up to you to choose where to seek care. I'm not exaggerating when I say this can be a life and death decision. 

The good news is that the information you need to make a well-informed decision is easy to obtain. Just go to Leapfrog Hospital Safety Grade and search by state, city, zip code or hospital name. Leapfrog even has an app you can load onto your phone, so this information is always at your fingertips.  

Mind the Gap

April 10 is equal pay day. It symbolizes the date when working women’s wages catch up to what men were paid the previous year--how far into 2018 women have to work (on average) to earn what men earned in the 2017 calendar year. Pew Research Center reported that in 2015, women earned 83% of what men earned. So, the gap is narrowing (you've probably seen the often sited 79 cents on the dollar statistic), but still persistent.  

The wage gap compares women’s wages to men’s on a very broad scale. It’s stated as a very broad statistic, women earn 83 cents on the dollar, or used to compare women’s’ wages to men’s wages within industries. Sarah Kliff at Vox wrote this article that clearly explains the wage gap. Some of the gap is certainly due to discriminatory practices, but the preferences of women also have an impact. The Gender Pay Gap persists despite equal pay laws. This white paper from Denmark explains how gender inequality in earnings stems from women's preferences after they have children.

Pay equity compares what women earn to what men earn for doing the “same work.” States are enacting pay equity laws because pay equity is viewed as something that’s within the employers control. Last year, I laid out a 10 step process for employers to follow to eliminate pay inequities. I’m proud to say it’s worked for ASHA.

Consumer-Focused Approaches Won't Curb Health Care Spending

Image from https://www.ballonkunstenaarpatrick.nl

The U.S. spends roughly twice what other developed nations do on health care. With all that money, we buy the lowest life expectancy and the highest infant mortality rate. Americans don't use more services than people in other high-income countries; we pay more the services we receive. 

In the fourth quarter of last year, health care surpassed retail and manufacturing to become the largest source of jobs in the United States. Health care is a huge driver in our economy, and one person's excess is another person's income. Putting pressure in one area to control costs is like squeezing a balloon--it increases the cost somewhere else. If we're going to spend more than every other country on health care, it would at least be nice to spend that money on things that improve people's health. We need greater transparency around the effectiveness and cost throughout the system, but especially with prescription drugs.

NPR put a human face on the problem in this story about a woman who's health reimbursement account was wiped out by a prescription for Kerydin--a $1,500 treatment that cures toenail fungus in 6.5% of the patients who use it.

Prescription Drug Spending in the U.S. Health Care System, provides a good overview of the issues. Policy Strategies for Aligning Price and Value for Brand-Name Pharmaceuticals describes options for value-based pricing.

What's the best approach for employers? Do you chase rebates or move toward value-based plan design. Today, employers cannot afford not to chase the rebates. If the Chronic Disease Management Act that was introduced in Congress in February becomes law, employers will have more tools at their disposal. The act would allow employers to cover some treatments without subjecting them to a deductible. This could lead to more innovative plan design. Reform is needed throughout the system though. Consumer-focused approaches won't curb spending unless we begin to align drug prices with the clinical value the drugs provide. 

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