Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important, since ''Talk of the Nation'' spent 30 minutes yesterday interviewing Don Berwick and me about it… on the day of Hillary’s speech!To listen to the show, click here. Also, here’s an article from USA Today that got the ...

Just returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced.First, the final “no pay” list. I’m not sure if this was CMS’s intent, but their trial ...

Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.” But when did we turn into the Holiday Inn?Let’s start by appreciating where this comes from. Many hospitals, including mine, tend to run ...

In this week’s JAMA, Dr. Don Berwick, CEO of the Institute for Healthcare Improvement, argues that evidence-based standards should be relaxed for quality improvement practices. Ironically, a few pages away, a Swiss study finds than an IHI-endorsed MRSA prevention strategy doesn't work.What’s a person or hospital to do?A little background on both ...

I must have ''you can't manage what you don't measure'' on the brain – here's a piece I wrote this week for AHRQ's Guidelines/Quality Measures Clearinghouses called ''Is the Measurement Mandate Diverting the Patient Safety Revolution?'' Well, of course it is. In it, I make the point that our hunger for measurable targets – generally a good thing ...

''You can’t manage what you don’t measure.'' This well-worn business axiom has been embraced by the healthcare quality movement, a trend this is healthy and long past due. But it comes with a risk:   Yin without Yang. What do I mean? With the (still scanty) evidence that tight glucose control improves the outcomes of med-surg (as opposed to ...

I recently participated in a meeting whose aim was to develop safety measures for hospital units (ie, med-surg, ED, L&D). As various measures were being ticked off, I muttered that we should also try to capture errors that occur as patients move between units. One of my colleagues, quite sensibly, asked, “but who will be accountable for that?” ...

A humorous and telling story about quality measurement, decision support, and human nature:I was visiting professor at a very good academic medical center a year or so ago. On these trips, one of the fun things I get to do is meet with the residents. Sometimes they present a clinical case to me, but this day they wanted to talk about healthcare ...

P4P (pay for performance) is all the rage in healthcare. And why not? In the face of the damning evidence that we ''get it right'' only about half the time, criticizing linking higher payments to better care seems frankly un-American. And there is accumulating evidence that P4P may work. A study earlier this year by my friend Peter Lindenauer ...