Posts by Chris Moriates

How I Realized QI Could Be a Dirty Word

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?” Recently, I read a paper that helped me realize I had been swimming in a different lake from most of the “real world” in medicine. I trained and then spent the first 4 years of my post-residency career at UCSF, where quality improvement (QI) was well established and celebrated. Sure, I suppose there were some eye rolls from a few surgeons, or…

More and More and More about Overuse

You probably feel like you have been reading a lot about medical overuse these days. You are right. The number of articles in academic journals addressing overuse has nearly doubled this past year compared to 2014. A recent systematic review published in JAMA Internal Medicine uncovered 821 articles on medical overuse in academic literature during the 2015 calendar year. That doesn’t even include all of the editorials and articles that have been popping up in our trade journals and in popular magazines and newspapers. What’s more, I don’t think this is the peak yet. In fact, research on overuse is basically just getting started. Why is medical overuse such an important issue? Overuse is not only expensive; it is a patient safety issue, since it leads to serious patient harms and downstream consequences. As hospitalists, we know this all too well. We are the ones that take care of the…

Respect the Body You Are Trying to Heal

“You must respect the body you are trying to heal.” I heard this said twice into my headphones, the second time more slowly and firmly than the first, while I sat on the runway about to take off. It continued to echo in my head over the course of the flight. As a physician, the reference to healing a body has obvious resonance. However, as I embarked on yet another gathering of healthcare leaders discussing how to make our healthcare system better, this assertion took on a broader significance. Clinicians often hear about – and experience daily – our “broken healthcare system.” There is little doubt that our system is sick, but it is not yet terminal. Physicians understand the art of treating a diseased person, bringing together clinical science and knowledge with emotional empathy and respect. Yet, when we become healthcare leaders, managers, or administrators and turn our sights…

Wine Lists, StubHub and Healthcare: Who’s Getting Value Right?

By now, you’ve probably heard the news: providing a price transparency tool to patients does not seem to lower healthcare prices. In fact, according to this very large JAMA study, patients who were offered access to a price transparency tool seemed to spend slightly MORE compared to those patients without access. So, I guess put that whole price transparency idea to bed. Well, perhaps not so fast. As Dr. Kevin Volpp thoughtfully points out in his accompanying editorial, this study shows that price transparency tools will not be a “panacea” by themselves (who actually thought they were going to be in the first place?), but that there are many important considerations for interpreting the results of this study. I think by far the most important caveat is that the tool only included cost information, without any real context. Think about this for a second. When looking at a long wine…

You’ll Receive High-Value Care…Or Your Money back?

As hospitals across the country increasingly focus on patient experience, one health system, as we’ve written about before here on The Hospital Leader, is really putting their money where their mouth is: they are offering patients direct refunds, no questions asked. An article in The Washington Post calls these refunds, “the most unexpected hospital billing development ever.” The article opens with, “At Geisinger Health System in Pennsylvania, hospital officials want to keep their customers happy.” Ok, I hear some of you already sharpening your pitchforks. You take care of PATIENTS, not CUSTOMERS. Agreed, but there is something that both of these titles have in common: underneath them are people. Real-life people, who care about how they are treated on a personal level and yes, they want the best possible medical care but they also would like their meal to be edible and their physicians to speak to them with respect,…