Health Care or Healthcare?

Is it "health care" or "healthcare?" We've all seen it spelled both ways.

Here is a quick review of the preferences of a dozen voices in the industry.

"Health Care"

• American Hospital Association
• American Medical Association
• Centers for Medicare & Medicaid Services
• NCQA
• The Joint Commission
• U.S. Dept. of Health & Human Services

"Healthcare"

• American College of Healthcare Executives
• Healthcare Advertising Review
• Healthcare Marketing Report
• Healthcare Strategy Institute
• Modern Healthcare
• Society for Healthcare Strategy and Market Development

Merriam-Webster and The New York Times use "health care." Hits on Google: "health care" 55.5 million, "healthcare" 12 million. I prefer "healthcare," but use it either way based on the client's culture. Sometimes I also use it hyphenated as a compound adjective, such as "health-care system."

What's your Vote?

Which version does your organization use? I'm adding an informal poll to this blog that will remain open indefinitely. Please take a moment to weigh in. (See right column.)

Later note: "healthcare" won by a large margin.

—Tom DeSanto

Death Rates: Of Patients and Hospitals

The news on death rates is out. It promises to drive U.S. hospitals toward further improvement in clinical performance. Eventually, fewer hospital patients will face unnecessary death. In the meantime, some hospitals may begin a slow death.

Without a doubt, the federal government has taken a giant stride in measuring and reporting hospital performance. The Hospital Compare website now posts reports based on deaths that occur with 30 days of admission among the 35 million Medicare beneficiaries.

Upside

The improved reporting method:

• uses heart attack, heart failure and pneumonia deaths to reflect overall performance
• compensates for differences in the acuity of patient populations
• retains simple categories for comparison
• delivers a 95 percent confidence level that each hospital is in the right category.

Downside

The new comparison data:

• assigns most hospitals to the "as expected" category, making comparisons difficult
• does not account for DNR orders of deficient follow-up care outside the hospital
• runs the risk of patients and consumers "over-interpreting" mortality rates
• places 115 hospitals, deemed to have higher than average death rates, on the spot.

Flip Side

Transparency around death rates is likely to improve performance and cull hospitals unable to reach posted standards. It's a new round of survival of the fittest.

If patients and consumers react strongly and stay away from hospitals that have higher death rates, the resulting loss of fiscal resources not only will make it difficult to make improvements, but also hasten the demise of hospitals already in the red.

Likewise, if physicians, nurses and staff lose faith in their hospital's ability to reach higher performance standards, their response will slow progress in achieving them.

Every hospital has highly trained physicians, nurses and staff who are dedicated to providing the absolute best care they can with available resources. The sad truth is that all that extraordinary talent, dedication and technology is undermined by a healthcare system that is an outmoded hodgepodge of ineffective governance, finance and information-sharing.

With the publication of death rates and subsequent media push, hospital communications teams have a lot of explaining to do. Updates from Quality Advisory offer help. But these communicators will need to offer hope.

— Tom DeSanto

Our Health Care Conundrum: Innovation vs. Access

Medical innovation advances while access to medical care declines. How can the U.S. drive innovation and expand access?

To me, a first step might be to get the government's purveyors of advancement and access working together. 

The Food and Drug Administration (FDA) evaluates the efficacy and safety of new interventions, but not their effectiveness in alternative clinical settings or cost implications.

The Centers for Medicare & Medicaid Services (CMS) has a mission "to ensure effective, up-to-date healthcare coverage and promote quality care for beneficiaries."

Why can't the FDA and CMS collaborate early on to ensure the clinical and reimbursement viability of new diagnostics and treatments?

I posed that question to Dr. Steven Gutman, Director of the Office of In Vitro Diagnostic Device Evaluation and Safety at the FDA, at a recent conference. He confirmed that the agencies currently work completely separately and that past efforts for collaboration have not been successful. Another overture is taking place currently, but he is unsure what the outcome might be.

As usual, the wheels of bureaucracy turn slowly, even in the face of evidence for change.

To fund biomedical innovation in 2007, the U.S. government provided $28 billion to the National Institutes of Health and $593 million to the National Science Foundation. 

At the same time, 47 million Americans, almost 16 percent of the population, did not have any healthcare coverage—which means they could not directly reap the benefits of medical advancements. 

Innovation is essential, but the high cost of new interventions is not always covered by a Medicare system that struggles for solvency.

Back in 1999, the RAND Corporation corporation recommended that "it would be beneficial, then, for policymakers to consider how their decisions may effect medical innovation indirectly through the effects of those decisions on private technology adoption, along with the more obvious direct effects of their decisions about coverage and payment under public health insurance programs."

A decade later, we're still not getting there. What's the answer?

Dr. Gutman provided a candid assessment at the conference. He said, "I have a perverse view that the health system will explode in three to four years and that will fix it."

No one, including Dr. Gutman, truly wants to see an explosion. But we could use a little fireworks. Maybe then our health system can break down more silos and reach a more acceptable equilibrium between innovation and access.

—Tom DeSanto