Comments on: Episodes of Care: You have got to be kidding

By: scottshreeve

scottshreeve — Fri, 30 May 2008 15:28:45 +0000

Vince,

Great comments as always. I am sorry you don’t believe . . . its what happens when you have been battling something for all the years you have. I remain fresh-eyed and non-jaded, but with a health respect for how difficult change is within health care.

Therefore, I believe the only way for this to work is to begin locally, to begin small, and to begin to do EOC by EOC. It is the type of disruptive innovation that won’t even be noticed because it is so difficult and so slow but ultimately some one or some group will figure out how to make it easier, simpler, and the collaboration/communication platform will increase such that it is not only possible but preferred way to contract for services.

I realize it looks like a pipe dream now, and I have been accused of smoking the good stuff before (open source in health care IT – you are crazy!), so I will take your comments as constructive and a good reality check.

I will keep plugging away, under the radar, and see where this road leads. Looking forward to catching up with you soon.

By: Vince Kuraitis

Vince Kuraitis — Thu, 29 May 2008 18:45:47 +0000

Scott,

I understand the intellectual appeal of the concept of episodes of care…and I applaud companies that are experimenting here.

Based on my 25 years experience in health care, I just don’t think it can work. Intellectually, logically appealing — YES; practical — NO. Obviously this a gut level judgement.

Porter and Teisberg have been big promoters of the concept, and I just don’t see them as having their feet on the ground — http://e-caremanagement.com/porterteisberg-jama-article-out-of-the-box-or-out-of-touch/ .

Your case study of a tonsillectomy is very interesting. Given the difficulties you encountered with what would seem to be a very straightforward EOC, how would you ever make the concept work with older patients with multiple chronic conditions?

I’ll try to keep an open mind, but I’m not yet convinced.

By: Mamma Mea (Culpa)! Ingenix Goes Open Source « Crossover Healthcare

Mamma Mea (Culpa)! Ingenix Goes Open Source « Crossover Healthcare — Thu, 29 May 2008 01:39:20 +0000

[...] Blog Vocabulary Episodes of Care: You have got to be kidding [...]

By: Endoguy

Endoguy — Thu, 29 May 2008 00:08:37 +0000

This was a facinating read. I hadn’t really considered the whole EOC concept in this type of detail.

My first thought in your narrative was – My God, what a totally tedious process, who would have time for this kind of research.

My second thought was – been there before in dealing with insurance companies in getting a straight answer.

There seems to not be the resources or tools out there to deconstruct the whole process in discreet components.

By: Ian Furst

Ian Furst — Wed, 28 May 2008 22:34:31 +0000

Interesting post Scott. It’s the first I’ve read about EOC’s (by that name). There is a common metric in the literature of cost per life year. In an EOC however, the patient will pass through many institutions (large and small) were soft costs are hidden (admin, infrastructue, depreciation, etc…). If you want to do the cost analysis you need to know not only employee hourly rates but depreciation, lease, bad debt and other expenses that go into total cost. Rather than trying to sort out the mess, why not do the analysis on an hourly basis. I (and I assume most institutions) know the cost of care on a daily basis given a certain level of patients. That level changes slowly over the years even though patient mix can evolve more rapidly. It would be a lot easier to microcap it too — 1/2 consult, 1/2 surgery, 2 hours pacu, 1 night floor, 15min post op x 2. Another main barrier to EOC’s I assume is concurrent care where nurses, anesthetists, etc.. may have multiple patients.
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