Sunday, August 30, 2009

Michael Vick

I am not a big Michael Vick fan. I didn't like him before his conviction. I still don't like him.

If I were a defensive coordinator facing the Eagles, I would do the following:

When Vick is lined up as a wide-out, especially near the formation, I would put a line-backer or defensive lineman on him and tell them to "tee off." When he is not lined up as a QB, he does not get the protection that a QB does. He's just another player at that point. I'd also find a linebacker who owns and loves dogs to line up against Vick. That would be just.

I don't buy the argument that says that Vick has "suffered enough." That's CRAP! He hasn't suffered anything like the suffering that he subjected his dogs to. At the least, he should be made to clean up kennels at dog shelters instead of spending his time in his mansion and in five star hotels.

I've never really liked the Eagles. I like them even less now. When you employ scumbags, you shouldn't expect everyone to love you.

I've added the Eagles to my list of teams that I root against.

Saturday, August 29, 2009

Another NFL Season

I'm not really much of a football fan.

I've lived in Michigan all of my life. During my lifetime, the Detroit Lions have won a single playoff game. They have been dreadful. Last year, they went 0-16. It's tough to be a football fan in Michigan.

I once worked with a fellow from Pennsylvania. We had to explain the NFL's "blackout rules" to him, as he had never experienced a home game blackout while he lived near Pittsburgh. It is merciful to keep us from having to see the Lions stink every game. The downside is that the NFL punishes us by not showing any game when the Lions are blacked out. Back in the analog teevee days, I could pick up games from Toledo on my rabbit ears, and could watch the Browns when the Lions were blacked out.

I used to think that the Lion's longtime General Manager, Russ Thomas was the primary reason that the Lions stunk. Russ retired years ago. The Lions still stink. The only constant during this long period of stinkiness has been ownership: the Ford Family. They just don't care. NFL teams are guaranteed to make a profit. The revenue sharing from the TV contracts is more than the salary cap. They make money before they put a single behind into a seat, before they sell a single cardboard pizza, and before they sell a single watered down beer. As long as the team makes money, whether they win or lose, why should ownership care? They obviously do not.

I will watch a few football games this year. As I type this, I am watching the Raiders get their lunch money taken from them by the Saints. They look awful. Jeff Garcia just played for the Raiders. He was better than their starter (who's name escapes me). The Raiders may give the Lions a run for their money for the worst team in the league this year.

The Saints are playing Joey Harrington at QB on this drive. Another refugee from the Lions. He just threw a touchdown pass.

I think the Lions won their exhibition game with the Colts this afternoon. The game was not on teevee here.

It's tough to be a football fan in Michigan.

Thursday, August 20, 2009

Health Care Quality

Back when I worked in manufacturing, there was a saying that went:

What gets measured gets done. What gets rewarded gets done well.

Healthcare escaped the "quality revolution" that swept through many other industries in the 80s and 90s. That is about to change. When manufacturing changed from a culture and reward structure that focused on quantity (build to the numbers) and incorporated quality metrics into the evaluation and compensation packages of leadership, we saw a dramatic improvement in quality. As I heard it stated once, "It's amazing what you can accomplish when management is paying attention." Management pays attention when their performance reviews, bonuses and promotional opportunities are influenced by achieving quality metrics.

ARRA requires HCOs to report 27 Quality Measures to CMS to qualify for "meaningful use" financial incentives.

Some of the ARRA Quality Measures seem to be pretty straightforward. For example, there is a requirement to report "The percent of orders entered directly by physicians through CPOE." We all know that the error rate is greater when physicians write out orders and someone else enters the data for them than it is with CPOE. CPOE has significant advantages over the manual order writing system. As a local radio commercial says "even McDonalds doesn't use paper orders in 2009." So, one measure of how effectively an organization is using its EHR will be the CPOE Percentage.

Another measure is to report the percent of smokers offered smoking cessation counseling. This is the sort of measure that I have an issue with. So, you offer them counseling. Big Deal. Since we are concerned with outcomes, a better measure would be "the percent of smokers that quit smoking." Just measuring whether you offered smokers counseling reminds me of those kids camps where every kid gets a ribbon for showing up, so that we don't hurt their feelings.

We know that once CMS has this data, it will be made public. And then organizations will be able to compare their scores against their competitors (yes, virginia, hospitals do compete with each other). Also, consumers will be able to look at the scores for hospitals and doctors and use this as a determining factor in deciding where to take their health care business.

An important component of any Quality Management System is specifying what is to be measured. If there is any ambiguity in the description of what is to be measured, we will end up with inconsistent results and will be "comparing apples to oranges."

HL7 is balloting a Healthcare Quality Measures Format (HQMF). I did some work helping to put the document together.