Monday Musings

No one in the private sector would blink if corporate management decided to merge two related overhead departments like human resources and internal services. Nevertheless, it appears from the House Oversight and Reform Committee meeting notice and this Federal News Network article that tomorrow's Congressional hearing on the Trump Administration's plan to take a similar approach with OPM is going to be a real three ring circus. Get the popcorn ready.

Kaiser Health News reports that

Walmart Inc., the nation’s largest private employer, is worried that too many of its workers are having health conditions misdiagnosed, leading to unnecessary surgery and wasted health spending.

The issue crystallized for Walmart officials when they discovered about half of the company’s workers who went to the Mayo Clinic and other specialized hospitals for back surgery in the past few years turned out not to need those operations. They were either misdiagnosed by their doctor or needed only non-surgical treatment.

A key issue: Their diagnostic imaging, such as CT scans and MRIs, had high error rates, said Lisa Woods, senior director of benefits design for Walmart.

So the company, whose health plans cover 1.1 million U.S. employees and dependents, has recommended since March that workers use one of 800 imaging centers identified as providing high-quality care. That list was developed for Walmart by Covera Health, a New York City-based health analytics company that uses data to help spot facilities likely to provide accurate imaging for a wide variety of conditions, from cancer to torn knee ligaments.

Walmart will enforce this policy with increased cost sharing on those who fail to follow this policy. The FEHBlog hopes that Walmart will evaluate, and share with the public, whether this policy delivers results.  

A healthcare quality pal of the FEHBlog's called his attention to this Joint Commission announcement about a sea change in hospital quality reporting. The Joint Commission is the principal accrediting body for hospitals.

The Joint Commission is shepherding in the next generation of clinical quality by expanding the capabilities of its quality measure program to provide accredited hospitals with year-round, real-time access to quality measures. Over the last two years, The Joint Commission has transformed its electronic clinical quality measure (eCQM) reporting process to increase value and reduce burden for thousands of their 4,500 accredited hospitals with a Direct Data Submission Platform (DDSP). The Joint Commission is now continuing that digital transformation by making the platform and quality measure results continuously available, allowing providers to measure and improve performance in near real-time without additional outside vendors.

In today's Econtalk podcast, the host Russ Roberts, who has a Ph.D. in economics, spoke with Mary Hirschfeld, who has Ph.Ds in economics and theology. It was interesting conversation between Mr. Roberts who is a fan of Adam Smith and Ms. Hirschfeld who is a fan of St. Thomas Aquinas. In any event this Russ Roberts quote gave the FEHBlog a knowing smile:

"[Economic] incentives have problems * * * when you use incentives only for the things * * * that are measurable. * * * And you ignore the things that aren't measurable.