Vol. 12 December 30, 2009 Health Care Reform, Jargon Watch


Now there are more overweight people in America than average-weight people. So overweight people are now average… which means, you have met your New Year’s resolution.

Number of days the lifespan of a woman in her 40s would be increased by a decade of mammogram screening:  5

Cost per quality-adjusted life-year (QALY) gained using current American Cancer Society guidelines for mammogram screening:  $680,000

Cost per QALY gained using newly recommended guidelines: $35,000 (1)

Chances that Dr. Susan Love, author of Dr. Susan Love’s Breast Book and renown specialist on women’s health issues agrees with the recent recommendations to delay and reduce the frequency of mammogram screening: 100%
.               “This is rationing – but it is rationing of the best kind”  (2)

Number of years before the current health care reform benefits are implemented: 4 (2014)

Number of years after passage that Medicare benefits were implemented: 1 (1966)

  • In 1966 there was some concern that implementing Medicare so quickly would cause a rush on medical facilities and some states developed plans for  National Guard deployment to manage the expected “disaster-like” run on medical services. The “rush” never happened, and the National Guard, of course, is now not available since they are all in Iraq or Afghanistan.
  • Cynics apparently consider this “delayed implementation” a device to get past the 2012 Congressional elections before voters really understand what “Congress has wrought”.


PILLARS – Communication horizontally between organizational units, as opposed to vertical communication along a chain of command, is considered extremely helpful in complex organizations, and a major barrier to that has always been the vertical “turf walls” making SILOs around each unit. Obliteration of “silos” has been a rallying cry of health care management consultants for years. Recent recognition that something vertical is actually needed to support “the structure at the top” has caused the  silo walls to be replaced with PILLARS.

RPI- “Robust Performance Improvement” – The new term coined by the Joint Commission of Accreditation of Health Care Organizations to emphasis their commitment to quality improvement efforts to distinguish them from new federally qualified accrediting competitors. (see also older terms of the same thing: QA, QAI, QI, PI, CPI, Six Sigma)

HARMONIZE THE DATA – Medicare is requiring that data from the various health care facilities and programs receiving Medicare reimbursement have similar format, content, and time periods to enhance comparisons of outcomes. This is called HARMONIZING the data reports. (A bit gentler than “homogenizing”, I suppose, and a symphony is always better than a cacophony.) Watch for this word to start popping up in the QI, PI, and even RPI plans of many health care systems.

TUG – “Time to get Up and Go” is a simple method to measure a patient’s ability to get up out of a chair and start to walk and is trackable over a defined time period like a hospital or nursing home stay.

SHOOTOUT – A drive-thru vaccination clinic originally devised for avian flu and now dusted off for giving swine flu vaccine at a fast food-food pace.


1. Cancer Epidemiol Biomarkers Prev 2009:18:718-25
2. NEJM361:26, Dec 24, 2009,2503 (see also “Live a Little:Breaking the Rules Won’t Break Your Health” by Dr. Susan Love)
3. A concept clearly stolen from WIRED Magazine

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