Paul Levy

The rankings are designed to advise patients with complex medical conditions, they are not an indication about the general level of quality of care or safety in an institution.

Lean is not a program. It is a long-term philosophy of corporate leadership and organization that is based, above all, on respect shown to front-line staff. Indeed, coaching others to help them learn to see problems is really what lean is all about.

The Lean process improvement philosophy can bring significant cultural change to a healthcare organization, if there is strong support from the C-suite. But what happens when a Lean-supporting CEO departs? Here is a cautionary tale.

While others have dispassionately made the point that there are unexplained variations in Medicare physician billing data that warrant careful consideration when using such data, one doctor thinks CMS has devious motives.

I am an unabashed proponent of the Lean philosophy in many settings, especially the clinical environment of a hospital. But Lean quickly goes by the wayside without the enthusiastic support and encouragement and personal involvement of senior management.

With the Massachusetts Attorney General granting Partners Healthcare System a long-term lease on life as the dominant provider in Eastern Massachusetts, it's almost certain that the state and its residents will continue to pay above-average healthcare costs.

Much attention has focused on the "patent cliff" faced by pharmaceutical companies. There is another patent cliff approaching that has not yet received much attention -- the end of patent protection for many minimally invasive surgery devices.

It is so striking that hospitals are keen to accept and publicize the results of the fairly meaningless U.S. News and World Report hospital rankings and yet complain bitterly when the Leapfrog Group posts scores based on data about preventable medical errors and injuries.

As financial pressures impinge the health care system, the various players sometimes seek legislation to protect their interests. I have heard of two such situations in Massachusetts, and I offer them for your consideration and your comments.

I don't want to be a stick in the mud, particularly as my able friend Don Berwick takes charge of CMS, but I want to point out that previous efforts by the government to be innovative in other fields have failed.