Friday, September 26, 2008

Shoe on the other foot

A story by Mark Hollmer in today's Boston Business Journal summarizes a recent report by the Mass. Hospital Association, entitled Hospitals Rate Health Plans: A Critical Look at Performance Variation. I'm told that the full report will be on the MHA's website on Monday. Here's an excerpt of Mr. Hollmer's article:

Hospitals prefer to deal with local health plans over their national counterparts. But Bay State providers still want them to try harder to reduce inefficiency and extra costs, according to a new survey released Friday by an industry trade group.

"What we found is that no one plan is really performing at the top at every attribute," said Lynn Nicholas, president and CEO of the Massachusetts Hospital Association. "But all plans have strengths and weaknesses, which provides a great opportunity to learn from those who do it well in an effort to improve the field overall."

...[H]ospital executives said they want insurers to update and distribute more evidence-based clinical guidelines to help promote more cost-effective care. They also want health plans to better educate their members about their insurance and obligations so they can make more informed consumer decisions.

I am sure this report will be viewed as self-serving by the insurance companies, but the points made and the language used are remarkably similar to the comments those companies often make about hospitals. My conclusion: Both segments of the health care industry have a long way to go. Transparency in both sectors would go a long way towards self-improvement.

In that regard, let's do an experiment. Check out the websites of your favorite insurance companies and hospitals. See how many have adopted quantifiable audacious goals for quality improvement, patient satisfaction, or efficiency -- and how many post their actual operating results to hold themselves accountable? (If you find some that do, please submit their links as a comment.)


Anonymous said...

I absolutely believe in more transparency, and, as someone who practices in a teaching hospital, I believe hospital transparency between physicians and administrations could be better, too.

I think every physician should know exactly how much they have billed, how much the hospital hasa collected and how much of that income stays in their own department versus spread out to subsidize other areas. Teaching hospitals are often very ineffecient because those that create the wealth have little say over how that wealth is ultimately spent.

Physicians must absolutely be a part of this process of transparency, or, you will find that certain measures of effiency will be used that are counterintuitive, and even counterproductive, because they are a sort of, well, marketing gimmick. Examples might be turn around time in pathology, for instance. Quality is not the same as quantity, nor speed. Speed matters, but, if you are producing a report with say, three data points on it versus a system with only one data point, your extra day of turnaround may very well be the better long term 'bargain.' Physicians can provide, and fight for, this sort of transparency.


Anonymous said...

Do insurance companies really pay for 'performance'? Really? Efforts to improve quality and safety are cost-saving tools for industry rather than harm-saving tools for individuals. Otherwise, insurance companies would pay for true systemic harm reduction rather than volume advantage. And if transparency and performance are currencies by which hospitals should be measured, why is the vast variation in pay-for-procedure associated with volume rather than quality? It is pretty clear who has the advantage. BIDMC improvements occur in the face of, rather than because of, insurance pressure.

David Szabo said...

You should check out for comparisons of health plans on a number of metrics that are important to providers. Its interesting reading.