Sunday, April 07, 2013

What was said, and what wasn't

The existence of an organization called the Association of Health Care Journalists is an indication of the resources being allocated across America and other countries to the coverage of this field.  I think it is a great thing that the group exists and is able to come together--virtually and physically--to build skills, compare notes, and bring in expert speakers, as they did recently in Boston.

Members of the association, though, may not have realized the danger of drawing stories from panel discussions.  Comments made by panelists are often designed to further promote the story lines of their organizations, lines carefully crafted over the years to support corporate objectives. There can be inadequate time to check the assertions made by panelists before writing summations of such sessions.

Here's one such story, about efforts by Massachusetts to contain health care costs.  Read it and see how the two dominant health care organizations in the state--an insurer and a provider network--coordinate the story lines on which they have joined hands.

First, the insurer expounds on its favorite capitated, or global, payment methodology, the one that ostensibly controls costs.  The "new payment method has not lowered overall spending, but it has controlled the rate of cost increases – below 2 percent annually," according to the story.

Taken at face value, this sounds good, until we remember two things.  First, the insurer padded first-year global payment budgets a few years ago to entice a number of hospitals and doctors to sign on.  It sure is easier to show a lower annual increase when you have an inflated base.  In addition, we need to remember what this insurer gave away to the dominant provider group.  As noted here:

Recall that the state's largest insurer gave away a huge rate increase to the state's dominant health care system  --  a 2-3% increase on a base that is, what, 15 to 20% higher than the rest of the market.

Think about the arithmetic.  The only way to give achieve an overall rate of cost increase below 2 percent while giving away a rate increase above that level to the largest provider is to give smaller increases to the subordinate providers in the state, thereby enhancing the market power of the dominant provider.

Oh, but what did the dominant provider agree to in return?  According to the AHCJ story, the dominant provider has "has changed its payment structure."

Really?  Let's go back to the deal that was signed, as reported by Robert Weisman in the Boston Globe:

Under the agreement, Partners agreed to participate in Blue Cross’s alternative quality contract, a so-called global payment that gives health care providers a budget for patient care and incentives for healthy outcomes rather than billing for each visit and procedure.
Th[at] new contract . . . covers only about 25 percent of the Partners patients insured by HMO Blue.

As noted, we can't blame the reporter in this case for reporting what was said in a panel discussion.  Perhaps, though, we can blame the conference organizers for creating a panel that was so likely to produce unsupported--and unrebutted--public relations story lines.

1 comment:

Gideon Gil said...

Hi Paul,

Thanks for the shout out for AHCJ, which has more than 1,400 members, including more than 80 in Massachusetts. I did want to point out, however, that the post you refer to on the AHCJ Covering Health blog is not a news story in the conventional sense but one attendee’s notes on the panel, “Lessons from Massachusetts in handling health care costs” -- any journalist writing about it for his or her publication would of course have done more reporting.

Also -- as the AHCJ post notes but you didn’t -- this panel included a third speaker: David Seltz, executive director of the state’s new Health Policy Commission. He’s clearly an alternative voice to the representatives of the “two dominant health care organizations in the state” who were on the panel.

Your readers also might want to know that a separate panel dealt more explicitly with the disparities in payments to hospitals. Called “Rich hospital, poor hospital: Stories of business survival”, the panel included Boston Medical Center CEO Kate Walsh and BU health policy and management professor Alan Sager -- again, esteemed speakers whose story lines were very different than those of Partners HealthCare and Blue Cross Blue Shield of Massachusetts.

I am biased -- I am an AHCJ board member and chaired the local organizing committee for the Boston conference. But a record number of people attended, which in part reflects the high quality of the speakers and panels.