Tuesday, October 31, 2006

The Week Before

The week before the drug company supplement in the NY Times Magazine, there was a glossy insert called "National Hospital Guide, a reference tool for health-conscious consumers". It portrayed itself as "designed to help you better manage your health care needs".

Of course, the major entries in the booklet were those hospitals that had shelled out the money to buy an ad in the same booklet. But then, a few others were included, too, including a few in Boston. When we inquired how the selection was made of those hospitals, the publisher told us that they had a selection process, but could not or would not tell us the criteria for selection. One group of hospitals included in that manner is a major purchaser of advertising space in the Boston Globe, which is owned by the New York Times. In the absence of public criteria for selection in the Times brochure, it is unreasonable to assume that there is some carryover influence from the Globe ad placement?

The point is this. Advertising is advertising. A selection process based on supposed clinical excellence is another. Shouldn't we expect the media to distinguish between the two when they are "guiding patients to better health"?


Anonymous said...

I would see if there is a similar financial arrangement between all or most of the hospitals featured in the article and the newspaper. If all of the hospitals have purchased ads then you have a solid conspiracy...

In the absence of a conspiracy I would suggest that the only reason to hide the criteria would be because there was none. The time pressure inherent in the news business means that they may have selected hospitals until they had enough for the story, without any criteria at all. If this happened it fully explains why they would hesitate to show you "the criteria".

To bring this point how you might come up with a straw man criteria (anything that would be a reasonable evaluation of the publicly available information about the hospitals) and show how using this dummy criteria there was no reason to choose those particular hospitals. If in fact the criteria was random, then that should highlight that fact.

Until these kinds of comparisons are done (and granted, they are probably not worth your time), the newspaper can pretend that they have a super good criteria, but its a super secret. Which seems super childish to me.

Anonymous said...

When we called, the Times said they used a "independent review source" but could not name it, nor was it included in the insert.

The insert itself suggests that people look at the JCAHO website to review hospitals. By that standard, our hospital, which had a perfect JCAHO score, outpaced all the other ones from Boston that were mentioned in the insert.

Anonymous said...

I was puzzled by the same insert. But the question that I have to ask is how much choice most patients have with regards to where they go for tertiary care? In the absence of Philly, NY and Boston, most people have one clear center designated as a referral source.

I'd be interested to hear your viewpoint on the coordination or competition among the hospitals in your area. I think there are competing factors at play including the profit motive that we all have to acknowledge and public service. Does having several hospitals in a city providing stem cell tranpslant benefit the public good? Would it be more efficient if one center were deemed the CT surgery center of excellence and another the sarcoma center of excellence? I'm asking because I don't know and I figure you might.

Love your blog.

Anonymous said...

As you suggest, as I discussed in my postings below on transplants, there are certain specialties that are expensive to provide to the public and for which some type of coordination would make sense. I note, for example, that it is hard to imagine why we want transplant centers that only perform two or three dozen procedures per year.

It is unlikely that the hospitals will agree among themselves to any allocation of specialties. Most large hospitals want to be able to provide a full range of services. Some of this is driven by the fear that a patient sent to a nearby hospital for one specialty service will be "stolen away" by that hospital, never to be seen again by the original one.

For other specialties, it is fine to have them offered in several hospitals around town. The set-up cost is less, and there are a sufficient number of cases being handled in each hospital to assure the highest level of quality and safety.

For the costly and difficult sub-specialties, who should decide this question? I suggest below that the insurance companies could have a major influence, basing their determination on quality and safety. This was done in MA for bariatric surgery.

Anonymous said...

From a patient point of view, most people do not read the N.Y. Times Magazine when there are sick; most people ask their primary doctor where their should be treated.

I have a very specific type of cancer, and my doctor at BIDMC (not my primary doctor) recommended me to go to MGH because he personally knew the best specialist to treat me who is at MGH. I also went to see a great specialist at DFCI, per my primary doctor recommendation.

The three doctors discussed in a conference call which will be the best type of treatment for my case. This is collaboration, and I like it. I feel that MGH-DFCI-BIDMC worked together to save my life and this is a memory that will be forever and it will be transmitted to several generations in my family and friends. Save lives is a memory for ever.

I do not want to write about what are the economical implications of this AD, because we should talk about health care from a different prospective sometimes and remember what health care means for patients.


Anonymous said...

Yes, that is the way things should work, and they often do. Thanks to LS for that important reminder!

The institutional and personal competition among the Boston hospitals and doctors is often put aside to get the best care for an individual patient in the right setting. Remember, too, that the doctors witin the Harvard system (which includes MGH, BIDMC, the Brigham, Daba Farber, Children's Hospital, MA Eye and Ear, among others) collaborate in many ways on research and teaching and therefore have underlying relationships that increase the likelihood of similar collaboration in caring for patients.

Anonymous said...

I am happy to see this post; its very timely. I deal with this issue frequently, from the patient bedside perspective. What is advertising posing as information, what is objective innocent sponsorship.

Maybe not the thrust of your article, but there is a bigger picture here.