Wednesday, February 27, 2008

Costs, costs, costs

As always, a thoughtful piece by Steve Bailey in today's Boston Globe, this one quoting Regina Herzlinger from Harvard Business School. An excerpt:

What consumers need, she says, is greater transparency. "The premise is that they are wonderful," she says of the hospitals. "Maybe they are. I would like to see some data that shows just how wonderful different hospitals are all across the United States. I would like to know how good is the Mass. General? How good is Brigham and Women's? How good is the Baptist? How many people get an infection? How long does it take to regain mobility after an operation? Dumb as I am, I could look at those data and understand them."

Well, as Reggie knows, you can check our website for this kind of information, in plain English, about BIDMC. Whether consumers use this information or not, we post it as a way to hold ourselves accountable to the public and ourselves to strive for ever greater clinical quality.

Mr. Bailey ends his column with this question: "Of course, we have to pay. The question is how much?" His question is also on the minds of John McDonough at Health Care for All and Charley on the MTA at Blue Mass Group. Previously, I have offered some of my ideas on this topic. And we are all looking forward to an expanded version of proposals from Senate President Terry Murray in the next several days.


Anonymous said...

I'm not convinced this information is terribly useful. My insurance company dictates where I can go for treatment. I have no choice, regardless of any costs, treatment quality, or any other reason. Blue Cross says I go to BIDMC. There is no other option.

What really irritates me is the different charges for different people. If I had to go to BIDMC and pay for it myself, the charges are 30+% higher that what BC/BS pays. Way to keep things affordable, guys.

Anonymous said...

I don't know of any Blue Cross plan that says you have to go to BIDMC, MGH, or any other specific hospital. That would be very unusual in Massachusetts.

Anonymous said...

As I've said numerous times before, I think it would be very helpful if the public could have access to the contract rates that hospitals (and doctors) accept as full payment from Medicare, Medicaid, and private insurers.

In the case of out of network providers, insurers could help members to create some countervailing power by making it easier to ascertain what Medicare pays for a given service, test or procedure. If a doctor bills a member four or five times what Medicare pays for a surgical procedure, for example, and the billed amount turned out to be at the 90th or 95th percentile for surgeons in the region according to Ingenix' Prevailing Healthcare Charges System (PHCS) database, as a member, I would certainly like to know that so I could challenge the bill as excessive and unfair. If it is a difficult case and the doctor has skills that are difficult or even impossible to duplicate anywhere else, I might well find his high charge quite acceptable. Under most circumstances, however, members could use some help from insurers, infomediaries, or others to create the ability to push back with facts in hand against doctors and hospitals. This kind of information, by the way, is already much more easily obtainable with respect to prescription drugs – both competing drugs in a therapeutic category or competing retail drug stores at which a given drug can be purchased.

Anonymous said...


I couldn’t agree more that greater hospital transparency and consumer-friendly public reporting is a direct path to improving clinical quality in our hospitals. To steal a phrase you have used in this space before, it generates a sort of ‘creative tension’ at hospitals and a heightened focus on improvement and accountability. Increasingly hospitals, like BIDMC, are taking the initiative to post their own data for their patients and families to examine. The challenge lies in ensuring that different measures are not measured in different ways and reported in different formats. I think it is important to point out that all Massachusetts hospitals are currently engaged in a groundbreaking effort in this arena. Our statewide website is remarkable in that 100% of hospitals participate, and they are doing so voluntarily. Additionally, every hospital is reporting data on the same, standardized measures in the same format (examples include bedsore prevalence, falls, staffing patterns, etc.). In the short time the website has been around, we have witnessed some remarkable examples of hospitals talking to one another, sharing best practices – ultimately moving the needle on quality. As we continue to add new measures that all hospitals can report on in the same manner (infections, serious adverse events), we will all benefit from not only improved care, but reduced costs.
- Lynn Nicholas, President & CEO, Mass. Hospital Association

Richard Wittrup said...

In addition to demanding transparency, we need to demand that BIDMC and its counterparts take responsibility for managing care.

I happen to be a diabetic (a mild and easily managed case, thankfully). I would like for BIDMC to convince me that it offers the best and least expensive care for my condition.

Richard Wittrup

Anonymous said...

Much of that care is offered and coordinated by primary care doctors, not the hospital.

Anonymous said...

Ah yes, but when that diabetic is hospitalized, it's another story. You have the nephrologist, the endocrinologist, the cardiologist, perhaps a surgeon for limb vascular problems, etc. I think people are now asking, should the hospital just be the passive "vessel" containing all this care (and charging for the room and all the imaging and tests ordered), or start to participate in offering the best value for a condition? Doctors and hospitals will eventually have to get married on these things.

Anonymous said...

Greater transparency would be great. I do believe that some of the problem lies with PCPs & the ‘partnerships’ they have with specific medical groups, specialists, and/or hospitals. I was previously on HMO with BCBS and required referrals --- because of my PCPs relationship with certain physicians or groups, he would only refer to those docs. For one medical condition I was receiving treatment, I was sent to a physician who specializes in treating children!!! That was the only person he was willing to send me to. I had the same experience when undergoing a surgery a couple of years ago and discrepancy between who my surgeon wanted to work with on his team for the procedure and who the PCP was willing to write the referral for. I had many conversations with BCBS about this & the docs I wanted to see were all in network, but they would not cover it unless he give me that referral.

I was lucky enough to change to PPO and change PCPs, but I think there are many people out there that are not so fortunate.


Anonymous said...

As you know MassGeneral is feeling the heat and only today launched a website for its Center for Quality and Safety which reveals some performance measures and quality metrics. Thanks Paul - for pushing these institutions closer to the fire.