Tuesday, June 24, 2008

Please join the Paul and Charlie show

I have been struck by the fact that, when major issues of public policy are raised on this and other health care-related blogs, the level of commentary drops noticeably. In contrast, human interest stories often prompt lots of back and forth. I guess the TV stations and newspapers and magazines realized this years ago, and we can see it in their choice of story topics!

But here's one on which you can join in, a discussion on the Health Care for All blog between me and Charlie Baker about the issue of public disclosure of the rates paid to hospitals and physicians. Try it. You'll like it.


Unknown said...

Hey Paul,

I haven't commented in a while. I've been busy finishing up school (finished my MBA/MHA by the way), but I have been catching your posts occasionally.

One thing I find, as a student / younger person, its often intimidating to voice opinion when seasoned industry people, such as yourself, are blogging. Its easy to post questions, or provide similar anecdotes from personal experience, but some don't want to go head to head and risk looking foolish. I discussed something similar with people in my org. behavior class, and find that I suffer from the same thoughts at times too.

A big hindrance I myself keep tripping over is, "Well, I'm in Louisiana and the basis of my knowledge is on the system we deal with here...surely I wouldn't have the foundation to talk shop with someone half way across the country." I keep that "we're too different, its not apples to apples" thought in my head. So I generally just read and digest, rather than comment and engage in talks / argument.

I'm just offering this up as a possible reason for your observation.

Anonymous said...

An excellent observation, Matthew. Thanks.

BTW, I never think of myself as a seasoned industry person. This is all still pretty new to me, too.

e-Patient Dave said...

Ditto on Matthew. I have all kinds of street cred on personal stories but I "hold no currency," as Paul Simon said, regarding policy matters.

You, of course, may be new to healthcare but you have all kinds of tire tracks (behind you and on your back) on policy matters.

So here's a challenge question: is policy actually something about which the average lay schlumpf can say absolutely valuable things, without having majored in it or studied it for years?

Anonymous said...

Of course you can!

Anonymous said...

All you have to do is listen to media pundits on TV to realize that people with no training and just big mouths and strong opinions can work themselves into positions of being regarded as "experts". In addition, I feel like thoughtful people outside a field often make observations that those too close to it cannot see. Paul is a living, breathing example of this phenomenon with his success in health care coming from, what? city planning?
Finally, I think once you hit 50 you no longer care whether people think you're foolish. So I say, have at it with the comments and opinions, whether you feel qualified or not! And as you can see, I do so!! (:


e-Patient Dave said...

Holy crap, THAT Charlie Baker?? I raved about HPHC in one of my first posts ever. My wonderful cancer care coordinator, Helen McNabb, told me I should get in touch with Charlie, and now look. All three of you in that post, and now again here.

Well, the world unfolds in chaotic and wonderful ways. Here we go.

Anonymous said...

I think the state of Massachusetts and the Health Care Quality and Cost Council deserve a lot of credit for taking this on. Price and quality transparency is a keen interest of mine because I think high quality, easy to use and access information can help to maximize how efficiently we allocate resources. With healthcare costs already consuming 16% of GDP and rising, this is no small matter for the economy and the society.

As Charlie Baker says, we have to start somewhere and the 30 or so hospital procedures that price data will be posted for is a reasonable place to start. Hopefully, the data will be quickly expanded to all procedures as well as fees charged by physicians, imaging centers, labs and retail pharmacies with Medicare and Medicaid rates included as well. While well insured consumers still may not care if their out of pocket exposure is relatively modest no matter how much is charged, insurers should be able to develop incentives that reward referring doctors for steering patients to the most cost-effective providers. Doctors and hospitals that demonstrate the ability to reduce utilization by eliminating unnecessary tests and procedures, keeping infections to a minimum, etc. could also be rewarded with gain sharing bonuses.

As for the criticism that transparency could potentially raise costs by inducing hospitals and doctors that charge less to raise their rates, this is easier said than done under the current system where rates are driven more by the market power of the institution and the provider network. If insurers can differentiate among providers based on value, they could easily tell a lower performing provider that we will be happy to agree to a higher rate as soon as you demonstrate that your performance / value is as good as your better paid, higher performing competitors.

Anonymous said...

Just to follow up, there seems to be a perception among consumers that both more care and more expensive care mean higher quality care. In fact, the highest quality care can often be the least expensive. In the case of an expensive surgical procedure, for example, doing the job right the first time and minimizing complications reduces costs. So does having complete records readily available to insure that tests are not repeated and drugs are not prescribed that might adversely interact with others the patient is taking. Hospitals and doctors who work well to minimize infections also save money. Efficiently run hospitals and physician practices incur less overhead expense. If hospitals and doctors could ever work together to offer a bundled price for all care necessary in connection with an expensive surgery and other procedures that lend themselves to bundled pricing, it is quite possible that the best teams could offer the lowest cost to insurers while compensating the surgeon and anesthesiologist competitively and still earn a satisfactory profit margin for the hospital. I think bundled pricing makes sense whether Medicare embraces it anytime soon or not.