Thursday, August 14, 2008

Which people?

"There are many people who would prefer to see this site never get off the ground, and as participants in the system, there are dozens of ways to delay and roadblock development and implementation."

Wow. This is a pretty important statement by Charlie Baker, CEO of Harvard Pilgrim Health Care. He was talking on his blog about continuing delays in the public posting of payment information by the MA Health Care Quality and Cost Council. The information would indicate how much individual hospitals get paid for particular services by the state's insurance companies. Charlie is a member of the Council and has been working for months in trying to move this along.

Let's think this through. Which people could possibly have an interest in slowing down the publication of this information? You can post your answers below.

(Disclosure: Charlie is a member of the BIDMC Board of Trustees, an advisory body to our hospital, not the fiduciary governing body.)


Anonymous said...

Good call-out, Paul.
The short answer is, no one. Baker doesn't name them because they don't exist.
What he's trying to do is portray those who stand in his way of publishing inaccurate or half-baked information as evil or self-interested.
The "poople" he's trying to write about really do support the publication of data - as long as it's good, meaningful and not harmful to patient care. It's doesn't have to be perfect, but it has to be a lot better than the trash currently purveyed by the GIC.
He and his allies have repeatedly justified their argument for half-baked bad data with the comment that "You have to start somewhere."
Maybe so. But Baker wouldn't tolerate the publication of demonstrably bad data for his own business, yet he repeatedly insists it's OK to do the same for others.
It's one thing for him to keep pushing hard for forward progress (not a bad thing), but he could do do without taking cheap shots at his imagined opponents, and keep his credibility intact.

Anonymous said...

The obvious answer is the monopoly calling themselves Partners Healthcare. Why should Partners' hospitals get more money for the same exact work as another hospital while not demonstrating their outcomes are any better? They simply grouped up enough covererd lives in their system to put a gun to the head of insurers to get huge rate increases. This all started when Tufts Health Plan caved to them a few years back as Partners threatened to leave the Tufts netowrk. Add in the signing bonuses and other cash payments to Partners and you will see they probably serve thirty five percent of their market but take fifty percent of the premium dollars to cover that population. They are the single biggest factor that has driven up healthcare costs in eastern Massachusetts and since they are politically well connected no one investigates if they are too dominant a force in the market. Who has the most to lose by disclosing these rates? Obviously, it is the ones getting grossly overpaid for their work and that is the Partners Healthcare system.

Anonymous said...

Other than the website, is there a way for normal people to request the data?

e-Patient Dave said...

Okay, you guys, I smell a rat. A big stinking rat.

How come nobody who claims to know anything about this is willing to identify themselves?

My guess is that the big stinking rat is fear of retribution. And it p*sses me off that something this important would be (apparently) smothered by fear of retribution.

Who is this industry about, anyway??

It doesn't even matter to me whom others might fear.

Anonymous said...

Here is my take on what this payment information is worth:

Contracted rates have become very complicated with various hospitals receiving different methodologies.
DRG's, per diems, caserates, fee schedules, capitation, discounts from charges, carveouts. Even for a seasoned expert you don't know what your comparing to apples to apples or apples to roast beef.

If you are a hospital who has a perdiem, flat case rate, capitation, etc. you have agreed to take a payment that is average amoung all your lines of business, as opposed to a fee schedule, drg or carve out which might be more specific. So what are you really comparing against looking at singular specific procedures?

In reality there are a lot of mitigating other factors that go into what a hospital needs to get paid by a commercial payor (area wages, payormix, casemix, size/volume, etc.) that cannot be compared in a general cookie cutter approach.

What does what an insurance company pay to a hospital, and it will not be detailed enough to do a proper analysis, have to do with what a patient would pay? A hospital may offer a variety of selfpay patient discounts which would not be factored in.

What will happen is that hospitals that are getting paid less than their peers will try to use this information in negotiations to leverage higher rates driving up insurance cost.

Insurance companies that are paying higher than their peers will attempt to use this information to negotiate lower rates. And maybe in some ways they are hoping that this does bring Partners down a notch who has incredible market power.But not necessarily more power than the big 3 insurance companies have over most of the smaller community hospitals in the State.

The media will use this data to write op-ed articles on slow days most likely in a negative spin.

And in the end the consumer who this is being touted for will barely use it and won't really understand it.

I'm all for more data and more transparency. But in the end people tend to go to the hospital that is in their community or where their physician directs them or is affiliated with. Those that feel Boston/Partners is a better place to go than the local community hospital will still go there. Most that go understand that it's more expensive, but believe rightly or wrongly that they are getting better care. The few that really want this data I truly wish that it could be put out their in a way that was useful, comparable and understandable but it will not be.

Just let's not kid ourselves that this will be a real consumer driven product which will drive patients to use less expensive hospitals, creating some fundamental change that somehow drives down the cost of health care.

Anonymous said...

Thanks for the commments. Believe it or not, I agree with much of what ANON #1 is saying. My support for the creation of the Health Care Quality and Cost Council, and for having the Council serve as the primary source of truth around cost and quality data is - I think - the same as his (or hers). To be meaningful, the information needs to come from an uninterested third party, should include everyone's data (which means Medicare and Medicaid, too down the road), and should be subject to some kind of public vetting process.

But sometimes, someone's pursuit of perfection looks more like an effort to deny progress - and I stand by my previous comment that perfection, in this space, has spent too many years as the enemy of the good. That "patient care" argument has been used for years to deny the public release of meaningful and useful information - like risk-adjusted infection, complication and mortality rates by provider - and it's only been in the past few years that the coin has flipped - and people have started to say that public disclosure is better for patients than non-disclosure. Good.

As far as casting blame is concerned, I'm on the Quality and Cost Council - and I made clear in my post that most of the reasons for the web site's delay are due to our processes and decisions. And I own 'em - just like the rest of the Council.

But to suggest - as ANON #1 does - that no one is opposed to the transparency and disclosure agenda - for whatever reason - is simply not true. Many people are - for a bunch of different reasons. If acknowledging there is opposition to public disclosure is a cheap shot, I stand guilty as charged - but I don't think saying that "a bunch of people don't support this agenda and would prefer to see it go away" meets that test.

Anonymous said...

The battle about disclosure of cost and outcome information rages on. While some will point at the general public's inability to understand this data. I think we should give our informed consumers more credit. The large hositals and health plans who object to this level of transparancy should not be allowed to stall the process any longer. Unfortuantely legislative committees have very little leverage to compel specific performance.

Anonymous said...

Well, let's see; perhaps anon 9:42 works for Partners and anon 10:45 works for a competitor of Partners?
Context is everything. Maybe Charlie and his fellow board members need to name the names themselves - is that illegal?

Full disclosure: this comment comes from someone who lives far south of Boston and doesn't really care what goes on in Boston. But I have NEVER liked dishonesty or back door politics, anywhere. So who is it?


Anonymous said...


I meant to say Charlie and his fellow Council members, not his fellow Board members. See, I can't even understand the terminology....


Anonymous said...

Nonlocal, it's clear you'd not be able to understand the payment data either- not that you'd care what happens in the nation's healthcare mecca. go back to bed.