Saturday, May 31, 2014

Why there is no public debate on PHS issues

In his weekly private letter to friends and colleagues, former Atrius Health CEO Gene Lindsey notes:

As of yesterday’s Globe, my statement in last week’s letter that there had been no editorial, op-ed or letter to the editor comments in The Globe about the AGs decision to endorse Partners’ Healthcare’s acquisition of Hallmark Health and South Shore Hospital has remained true. Just as Garrison Keillor might say,"Well, it's been a quiet week in Lake Wobegon, Minnesota, my hometown”, I could say, “Well, it’s been a quiet week at The Globe, my hometown paper.” I would have thought that all of The Globe’s editorial focus and expertise would have been brought to bear on an issue with such significant future implication for healthcare in Massachusetts.

Well Gene, it goes well beyond the Globe, and the answer might be that so many people in town receive financial support from Partners that the public commentary on such issues is biased by that financial power.  Let me provide two examples.

Take Health Care For All, the most prominent health care NGO in the state, whose mission statement reads:

HCFA seeks to create a consumer-centered health care system that provides comprehensive, affordable, accessible, culturally competent, high quality care and consumer education for everyone, especially the most vulnerable among us. We work to achieve this as leaders in public policy, advocacy, education and service to consumers in Massachusetts. 

HCFA publishes a blog called "A Healthy Blog" with wide-ranging commentary about health care issues in the state.  I've reviewed the contents of that blog, and I have also searched for public comments by HCFA executives about the PHS market power issues.  I find none.

Prominent among HCFA's supporters is, you guessed it, Partners Healthcare. Is this just a coincidence?

Take WBUR and its Commonhealth blog.  Yes, they do cover the Partners issues and do so as fairly and comprehensively as anyone in town.  But again, prominent among WBUR's supporters is, you guessed it, Partners Healthcare.  Here, the issue is not that PHS influences the editorial policy of WBUR:  That clearly does not happen.

In this case, the power is more subtle but no less effective: Whatever points might be made in the Commonhealth blog on this topic--read by a few thousand readers--are dramatically reduced in impact by the quid pro quo given to Partners, i.e., repeated self-serving messages on air, heard by tens of thousands of listeners during drive time. In addition, as you see above, PHS gets to place an ad on the Commonhealth site, persisting with its message day after day.

Sorry Gene, the fix is in.  Don't expect a level playing field when it comes to a public debate on the Partners Healthcare market power issues.


Anonymous said...

It seems to me that your real problem in Boston is that the public just doesn't care how much power Partners accrues, as long as their insurance plans include it. They perceive that it costs them nothing, and no one is successfully educating them otherwise, least of all the public institutions in Partners' debt.
Boston is behaving just like a rural small town whose only source of employment (and accompanying embedded political power) is the one local community hospital. Pretty amazing that a city of such size and purported sophistication has been so captured.

nonlocal MD

Anonymous said...

Perhaps because folks are not all that enchanted with what the PHS or other feds have to offer regarding what those organizations have deemed in their administrative wisdom passes for good healthcare. Witness the Massachusetts Mess and well as VA nationwide. Perhaps Partners has simply captured the market with excellence in spite of claims to the contrary. I have begun to find your Partner bashing and pot stirring rather creepy.

Barry Carol said...

Does PHS get paid any more than competing local academic medical centers for services provided to Medicare and Medicaid patients? If so, how much more are they paid and how much higher are their costs? If their payment rates are comparable, then their market power to extract higher prices is limited to the commercially insured population below age 65. For this population, it falls to employers and insurers to educate employees and insured members about significant differences in costs for care of comparable quality. Insurers have tools including tiered networks and narrow networks to address this. They can also move to implement reference pricing where it makes sense,

Anonymous said...

@anon 1:26, your comment would be much more powerful were it not hiding behind the veil of anonymity. I wonder what your relationship is to Partners. On the substantive front, if Partners really is better than everyone as they claim, why not publish their clinical outcomes data? Every single hospital collects this information; few make it transparent in real time. I find it highly ironic that, despite Atul Gawande's widely accepted work on surgical checklists, his own hospital, the Brigham, doesn't have this protocal in place. That's just one example of where Partners' hospitals aren't following evidence-based best practice. If Partners does in fact have better clinical outcomes than other places - and a real claim to excellence other than reputational marketing - what do they have to hide by not publishing outcomes data in real time?

M.E. Matlaw

Anonymous said...

I have to agree with ME Matlaw. Partners is one of the few hospital systems in the country, nay the world, with the financial and other resources to do truly ground breaking work in health care delivery and patient safety/quality. Instead, they have concentrated on amassing a war chest of money and political power more befitting a Wall Street bank than a hospital. This smacks of leadership ego rather than caring for patients.
Although as a practicing physician in the Southeast I had always subscribed to the idea of clinical excellence at MGH and others, my eyes have been opened. Time to get off the pot and do the things to deserve your reputation, which is rapidly eroding.

Anonymous said...

You are correct in pointing out the lack of discussion on such an important topic. These very same people will be yelling the loudest when the ramifications of this agreement find their way into the marketplace with a group like NEMC or Steward making huge layoffs or hospital closings. When this does inevitably happen it will be interesting to see the politicians and others express shock and outrage that such a thing could happen when it is clear as day to anyone who follows the Partners story.