tag:blogger.com,1999:blog-32053362.post8978401505135671256..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Selling out to PartnersPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-32053362.post-31860453169558833732014-05-18T21:34:48.549-04:002014-05-18T21:34:48.549-04:00The "politization" of medicine has tramp...The "politization" of medicine has trampled virtually all the lines that once defined ethics, craftsmanship, and commitment. It's money-driven now-often under the guise of expanded care or improved delivery of care. Quality has become 'the appearance of quality.' Good enough for Government work!! <br /><br />And somewhere, in quiet rooms, deals are made daily that begin before we knew they existed, and roll over us like a road-grader. When we discover them, there are too many snakes on Medusa's head to kill. And if we stare at her in disbelief, we are turned to stone.Peternoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-87640492348705483612014-05-18T08:37:11.877-04:002014-05-18T08:37:11.877-04:00Perceptions about academic medical centers "h...Perceptions about academic medical centers "high quality" for routine care can be rebutted if the facts are publicized.<br /><br />Just make a point of publishing the quality of routine care "as public service announcements" in local newspapers, radio stations etc. <br /><br />The Boston area has some of the best community hospitals in the country. The have superior quality, as good as MGH and B&W for routine matters, at literally half the cost in most cases. <br /><br />If each local community had local papers, radio stations etc periodically [quarterly?] publish quality statistics for routine procedures it would help.<br /><br />Just look at a given region, say the North Shore of boston, identify where patients have routine care done and publish the data for those hospitals. There is no point publishing the statistics for hospitals not often used by those in the region - say those in Worcester, Western Mass or the South Shore. <br /><br />If the real differences in quality were understood [for routine care MGH and B&W quality is the same as average community hospitals], and especially if patients could pay far less for the care, that would shift the dynamic we see in Boston.<br /><br />So what do you say?<br /><br />Public Service announcements on quality of local care? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-4358227434248008932014-05-17T15:31:24.562-04:002014-05-17T15:31:24.562-04:00I wonder where the root cause of this (probably) u...I wonder where the root cause of this (probably) unique situation in Boston is, where all the residents think of the academic centers as their home hospitals. Way back before all these mergers started, Partners and others, was that the case? if so, the die may have been cast long ago and it was simply a case of which AMC got the biggest first who won the market. But, patient perceptions of high quality being limited to AMC's were apparently skewed very early on.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-70728417584653039132014-05-17T14:03:56.798-04:002014-05-17T14:03:56.798-04:00One issue too is the local municipalities around S...One issue too is the local municipalities around South Shore Hospital such as Braintree and Weymouth are all in favor of this deal despite the fact municipalities in general(not necessarily Braintree and Weymouth)were all crying poverty just a few years back regarding high healthcare costs.Timhttps://www.blogger.com/profile/03894651289037073128noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-5808670289920531462014-05-17T13:36:15.506-04:002014-05-17T13:36:15.506-04:00Paul,
I understand the market perception of quali...Paul,<br /><br />I understand the market perception of quality regarding MGH and B&W. However, if there were some decent data regarding both contract reimbursement rates and quality, it should be possible to steer a considerable amount of routine outpatient business and even lower complexity inpatient business away from PHS, especially its community hospitals which, presumably, command much higher reimbursement rates than other community hospitals in the region.<br /><br />Also, I think regulators could make it easier for insurers to contract with some hospitals within a hospital system but not others. In theory, insurers should be allowed to strike deals that include MGH and B&W where the most sophisticated care presumably takes place but not some or all of the PHS community hospitals as well as its stand-alone imaging centers, clinics and rehab facilities. PHS probably insists on all or none contracting now but I don’t know that for sure.<br />Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-20442467207372455142014-05-17T12:10:28.300-04:002014-05-17T12:10:28.300-04:00Barty, what you say makes a lot of sense and might...Barty, what you say makes a lot of sense and might eventually be the case. But to date, there's not much evidence in Eastern MA that a limited network is seen as attractive by businesses or by individuals. There is a perception--of course not based on reality--of greater quality at the Partners' flagship hospitals. Therefore, many people consider them as must-have's.<br /><br />Also, please remember that a clever monopolist is very good at profit maximizing. Even if there is some loss of business, income is based on quantity X price. You can bet that the PHS finance folks have figured out the price elasticity with regard to their services.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-61139311644126926772014-05-17T10:59:51.633-04:002014-05-17T10:59:51.633-04:00I wonder what the difference is in insurance premi...I wonder what the difference is in insurance premiums between health plans that include Partners in their network and those that don’t and to what extent are the plans that don’t include Partners gaining traction in the market.<br /><br />I continue to think that disclosure of actual contract reimbursement rates would be helpful especially to help educate people about cost differences for similar services with no discernible difference in quality. Tiered networks and reference pricing would also be helpful tools to steer business away from expensive providers like Partners. Perhaps medical tourism could also play a role especially for expensive and high profit margin services like hip and knee replacement surgery and cardiac surgery.<br /><br />If employers don’t want to take a more proactive role on this issue, they may find it in their interest to transition to a defined contribution model for health insurance and let their employees purchase a policy that best meets their needs through a private exchange run by the big benefits consulting firms like Towers Watson, Aon Hewitt, and Mercer among others. The evidence on the public exchanges so far, as I understand it, is that people are extremely price sensitive which suggests that narrow networks may become increasingly acceptable if the price discount vs. the broad network products is wide enough.<br />Barry Carolnoreply@blogger.com