Chasing the Rabbit: Official Blog by Author Steven Spear

When asked by Pimm Fox on Bloomberg Radio what I thought of health care reform proposals, I answered that they all miss the larger point: We spend too much and get too little because patients and payers cannot distinguish good providers from bad.  This drives down quality and drives up cost–financial and human suffering (Please read the rest of this post to see why transparency is so critical.)

Democrats and the Republicans are focusing on how much America can afford to spend on health care and to whom responsibility should be assigned for paying for it.

They are talking past a critical issue: making sure patients and payers (self insured, private and public insurers) have the best possible information to make informed choices when selecting providers.

Why does this matter?  There are enormous disparities in the efficacy (e.g., quality) and efficiency (cost) with which care is provided.  This is true in diagnosis and in treatment and it exists along the spectrum from preventative through chronic, acute, urgent, and extended care.  For example, in some hospitals, the chances of suffering a complication while an in patient are minimal–near zero; other places they are terrible–one in one hundred or worse.  Wait times in emergency departments for diagnosis and treatment can be negligible to incredible (minutes to hours) and patient flow through specialty practices such as orthopedics and ophthalmic surgery (e.g., cataracts) can be double or triple–with the most productive practices having the best results and fewest complications.

The problem is, as a patient, knowing where to go for the best care at the lowest cost is incredibly difficult if not impossible.

The result? We haphazardly select therapists based on criteria often markedly unrelated to the value they are able to provide.  Do I have a greater or lesser chance of getting an astute diagnosis and treatment at this practice?  Do  I have a greater or lesser risk of suffering a complication when being treated at this facility?  Because those questions are awfullly hard if not impossible to answer, we don’t know where to go and whom to avoid.  So, we are forced to make choices based on best guesses, scuttlebutt, or arbitrary criteria.  (I once picked an emergency department when my daughter fell in the playground based on ease of parking.)

Therefore, great providers are penalized by not getting the traffic they deserve and crummy ones get business they haven’t earned.  Imagine buying a car not knowing in advance whether you will get a Yugo or a Lexus. Net net, overall quality suffers terribly while costs are driven up extraordinarily.

The thing is, this is all avoidable because we could have the information we need to make informed decisions if we wanted to.  Were the administration to make a lasting contribution to the betterment of society through health care reform, it would push for transparency about performance.

How?

First, start with the simple stuff.  Demand that any institution that wants federal funding–Medicare, Medicaid, NIH, etc.–has to keep current and make public (e.g., updated daily on their website) the number and rate of ‘never events’–cases of pneumonia suffered by ventilated patients; surgical site and catheter related infections; medication errors; patient falls; quick readmissions after discharge and that sort of thing.  That would give us some visibility into which organizations manage the delivery of care exceptionally well and which do not.

Second, start building more detailed specific measures about which institutions do the best job handling different types of cases.  Where do I go for knee injury repair, well births, management of chronic conditions such as diabetes, hypertension, or depression?

Those metrics could be generated were we to put our mind to it.  Payers gather extraordinary amounts of data about patients–who saw them, for what complaint, what was done, with what result?  Were these data mined–processed and analyzed to find structure and meaning within it, we would be able to measure and compare amongst providers.  Once we start doing that, we can–individually and societally–trust our well being and invest our wealth to the most capable and protect ourselves from the least.

The net result would be much better care, provided to many more people, at a far lesser burden of financial cost and human suffering than we experience today.

Related posts:

1. Provider Competition Key to Health Care Reform
2. Paul Kruman misses the point (again): Better care at less cost is the key…
3. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
4. Measuring Value-Added, not Compliance, Key to Health Care Reform
5. Theory and Evidence for Repairing Health Care Markets So Markets Can Repair Health Care Delivery…