I’m writing this blog the day of the third game in the Red Sox-Yankee three game series, and while hope springs eternal, we already know the bad news about games one and two. All of which makes me feel a little skeptical about other recent news coming from New York. It appears possible that even health care reform isn’t faring as well in the Empire State as it is in Massachusetts. New York’s Attorney General has taken on the issue of physician tiering and seems to be suggesting that the goal of transparency should not extend to ranking doctors, despite the evidence that there is significant variance among doctors treating the same conditions in terms of both quality and cost has been known for years. We can hope that as the NY AG digs deeper into the facts he can be convinced that consumers are better served by more, not less information. We at the GIC don’t have a horse in this particular race – we don’t contract with any of the three health plans under scrutiny in New York. A spokesman for A.G. Cuomo’s office has said that they are not opposed to physician profiling in principle, but…and it’s the “but” that makes me nervous. We hope that their efforts will result in recommendations that will make the three companies’ products better and more useful to consumers and providers. One way or another, it’s time to look more critically at what we are getting for our health care dollars and identifying which providers serve us better with both skill and efficiency. In the last analysis, giving patients information is the best consumer protection – and the best road to lasting health care reform.
Dolores L. Mitchell, Executive Director of the Group Insurance Commission of the Commonwealth of Massachusetts, the agency that provides life, health, disability and dental and vision services to over 285,000 State employees, retirees and their dependents.
There is no doubt that more accurate information about health care serves all involved better. The key word here is “accurate.” What concerns us at the Medical Society has more to do with the fact that using medical bills as a source of clinical information is fraught with inaccuracies.
Providing patients with more information is an important goal, but only if that information is truly useful in helping to make decisions.
Providing physicians with more information also is an important goal, but only if that information is truly actionable.
We agree that the plans have a great deal of information that has the potential for improving health care delivery. But generating reports years after the fact using data that has not even been verified by the doctors involved is not the way. If cost is truly an issue why not make the cost of the care that doctors order available to them real time? What person could control their budget if all that they had to go by was a note stating that they overspent two years ago and they shopped in a market with no prices on the products? This is how the guts of the GIC’s tiering program works. Managed care companies will advance the promise to “manage care” when they more actively partner with the doctors who take care of patients and provide information that they can use to improve patient care.
We know that when doctors push for release of the details of their data they are finding that they have been misclassified. We know that the results of just a few patients can move a doctor from one category to another. And, we also know that no one is keeping track of this experiment to see if anyone is being harmed by it. Some transparency!
To continue my baseball metaphor, Dr. Magee’s suggestion that analyzing physician performance on a real time basis rather than looking at performance over time would be roughly like deciding which team should be designated the league champion on the basis of yesterday’s game and ignoring the whole season and its attendant statistics. Dr. Magee knows full well that fairness demands looking at a large data set, aggregating a statistically significant number of physician encounters, and then, and only then, making judgments about performance.
On his other concern, let me assure him that the GIC is, in fact, tracking the results of our provider profiling program. We are doing our own tracking; our data vendor, Ingenix, is developing metrics to evaluate the program’s performance; our consultant, Mercer Human Resources will specifically be looking for any unintended consequences; and we are currently in conversation with a nationally recognized health economist from one of our prestigious universities to do a longitudinal analysis of the program.
Having said all that, our readers should know that Dr. Magee and two of his Mass Medical Society colleagues are active participants in our physician advisory group — they are, and will continue to be, part of our ongoing commitment to providing continually improving direct-to-physician reports.