Pay No Attention...

Regular IB readers know that we (okay, I) have somewhat of a fixation regarding transparency in health care. I’ve often used the McDonald’s Model (e.g. flu shots: $5, appendectomies $450, etc) to illustrate the point.

But we’ve also pointed out that prices are not the only (nor, often, the most important) factor: quality of care and outcome of process are key, as well. As more carriers bring their transparency programs online, and as consumers make more use of them, it seems reasonable that there may be a (for lack of a better word) backlash against the process.

And so there has been:

“Regence BlueShield and UnitedHealthcare informed [Dr] Kelly that he failed to qualify for their respective designations as a high quality doctor…a family physician in practice outside Tacoma, Wash., who is now suing Regence over its program.”

Dr Kelly believes that he was inappropriately singled out for exclusion in Regence’s now discontinued rating program. Which is an interesting, if not surprising, development: as such programs become ubiquitous, providers are going to be under increasing scrutiny for cost/benefit ratios. It’s a conundrum, of course; balancing the patient’s right to appropriate medical information and care with providers’ right to practice medicine as they deem fit.

"We're concerned that as insurers try to maximize profits they are saying that the doctor that charges the least amount of money is the highest quality," said Dr. Jim Rohack, a cardiologist who is an AMA board member.”

Of course insurer’s seek to maximize their profits, as would any other business. But it seems to me that the issue is more complex: the patient also wants to maximize his health and well-being, and any tool that can help him in this regard should be available. Of course, this presupposes that the patient wants to maximize his well-being, and that may not always be the case.

There are, of course, instances where using these tools is pretty much out of the question: an emergency heart surgery comes to mind, or a stroke. There are, undoubtedly, countless other such exceptions. But for routine, preventive or elective procedures, having such information available is a necessary stepping-stone to consumercentic care.

For their part, doc’s claim that such tools tell only a part of the story: “an insurer may look at an older female patient's claims data and see that she hasn't had a mammogram — information that would reflect badly on a doctor. But that record won't show that the patient simply refuses to get a mammogram.” A reasonable argument. But one wonders whether that is the exception, rather than the rule.

Another problem is availability of information. Minnesota BX’s program relies on consistently updated records, but that requires an investment in electronic infrastructure, both at the provider and carrier levels. As more providers move to EMR (electronic medical records), we may see some relief in this area.

Perhaps the most obvious answer is the simplest, provided by Aetna’s Dr. Charles M. Cutler: “The key is to work with physicians so they understand the product and the rating system.”

Ya think?!