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Propublica's Surgeon Scorecard has been controversial and has garnered much praise and criticism. Everyone acknowledges that it's not perfect, but some (like us) think that it's a tremendous step forward, while others think that Propublica should have not published their findings. Kaiser sponsored a panel discussion about it, which was quite interesting. A couple people seem to claim that medical errors are worse now, than in 1999.

Propublica's Surgeon Scorecard has been controversial and has garnered much praise and criticism. Everyone acknowledges that it's not perfect, but some (like us) think that it's a tremendous step forward, while others think that Propublica should have not published their findings. Kaiser sponsored a panel discussion about it, which was quite interesting. A couple people seem to claim that medical errors are worse now, than in 1999.

Fortunately, everyone on the panel (including someone in hospital administration) seems to be in favor of performance transparency in principle. Questions remain as to how to go about increasing transparency, and whether incremental efforts are good enough.

Kaiser Health News published an interesting article about Medicare investigating different ways of increasing cost-effectiveness when paying for drugs. One idea is to reduce the percentage that Medicare reimburses for the overhead of purchasing and administering drugs. The current scheme gives providers an incentive to recommend more expensive drugs since they would be reimbursed more themselves. Under the proposal, Medicare would reduce the payment for overhead by more than half. It seems like Medicare could go further by offering a percentage overhead reimbursement, up to a fixed limit, with exceptions being carved out for drugs that need special handling. However, that introduces complexity that might offset the savings. Medicare is also reportedly considering applying reference pricing for drugs, which could be an interesting way of giving patients an incentive to seek better value while preserving some choice. The article points out that these ideas come from industry.

Kaiser Health News published an interesting article about Medicare investigating different ways of increasing cost-effectiveness when paying for drugs. One idea is to reduce the percentage that Medicare reimburses for the overhead of purchasing and administering drugs. The current scheme gives providers an incentive to recommend more expensive drugs since they would be reimbursed more themselves. Under the proposal, Medicare would reduce the payment for overhead by more than half. It seems like Medicare could go further by offering a percentage overhead reimbursement, up to a fixed limit, with exceptions being carved out for drugs that need special handling. However, that introduces complexity that might offset the savings. Medicare is also reportedly considering applying reference pricing for drugs, which could be an interesting way of giving patients an incentive to seek better value while preserving some choice. The article points out that these ideas come from industry.

Interestingly, not all of the ideas lead to short-term savings. The last idea discussed entertains reducing or eliminating patient copays for drugs that are considered effective. The idea is that while Medicare would end up paying more in the short-term, patients are more likely to adhere to their prescriptions, presumably enjoying better health and avoiding more expensive procedure costs.

Kaiser Health News reports on two states that are trying to help consumers compare pricing information. New Hampshire has started publishing the prices of some dental procedures and some prescription drugs, both of which are easy to shop. California, meanwhile, is posting average prices of medical procedures for large physician groups. The efforts seem modest in scope, but are nevertheless encouraging of a larger trend.

Kaiser Health News reports on two states that are trying to help consumers compare pricing information. New Hampshire has started publishing the prices of some dental procedures and some prescription drugs, both of which are easy to shop. California, meanwhile, is posting average prices of medical procedures for large physician groups. The efforts seem modest in scope, but are nevertheless encouraging of a larger trend.

Meanwhile, the article also referenced a study by the Health Care Cost Institute, which questioned the extent that healthcare consumerism is likely to affect healthcare spending. The study found that 43% of the money spent on healthcare services for commercially insured patients were considered shoppable, with only 7% being paid out-of-pocket for shoppable services. I suspect that the 7% figure will increase with time, making consumerism a more powerful force than that study acknowledges.

NEJM Catalyst published a piece written by someone within health care, detailing why providers should publish physician performance data. One of the stated reasons resonates with some thoughts outlined earlier on this blog -- that providers will get to "define the terms of transparency" and to guide consumers in terms of what they should be looking for when selecting a provider. The author outlines some other reasons, which overall make for a persuasive piece as to why providers should engage in transparency efforts. Nevertheless, the author acknowledges that we've only witnessed the start of this movement, and the initial data has been "modest." We agree with the assessment that the trend is growing, and are encouraged that someone from within the healthcare community is pushing for transparency.

NEJM Catalyst published a piece written by someone within health care, detailing why providers should publish physician performance data. One of the stated reasons resonates with some thoughts outlined earlier on this blog -- that providers will get to "define the terms of transparency" and to guide consumers in terms of what they should be looking for when selecting a provider. The author outlines some other reasons, which overall make for a persuasive piece as to why providers should engage in transparency efforts. Nevertheless, the author acknowledges that we've only witnessed the start of this movement, and the initial data has been "modest." We agree with the assessment that the trend is growing, and are encouraged that someone from within the healthcare community is pushing for transparency.

Interestingly, the author predicts that ratings outlets will be affected by the release of physician performance data. We agree, and look forward to the time when physician performance data is released in sufficient quantity in a sufficiently standardized manner that users can meaningfully compare providers.

The federal government and the industry trade group representing most health insurers in the US (America's Health Insurance Plans) released an initial set of measures to track physician performance. Historically, physicians have generally been averse to having their performance publicly assessed (as one might expect practitioners of any industry to be). Some physicians have even claimed that it's impossible to measure quality. As insurance companies rolled out a variety of pay-for-performance programs in the previous decade, physicians rightfully pointed out that the programs from different insurers conflicted with each other, and that such programs also frequently lacked the very transparency that they were supposed to promote.

The federal government and the industry trade group representing most health insurers in the US (America's Health Insurance Plans) released an initial set of measures to track physician performance. Historically, physicians have generally been averse to having their performance publicly assessed (as one might expect practitioners of any industry to be). Some physicians have even claimed that it's impossible to measure quality. As insurance companies rolled out a variety of pay-for-performance programs in the previous decade, physicians rightfully pointed out that the programs from different insurers conflicted with each other, and that such programs also frequently lacked the very transparency that they were supposed to promote.

Therefore, this moment could be significant if the movement lasts and the idea of a common scorecard persists. Rather than simply arguing about whether quality can be measured, the discussion would instead focus on how to measure quality. Up until recently, physicians have not had to pay too much attention to quality metrics for financial reasons (e.g. the previous pay-for-performance programs generally accounted for less than 10% of a physicians' incomes). Now, however, if more insurance companies were to adopt a common rubric, more of physician reimbursement could be tied to performance, which might lead to better-performing doctors being paid more.