Physicians

HOSPITAL/PHYSICIANS/POLICY/POLITICS: Hubbard, transparency, clarity, earth & water, mixed

Today, direct your attention over to Spot-on, where I’m up with my summary over Hubbard’s arguments with providers over price transparency—it’s called Clear as Mud.

As ever you can come back here to comment. Somehow this topic tends to get some of you riled up. I, for sure, don’t know why!

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Yehuda DraimanSteve Beller, Ph.DThe Medical Blog NetworkMatthew HoltTom Leith Recent comment authors
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Yehuda Draiman
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Yehuda Draiman

Competition in Health Care: Both Health Insurance and Provider Markets Need to Function Competitively As in other markets, the goal for health care markets should be to ensure that consumers benefit from a competitive marketplace where neither the buyers nor sellers unlawfully exercise market power. Policy should focus on ensuring that there is a competitive marketplace where neither health insurance plans nor health care professionals are able to obtain or exercise market power to distort the competitive outcome. Any other result inevitably will lead to governmental regulation of the health care market — an outcome that is not likely to… Read more »

Steve Beller, Ph.D
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Sorry for the late post. I agree that ranking PCPs can be tough in cases where a patient is referred to a specialist and the outcomes have more to do with the specialists’ competency, than with the PCP’s actions. The PCP, however, can be evaluated in terms of making appropriate diagnoses and referrals, effectively coordinating patient care when multiple specialists are involved, doing the correct screenings and order the right blood work, following-up with patients in a timely manner, communicating with patients about diet/lifestyle changes and maintenance for chronic conditions, etc. There are several challenges, however. One is figuring out… Read more »

Barry Carol
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Barry Carol

Dr. Hinson, Congratulations! I think you’ve finally convinced me of the difficulty in determining quality ratings, at least for primary care physicians. I would just like to make a couple of final points, however. If it were possible to determine credible ratings, it is conceivable (and possibly even likely) that all four of the doctors in your small town would score the college equivalent of an A or A- in which case, patients would be in good hands with any of you. I do think, however, that if there were a strong consensus among knowledgeable doctors and nurses that a… Read more »

Tom Leith
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Tom Leith

I am not advocating it, and I said I am not defending it. I am saying how I think it came to be.
> The “care managers” of all stripes ought to
> be ashamed of advocating opacity.
Does this go for doctors and patients as well?
t

The Medical Blog Network
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“One way to avoid this is to keep changing the rules.”
This is called fraud and one that puts people’s lives and finances in danger. The “care managers” of all stripes ought to be ashamed of advocating opacity.
Patients and physicians deserve to know what coverage they can rely on. And everybody who was ranting about United’s CEO comp package should not be railing against market-based healthcare.
Health system is failing because the market is not transparent, especially insurers.

Tom Leith
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Tom Leith

> Medical practices are just like any other business… Well, I had asked about pricing, and you talked about planning, so you’re not going to say how your pricing behavior would change? > Who benefits by concealing reimbursement policies? > It surely isn’t the patients. I think it was supposed to be the patients, albeit indirectly. As Matthew has said, physicians (and hospital managers) will figure out how to game any FFS system. One way to avoid this is to keep changing the rules. So to the extent health plans compete for premium dollars, members benefit by preventing this by… Read more »

Amy Tuteur
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“I am not defending the opaque reimbursement practices of payers, but can you tell us how your pricing behavior would change if reimbursement practices became utterly transparent?” Tom: Medical practices are just like any other business in that they have to cover their costs, and they have to be able to anticipate their revenues in order to hire employees, etc. If you have absolutely no idea what you will be reimbursed you cannot operate like a business. It’s rather ironic, don’t you think, that there is so much pressure on physicians to behave more like business people, yet they are… Read more »

Matthew Holt
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Matthew Holt

Believe it or not, I am in general with Greg here. I think that we somehow have to get a financing system that gets these decisions down to a physician level, and encourages them to get into professional organizations (a la Mayo clinic) that have continuous improvement as part of their DNA, but insulate them from the risks of exposing pure price/unsophisticated quality measures to an open market which has no real way of judging them.
That’s where the current system is heading, and it cannot work.

Greg Hinson
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Greg Hinson

Barry, I agree with the sentiment. Patients ought to have a way to better determine the quality of the physician they are seeing. But doctors are not like Consumer Reports cars. With a car, you can easily judge its quality by how often it breaks down and how much service it needs. Further, you can calculate the total cost of ownership. You cannot point to objective data points like this with physicians (or other professionals). I just cannot see it. Let me give you another problem. I live in a town of 10,000 people. Our town is quite isolated and… Read more »

Tom Leith
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Tom Leith

> Providers do not know how to price their services
> because insurers will not make reimbursement rates
> public.
I am not defending the opaque reimbursement practices of payers, but can you tell us how your pricing behavior would change if reimbursement practices became utterly transparent?
t

Amy Tuteur
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Peter:
“I find it hard to believe that under the contract with the insurer the wording states, “we will determine how much to pay you only after the procedure is performed and on our whim.”
I’m not making this up. Providers do not know how to price their services because insurers will not make reimbursement rates public. If a doctor asks an insurer what the reimbursement rate for a particular procedure is, she will be told “it depends”.

Barry Carol
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Barry Carol

Dr. Hinson, First, I really appreciate your willingness to take the time and effort to respond to some of my comments with such detail and clarity and to illustrate some of the complexities inherent in the doctor scoring and quality assessment issue. However, it seems that it should be possible to significantly improve upon what we have now which is not very much. I was struck, for example, by a comment that Amy Tuteur made in response to one of my earlier posts on this issue. She made the point that a bad doctor will have no doctors or nurses… Read more »

Peter
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Peter

Amy, first I find it hard to believe that under the contract with the insurer the wording states, “we will determine how much to pay you only after the procedure is performed and on our whim.” Who would sign such a contract? Anyway you just gave a good reason for a single pay government run system where the insurance companies are cut out of the system (they’re scum anyway) and where providers know exactly what they are going to be paid, and so will the patient know what their costs are as welland the guvmt will be the one to… Read more »

Greg Hinson
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Greg Hinson

Barry writes: “In my perfect world, I would like to see it translated to a scoring system, akin to credit scores but reduced to a 10 point scale, with the key variables and weights determined by what doctors think are the most important factors.” Barry, you have to give this up. There is no feasible or fair way to create such a scoring system. Quality transparency would be nice, but there is a such a huge variation in how things are done, size of practices, patient populations, etc., that we are more likely to get a Bush to agree to… Read more »

Barry Carol
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Barry Carol

Amy, do you (or anyone else, for that matter) know why insurers do business this way — not telling doctors what they will be paid before contracts are executed? I’m not sure what it is they are afraid of, and I can’t imagine that they think this would be a fair way to do business if they were in the doctor’s shoes. Some information is starting to become available to consumers regarding what insurers pay specific doctors and hospitals for specific procedures. Perhaps at least one enlightened insurer will wake up and start to make the same information available to… Read more »