When report cards of performance became available, cardiac surgeons in New York and Pennsylvania avoided high risk patients. Could something similar happen, nationally, after the forthcoming revolution in transparency inspired by Propublica’s data release?
Take two fictional orthopedic surgeons, Cherry Picker MD and Morbidity Hunter MD.
Cherry Picker lives in the Upper East Side of New York. His patients give him great reviews on Yelp. His patients read every comment on Yelp before making any decision. Cherry Picker has a beautiful family. When he smiles, light refracts from his shiny teeth.
Cherry regularly appears on TV. He writes for the sleek, metrosexual publication, FHM. Cherry specializes in knee injuries in weekend warriors. His patients often call him from the ski slopes in Colorado, Whistler and Zermatt. Cherry is good at his craft. But his patients are even better at their craft – post-operative recovery. Cherry doesn’t actively seek such patients. His patients are selected for him by his zip code, reputation, long waiting list and Yelp.
Morbidity Hunter’s real name is Harjinder Singh. He migrated from Punjab and works in a safety net hospital in North Philadelphia. Singh wanted to work in Beverley Hills, but to convert his J1-visa to a green card, he had to work in an area of need. Once he started working, he liked his job. His daughters liked their school and his wife liked the house they bought. Singh doesn’t have shiny teeth. He hasn’t appeared on TV, although his daughters tease that he can play Sonny from Exotic Marigold Hotel.
Singh’s colleagues named him Morbidity Hunter because he operates regardless of how sick his patients are. He never says no. Nearly all his patients are obese and diabetic. The School of Public Health sends students to shadow him to learn about polypharmacy. The hospital went on a spree of hiring hospitalists when Singh started. Continue reading…
If the federal government’s new Open Payments website were a consumer product, it would be returned to the manufacturer for a full refund.
Open Payments is the government’s site for publishing payments made to doctors and teaching hospitals by drug and medical device manufacturers. It includes 4.4 million payments, worth $3.5 billion, to more than half a million doctors and almost 1,360 teaching hospitals.
In a news release announcing the site’s launch, the Centers for Medicare and Medicaid Services said the goal is “to help consumers understand the financial relationships between the health care industry, and physicians and teaching hospitals.”
These reports make unfounded leaps in their efforts to subject doctors to levels of skepticism once reserved for politicians and lawyers. They’re going to end up doing patients a disservice.
For this particular hunting expedition ProPublica set its sights on Dr. Yoav Golan, an infectious diseases specialist caring for patients at Tufts Medical Center in Boston who also works with pharmaceutical companies developing antibiotics.
But in its zeal to argue how physicians like Golan are corrupting medicine through their industry partnerships, ProPublica went to press without an iota of evidence Golan is corrupt.
A close look at Golan’s impressive career suggests quite the contrary and raises questions about ProPublica’s claim to objectivity.
Yoav Golan is a remarkably bad choice for anyone who hopes to use him as a poster boy of pharma-physician malfeasance.
As Tufts said in a statement in response to the ProPublica story, Golan enjoys international respect in the infectious diseases community and has assisted the development of “two important antibiotics, including the first antibiotic developed in the past 25 years to treat the growing threat of deadly C. difficile.”
(Disclosure: I held an academic appointment at Tufts for one year when I was practicing in Boston, but in another department and I never met Golan before this story.)
That antibiotic, fidaxomicin, is pricey, and you’d think an industry shill would liberally advise its use. Yet Golan and his team advised a Tufts committee setting internal standards for its use that the hospital should heavily restrict the drug. “We were very active in making sure it’s not used in pathways where it’s not cost effective,” Golan told me.
I am happy to announce the release of the doctor “referral” social graph. This dataset, which I obtained using a Freedom of Information Act request against the Medicare claims database, details how most doctors, hospitals and other providers team together to deliver care in the United States. This graph is nothing less than a map of how healthcare is delivered in this country.
For the time being, the only way to get a copy of this data set is to support the Medstartr crowd funding campaign for either $100 (for the viral “open source eventually” version of the data) or $1000 (for the proprietary friendly version of the data, that any business can freely “merge” with other data). If you need consulting around this data, you can buy in at the $5k or $10k levels. Also, we are going to have really awesome t-shirts.
I will be writing a more in-depth technical article about this dataset over on the brand new O’Reilly Strata blog (which focuses specifically on Big Data) so I will gloss over most of the technical details here, with a few important exceptions.
First, when I say a “graph” I am not talking about a diagram. I am talking about a mathematical model that supports nodes and connections between those nodes. These are visualized as diagrams, but it is not possible to really analyze large graphs without a database. In this case, the nodes are doctors, hospitals and other providers and the connections between those nodes represent the degree to which they collaborate on specific patients.
Also, despite my branding to the contrary, this is not strictly a “referral” data set, although a fairly large portion of the data do represent referral relationships. Instead, it depicts the degree to which any healthcare provider “works” on a patient in the same time frame as some other provider. This means, for instance, that many primary care doctors are linked to emergency rooms. But this just means that a patient they were seeing was also seen by the emergency room in the same time period. Referral relationships can be inferred from this data, but not presumed.Continue reading…
Transparency is a powerful tool. Framed properly to illustrate the collaboration between America’s biopharmaceutical companies and physicians, it can empower patients to become more engaged in the care they receive. Transparency can also lead to misinterpretations, discouraging even the most ethical, unbiased doctors from future collaborations that could improve patient health.
ProPublica, whose reporters, Tracy Weber and Charles Ornstein, penned The Times’ Sept. 8 Op-Ed article, “What the doctor ordered,” recently updated its “Dollars for Docs” database of doctors who have received money from biopharmaceutical companies. By listing only names and compensation figures with limited context, patients may assume their care is compromised by tainted doctors. Such an incomplete picture creates unnecessary confusion and, in most cases, is completely unfounded.
We agree with ProPublica that patients should know that many physicians work with biopharmaceutical companies. To be completely transparent, however, they should also know why it benefits them and how the relationship is closely managed to ensure it remains ethical.Continue reading…
In a decade when there are countless really, really important issues to investigate in health care, ProPublica took more than $400,000 and spent it on a rehash of a well known story. The story was about a completely exceptional circumstance that will likely never happen again. The original criminal investigation against the alleged perpetrator of the “crime” was abandoned. And the big important result that this new investigation caused in our health care system? Nothing.
This was a complete waste of resources in an era when very few are available to investigate the major issues in our health care system which cause so many problems for so many people. Could ProPublica really not think of any other major investigative health care story to pursue? Like one that impacts millions of people? They could have asked me for a few suggestions. Instead they went looking for something that was purely sensationalist, akin to the National Enquirer chasing down Tiger Woods.
The Joint Commission, which accredits four-fifths of the nation’s hospitals, is being accused of misleading consumers about the quality of care at those hospitals and then ignoring suggestions on how to correct the problem.
“The organization that accredits hospitals around the country, and voices support for transparency about hospital quality, has a Web site that obscures the reality of many hospitals’ performance,” said Charles Ornstein, president of the Association for Health Care Journalists (AHCJ) and a reporter for the public-interest journalism group ProPublica . In a March 1 letter sent to Dr. Mark R. Chassin, the Joint Commission’s president and CEO, Ornstein noted that not only has the group not addressed the “navigational issues” raised by AHCJ more than two years ago, but problems that make the commission’s QualityCheck site even less useful have cropped up.
For instance, that “Gold Seal of Approval” for your local hospital? Perhaps it should be called a Gold Seal of Possible Approval. Says the AHCJ: “[It] is misleading because hospitals with conditional accreditation or preliminary denial of accreditation still receive the same gold seal as fully accredited facilities.”Continue reading…
Four months after we first reportedon a sketchy AIDS "charity" with a nationwide fundraising campaign,
authorities have begun to crack down. But the move might not have much
impact if other officials don't follow suit.
In March, we notedthat the group promoted false health informationand ineffective herbal remedies, misled potential donors with claims about its battle to "stop
AIDS," and repeatedly failed to provide a full accounting of how it
spends contributions. Its financial records show no expenses, and there
is no evidence that it has provided any services to people with AIDS,
its stated mission.
The fallout has continued. There have been a slew of follow-up editorials and articles in California newspapers. One, in the Los Angeles Times, said of the governor's response: "This time, he acted to protect patients, but where was the gubernatorial outrage when the state Board of Chiropractic Examiners, which included several of Schwarzenegger's friends, was accused in a state audit of similar failures to put consumers first?"
Another, in the San Francisco Chronicle, suggested that "Schwarzenegger shares a measure of blame too: his imposed work furloughs will slow investigations, and his administration should have been on the problem earlier."
Gov. Arnold Schwarzenegger replaced most members of the California
Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious
He fired three of six sitting board members– including President Susanne Phillips – in two-paragraph letters curtly thanking them for
their service. Another member resigned Sunday. Late Monday, the governor's
administration released a list of replacements.
During that time, nurses accused of wrongdoing are free to
practice – often with spotless records – and move from hospital to
hospital. Potential employers are unaware of the risks, and patients have been
harmed as a result.