Regular readers will know that, last Sunday, I posted a column that pointed to HHS’ schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org’s lawsuit demanding the release of data in 4 states and DC. (The AMA’s Board Chair has admitted that they lobbied HHS to appeal the court’s finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities – these are coalitions of employers, payers, providers and consumers – and then hand over the same physician data they’ve been fighting the courts to keep secret so these groups can combine them with data available from the private sector and create physician quality/cost report cards.
Now that health care reform is once again an active, visible issue in state governments and the presidential campaigns, the ideas are flying fast and furious. Predictably, some ideas are better than others.
Over at Health Care Policy and Marketplace Review, Bob Laszewski asks an important, practical but vexing question for universal coverage advocates: Can you really mandate people to buy health insurance?
I was reading through other peoples’ blog posts yesterday when amazingly enough, I was here on THCB and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston.
Of course, many readers are aware that Paul has made news by establishing a blog called Running a Hospital. I think he’s probably taken some good-natured ribbing by his more straightlaced colleagues. But I admire that fact that he’s broken the bounds of decorum and speaks openly about the many tremendously difficult issues that face hospital executives.
I heard a great presentation this morning by Joe Newhouse,
from the Department of Health Policy and Management at Harvard Medical
School. There was one point that he made that really caught my
attention. It was a cite to a 2004 article in the Journal of the American Medical Association
(Dimick, et al, JAMA 2004; 292: 849) that presented the issue of how
many cases you would need to collect of a certain clinical procedure to
be able to make a determination that a given hospital’s mortality for
that procedure was twice the national average. It turns out that only
for CABGs (coronary artery bypass grafts) are there enough cases
performed to have statistical confidence that a hospital has that poor
a record compared to the national average. For other procedures (hip
replacements, abdominal aortic aneurysm repairs, pediatric heart
surgery, and the like) there are just not enough cases done to make
this assessment. (By the way, if you just want to know if a hospital is
say, 20%, worse on relative mortality, you need even a bigger sample