I guess I spend too much time getting grumpy about the use of space in the NY Times, but come on. Atul Gawande is a great writer who writes fascinating articles for The New Yorker. But when it comes to his solution for health care? He gets not one but two op-ed columns in the New York Times. And what does he say in Curing the System? Following the Massachusetts system might be an option. Or we can expand SCHIP. That’s it. To say the same thing I used one line.  I think the NY Times
owes me (or someone) 2 columns to really discuss health care. After all
they’ve spent plenty of time licking sores about the issue.

In response to yesterday’s post on AthenaHealth’s 2007 insurer ratings, Brian Klepper of the Center for Practical Health Reform writes:

I suspect that AthenaHealth would be unwilling to publicly report physician performance. Who wants to antagonize their clients?

But if AH has access to the information within the individual claims
records, it could add significant additional value by discretely
providing physicians with their relative performance values and
performance benchmarks. Physicians could use this information in health
plan negotiations and to guide performance improvements that will
become increasingly important as P4P takes root. At this point, the
only data most doctors have access to during contracting are the
numbers the health plans give them.

While health plans have actively campaigned for provider performance
transparency, their own performance has remained fundamentally opaque.
If this continues, it will render the changes possible through P4P –
which changes the incentives to reward the right care instead of simply
more care – much more difficult to achieve, because providers inherent
distrust will bubble over, as it did with managed care. After all, if
I’m not willing (or able) to tell a physician or hospital what
utilization or cost changes resulted from the incentive shift, or how
the savings were distributed, the conclusion will be that the health
plan simply pocketed the dollars with no savings to the system.

In this sense, AthenaHealth has taken a major step forward in
precipitating health plan transparency, and they deserve our collective
thanks.

That said, its useful knowing how long it takes for plans to pay
claims, but hardly what’s required to fully understand health plan
performance. A more robust tool is eValue8 (www.evalue8.org), developed
by the National Business Coalition on Health (www.nbch.org). This last
October, the Florida Health Care Coalition performed an evalue8
analysis of major health plans operating in Florida and then released
the results. These tools finally begin to provide a credible method for
purchasers and providers to get a handle on the complex, confusing
workings of health plans.

If AthenaHealth could leverage their resources a little further by
broadening their analysis, they’d add real value to changing the
dysfunction that plagues this part of the system. 

In a retort to the post on the growing support on Wyden’s health care plan, Barry Carrol writes:

I wonder about several things with the Wyden approach.First, how efficient will it be to, in effect, sell health insurance
one policy at a time as opposed to thousands at a time (through a large
employer)? The main problems with employer provided health care, in my
opinion, are lack of choices and lack of access to affordable coverage
if one loses or leaves a job or retires before becoming eligible for
Medicare. An employer mandate, at least for all but the smallest
employers, coupled with lots of choices similar to the Federal
Employees Health Benefits Plan might be a more workable approach.

Second, the Massachusetts experience is instructive on several
levels. First, Massachusetts has the highest per capita healthcare
costs in the country (over $9.000), a below average percentage of the
population that is uninsured, and a market that is overwhelming
dominated by non-profit insurers and hospitals.  Supposedly greedy for profit insurers and hospitals are simply not much of a factor in Massachusetts.

Within the last couple of days the Massachusetts health connector
website went live. People can key in their zip code, date of birth,
number of people to be covered, etc. and get rate quotes from four or
five different plans for each of four coverage levels – Bronze (both
with and without RX), Silver and Gold. Type in a Massachusetts zip code
and try it out. The website is: www.mahealthconnector.org.

In the comment thread on Andy Grove’s prescription for solving the healthcare crisis, Gregory Pawelski writes:

"It is entirely inappropriate to regard the randomized clinical trial as being the "gold standard" for judging whether a treatment does more good than harm. In life or death situations, one must make judgements based upon preponderance of available evidence as opposed to proof beyond reasonable doubt. It seems obvious that evidence-based medicine proponents may fail to apply this common sense standard on a consistent basis. "

In response to Beth Israel Deconess Medical Center CEO Paul Levy’s critical post on pay-for-performance plans, Mehul Dalal writes:

"We cannot talk about closing the income gap between the cognitive
and procedural specialties without mentioning the role of the Relative
Value Scale Update Committee (RUC). Their proceedings are opaque and
dominated by specialists and my understanding is that CMS adopts their
recommendations rather uncritically.

It seems that these proceedings should be more transparent and
perhaps an independent entity should ensure their recommendations are
aligned with the preferences of the beneficiaries. (this is public
money after all)."

PMH had this to say in the thread on the interview with MDVIP CEO Ed Goldman.

I attended a MDVIP kick-off last night. It was an older doctor (my
wife’s) who falls into the category of "frustrated over having too many
patients, wants a life." A lot of his patients seemed to be older and
probably have the money. Nobody walked out, and it was pretty well
received.

"Our pediatrician had booted the insurance companies before my kids became patients. Luckily, my family has been healthy. There have been a few emergency room visits over the years and one daughter went through a battery of allergy/asthma evaluations. While the cost of annual doctor’s visits has added up over the years, it was the testing, specialist, and emergency room visits that were by far the biggest hits. Insurance was applicable to those services.

The pediatrician seems to have been successful with his approach. His staff is small and he’s accessible, as well as being a good guy."

M.W. writes in to criticize Dr.Anna Pou’s supporters:

Having read many of the sympathetically concerned statements regarding the Dr. Anna Pou/Memorial Hospital Case, the majority positions of support, based either on personal character assessments or assumptions regarding professional competency, are sadly but well intentionally misplaced. The truth of the matter is that injections of combined drugs in conjunction with saline were administered to chronically ill elderly patients with the intent to humanely end life. Also, the supportive statements are unaware of the single 30ml immediate-release morphine sulfate bottle which plays an important but  ancillary role in this case.