Physician Performance Assessment

A bit of a departure from my usual transparency efforts, but this week we launched our Clinical Data Portal, a Web-based portal that allows physicians to upload clinical data directly from the chart or from an electronic medical record software and be assessed instantly on their clinical performance. Physicians who score high enough automatically start receiving bonus checks from the Bridges to Excellence program. Pretty neat stuff.

We have started with Diabetes and Cardiac Care, but we'll be rapidly adding more topics for physicians to measure themselves with. Physicians are free to become recognised for any of the topics, but if they fall under a BTE program area, they are eligible for real reward dollars. Next up we'll be processing batch files of data from EMR vendors. Exciting stuff.‎ Full story...

Why I'm Not Camping

Ahh, my poor blog languishes. As I have nothing interesting to say here's a list of what I'm working on, which may explain why my blog is so sparse these days.

Pay for Performance: Physicians are eligible for many programs that will pay them bonuses for delivering care at defined levels. For example, there are strict measures of evidence-based care that should be delivered to a diabetic patient. Starting this month, physicians will be able to enter data into a new clinical data portal that will instantly or near enough instantly score their performance and - if the physician achieves the correct performance level - be identified to these programs. We'll be kicking off with diabetes and cardiac care. Down the road,we'll also process data directly from EHR systems. Go live mid June, 2009.

Transparency: Illinois has elected to use my team to produce their state's hospital report card, we'll be publishing everything you never wanted to know about Illinois' hospitals. Go live Octoberish, 2009.

Transparency: This year's Regional Health Care Report Card is underway, and will split HMOs from hospitals, making it easier to review one or the other. Additionally, this year's hospital report will be the juiciest report card you've ever seen. Go live end August 2009.

Quality Improvement: Phase two of the WhyNotTheBest.org Web site is coalescing, more data, more benchmarks, more quality improvement resources. User interface is being reworked for a smoother, faster onramp to the content by a very cool team, and we're following behind loading up the new data. Go live November 2009?

Transparency: Pellucid is my new project to collate every ounce of publicly reportable data that exists. As you can imagine, that one's keeping me up nights. Go live of yesterday or never, depending on when you ask me.

All that, plus my youth rugby team made it to the semis in the Annual NYC Mayor's Cup. Busy year...

‎ Full story...

Uninsured and Charges

Two items caught my eye today that neatly juxtapose. One is from California, which discusses the publication of hospital charges (retail sticker price) for surgeries, and the hospital's insistence that these prices are meaningless. The other is from a Families USA study counting how many people were without health insurance for some period in 2008.

"That database is meaningless," said Jim Lott of the Hospital Association of Southern California. "There’s no relationship between the price on that list and what your insurance company has negotiated."

OK, fair enough. So how many people *didn't* have insurance, and thereby didn't have the benefit of a negotiated rate?

Turns out in California, during 2007 and 2008, 37.4% of the population under 65 spent some time without health insurance. Of these, 76.9% were without health insurance for six months or more.

80.2% of all people who went without health insurance were members of working families, i.e., someone at the house has a job. i.e., employment does not mean health insurance.

Most interestingly, 26.2% of uninsured people have incomes at or above 200% of the federal poverty level. I would hazard a guess that these folks are not rushing to claim bankruptcy to avoid the bill.

And of course, *all* these people are subject to the meaningless numbers. They all are charged sticker price. Maybe they don't pay them, but someone does, either through direct write-offs which impact us at the local tax level (we pay it for them) or indirectly through these folks becoming indigent.

Sticker prices hurt all of us. They are not meaningless. I myself have been charged them, even with my PPO in place.

I, like many other folk in public reporting, would prefer to report the cost of care - how much it costs a hospital to perform a given procedure - but this data is still hidden from us.

In the meantime, and even if I were to have cost data in hand, I would still publish charges, because charges most certainly do mean something, and they mean something to an ever-growing portion of the population.‎ Full story...