INFORMATION: Do Consumers Have Enough to Choose a Plan?
"Chances are that very few people ... have ever seen a cold, scientific evaluation of the doctors, nurses and hospitals in their health care plan," NPR's Frank Browning reports in the third segment of his series on the future of health care in America. Lee Newcomer, medical director for United Health, is one of the leaders in a new "vanguard" trying to force the health system to be more accountable to patients. He said, "We're finding that, no matter where we look across the United States, when you look at very standard care, that it's not done somewhere between one-third and one-half of the time." He cites the example of prescribing beta-blockers for heart attack patients, which was not done in 30% of cases studied. But where to find the information? Browning notes that some accepted measures of quality and storehouses of data, such as the National Practitioner Databank and HMOs' patient databases, are off-limits to the public. Phil Lee, assistant secretary for health under Presidents Johnson and Clinton, said while many HMOs make such records public, they usually amount to mere "public relations" efforts. "Where they do well, they put out the good news, where they don't do well, they don't," he said.
Holding Docs Accountable
The American Medical Association credits managed care with raising the quality reporting bar for physicians: a proven track record is necessary for physicians to be accepted into many top HMO panels. AMA President Nancy Dickey said, "To say 'Hey, I'm pretty good at what I do' isn't adequate for managed care if you want to get into one of the competitive programs." But Beth Horowitz, an internist at George Washington University Medical Center, questioned the types of "report cards" currently being used by HMOs. She said they often base evaluations -- and compensation -- on the doctors' ability to save the HMO money by writing fewer prescriptions or making fewer referrals.
Advocates for quality measurement argue that if "real information" becomes a reality, a health care system based upon patient choice may be better able to hold costs down than the employer-driven system. Browning concludes that the "trick ... will be turning money management into real health management" ("Morning Edition," 3/3).