Time Capsule: Healthcare Transparency 2.0: Using RHIOs to Rate, Criticize, and Publicly Rat Out Idiot Patients Wasting Everybody Else’s Healthcare Money

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2009.

Healthcare Transparency 2.0: Using RHIOs to Rate, Criticize, and Publicly Rat Out Idiot Patients Wasting Everybody Else’s Healthcare Money
By Mr. HIStalk

I’ve always made fun of those “Get a Free Medical (wink, wink) Scooter” commercials that run during the fake judge TV shows that are watched religiously by homebound, unemployed, and intentionally deadbeat people while the rest of us are at work. I see them occasionally while getting my oil changed, waiting to have labs drawn, or getting a haircut. I feel like I’m peering into a sociology experiment gone horribly wrong.

The scooters don’t really look all that fun, but apparently “free” makes them a blast, at least to that latter category of people (since so many of us are joining the “unemployed” category involuntarily, I’ll focus on the intentional deadbeats). “When did you realize your mobility was impaired, Mr. Jones?” “Why, when I saw that sweet scooter model that looked like an ATV with a beer can holder and a ‘Free with Medicare’ sign on it, sir.”) I suspect it’s the same people who borrow someone else’s handicapped sticker to get the best parking place.

Apparently that “intentionally deadbeat” demographic is a rich vein to be mined by semi-scrupulous companies who know that “Jerry Springer” moves some medical iron while “Meet the Press” doesn’t. Now comes mesothelioma time, valiant ambulance chasers channeling Robin Hood by taking money away from anyone who has it and redistributing it (minus the 90 percent legal fees) to the daytime TV audience not quite up to the subtle nuances of General Hospital.

My solution is either simply brilliant or brilliantly simple (I can’t decide). Use RHIOs to turn healthcare professionals into a constantly communicating network of fraud- and sleaze-sniffers and pay them for turning people in (the government is terrible at detecting Medicare fraud, yet is puzzlingly world class at snooping on citizens). Everybody wants transparency, so let’s make it work both ways. Patients ought to have some skin in the game.

Anybody can rate doctors and hospitals anonymously, even to the point of adding vicious, unsubstantiated comments. If Mr. Smith rips Dr. Jones on a public doctor rating site, Dr. Jones should be able to, as on eBay, add a blistering response, such as, “This lard-butt patient smokes, ignores my advice, has sued three doctors so far, and has never paid a dime of what he owes me.”

RHIOs could be the interoperability platform for exchanging information about those crackpots who ruin the system. Doctors, nurses, pharmacists, and dentists could flag patients who stiff them on co-pays even though they drive Jags, who use someone else’s insurance card, or who are just plain nasty. Let the doctor check their credit report, criminal record, IQ, and work history while they’re at it. They’re the ones who will be facing them naked (the patient, not the doctor) in an exam room, so it shouldn’t be Mystery Date in there. Like the stockbrokers say, “Know your customer.”

Patients who have filed more than one malpractice suit would get tagged so other doctors can avoid them. It would be like the NFL: patients get one medical challenge with no hard feelings, but frequent malpractice flyers get marked as trouble, as do drug-seekers and scooter-wanters.

Forget evidence-based medicine. If you really want to save healthcare dollars, give doctors the tools to identify and avoid those who seek to use them dishonestly and irresponsibly. That fruit is abundant and low-hanging. Plus, it’s not like the RHIOs are really doing anything anyway.

Post the information publicly and let’s put some shame back into dishonesty, criminal behavior, and irresponsibility. It could even be made cost-neutral by charging the public to peek at the postings. I bet people who make “Cops” or “Dog the Bounty Hunter” could figure out how to monetize it.

Now if you’ll excuse me, I think I’m coming down with a touch of mesothelioma, so I’ve got a scooter to order while they’re still free.