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July 16, 2015 Readers Write 11 Comments

WikiLeaks for Healthcare
By Todd D. Johnson


Did you feel the earthquake that hit healthcare this week? If not, you weren’t paying attention. On Monday, ProPublica, an independent, non-profit newsroom, published Medicare data about complication rates for surgeons and hospitals across the country. For the first time ever, the complication rates are reported all the way down to the individual surgeon.

This is big, sort of a WikiLeaks for healthcare. ProPublica has also used the stage to call out some of historically best-regarded healthcare institutions in the world on their outcomes.

Let’s agree that the train of transparency and value based healthcare has already left the station. If you didn’t believe it last Wednesday — when the Secretary of HHS, Sylvia Burwell, sent a strong market signal accelerating the movement requiring physicians to provide a “warranty” for their services — believe it today. Now any individual (patient or referring physician) can (and should) look up complication rates by surgeon and by hospital as they are shopping for doctors.

Furthermore, any payer, medical malpractice carrier, and any physician-employing entity can use the same data to negotiate reimbursement, premiums, and employment terms, respectively. This changes everything.

Arguably, #SurgeonScorecard is simultaneously both the best thing and the worst thing that could have happened for our healthcare system right now. Any physician or hospital that somehow thinks that the market economics aren’t going to shift needs to wake up. They can neither ignore nor hide from these data. Even if payors aren’t going to mandate change, patients ultimately will, and both patients and payors now have the tools at their disposal to do so. Furthermore, this data is public, and physicians and/or hospitals no longer have the only key to the safe containing physician-level outcomes.

Like every empire, the days of Fortress Medicine are now numbered. Those provider organizations that can find and use new tools to help them learn, improve, adapt, and evolve will survive, and those that don’t will succumb to market forces. Ultimately, this is the best thing that could have happened because it will lead to greater patient safety and improved outcomes.

It also might be the worst thing that could have happened to healthcare today. Change is difficult for many of us, including physicians, and therefore it’s hard to adapt and improve. Really hard. Physicians have lost control of their practices and their data. Just ask them. The data held in EMRs and claims data sets are not at the fingertips of the very practitioners who need them.

Furthermore, the retrospective data are being used by third parties to tell physicians about their performance and about how much or little they may be entitled to for reimbursement. This is to say that the data are often used to hold the providers hostage.

Physicians need new tools to empower themselves by using their own data. These tools must enable them to proactively treat patients in more high performance ways at lower costs. Just like ProPublica uses big data to learn about populations, physicians need to use their own data to gain more insight, work more efficiently, get better outcomes and measure them. But their data is are either sitting behind the walls of Fortress Payor or sitting in EMRs (otherwise called “wait-a-bases.”)

Just ask a doctor how easy it is to get data from his or her IT department these days. Most physicians haven’t the slightest idea how to access their own data. This is an unacceptable situation.

How can we ask providers to improve when they are flying blind? You may ask, “But didn’t we just spend $40B of taxpayer money to subsidize the purchase of fancy EMR systems to help providers improve performance?” Sadly, the flaw is that those EMRs can’t tell them which patient is sitting at home three days after surgery with a fever and early signs of an infection. That EMR isn’t telling them that their patients aren’t performing their daily at-home exercises to reduce their risks of blood clots. That EMR isn’t telling them that the patient isn’t understanding their treatment plans and adhering to them. At best, that EMR is only telling them that the patient was admitted to the emergency room after developing an infection.

As its title indicates, the EMR is merely a “record,” of that which has already happened rather than a live stream of what is happening, or a forward-looking tool for what is likely to happen. But more than that, EMRs only “know” the events that occur within the system in which they record.

Research out of the University of California San Francisco, reported last month in the Annals of Internal Medicine showed us that within three days of an emergency room visit, one-third of all return visits happened at another institution. This is worth repeating. One-third of all patients returning to an emergency room within three days of an initial visit occur at a the emergency room of a different hospital.

This means that there is tremendous, costly leakage outside of the walls of the index institution, and the events (and associated costs) around that leakage are unknown to the physician until the claims data (with reduced reimbursement) appear at the door. Just as patients are gaining increasing access to their own data, so too is there a need among providers and provider organizations for self-directed visibility into their own data.

Now is the time that physicians need to challenge themselves and their organizations to embrace value-based agreements. They should advocate for transparency; not hide from it. Some providers and provider organizations will undoubtedly feel victimized by these new and very transparent scorecard data. But those who see the opportunity will realize that with the right tools in place, these data can be extraordinarily empowering.

Use of digital engagement platforms with real-time patient reporting that is built right into the physician workflow can empower healthcare organizations and providers to discover and glean insights like never before about their patients. Furthermore, healthcare organizations needn’t wait to be told by payers what their complications are (and correspondingly what their value-based reduction in reimbursement may be) when they can glean from other digital sources exactly what their complication rates are in real-time.

The Surgeon Scorecard is a wake up call for providers to empower themselves to control their own data and not be victims of it. This is the time that they should critically evaluate and invest in new ways to deliver care that leverages the latest digital health tools, remote monitoring, and data analytics.

Years from now, we may well find ourselves referring to the new era after this pivotal moment in healthcare as “Life after the Surgeon Scorecard.” Really, the surgeon scorecard is just the beginning. Next, we will see similar reports extending beyond the eight elective surgeries covered in the ProPublica article. After that, we will see similar data reported for physicians in non-surgical specialties.

Just as it was the consumer market that has been dragging Fortress Medicine into the digital health era, so too is consumer demand for transparency about physician performance dragging data such as those reported today into full view. But physicians themselves are the ones at risk of being left behind. They must become proactive rather than reactive consumers of their own data, adopting and utilizing any number of the emerging workflow-friendly digital health platforms that put the data right into their hands.

Todd D. Johnson is chief executive officer of HealthLoop, Inc.

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Currently there are "11 comments" on this Article:

  1. Transparency is scary. And then you learn to adapt. Eventually you wonder why you ever worked any other way.

  2. Much of the reaction (though not all) gives new meaning to to term “defensive medicine.” Let’s push NSQIP — the Surgical Quality Improvement Project — to release its numbers, if surgeons believe PP’s data is off. After all, it covers a far broader patient population and range of procedures. Let’s also insist that CMS gather and report Medicare Advantage surgeries/other metrics; 30 percent (and growing) of all beneficiaries choose “private Medicare” now. Patients, particularly in Kaiser and other big HMOs, get left in the dark on important measures.

    Thank you, ProPublica, for moving this conversation forward.

  3. At first glance, I LOVE this idea. I absolutely love this…. it puts important data in individuals hands to help them determine the care they should receive.

    The problem is this has one very nasty and unforeseen consequence…. it encourages surgeons to not accept Medicare. If you don’t accept Medicare they avoid being rated. Surgeons will have even less incentive to accept Medicare. People on Medicare will have less choice.

    The only way to do this right is to require ALL claims data be made public not just Medicare…until then this really could do more harm in an unexpected way than good.

  4. PM_from_haities: You are absolutely right. Can you imagine what the reaction would have been if this kind of publication had been driven by doctors for all payers? Much more credible and useful. My gut says that surgeons won’t limit their panel to non-Medicare patients because of ProPublica – they’ll just become increasingly defensive about data that is published. But time will tell.

    Naomi: Agreed. I hope that physicians push to take the lead on transparency. It’ll give a ‘peer reviewed’ credibility to information that can be useful and actionable for individuals seeking better healthcare.

  5. PM_From_Haities: Re: it encourages surgeons to not accept Medicare. If you don’t accept Medicare they avoid being rated. Surgeons will have even less incentive to accept Medicare. People on Medicare will have less choice.

    That would seem to be a really DUMB move to me if surgeons stop accepting Medicare given the increasing baby boomers going on Medicare (over 10,000 enrolled each day!) Isn’t that kind of like walking away from your future paycheck? As they say, ‘you can run, but you cannot hide!’ We should not shy away from transparency.

  6. I’ve noticed you tend to have morbid post on this website. What about physicians who take great care of their patients and expand their Medicare panel and use transparency as a marketing tool. I guess it’s how you look at the world.

  7. When your medical care hurts, do you Yelp? Consumer rating systems like Yelp will also play an important role in evaluating providers. So whether it’s Yelp, the Surgeon Scorecard, or any other measure that the market can see & analyze, the transparency message is clear — Adapt or Die.

    Those on the top of the healthcare mountain and slowest to adapt may be most at risk from disruptive change. After all, 429 of the original Fortune 500 [1955] are no longer in business or anywhere near the top, and that’s a scary thought for those NOT seeking & embracing disruptive change.

  8. Jaded maybe, but not morbid. My post isn’t morbid at all. It’s reality. Good surgeons have enough work to keep them busy for several lifetimes. They have a choice to accept Medicare patients where reimbursements are less than other insurance providers. Where some surgeons may have accepted it out of obligation, they may not accept them now.

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