Thursday, September 20, 2012

The Secret that Doctors Know...and You Should Too.

I read this in Newsweek while getting ready for work this morning.  I'd like to say it surprised me, but unfortunately, it doesn't.  We live in a free country where we can get candid reviews on everything from restaurants to lawnmowers to investments, but when it comes to the most important thing--our health (and life itself)--we have almost no information about our hospitals.
A 2010 New England Journal of Medicine study concluded that as many as 25 percent of all hospitalized patients will experience a preventable medical error of some kind, and 100,000 will die annually because of errors. If medical error were a disease, it would be the sixth-leading cause of death in the country.
How can we as consumers of healthcare make informed choices when we don't have information on where the best and safest care is provided?
Take, for instance, the National Practitioner Data Bank collected by the U.S. Department of Health and Human Services, which is also known as the national “blacklist” of doctors. The public has absolutely no access to it. When I requested the list, I was given a version with the doctors’ names deleted; the only groups that can query the list are state medical boards or human-resources departments doing background checks. Ironically, sex offenders’ names are broadcast to the community when they move into town, but doctors who lose their license in one state because of sexual misconduct with a patient are shielded by name in the database if their license is later restored or if they continue to practice medicine in another state.
Competition and the free flow of information improves any product, industry, group of people.  At least one state, New York, is doing it right:

In the early 1990s, New York state set out to address the horrific patterns of bad outcomes that health officials had heard about in some of the state’s heart hospitals. Mark Chassin, who became health commissioner in 1992, didn’t want to just slap wrists. Instead, he and his team did something radical: they made heart-surgery death rates public. Instantly, New York heart hospitals with high mortality rates scrambled to improve. Hospital executives held meetings with heart surgeons, nurses, and techs to find out what they had to do to improve quality and safety. At one hospital, the staff reported that a surgeon wasn’t fit to be operating; his mortality rate was so high it was skewing the hospital’s average. His hospital administrators ordered him, point-blank, to stop doing heart surgery.
The result of the release of this data? Big, broad improvements in mortality statewide. Despite some criticism of the program’s notable loopholes, with each passing year of public reporting the state’s average death rate went down. In addition, bad outliers, like the hospital with the 18 percent mortality rate, were reined in. Erie County Medical Center was the state’s worst-performing hospital, with an overall mortality rate higher than that of soldiers wounded in the Iraq War. Within three years the mortality rate was cut to 7 percent, and in the years since, it has fallen to 1.7 percent. Introducing transparency to New York’s heart centers brought something very novel and powerful to health care: public accountability.