Surgery with a warranty?

An article in the New York times  discussess the new HHS reporting on mortality for cardiovascular admissions, (among other things). It was clear that the executive branch was not too enthusiastic in the first place. Not clear why they relented, but the link to the HHS site containing the  "report" takes you to a  fragmented database query screen that after some significant massaging gave me the reassuring news that none of the Nevada Hospitals were any worse (or better) than the other 4400+ average hospitals in the country. No "shame" list of the worst, no "praise" list of the best. You gotta ask the right question. Fifteen years ago, when I was Chief of Staff, every hospital in town had much better data on outcomes than has ever seen the light of day. It is in everyone's commercial interest to advertise the "perception of quality" rather than compete on outcomes and measurable quality. Data has a pesky way of getting in the way; just ask GM.

There was another thing in the paper a while back; Geisinger clinic in PA is marketing surgery with a warranty; 90 days fixed price, all costs included CV surgery. Bring-backs - 0$. Sternal debridements - 0$ Pacers/AICDs - 0$(?) Don't know that one. Presuming they hike their doctor reimbursement appropriately, that's a nice way to align everyone around efficient, good outcomes. Mike and Rob, what do you think?

Comments

[Mike O'Connor]

Surgery with a warranty?

More like surgery with cost-averaging. Big systems, like Geisinger, the VA, and Kaiser, can calculate fairly precisely their total cost of providing care and average this across the entire market segment. They track these costs carefully anway, for a variety of very good business reasons. This warranty is nothing more or less than a marketing gimmick. TANSTAAFL.

It might have some downsides... but I'll explore those in other posts.

As for report cards - they're only as good the people reporting the data are honest and the people assembling it are insightful. My direct experience is that they are almost completely uninformative.

[mkeamy]

sure, looked at from the hospital perspective. But looked at from the buyer perspective, it aligns an incentive. Now one concern you might raise is that it provides a perverse dis-incentive to additional interventions (let's wait to put in that pacer, and bring him back in a few months...)

As to report cards and the like; nothing is going to be very good at first, but until outcomes centered quality becomes a competitive "metric" (I hate that word) it's all just snake-oil, in my opinion.

[Deano]

I thought it was an interesting concept and have often thought that you get paid for your complications in medicine a perverse fact. They are a big system with a staff model that doesn't exist in many private practice hospitals. Given that I doubt their cost accounting is any better than any other medical center and would like to see if they make or lose money on this venture. I agree with Mitch it alings incentives between medical staff and hospital. Gotta go, more on the subject later.