As a pre-medical student and a future doctor I’m well aware of the fact that it will be a number of years before I become a practicing physician. I’m also very well aware of the fact that the medical environment and community that I will be practicing in could be very much different than the medical environment of today.
That’s neither a good thing nor a bad thing, hopefully it’s good, but for now it’s just a fact. So I always do my best to keep an eye out for information that could help me understand the direction medicine is going so I can envision what medicine will eventually look like.
One thing I hear a lot about is this effort to hold doctors accountable and to empower patients to use data to select the most appropriate healthcare. I think the goal behind that mission is absolutely wonderful. Doctors are supposed to first and foremost help their patients, and patients deserve the opportunity to be able to learn and decide for themselves where they want to obtain their care.
The only concern I have though, is that the metrics and data being provided to patients to make their decision are not always truly indicative of good care. For example, one thing I’ve heard about is both paying and judging surgeons based on their rates of complications. Seems like a decently fair strategy. But what happens if you’re an amazing surgeon, but you decided you wanted to help a lower income population. Isn’t very much possible that the environment your patients are in after they leave the surgery could affect the degree to which they have complications? That doesn’t necessarily make you a worse doctor does it?
Just the other day I came across a phenomenal article about this subject from Lisa Rosenbaum MD, from the New Yorker titled “What Big Data Can’t Tell Us About Healthcare”. In this article she talks about a recent release of Medicare payments that was made available to the public. In this release anyone, including patients, can look up the amount doctors are billing and how they rank amongst their peers.
The basic idea is that transparency can help patients make informed decisions. And the implied message is that doctors who are billing higher are misusing the system and ripping you off.
“The hope is that members of the public will be empowered by their access to payments data, and will use this information to identify doctors who are behaving badly, helping to end fraud and profit-driven overuse.”
But that’s extremely missing. Just knowing how many Medicare specific treatments your doctor does , how much he or she bills for them, and what their total overall billing is does not provide nearly the whole picture. You don’t know what the doctor’s costs are; maybe the area they are in requires higher costs? You don’t know the exact breakdown of the doctors billing system within their practice. Often times a single doctor bills the entire practice’s procedures.
And there is an overall dilemma between doctor judgement and what’s deemed as necessary that this also highlights. Is a test unnecessary just because it doesn’t return positive results?
How do we define quality care and how do we provide patients with a data set that is truly reflective of that? That’s still a challenge that is yet to be answered.
http://www.newyorker.com/online/blogs/currency/2014/04/the-medicare-data-dump-and-the-cost-of-care.html