3 ms·

I think there is an opportunity for the amazon / BH / JPM JV to use its scale, visibility and "outsider" status to create a standard that is simple and easy to

I think there is an opportunity for the amazon / BH / JPM JV to use its scale, visibility and "outsider" status to create a standard that is simple and easy to understand by consumers, and actively market that standard in a way that medicare, startups or industry coalitions have not been able to most quality standards are not even well known or standardized within the healthcare industry, and there are so many competing interests that it is hard for providers, payers, other stakeholders to align on a standard, useful and enforceable definition of quality. the JV is already insanely visible / high profile without anyone knowing what it does; if they create a quality rating system it will certainly get more attention than any other one created to date also, amazon / bh / jpm in theory is better aligned with society in terms of what they want out of healthcare: 1) lower cost and 2) customer satisfaction. that group cares about making its employees happy, whereas other stakeholders dont have the same direct accountability to employees / patients: payers are only accountable to patients through the employers they serve, and providers are in theory accountable to patients but in reality more influenced by the health system that owns them or the payer that pays them

nradov 9y ago
The major quality standards are published by CMS (Medicare) and they're very well known because reimbursement is now tied to hitting those metrics. But in a broader sense it's really impossible to define objective quality metrics for individual healthcare providers. If a heart surgeon has a high patient death rate is it because she's incompetent or because she takes on the most fragile patients that no one else is willing to operate on? You might think that those differences could be controlled for but in reality there are too many confounding factors and research hasn't even been done to accurately quantify many of them.
- aaavl2821 9y ago
  It is hard, and once you've defined quality metrics, it's even harder to write a contract that captures them and get parties to agree on them The latter issues might be resolved somewhat by the Amazon group; the former is still a concern, but I think there are opportunities to do meaningfully better things This is just an idea, and I've not done much research on it, so take with a grain of salt: I think patient focused quality measures might be better. For example, look at cohorts of patients with similar characteristics (like in case control studies) who are experiencing a similar health event (knee surgery) and compare providers based on the outcomes these types of patients have. This is something the JV could do, is patient focused, and avoids all the challenges you mention with metrics measuring / managing individual providers (which isn't just hard to measure but demoralizing to docs)
  - nradov 9y ago
    That's exactly the problem. There's no reliable way to construct a cohort of "similar" patients. We don't even know all the variables other than provider quality which impact the outcome of knee surgery. Do we have to consider age? Genetics? Sex? Fitness level? Co-morbid conditions? Blood Type? Personality? Something else? That data simply doesn't exist, and won't exist in our lifetimes. With large enough populations some of those confounding variables even out. But that doesn't help when trying to evaluate individual providers who treat relatively small numbers of patients per year. Of course in any area all of the local doctors know from subjective experience and word-of-mouth which other doctors are skilled and which are quacks. But none of them will say so publicly, and you can't quantify those opinions.
    - aaavl2821 9y ago
      People do case control studies all the time, the factors used depend based on disease but there is plenty of literature to support selection of matching factors I think it would make sense to start at the hospital level; provider level probably isn't feasible as you say. Hospitals see enough patients where the sample sizes are pretty big, and they are the main cost driver in healthcare, so rating hospitals by cost / quality could work

nradov 9y ago

The major quality standards are published by CMS (Medicare) and they're very well known because reimbursement is now tied to hitting those metrics. But in a broader sense it's really impossible to define objective quality metrics for individual healthcare providers. If a heart surgeon has a high patient death rate is it because she's incompetent or because she takes on the most fragile patients that no one else is willing to operate on? You might think that those differences could be controlled for but in reality there are too many confounding factors and research hasn't even been done to accurately quantify many of them.

aaavl2821 9y ago
It is hard, and once you've defined quality metrics, it's even harder to write a contract that captures them and get parties to agree on them The latter issues might be resolved somewhat by the Amazon group; the former is still a concern, but I think there are opportunities to do meaningfully better things This is just an idea, and I've not done much research on it, so take with a grain of salt: I think patient focused quality measures might be better. For example, look at cohorts of patients with similar characteristics (like in case control studies) who are experiencing a similar health event (knee surgery) and compare providers based on the outcomes these types of patients have. This is something the JV could do, is patient focused, and avoids all the challenges you mention with metrics measuring / managing individual providers (which isn't just hard to measure but demoralizing to docs)
- nradov 9y ago
  That's exactly the problem. There's no reliable way to construct a cohort of "similar" patients. We don't even know all the variables other than provider quality which impact the outcome of knee surgery. Do we have to consider age? Genetics? Sex? Fitness level? Co-morbid conditions? Blood Type? Personality? Something else? That data simply doesn't exist, and won't exist in our lifetimes. With large enough populations some of those confounding variables even out. But that doesn't help when trying to evaluate individual providers who treat relatively small numbers of patients per year. Of course in any area all of the local doctors know from subjective experience and word-of-mouth which other doctors are skilled and which are quacks. But none of them will say so publicly, and you can't quantify those opinions.
  - aaavl2821 9y ago
    People do case control studies all the time, the factors used depend based on disease but there is plenty of literature to support selection of matching factors I think it would make sense to start at the hospital level; provider level probably isn't feasible as you say. Hospitals see enough patients where the sample sizes are pretty big, and they are the main cost driver in healthcare, so rating hospitals by cost / quality could work