6 ms·

Interesting data, but good to note that cheap does not equate with better in the medical field typically.

by ocfx 13y ago

jaibot 13y ago
Is there evidence of correlation?
- ajiang 13y ago
  The next step would be to bring in death/complication statistics by hospital and ratings by surgeon
  - phren0logy 13y ago
    I would hesitate to interpret this so naively. For example, there are some vascular surgeons who take on patients that nobody else will touch. These are patients with many bad prognostic risk factors, but they will die without the surgery. The surgeons who take these patients may end up having terrible stats, but be the most skilled if only because their mortality rate is not pushing 100%. Comparing this statistic the way people compare gas mileage is a disincentive for these surgeons to operate on patients that need help, but are high risk.
  - carbocation 13y ago
    Selection bias (by the physicians) should make that extremely challenging. You could adjust for underlying comorbidities, though that will often not give enough adjustment to make an impartial expert observer feel that it is sufficient.
  - refurb 13y ago
    CMS is actually doing that already (at least for hospitals). Early next year, CMS will post healthcare quality metrics that it's collected from providers who bill to CMS. In 2015, hospitals will start getting reimbursed based on quality, which is a step in the right direction, however, it is chocked with problems (i.e. treating the best patients will advantage a hospital)
  - benmaraschino 13y ago
    Some states already do this. For example, for CABG and valve surgery, NY State publishes raw, as well as risk-adjusted mortality rates (RAMR) broken down by surgeon: (warning, PDF) http://www.health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2008-2010_adult_cardiac_surgery.pdf http://www.health.ny.gov/statistics/diseases/cardiovascular/... (begins on pg 21) Fun fact: Dr. Oz is in there and it even looks like he might be one of the better performing surgeons too. Another fun fact: it can be hard to draw inferences about individual providers this way; check out just how wide some of the the 95% CIs for the RAMRs are, and a lot hinges on how good your risk adjustment model is (details on pg 13).
- codex 13y ago
  If you were a doctor, would you rather charge more, or less? What keeps you from charging the highest fees in the world? Your reputation. If you're not the best, you cannot charge the most. All of capitalism works this way.
  - TrainedMonkey 13y ago
    If you are only doctor performing that procedure in a city... Well you get the point.
    - johngrefe 13y ago
      agreed. How many times have you actually shopped out a procedure by making 10 doctors appointments for checkups and quotes, typically, when they need to operate, you just go with what they say.
      - mgkimsal 13y ago
        I don't go to the doctor much, but when I go I ask "how much will this cost?" and 99% of the time I get "hrmm... I dunno..." and a shrug.
        auctiontheory 13y ago
        Most doctors in rich (i.e. insured patients) hospitals have no idea. My ENT was quite surprised when I told him the charge (>$1000) for his quick look down my throat. And that was only after a lot of shopping around and negotiating on my part. And it didn't include any "treatment" - it was just to look and possibly diagnose.
        mgkimsal 13y ago
        I'm usually asking the receptionist or other office person - they handle most of the billing stuff, and the other response I sometimes get is "oh, we have to run it through insurance first". They just run a code, and get told what they'll get paid (apparently), not necessarily what my cost/price is. The system is so fundamentally out of whack, and not at all 'market driven' and yet somehow... my 'free market capitalist conservative republican' friends (I have a few) are really against "socializing" medicine/healthcare. As if, somehow, what we have now in the US is a bastion of free market enterprise. The cynic in me thinks that the conservative elite really really really enjoy having a dependent class, and ensuring people are at the mercy of private health insurance companies vs the federal or state government helps ensure that dependency in a way they can still control. But... I'm overly cynical, it's late, and my words aren't coming out exactly as I think they should. :/

Interesting data, but good to note that cheap does not equate with better in the medical field typically.

by ocfx 13y ago

Interesting data, but good to note that cheap does not equate with better in the medical field typically.

jaibot 13y ago

Is there evidence of correlation?

ajiang 13y ago
The next step would be to bring in death/complication statistics by hospital and ratings by surgeon
- phren0logy 13y ago
  I would hesitate to interpret this so naively. For example, there are some vascular surgeons who take on patients that nobody else will touch. These are patients with many bad prognostic risk factors, but they will die without the surgery. The surgeons who take these patients may end up having terrible stats, but be the most skilled if only because their mortality rate is not pushing 100%. Comparing this statistic the way people compare gas mileage is a disincentive for these surgeons to operate on patients that need help, but are high risk.
- carbocation 13y ago
  Selection bias (by the physicians) should make that extremely challenging. You could adjust for underlying comorbidities, though that will often not give enough adjustment to make an impartial expert observer feel that it is sufficient.
- refurb 13y ago
  CMS is actually doing that already (at least for hospitals). Early next year, CMS will post healthcare quality metrics that it's collected from providers who bill to CMS. In 2015, hospitals will start getting reimbursed based on quality, which is a step in the right direction, however, it is chocked with problems (i.e. treating the best patients will advantage a hospital)
- benmaraschino 13y ago
  Some states already do this. For example, for CABG and valve surgery, NY State publishes raw, as well as risk-adjusted mortality rates (RAMR) broken down by surgeon: (warning, PDF) http://www.health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2008-2010_adult_cardiac_surgery.pdf http://www.health.ny.gov/statistics/diseases/cardiovascular/... (begins on pg 21) Fun fact: Dr. Oz is in there and it even looks like he might be one of the better performing surgeons too. Another fun fact: it can be hard to draw inferences about individual providers this way; check out just how wide some of the the 95% CIs for the RAMRs are, and a lot hinges on how good your risk adjustment model is (details on pg 13).
codex 13y ago
If you were a doctor, would you rather charge more, or less? What keeps you from charging the highest fees in the world? Your reputation. If you're not the best, you cannot charge the most. All of capitalism works this way.
- TrainedMonkey 13y ago
  If you are only doctor performing that procedure in a city... Well you get the point.
  - johngrefe 13y ago
    agreed. How many times have you actually shopped out a procedure by making 10 doctors appointments for checkups and quotes, typically, when they need to operate, you just go with what they say.
    - mgkimsal 13y ago
      I don't go to the doctor much, but when I go I ask "how much will this cost?" and 99% of the time I get "hrmm... I dunno..." and a shrug.
      - auctiontheory 13y ago
        Most doctors in rich (i.e. insured patients) hospitals have no idea. My ENT was quite surprised when I told him the charge (>$1000) for his quick look down my throat. And that was only after a lot of shopping around and negotiating on my part. And it didn't include any "treatment" - it was just to look and possibly diagnose.
        mgkimsal 13y ago
        I'm usually asking the receptionist or other office person - they handle most of the billing stuff, and the other response I sometimes get is "oh, we have to run it through insurance first". They just run a code, and get told what they'll get paid (apparently), not necessarily what my cost/price is. The system is so fundamentally out of whack, and not at all 'market driven' and yet somehow... my 'free market capitalist conservative republican' friends (I have a few) are really against "socializing" medicine/healthcare. As if, somehow, what we have now in the US is a bastion of free market enterprise. The cynic in me thinks that the conservative elite really really really enjoy having a dependent class, and ensuring people are at the mercy of private health insurance companies vs the federal or state government helps ensure that dependency in a way they can still control. But... I'm overly cynical, it's late, and my words aren't coming out exactly as I think they should. :/