Thursday, February 11, 2010

Gingrich & Goodman Idea #7: "Inform Consumers"

As a healthcare consumer, you already have a lot of information available to you. In what they purport to be a GOP reform idea, Newt Gingrich and John C. Goodman want to give you more. It's reasonable enough to make information available, but here's the thing: this is complicated stuff. If you're going to try to reduce terabytes of data into a form that a typical layperson can understand, to put it mildly the result will be oversimplified. If you try to add the context necessary to understand the data, the result will be complex. Does a hospital's survival rate for a particular procedure directly correlate to the skill of its surgeons, or is it that the hospital with the better survival rate turns away the difficult patients? Also, at times data will inspire a conclusion that is premature or incorrect, due to a lack of sufficient data to support a statistically significant finding, differences in procedure not reflected in the data, data entry errors, and many other potentially confounding factors.

Further, these are the type of issues where patients should be able to rely upon the advice of their own doctor. The doctor should be able to advise them about choices of procedure, surgeon, clinic or hospital, and ensuring that the doctor has good data available could assist her in making a recommendation. But to dump that information and responsibility upon a typical patient is not helpful, and will often be overwhelming.

Gingrich and Goodman specifically propose using government data, "like Medicare claims data (stripped of patient information)", to "help consumers answer important questions about their care." Do they mean that the data should be stripped of patient information before it is analyzed? Because without that context you're inevitably going to skew the result of the analysis. I don't believe that Medicare is presently willing to release any such data for analysis without stripping individual patient information, so if Gingrich and Goodman want that to happen they will have some serious privacy concerns and regulatory hurdles to overcome. (Even if a patient is identified by a random number, if you put enough pieces together you can often associate the record with an actual person. But without that data, you don't necessarily know if the person who died during a heart bypass operation had a health history that put them at high risk of death, skewing a hospital's statistics.)

But you know what? More information is rarely a bad thing, and a lot of those concerns can be overcome. Even if the data is used primarily by doctors advising their patients, it could be very helpful. And there are politicians actively working toward this type of solution. So let's look at this "GOP idea" in the real world.
Equipping patients and the entire health community with the most accurate medical research available will enable them to make the best possible clinical decisions, improve care quality, and avoid ineffective and harmful health outcomes.

What’s more, a better understanding of which medical treatments work and which don’t could save money. It’s estimated that one-third of procedures and treatments administered in the United States have no proven benefit and account for up to $700 billion annually in current spending. Moreover, some of these treatments can have harmful side effects, produce worse health outcomes, and then, as a result, add to the soaring costs of medical care.

Congress and the Obama administration have recognized the importance of this research by investing $1.1 billion in comparative effectiveness research as part of the $787 billion American Recovery and Reinvestment Act. Despite broad support for this kind of research among the American people, health care providers, and much of the health care industry, there has been vocal opposition to comparative effectiveness research based on fears that the government will intrude on the patient-provider relationship and coverage policies.
The GOP response to that? Largely the accusation that the Obama Administration was trying to put a bureaucrat between patients and their doctors and ration their care. An actual GOP proposal attempted to cancel funding for comparative effectiveness research. Gingrich and Goodman have their political parties confused.

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