Saturday, December 1, 2012

Eaves-tweeting (Boise hospitals)

Saturday’s New York Times story headlined “A Hospital War Reflects a Bind for U.S. Doctors” inspired interesting dialogue and commentary on Twitter. See the original story here. The story tells of how the national hospital efficiency trend is playing out in Boise, Idaho.

As the Times reported, “Boise’s experiences reflects a growing national trend toward consolidation.”

Here’s a glimpse of the reactions on Twitter:

On the Boise battle: 1. W/o transparency about quality, Big Med, under fee for service, produces more care & cost.

@Atul_Gawande Agree that transparency is key. How setting an example in Boston with real-time metrics, not 2- to 3-year old data?

2. To produce real teamwork for patients, we're switching to Accountable Care--i.e., lump sum payment--which makes Big Med necessary.

@Atul_Gawande And it doesn't matter if it is fee-for-service or global. Overall price levels rise when monopolies take charge.

3. There's a chicken-and-egg problem here, therefore. Change payment systems first and then bring in consolidation (#BIgMed)? Or vice versa?

@Atul_Gawande Focus on payment model is misplaced when monopolies exist, e.g., Partners gets higher global AND fee for service rates.

4. In the meantime, without real data about actual quality and cost--i.e., transparency--everyone's flying blind.

NYT article on hospital mergers; No mention what Catholic expansion means for patient services.

For a different perspective on the modern efficient hospital, see Dr. Victoria Sweet’s powerful book, “God’s Hotel” (blogged about here).


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