Article: HealthCare is becoming a Numbers Game

                    Web Sites are not the Answer

        Recently, BlueCross/BlueShield of Tennessee announced the establishment of a web page designed to relay cost and quality information concerning area physicians. Another insurance giant, CIGNA, has described a similar plan. On the surface this would seem reasonable, though there are other issues to consider.

        First and foremost, the primary goal of a health insurance company is to make money. A recent article in American Medical News gave the 2007 annual compensation for the CEOs of several health insurance companies. Among them was Mr. H. Edward Hanway, of CIGNA, who was listed as making 25.8 million dollars in 2007. The salaries of six other CEOs were listed in this article, with their average compensation for 2007 being approximately 12 million dollars each. The Executives of BC/BS of Tennessee were not listed, though I suspect they did quite well.

        In order to maintain these salaries and, where appropriate, to pay their stockholders dividends, these companies have been harassing providers for years by denying medications, limiting procedures and by refusing to pay for hospital stays, among other things. While doctors and hospitals have scrambled to maintain quality patient care, these companies have continued to press us to reduce testing, procedures, and medications as much as possible. Establishing these web pages is simply a clever way to do just that.

        What will these web sites actually tell us? The data will be generated by computer analysis and by employee review of billing data, not health information. Certainly not by visiting with the patient to assess their quality of life, not by looking at that patient as an individual and seeing if the doctor is doing the best that can be done for a challenging patient, and not by considering that that doctor may have done more for that patient over the last several years than any other doctor that patient has seen, though the patient still may not meet "treatment goals".

         They will analyze their data to see if the doctor is following the "company program" in using the drugs they want used, in ordering the tests they want ordered, in admitting to the hospital when they feel the patient is sick enough, to discharge them when they feel the patient is well enough, and to generally save themselves as much money as possible. The real concern of the insurance industry is in how a doctor affects the companies "Medical Loss Ratio" and thereby the profit margin. These sites will definitely not tell you much about quality. In fact, the providers who score well on these web sites may be the ones most indoctrinated and influenced by these companies.

       If the insurance companies play this numbers game, the providers will be forced to do the same thing. We will have to carefully select our patients in order not to make our numbers look unfavorable. Certain patient types will help to improve our profile. These patients would be already healthy, trim and well exercised, with no bad habits, and who are compliant with their medical advice.

        We would not want patients who would make our numbers look "bad". This would include patients who are under-motivated, are obese, are users of tobacco or alcohol, have diabetes, are hypertensive, have elevated cholesterol, don't exercise, are depressed or have too many stress issues. Also, patients who already have heart, liver, or kidney disease, or who have a diagnosis of cancer, would not be desirable. Only a few doctors would actually fire their current non-compliant patients. However, before taking any new patient, we would be forced to evaluate that person's medical records to see if they would pose a risk to our "web site quality numbers". Blue Cross would certainly not want us to take on a challenging patient who might pull our score down and make us look bad on their web site!

        These insurance companies are now making healthcare a "numbers game".   Instead of concentrating on patient's quality of care and the quality of their lives, we now have to concentrate on how we appear on an unscientific web page. I enjoy a challenging patient and the chance to motivate them into caring for their health, perhaps for the first time in their life. Often it takes years to help them to change. With this twisted analysis of billing data, how can I continue to take on and to care for the difficult patient?

     These web sites will benefit the insurance company's profit margins and the executive's year-end bonus far more than enhancing public health. I believe it is more about shaping and controlling doctors than quality control. I would be glad to debate this issue in a public forum, if any of these insurance executives would like to do so.

      Suffice it to say that healthcare delivery in the United States is terribly fragmented, woefully inefficient, embarrassingly expensive, tragically apportioned, and is being financially ravaged by profiteers. "For-profit" health insurance companies only take from this overstressed system while working on ways to cement their hold over it. Publishing these types of flawed data furthers their efforts to control providers and thereby to control your healthcare resources.

        We need healthcare reform in America, but it will take a public outcry to make it happen. I would like to further address this problem. Talk to your friends. Force your legislators to engage, and not along party lines. Neither of them have a suitable plan.

MarkEGreen MD

463 POB BMH

Maryville, TN 37804

MarkGreen@OurHealthReform.com