Blog | Monday, February 23, 2015

So what else is new?


Steven Brill made a name for himself with an article in Time magazine back in 2013 entitled “Bitter Pill,” in which he harshly criticized how health care providers (especially hospitals) inflate the costs of their services. The piece created a lot of buzz, and some backlash from hospital groups and others. Now it seems that Mr. Brill has had a bit of a “sick-bed conversion.”

He has a new piece in the Jan. 19 issue of Time called “What I learned from my $190,000 open-heart surgery: the surprising solution for fixing our health care system.” Since Time won't let you read the article without subscribing or paying, I will save you the trouble. It seems that what he learned is that health care providers, the same ones he vilified in 2013, were pretty great when they were taking care of his heart in 2015. In fact, he now believes that the way to “fix” health care is to “let the foxes run the henhouse” by allowing large integrated health systems become insurance companies and compete on price and “brand” and regulate their profits to assure that they are acting in the public interest. Yeah, well, no kidding.

The surprising thing about this article is that it is both unsophisticated and un-original, yet presented as nothing short of brilliant and novel.

First of all, the whole idea of systems of care competing on the basis of “brand” is dangerously simplistic. While Mr. Brill does make a brief nod to the need for “data transparency” around “quality ratings,” he completely misses the boat. This isn't about marketing the brand, it is about improving the outcomes. Patients shouldn't go to the Cleveland Clinic because of their brand; they should only go if the Cleveland Clinic can prove that their clinical outcomes are as good as or better than other providers.

Even more disturbing, there is nothing new about the basic idea of providers competing on the basis of price and quality. As I wrote back in December 2013, Michael Porter and others have been writing for years about shifting reimbursement from volume-based to value-based, and payors and providers are actively engaged in that transition right now. Thanks for the “suggestion” that health systems should consider becoming insurance companies. North Shore-LIJ started its insurance company, Care Connect, in 2013.

I guess I should be pleased that Mr. Brill has a better appreciation of health care providers and now believes that we should be taking on the role of insuring the health of a population. I just think it is a shame that it took heart surgery for him to see what has been clear for a long time.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.