Prying Open the Doors Concealing Health Care’s Secrets

The following is an excerpt from my new book: The Myths of Modern Medicine: The Alarming Truth About American Health Care (Rowman & Littlefield Publisher, released on 9/16/14)

Talking the Talk, but Not Walking the Walk

Health-care organizations bandy about the term transparency—using it to suggest an air of openness and disclosure about their performance and cost data. They have made repeated pledges to be more transparent. Unfortunately, they have been painfully slow in making good on their promises, causing the Institute of Medicine to observe that “a serious commitment to transparency means that we will strive to provide consumers with a comprehensive price and cost analysis, including effectiveness, adverse events, administration, and the impact of individual references relative to convenience and access.”[i] Apparently this prestigious scientific body agrees that providers are not taking transparency seriously. The absence of data is not merely a sin of omission. The health-care industry has done a magnificent job of methodically shielding us from this vital information on which we could make value-based decisions regarding our health care. The providers simply don’t want us to have the data: “A Commonwealth Fund National Survey of Physicians and Quality Care revealed that 69 percent of physicians were opposed to sharing quality-of-care data with the public. Forty percent of these physicians would not even allow their patients to be privy to such information.”[ii] It’s not just the doctors. Hospital executives want to be certain that any type of damaging information never appears on your radar screen. The 2003 Commonwealth Fund International Health Policy Survey of Hospital Executives revealed that hospital CEOs in the United States were significantly more opposed to public disclosure of medical-error rates, hospital-acquired-infection rates, patient-satisfaction ratings, and average waiting times than CEOs in four economically advanced countries.[iii] Data behind Closed Doors Although you may not be able to access it, hospitals are nonetheless amassing a wealth of data on key quality variables. Federal mandates are partly responsible, though progressive hospitals interested in quality improvement are collecting data proactively. Some of the most important and potentially powerful data in terms of providing a window into the meaningful differences in quality between providers includes:

• iatrogenic events
• expected versus experienced mortality rates
• sentinel events (in which the life of the patient has been threatened)
• surgical-infection rates
• unscheduled returns to the operating room
• readmission rates (which are now becoming publicly available) and
• punitive actions or sanctions imposed on physicians by their peers.

Don’t be put off by the unfamiliarity of the terms. Though you may need some assistance with translation, you’ll quickly grasp the significance of the measure. Take iatrogenic events for example, which, in plain English, translates into a hospital-acquired illness or injury. Why do we care about something as esoteric sounding as “iatrogenic events”? We care because, by definition, an iatrogenic event is avoidable. Furthermore, it adds unnecessary costs and can even result in death or serious impairment. Imagine going to the hospital for a simple outpatient plastic-surgical procedure and having your surgeon accidentally ignite the oxygen you are breathing with an inadequately grounded electric cautery. It happened at one of my hospitals. Iatrogenic events are not rare occurrences. Rather, they are daily events within the life of the American hospital. We generally only hear about them when they are egregious in nature, such as the amputation of the wrong limb, the overdosing of a patient, or the rapid spread of infection through a hospital. The media pay far less attention to the rate of falls in a given hospital, though such commonplace accidents can permanently impair an elderly patient who suffers a resulting hip fracture. This paternalistic attitude and the resulting lack of information divulged to the public stymies market dynamics. Regardless of who is paying the health-care bill, U.S. health care will never achieve true greatness without addressing the issue of transparency.

TO READ MORE ABOUT THIS VITALLY IMPORTANT TOPIC, please see The Myths of Modern Medicine: The Alarming Truth About American Health Care — Available at Amazon.com