The Emerick Ethics Index. Tom Emerick spent the better part of 25 years working in benefit design for companies like Burger King, BP, and most recently, Wal-Mart, where he worked alongside Dillman and Simon, as Vice President of Global Benefit Design. Emerick came away with many lessons, but one stood out. It requires some explaining. Often Emerick’s role inside companies was to decide where an approved medical procedure would be performed—this hospital, or that one? The criteria used to make these decisions typically included: cost, past performance of the provider, and risk to the employee from any travel. But the ethics of the procedure, and the ethics-record of the providers, were almost never considered. Emerick thinks this is why many procedures that could be performed -- and were covered -- were performed, whether or not they were medically necessary. (“I saw lots of inappropriate organ transplants,” he says). Emerick argues that if “ethical constructs” were added to the filters used by decision-makers like him, then situations like McAllen, TX wouldn’t take place so often. “Transaction happy” hospitals would eventually get caught in the screen,  and employers could send workers to hospitals that just perform what is necessary. All this boils down to one realization: currently in the healthcare system, “quality” is judged according to competence—was the procedure successful?—not, was it the right thing to do? And while we have chapter and verse on the substance of ethics, Emerick couldn’t find a tool suitable for measuring ethical performance by providers. So he built one. The Emerick Index sets objective criteria for ethical performance, and will rate providers against these over time. One day, employers could decide where to source care for their workers, informed by cost, competence, and whether a hospital does the right thing. It’s an ambitious idea, but with fee-for-service on the ropes, seems well-timed. And we like people wiling to try tough things.

"I saw lots of inappropriate organ transplants."