Emerick Index: An ethics scorecard for hospitals
What:
A framework that employers and consumers may use to evaluate hospitals and clinics based on their ethical performance, in addition to procedural competence, to determine whether they overtreat.
When:
Debuting this month in a medical travel survery with HighRoads, a technology consultancy.
Where:
Boston, Mass.
Who:
Tom Emerick, Emerick Consulting; with Lori Dustin, CMO, of HighRoads.
Why:
We like lists. Emerick's straigtforward questionnaires are designed to reveal whether a hospital or clinic is managed ethically, and whether the insitution performs unecessary procedures. Simply by applying Emerick's litmus tests, employers and consumers can determine whether a clinic is "transaction happy," and then vote with their feet, taking their healthcare needs to those hospitals and clinics that do not overtreat. Such grass roots decisions are the events that, ultimately, will force institutions to change -- and long before reform bills are in place, or any top-down healthcare overhaul is complete. And as always, surverys are cheap, portable -- infinitely scalable.
Cost:
< $ Sample ethical survey is free on healthspottr, courtesy of HighRoads.
We first wrote about Tom Emerick and his evolving Ethics Index in the future health 100. In September, Emerick will release results of his first ratings of 50 U.S. hospitals. They aren't likely to be rosy, he says. Today we share with you one of Emerick's ethics surveys, developed for a client called HighRoads. heathspottr likes lists, and this simple questionnaire is an innovation worth sharing. We encourage you to use it before you choose a hospital or clinic for your own healthcare needs in the future.
Emerick spent much of his career working in benefits management at companies like Burger King, BP, and Wal-Mart. In these roles, Emerick never decided whether a procedure should be covered and performed. Emerick determined where an approved medical procedure would be performed -- this hospital, or that one?
No surprise, he came away discouraged. "I saw lots of inappropriate organ transplants,” Emerick says. The scourge of excessive procedures is a common enough topic now. The solutions seem clear, too: coordinated care models; salaried doctors; payment reform; more preventative care. But this where the conversation stalls. Coordinated care requires overhauling a hospital (costly). Most doctors don't wish to be salaried and dislike payment reform even more (politics). The cultural shift required to move a critical mass of physicians away from treating illness and toward "treating" health will be years in the making (glacial melt).
So in the interim, what can a person tasked with monitoring a company's healthcare costs do to limit expenses from unnecessary procedures? How can you be sure that you are picking the best facilities to deliver care to your workers -- facilities that do not overtreat?
The answer is simple, if not easy, Emerick says. By asking a few key questions of your doctor, or the hospital or clinic administrator, consumers and employers can learn what they need to know to assess how ethical a hospital tends to be.
The questions are straightforward enough:
- Are any of your doctors on salary?
- Which of the following best describes the surgeons who perform surgery through your hospital: a) Salaried; b) Salaried with paid incentives based on volume; c) Paid on a fee for service basis?
- When patients come to your hospital for a surgical procedure, are such patients screened by impartial physicians, other than the physicians who will perform the surgery, to help determine the safest, least invasive, treatment protocol to achieve the desired patient outcome?
- Is your pricing transparent to patients?
You get the idea. The hard part, Lori Dustin of HighRoads discovered, is in getting hospitals to answer these questions.
HighRoads is a healthcare consulting firm that specializes in procuring and managing health plans for Fortune 500 companies. HighRoads uses reverse auctions to match plan features, with lowest prices. With claims costs skyrocketing, HighRoads clients want new ways to price-compare, not only for plans, for specific procedures between hospitals -- even between hospitals in different countries.
"There was no way to do it," says Dustin, HighRoads' Chief Marketing Officer. "There was no way to compare the cost of a hip replacement at Mayo [Clinic] versus Cleveland Clinic, against a hospital in Argentina, and Mass General."
With Emerick's help, Dustin decided to collect the data herself. This summer HighRoads circulated a "request for information" to 15 large hospital systems in the U.S. The RFI follows tightly to Emerick's ethics questions, above. Complete RFI
The results?
"Many hospitals chose not to respond. Which was, I have to say, completely a shock to me," Dustin says. She won't reveal the full list of 15 hospitals HighRoads canvassed, but those that did respond were: BridgeHealth, Healthplace America, HIMA Health, Intermountain Healthcare and Scott & White Healthcare. (Some notable names are missing.) Some offered pricing for standard procedures. The ranges are noteworthy. For coronary artery bypass surgery, prices ranged from $19,000 to $59,279. For total hip replacement, prices ranged from $9,900 to $29,005.
Dustin plans to publish the full survey results in next week. "Our hope is that if we can draw attention to this, hospitals will see that they can't just keep their heads in the sand," she says. "Our employers represent over 10 million lives-covered. If we share this information with our employers, and they select to work with the hospitals that did respond to our RFI because of the transparency, then I think other hospitals will see the benefit of being involved."