Dr. Marty Makary: "Unaccountable: What Hospitals Won't Tell You And How Transparency Can Revolutionize Health Care"
http://thedianerehmshow.org/shows/2012-09-19/dr-marty-makary-unaccountable-what-hospitals-wont-tell-you-and-how-transparency-can
Dr. Marty Makary, third from left, speaks with residents at Johns Hopkins Hospital.
(Photo credit/Keith Weller)
A New England Journal of Medicine study concluded as many as 25 percent of all hospitalized patients will experience a preventable medical error of some kind. Other studies indicate one in every five medications, tests and procedures is unnecessary. Consumers have the tools to comparison shop when deciding on a new car, home or other major purchase. But when it comes to choosing a hospital or doctor, they are largely in the dark. Most patients do not have access to data on safety and quality from individual hospitals and doctors. Johns Hopkins surgeon and health safety advocate Marty Makary says transparency can revolutionize health care. We discuss what hospitals won't tell you and why you need to know.
Guests
Dr. Marty Makary
surgeon at Johns Hopkins Hospital and associate professor of health policy at Johns Hopkins School of Public Health.
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Read An Excerpt
Excerpt from "Unaccountable: What Hospitals Won't Tell You And How Transparency Can Revolutionize Health Care" by Marty Makary. Copyright 2012 by Marty Makary. Reprinted here by permission of Bloomsbury Publishing. All rights reserved.
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A preview of "Unaccountable" by Marty Makary, M.D.
Comments
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Dear Diane and panel,
Please address two topics: a. VREs......serious infections caught by patients ar hospitals and very difficult to trear/cure.
b. moving from fee-for-service to wellness reimbursement.
Thanks
Abe is onto something in his a. inquiry about VREs.
As an advocate for the unsupported and/or indigent elderly I frequent hospitals and nursing homes. I have observed a pattern of irresponsibility over the last several years. Hospital staffs and doctors are failing to inform family, visitors and some caretakers that patients are infected with superbugs. Often the only indicator is a protocol placard on the hospital room door (for nursing staff). I have had a terrific challenge getting straight answers about treatment even when patients were not infected and have had to resort to buying their medical records. Hospitals have a secrecy policy when it comes to sepsis, MRSA and VREs. And they do not hesitate to discharge persons with active contagions back to nursing homes (and uninformed households) where others are weak and highly vulnerable. Rest homes are obviously incubators for superbugs these days. I blame it on the profit motive in medicine. This is now a public health issue undermining our entire health care system, but few want to discuss it.
Well done!!!
Can you please discuss the reporting data available through CMS online.
How accurate is CMS Hospital compare?
Thanks
Jeff Harris
One method of accountability is malpractice cases. Despite what most individuals and doctors think, malpractice cases are nearly impossible to win. First, much of the information your caller has been discussing is not discoverable. Second, some insurance companies require doctors to sign riders that if the testify in a malpractice case, their own malpractice insurance will be subject to "review". Yet, doctors are so afraid they will be sued for malpractice, to the appoint of a paranoia, they won't discuss issues with patients. Instead of a "blue wall of silence" there is a "white coat of silence."
One method of accountability is malpractice cases. Despite what most individuals and doctors think, malpractice cases are nearly impossible to win. First, much of the information your caller has been discussing is not discoverable. Second, some insurance companies require doctors to sign riders that if the testify in a malpractice case, their own malpractice insurance will be subject to "review". Yet, doctors are so afraid they will be sued for malpractice, to the appoint of a paranoia, they won't discuss issues with patients. Instead of a "blue wall of silence" there is a "white coat of silence."
There are roughly 40,000 traffic deaths every year, so truck drivers are legally limited to working 11 hours a day.
There are roughly 100,000 medical mistake deaths every year, yet it is perfectly acceptable for a nurse to choose and administer deadly drugs after a 48 hour shift, or a brain surgeon to operate after a 72 hour shift, and medical students are expected to work 72+ hours shifts while "learning."
Does your guest have a comment on these numbers?
It's unforfunate that the greedy bean counters have ruined the medical profession. I have more respect for my mechanic. I view doctors as spineless drones in a broken industry.
I am a practicing gastroenterologist and have observed three other factors contributing to wasteful spending: 1) medicolegal concerns, 2) unreasonable patient expectations, and 3) lack of patient adherence. I am interested in your thoughts on these as contributors to a broken system.
What's always bothered me is that a doctor still gets paid if he or she messes up. The patient still pays and pays for the problem to be resolved. How is this fair and why isn't anyone looking to change that system?
Is it true that there are now empty places in America's medical schools due to young people not wanting to get into medicine due to all the problems you are talking about today?
Is it not true that the future will be "importing" more foreign doctors? (Actually, I always wondered why we've had SO many here over the last 40- 50 years)
Diane R show - please have more programs like this one -- we all have a big stake in the state of american medicine today!
Thank you so much to Dr. Makarty for his thoughtful perspective. I wonder if he could address potential unintended consequences of health care transparency. In the mental health field there are often multiple possible approaches, all equally valid, but NOT all equally supported by insurance companies. Often insurance companies use statistics improperly, and will privlege certain methodologies over others. I address this problem by having a conversation with my patients about the different theoretical approaches to treatment (e.g., cognitive/behavioral/pharmacological/psychodynamic) and giving them the choice. I think its often very difficult in health care to say, "I don't know for sure" or "There are lots of different things we could try, all with their own pros and cons."
Can you address the problem of the new computerized record keeping required of doctors? My husband is a physician who claims the new system reduces the quality of care he can provide , takes additional time and is actually inaccurate because what he actually does doesn't always fit the computer's templates. We have known many doctors who have retired over this, and the only "person" who benefits is the insurance corporations.
What is your opinion of Doctor owned Hospitals and ancillary services such as MRI Units, etc.
Would you not consider this as a conflict of interest?
What about core measures?
Dear Dr. Makary and Steve,
You have just stepped out as a courageous, credible spokesperson for one of the critical gaps in our health care system which could be one of the best in the world with the exception of the corporate and insurance sectors. The doctors and providers who continue to be paid less and less as our providers are giving their share up to the corporations and insurance markets not to taxpayers or patients. Tort reform can only take place if there is the transparency you are so articulately describing.
I have been involved in health care in developing countries who are noted in the US as corrupt. An outstanding system I recommend to your study is Bamranguard Hospital in Bangkok. I have had several annual check ups there, due to my global health care requirements. First rate, efficient, affordable; they attracted leading specialists and first rate general practitioners. I hope you have the opportunity to work in a developing country or even participate in Skype fed physician study groups with providers in emerging systems.
A fan (I'll be distributing your book),
Lynn Robson
In addition to the financial incentives ... I wonder how much the political imperative to proclaim American exceptionalism ("we have the best health care system in the world") retards the movement toward reform.
I am part of the baby boom general. Given our numbers, collectively we are in a position to improve the health care system for ousevles and future generations. As a group, how can we go about changing the system?
Clare
Does the new Affordable Care Act provide more medical accountability, and actually make things better for doctors, staff, patients?
(didn't hear first part of the show, so perhaps this was already answered?)
I have two comments about this article.
First, Dr. Makary is right that there is much burn out among doctors that are pushed to see more and more patients. Changing pay structure to salaries will help only if the hospitals will except less prodcutivity from the doctors. Most likely they will not which will lead to productivity "targets" which is code for what we have now. Otherwise there will have to be depression of wages of doctors to make up lost profits.
Second, Dr. Makary at the end of the article made a comment that plastic surgeons are forced to learn billing codes to pass their boards. The implication was that this is to promote overbilling. This is a gross misunderstanding what happens. Plastic surgeons are required to show what they have done in the year leading up to taking their board exam. This includes demonstrating coding pracitices. The purpose of this is to weed out unscrupulous surgeons who unbundle or overcode their procedures. Unlike most surgeons, plastic surgeons are often practicing in a small businiess enviroment and are essentially self employed. They need to know how to bill insurance companies properly.
Question:
How does Johns Hopkins stack up as a medical corporation?
It not only has the medical school and hospital(s) in Baltimore, but has been buying up other hospitals, and operates as the owner behind the scenes.
How has Johns Hopkins, as owner, incorporated reforms for doctors, staff, and consumers - and provided a model of transparency in the hospitals it has bought?
When you say that a large percentage of tests are not necessary, please define that. I am a pediatric RN at a leading hospital. We often run tests to rule out serious health issues, especially when a patient has a collection of symptoms that are not responding to conventional treatments. While most of the time the rule-out tests are negative, they still have value and are as necessary as tests that have positive results. I have not seen nearly the statistics in medication error and procedural error that your guest mentions in his statistics. We are not error free but the rate is very low. We also take direct actions to protect against hospital acquired infections including central line infections and vent acquired pneumonia. Our rates are quite low compared to national statistics.
This issue seems to me to be rooted in the air of prestige in which doctors and medical (as well as academic) professionals are held. Since it is in fact a capitalistic venture, and not a purely academic one, to run a hospital, that prestige has had the same effect as does nepotism within the business. This creates an environment of hierarchy that is unassailable from within, and that is unaccountable to the basic interests of the principle (in this case the patient). This system needs to be run by not for profit organizations. Adding the concept of profit to an essential service leads to abuse and the deprioritization of the patient. Same thing happens in law, health insurance and education (both primary and higher). This is a no-brainer as far as I'm concerned.
Any hospital administrator caught telling a surgeon to "do more operations" just to get the billing up, should be hung by their big toes and poked with a stick by the subjected patient. This is perverse, and should not be tolerated. What in the world are these people thinking? Do they have no independent ethicists in these hospitals? Or are they only run by bean counters?
I have been a hospital administrator for many years. I have never heard a patient say they came to my hospital because the parking was good. Virtually EVERY patient goes to the hospital their doctor tells them to go (unless emergency, then proximity). A hospital (non physician) employee has NEVER ordered a test, performed a surgery or admitted a patient.
Once a patient is admitted, hospitals do not get paid any more for additional tests, procedures, drugs....beyond the original diagnosis. It is incumbent for hospitals to manage costs within a predetermined price set by CMS or managed care companies.
Doctors are the only ones who get paid more for more service.
I agree, quality measure are extremely important. Regulatory bodies such as Joint Commission, DNV, CMS....hold hospitals accountable for physician errors. Simple things, like timing and dating of orders or "timeouts" before surgery are pushed on the hospitals to correct. Physicians are not held accountable. What we need is an organization that holds physicians accountable. The only time physicians are held accountable is after a mistake and the lawyers get involved.
I have never had the privelege of working at a hospital like Johns Hopkins, Cleveland Clinic, Mayo, which most physicians are employed and not compensated for seeing more patients, but in the "real" world, the other 95% (excluding government) of the population is treated, physicians work on a fee for service basis, they expect to be paid for all services performed and the more services they perform, the more money they make.
There is no doubt our healthcare system is flawed, hospitals and hospital executives included, but let's keep the conversation fair.
I would never begrudge a physician's right to earn money, they sacrifice a large part of their life in training, making little to no money. The largest profit margins in healthcare are insurance, pharmaceuticals and devices.
Follow the money and the truth is always revealed.
Dear Diane and Panel, My daughter ws diagnosed with colon cancer. She was operated on to remove the cancerous piece of colon. She complained about pain for 3 days. On the 4th day, she was admitted to the intensive care unit. An infection was discovered and diagnosed as sepsis. We were told it happens to some patients. After 6 weeks in surgical intensive care unit, the doctors advised us it would be better if we let hr go because there was not much, if any improvement. Her lungs were very damaged. Her kidneys are failing.
she is hemorrhaging. She never even got a chance to address her cancer. She is 44 years old and leaves 2 teenagers behind. I would like to see hospitals held accountable for conditions that can cause sepsis as I hear it is on the rise. Thank You for hearing me out