Few are aware of the practice of public reporting for health care and on its face, it seems to be an obvious goal for policymakers. However, comparing health care systems, hospitals, or individual physicians is incredibly complex and probably impossible to do in any sort of meaningful way. Traditionally, patients relied upon local knowledge with their primary care physician to refer to the best few specialists. Today, with employed physicians compelled to refer internally within their network and public reporting processes encouraged by the state and federal government clinicians are discouraged from caring for those who are sick and might lead to poor outcomes.
My guest, Dr. Anish Koka, is a cardiologist who writes extensively about health care and tells his story about how a patient of his was harmed because of public reporting. His patient was a sick man with an infection that could only be cured by surgery. The patient had other diseases which put him at a higher risk for recovering and surviving longer than six months but his quality of life was good before getting the infection. Despite a 100% certainty that he would die without the surgery, Dr. Koka could find no surgeons and facilities willing to operate on the man because the surgeons and hospitals would be penalized if there was a poor outcome. One surgeon even referred to the patient as a casualty of the public reporting system because it impacts hospital payments.
What is most upsetting is public reporting risks millions of dollars to hospitals to take care of the sickest and those without any political power. Clearly, those who have political power (public officials) would receive the riskier care while those without are left to die and/or suffer. The real outcome - proven in many studies - is that public reporting encourages risk aversion which means those who need care the most are more likely to not receive it.
Dr. Anish Koka is a co-host of the AccadKoka podcast and an extensive writer on health care.show notes
The High Cost of Public Reporting: The article by Dr. Koka with the anecdote about his patient who was denied surgery because of public reporting and its tendency to discourage caring for difficult patients. He discusses the history and problems of public reporting
Accad & Koka Report: Dr. Koka's fantastic health care podcast that he co-hosts with Dr. Accad (star of episode 011). Well worth your time and subscribing (after this one, of course!)
Anish_Koka: Dr. Koka's twitter handle where you can follow his musings and writings.
Health Care Blog: Search for Anish Koka and find his great writing.
Episode 011: Dr. Accad of the same podcast describing the problem with
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