Doctors' Scarlet Letter: The Big Blue Dot

Today the New York Times reported that there is a wide discrepancy in reimbursement rates of private insurers from hospital to hospital for patients in need of open heart surgery in Pennsylvania. (Medicare rates are relatively fixed and only vary slightly based on geographic location). They based their report on Pennsylvania’s Health Care Cost Containment Council’s report published today.

While the information is interesting and serves as a reasonable overview, it has no “drill down feature” to look a specifics of the data collected. Instead a complicated, obfuscating, and proprietary weighting scheme (see the last page of these technical notes) was used to determine measures such as expected mortality rates. Cardinal Health claims the trademarked Atlas Outcomes™ methodology has been verified, but then they stand to profit from the data, don’t they?

But what was not discussed in the Times report was that physican mortality data was also presented in the Pennylvania report. Simply. Graphically. You see, rather than reporting an actual number or percentage mortality with details to view, various graphics analogous to Consumer Reports methodology were printed representing mortality data: an open circle (better than expected), dotted circle (expected), or Big Blue Dot (higher than expected).

For Pennylvania physicians that performed with in-hospital mortalities higher than their colleagues in 2005, they are branded with this scarlet letter of health care on the report: the Big Blue Dot. It becomes clear that even one of these Blue Dots might spell disaster for future referrals for a physician. But administrators, insurers, and likely patients will praise the simple graphic.

But health care is anything but simple. Just look at the letter one surgeon in Pennsylvania sent in to the Health Care Cost Containment Council in an attempt to explain his higher mortality rate (looks like three of 43 patients put him at the Blue Dot level). These folks were sick! But his explanation, while posted on Pennylvania’s website, did nothing to change his label.

His Big Blue Dot still stands for eternity for the world to view.

So what will happen with this doctor next year? Surely he will hope to avoid the Big Blue Dot again.

And so, this surgeon might hesitate just a bit before offering surgery to complicated patients with multiple medical problems. It’s not because he wants to be mean-spirited. No, it’s just that now he has to manage the risk to his reputation in concert with the risks of the procedure to the patient. Hopefully, by caring for patients who are less sick, his Blue Dot will be revoked next year and his name cleared. And the sick patients? They’ll either be left to fend for themselves medically, or referred to higher volume centers where, perhaps, the risk will be better absorbed.

And if every surgeon does this, there will be no more Blue Dots. Health care will be better, right?

Well, at least the report will look better.

But for the sickest of patients, they may stand to lose.

-Wes