I chose this blog because I believe it is a great example of how an executive can create a meaningful dialog between customers (in this case patients), staff and the industry. While there are other hospital executives who've embraced blogging and Twitter (Jimmy Weeks of Greenwich Hospital and Dr. Harry Greenspun who is currently a CMO for Perot Systems), Levy's stands out in its ability to address hospital issues in a way that is in-depth without being too "inside baseball."One thing I really appreciate about his approach is he isn't afraid to address sensitive issues publicly. In particular, he gained attention by releasing BIDMC's infection rates even though Massachusetts law does not yet require hospitals to disclose this information. Since I have experience working on the informatics side of health care, I find his view of transparency and his genuine efforts to make medical care better very interesting.
His most recent post is a perfect example of what I like about his blog. He discusses one of the elephant-in-the-room topics in the health care industry: Cost of Procedures.
In this post, Levy addresses the issues related to the trend of hospitals purchasing proton beam machines. As Levy explains, these machines are used to treat specific forms of cancer. Mass General Hospital has one of these machines, which helps to serve the region. However, a recent study showed that these machines are starting to proliferate beyond their need.
Levy does a great job explaining how this affects everyone from the hospitals to the patients to the taxpayers. These machines are expensive (as much as $150 million). If a hospital purchases one, they need to use it. However, the actual number of cases that would be appropriate for this machine does not necessitate having them on anything more than a regional level. What is the result? In an effort to make a profit on the machines, hospitals have begun using it to treat other forms of cancer (most notably prostate cancer), which could be treated just as effectively and for less money with other methods.
This is not new to the medical industry. This has happened with CT Scans and MRI machines as well. As Marshall McCluhan observed, technology creates its own demand. When hospitals spend money on technology, they need to use it or risk losing money. But the misuse of this technology creates waste--part of the problem at the core of our health care industry.
According to an article on Forbes.com, cited by Levy:
Most of the $1.5 billion that has been sunk into or committed to building proton centers has come from investors hoping to make a profit. Even the proton center at the august M.D. Anderson Cancer Center in Houston is mostly owned by various investors...Medicare pays twice as much for a round of protons as for X-rays: $34,000 for eight weeks of therapy versus $16,000.
Levy points out that when profit becomes involved in medical care, hospitals start making decisions based on business factors instead of clinical factors. To combat this, people haves started to advocate for pay-for-performance standards, which reimburse hospitals based on outcomes rather than for the particular services performed. For instance, instead of paying for every X-ray or MRI, hospitals are paid for successful patient outcomes, based on agreed upon standards. This system certainly has flaws, particularly with regard to the standards, but it is a move in the right direction.While there is some room for discussion (the National Association for Proton Therapy popped up in the comments to protest his view on the machines), Levy's larger point is dead on. As much as people protest the figment of Sarah Palin's imagination (Death Panels), hospitals need to evaluate cost and benefit of procedures related to expected outcomes. It is a necessary part of any honest discussion about health care reform.
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