Eaves-tweeting (Boise hospitals)

Saturday’s New York Times story headlined “A Hospital War Reflects a Bind for U.S. Doctors” inspired interesting dialogue and commentary on Twitter. See the original story here. The story tells of how the national hospital efficiency trend is playing out in Boise, Idaho.

As the Times reported, “Boise’s experiences reflects a growing national trend toward consolidation.”

Here’s a glimpse of the reactions on Twitter:

Atul Gawande ‏@Atul_Gawande

On the Boise battle: 1. W/o transparency about quality, Big Med, under fee for service, produces more care & cost.

Paul Levy ‏@Paulflevy

@Atul_Gawande Agree that transparency is key. How setting an example in Boston with real-time metrics, not 2- to 3-year old data?

Atul Gawande ‏@Atul_Gawande

2. To produce real teamwork for patients, we're switching to Accountable Care--i.e., lump sum payment--which makes Big Med necessary.

Paul Levy ‏@Paulflevy

@Atul_Gawande And it doesn't matter if it is fee-for-service or global. Overall price levels rise when monopolies take charge.

Atul Gawande ‏@Atul_Gawande

3. There's a chicken-and-egg problem here, therefore. Change payment systems first and then bring in consolidation (#BIgMed)? Or vice versa?

Paul Levy ‏@Paulflevy

@Atul_Gawande Focus on payment model is misplaced when monopolies exist, e.g., Partners gets higher global AND fee for service rates.

Atul Gawande ‏@Atul_Gawande

4. In the meantime, without real data about actual quality and cost--i.e., transparency--everyone's flying blind.

Ann Neumann ‏@otherspoon

NYT article on hospital mergers; No mention what Catholic expansion means for patient services.

For a different perspective on the modern efficient hospital, see Dr. Victoria Sweet’s powerful book, “God’s Hotel” (blogged about here).