The value of volume: Insurers decide more is better

Lacking better ways to define quality, plans are pushing hospitals with high quantity.

By Andis Robeznieks, amednews staff. April 28, 2003.

As consumer and employer groups are getting more involved in health care decisions, referring a patient to a hospital for surgery is becoming a lot more complicated for the primary care physician.

Studies show that people generally choose a hospital based on geography, familiarity and word-of-mouth advice. Physicians prefer to steer their patients to surgeons with whom they have an established relationship and a track record of positive outcomes.

Health plans, however, may force referrals to be based on economics, and now employer groups (who like to refer to themselves as "purchasers") are trying to force health plans to base more of their decisions on that nebulous factor known as "quality."

But quality is tough to define. So until something better comes along, quantity is being used as a substitute. Under the pretext that "practice makes perfect," purchasers are pushing their employees toward a "more is better" philosophy and asking patients and physicians to consider a facility's surgical volume when deciding which hospital to choose.

With more organizations and institutions posting hospital volume and quality measures on the Internet, experts say patients soon will be expecting physicians to back up their referrals with evidence showing why one hospital or one surgeon is a better choice than the others.

The Leapfrog Group, a coalition of 130 corporations providing health care benefits to 33 million employees, is leading the way on this issue with its "Evidence-Based Hospital Referral" standard. The group's leadership acknowledges that volume is not a perfect indicator of hospital performance, but it has to suffice until better evidence can be collected.

[...]

Full text of American Medical News content is available to AMA members and paid subscribers.

Access details

Join the AMA

RELATED CONTENT
» AAFP wary of hospital-based ICU standards  Feb. 18, 2002
» Leapfrog business group wants to jump-start patient safety initiatives  Dec. 4, 2000
» Volume-based quality reports anger N.Y. doctors  March 20, 2000

The doctors are in the house
The AMA's House of Delegates is holding its Interim Meeting Nov. 7-10 in Houston, addressing issues such as health system reform and physician payment.
Meeting coverage - Slideshow