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News of the Day ... in Perspective


Best known hospitals less preferred by Blue Cross

Blue Cross subscribers who choose the Mayo Clinic in Rochester will pay twice as much in coinsurance.

Mayo, along with Abbott Northwestern in Minneapolis, Children’s Hospitals in Minneapolis and St. Paul, and St. Mary’s & Miller-Dwan in Duluth are among 16 Tier II hospitals. Blue Cross is trying to steer its subscribers to the 52 Tier I hospitals. Hennepin County Medical Center, which has one of the three trauma centers in the Twin Cities, fears that its ranking in Tier II will decrease its appeal to paying patients.

Quality plays a role in the rankings, but the key driver is cost. The tier system is part of the new “transparency” movement.

The quality criteria include: existence of a pain management program, number of overnight doctors in the hospital, the number of doctors trained in critical-care medicine, the availability of information on post-operative infection rates, the level of patient participation in treatment choices, the use of a computerized system for ordering drugs, and the existence of a follow-up program for discharged patients (Star Tribune, May 5, 2005).

Because of protests from doctors, Blue Cross reversed its decision to tier doctors as well. Doctors who did not commit in writing to refer to Tier I hospitals would themselves have been relegated to Tier II under the initial plan. (David Phelps, Star Tribune, May 13, 2005, www.startribune.com).

Additional information:

“High rates of adverse drug events in a highly computerized hospital” by Nebeker JP et al., Arch Intern Med 2005;165:1111-1116.

“Pay for performance,” AAPS News, September 2004.

“Best practices,” AAPS News, April 2004.

“‘Quality’ = compliance.” AAPS News, November 1998.

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