Ten Rules for Health System Boards of Directors to Follow to Reduce the Risk of Fraudulent Outcomes Reporting and Scientific Misconduct

Enjoying a good spin

Are you on the Board of Directors for a large health service provider, population health vendor, integrated delivery system, managed care organization or other care corporation? 

If so, your company is likely collecting, analyzing and publicly reporting quality and cost data. Not only do superior results in journals, meetings, splashy web sites and glossy marketing materials present a competitive advantage, achieving superior outcomes is part and parcel of your organization's mission.

The Disease Management Care Blog reminds Board members that intentionally or unintentionally misrepresenting outcomes is an existential threat to health care organizations.  Having to retract a publication, correct a white paper, meet with grumpy regulators, confront claw backs, deal with a whistle-blower, respond to allegations of interpretation spin, uncover suppression of bad results or defend the integrity of your brand is something no Board wants to deal with.

To the DMCB's knowledge, this hasn't happened to any ACOs, risk contracting systems, managed care organizations or population health or wellness vendors.

Yet. 

It's just a matter of time.

While the risk of allegations of scientific misconduct can never be reduced to zero, the DMCB offers up ten best practices for Boards to follow:

Reduce opportunities by:

1. Exhibiting healthy skepticism regarding all outcomes reported by your management team, especially if the results seem to be too good to be true.

2. Insist that your management team has two persons with access to any data base, and that they have separate reporting relationships.

3. Insist that your management team has two persons independently involved in any data analysis, and that they have separate reporting relationships.

4. Be familiar with and insist that the rules on research on human subjects be followed.

5. Maintain a low threshold for conducting internal or external audits of any databases and any interpretations of those data.

Combat any rationalizations that fudging outcomes is OK by:

6. Recruiting Board members with research expertise.

7. Explicitly engage the Audit Committee and any other Board member or committee with oversight of risk to view "outcomes" with the same level of scrutiny as your company's financials.

8. Maintain an ethical "tone at the top" when it comes to research.

9. Have a disaster plan ready to go.  For starters, train your Board on how to deal with hostile media inquiries.

Reduce incentives by:

10.  Asking your CEO if any compensation plans including bonuses or unwittingly promoting unethical or fraudulent behavior.

Twelve Health Care Predictions for 2015

While the Disease Management Care Blog eschewed forecasting for 2015, it has decided to reverse course and inaugurate the 2015 blogging season with a contrarian duodecimal exercise in futurism.

Will this antidecimal augury align with the mysterious cosmic order and governing perfection?  Let the thousands of DMCB readers (more on that in a future post) be the judge in January 2015......

1. Obamacare will neither succeed nor fail.  This hugely complex law will have too many outcomes, statistics and analyses that will be subject to too much spin by both supporters and detractors. Like puppies clamoring for the mother's attention, the loudest wins, but only in 15 minute media increments.

2. Inflation returns, with a vengeance: While we won't know it until well into 2015 or 2016, 2015 will be the year that the sleeping giant of healthcare costs awakens. Millions of new insureds in an improving economy will finally get their pent-up pricey preference-sensitive health care needs fulfilled.

3. All boats benefit.....While the PHM industry will continue to extol its cost-savings value proposition, its investors will profitably ride the rising tide of overall increased health spending.

4. Duh, it's the delays stupid: While low income Americans will appreciate having access to subsidized health insurance and Medicaid, the middle class' unsubsidized sticker shock will threaten the fall 2015 elections. Caught between conflicting advice of insurance actuaries and political hacks, the White House's regulatory choices will be obvious.

5. Unfavorable prognosis for physician income means an emerging bull market for concierge medicine: Past attempts to replace the SGR never fail to disappoint and 2015 will be no exception. That, however, will only be on the icing on the bitter cake of foregone co-pays and coinsurance by patients who chose all those stinky bronze plans.  As a result, more docs will bail on their insurance contracts and open "concierge" practices.

6. Navigators Ver. 2.0: Knowing that 2015 could be a high water mark for top-line income from newly insured patients, hospitals will step up and hire their own "navigators." Unsurprisingly, they will not seek out the healthy millennials. And insurers, thanks to the "3Rs" that are largely backed by Uncle Sam, won't care about the resulting adverse selection.  

7. Snowden blow-back: as the promise of big-data grows, fearful health care consumers will be even less inclined toward allowing access to their health information.  Too bad they won't be given a say.

8. Innovator's Dilemma for health tech: solutions that are simple, transparent and modular will continue to make 'from the bottom' inroads into a tech industry that - like early data storage - is too complex, opaque and entangled.

9. Speaking of health tech, patient-monitoring solutions that offer more insight and less data will grab market share.  Instead of a series of blood glucose results dumped into an electronic inbox, think algorithms that suggest insulin dose adjustments.

10. Thanks to the battered healthcare.gov brand, conservatives will be better positioned to thwart other "big government" proposals in 2015 outside of health care (for example, education, carbon markets or immigration reform). Progressives will focus on simpler stuff, like increasing the minimum wage and keeping The New York Times afloat, but miss a decades-long setback of Obama-inspired liberalism.

11. ACOs stumble: Far more ACOs will fail than succeed in hitting their risk-share thresholds because docs can't say no, one patient at a time. As a result, we'll see these organizations begin to cut costs by parting company with some of their recently hired physicians, further fueling the concierge medicine movement.

12 Commercial scientific misconduct: Unable to resist the allure of bonus payments (like this) or the branding that is dependent on the public release of quality outcomes, at least one large health entity will be caught committing "reporting fraud."