This week the White House announced yet another Obamacare delay–actually, to be precise, they termed it an “accommodation”. The reason given for the delay was that there were concerns voiced by the Obama administration that the “rush” to sign up during the final days may cause delays and result in a website crash. Therefore, it was proclaimed that those who were “trying to sign up” would be given an extension to mid April to complete the process. Overall there have been more than 20 unilateral changes/delays/exceptions made by the President without Congressional approval or oversight. Exceptions have been provided for businesses and those who serve and work in our Congress BUT the individual mandate remains in place. In the meantime, many that have been counted as “signing up” have no insurance and a large number have not yet paid their premiums. However, the biggest problem with the manipulation of the Affordable Care Act (ACA) may actually be the commentary of one of its greatest supporters–Senator Harry Reid.
With the 2014 Midterm elections looming, many of those in Congress who are facing reelection have commented on the latest delays in an effort to positively spin the news. As you might expect, those in leadership roles such as Senator Harry Reid have tried to minimize the impact of repeated Obamacare failures and fixes on his part (a desperate attempt to cling to a majority). In an effort to explain the need for the latest delay Senator Reid has shown his complete lack of connection with the nation. He publicly proclaimed and was quoted in the Washington Times as saying that “some [old people] may not be educated about [or understand] the internet”. In reality, more seniors than ever before are utilizing the internet in order to maintain medical information. Pew Research Center data indicates that as of 2013, nearly 60% of all Americans in the 50-65 year old age group are actively engaged in internet based social media. Even more telling is the fact that 50% of those over the age of 65 are involved in AT LEAST one internet based social media outlet. It is clear that the internet and medicine will be intimately connected in the future. Twitter, a popular site for micro-blogging in 140 characters or less has seen a 79% increase in utilization by users in the 50-65 year old age group. When you carefully examine the Senator’s comments he is clearly referring to those in the 50-65 year old range–those over 65 will be enrolled in Medicare and have no need to go to the exchanges. The younger populations-such as the millennials–are assumed to be web savvy from birth.
The delivery of healthcare is already evolving digitally–particularly in the areas of the electronic patient and in mobile health applications. For Senator Reid to make such a statement concerning the inability of older Americans to “understand” the internet not only is insulting but shows a complete lack of connection to and respect for the very people he claims to want to protect. Seniors are more web savvy now and are able to access the web in a variety of ways–there is data from non biased scientific surveys (such as those conducted last year by Pew) to substantiate my statement. In reality, his comments are a sad attempt to explain the inexplicable–why do the Democrats in Congress continue to hang on to a system that is clearly failing?
The ACA continues to suffer setbacks–most of them at the hands of the President who has dedicated his legacy to its success. The latest delay (or accommodation, as the Obama Administration prefers to call it) is more about the lack of enrollees and less about the ability of older Americans to successfully interact with the internet. Many seniors are surfing on a daily basis. The internet is not the problem with the ACA and healthcare reform–rather it is the legislation that is broken and badly in need of a fix.
In the past, learning about a good doctor or a pleasant hospital experience was a “word of mouth” phenomenon. Today, more and more patients are going online for information about potential healthcare providers and hospital systems. But exactly how accurate is the information they are accessing? Recently, multiple surveys and research investigations have been published about the validity of online physician review sites. Like most things that we find on the internet, the best advice is to take what you see there “with a grain of salt”.
A recent survey performed by the Pew Research Center asked participants a simple question. “What percentage of adult internet users have consulted or posted online health reviews?” The results are quite startling. The minority of users actually post–but a fair number of users read and consult these reviews.
Source: Pew Research Center “Health Online 2013”
So, as consumers of healthcare, how in the world do we interpret this data. The fact that only 3% of the folks surveyed actually posted reviews suggests that the reviews are somehow biased–either good or bad. This can certainly lead to misleading comments and ratings and can drastically change how a provider is perceived. We must remember that these MD ratings sites are unregulated and not very well controlled or policed. Typically, in any customer service industry, we find that most comments come from dissatisfied customers–it is rare in corporate America that someone takes the time to leave a positive comment. There have been many published studies in the literature have shown that negative events are much more likely to elicit comments.
An article published in the New York Times in March 2012, discusses the neuropsychiatric basis for this very fact. In the article, Stanford researcher Dr Clifford Nass states that the brain handles positive and negative events differently and in these events are even processed in separate locations within the cortex. His research has demonstrated that we tend to process negative experiences more thoroughly and tend to ruminate about negative more than positive–in other words it takes many many positive experiences to overcome one negative interaction. A recent study in the Journal of Urology evaluated the ratings of common sites such as Vitals.com, Healthgrades.com and RateMDs.com and found that from a random sample of 500 Urologists whose ratings were examined, the average number of evaluations for each was 2.4 ratings. Many of the reviews focused more on the office experience (decor, wait times, etc) rather than the interaction with the physician or the providers knowledge or ability. Obviously with very few respondents the results can be significantly skewed by either a remarkably high or a remarkably low rating. The results suggest that physician rating sites are probably not the most effective way to evaluate your next potential healthcare provider
What are some possible sources of bias in MD ratings? The internet allows for anonymity and promotes the ability to say things that we normally may not say in a face to face interaction. Disgruntled employees, angry family members or patients frustrated by their disease may provide unwarranted negative ratings to healthcare providers. Conversely, family members and friends may also provide unwarranted high praise. Altogether, these types of bias limit the utility of physician ratings sites. Other options for choosing a provider include social media sites such as twitter. There are disease specific tweet chats that promote interaction among patients. Patients in the chat often recommend certain therapies, physicians and hospital systems. These groups tend to be very well informed and the information is fairly reliable. Ultimately, as an article on the NPR website last week suggests–we may just have to go back to the prehistoric pre-digital era when it comes to rating and choosing physicians–we might just have to talk to one another!