Thoughts on L.A. safety, cash payments

This has been an interesting week for feedback from readers, so I thought I'd give some of you the podium.

One slightly outraged letter came in this week from an L.A. hospital emergency department director who (not unfairly) accused me of going over the top in a Wednesday story. (I had written that L.A.'s healthcare system looked shaky enough, given the seeming epidemic of patient dumping by major hospitals and the trouble at public King/Drew, that I was glad not to be a patient there.) His response:

"Ouch! The last line of your story on the patient dumping issue in L.A. went a little over the top by stating that 'it kind of makes me glad I'm not sick in L.A.' King/Drew and the homeless destination issue provide a rich source of copy for print and media outlets. And any health care facility found to be treating patients disrespectfully or endangering the safety of patients deserves such public scrutiny and attention.  At the same time, the greater number of hospitals in Los Angeles County provide excellent to outstanding care day in and day out to all who enter our doors."

I certainly see his point, and apologize to all those who are working hard to provide good care there. That being said, the region's rash of patient dumping cases seem so widespread that my gut tells me there's a larger cultural problem here.

I drew more fire this week for last Friday's column, in which I suggested providers could beat competition from medical tourism by a) dropping prices dramatically and b) doing a cash business.  Here's some of what gastroenterologist Dr. Narayanachar S. Murali had to say:

"Medical care is complex. It is not as simple as you (or Michael Moore) make it out to be! For procedures like endoscopic exams or at the other extreme very complex procedures like pediatric heart surgery/complex neurosurgery, both the patients and insurance companies have no problems paying, as the value is clear and the benefits are palpable.  It is the 80% of the less complex, high volume, elective type of surgery which can be done anywhere that cost matters. ... [The thing is,] in the U.S., it is hard to discount charges when the bill is not unified. A surgeon may be willing to reduce the bill but the hospital may not."

My question for you this week is whether you think the latest crop of insurance-backed physician rating schemes are fair. On insurance blogs, you'd think using claims data to rate physicians was the most obvious thing in the world to do, while physicians (and other critics) say rating doctors using claims data is a bad idea. 

What do you think? Is using claims data a reasonable way for insurance companies to rate doctors?  If not, what alternative--if any--makes sense?  Let me know and I'll touch base in next week's column. -Anne