Future Shock

Are we ready for the onset of online bidding for medical care, or the death of confidentiality?

1. Todd B. Richter, CFA, is Managing Director and Head of the Health Care Services Equity Research Team at Banc of America Securities, LLC. He mostly spoke about what the FPA and MedPartners failures really mean to our immediate future. Not surprisingly, because of these sorts of failures the health care stock sector has been doing badly. But this may be bad news for all of us as well. If health care stock prices stay down, money for expensive, but necessary, health care infrastructure improvements will be much harder to get. We may all suffer from this Wall Street fallout.

Richter dropped his real bombshell almost as a throwaway line at the end of his talk. In the very near future expect to see online bidding for medical services patterned after priceline.com. Wow! The mind boggles to think of XYZ Health Plan tossing out for online bidding: "30 MRIs in the next three weeks. What are we bid?" How low will a radiology group go to get those 30 studies? How about up to 90 knee surgeries in the next six months? How much would it be worth to an orthopedic group to bid on that package for a fixed price and take the chance that the health plan won't need all of those surgeries? Accepting risk will take on a whole new meaning in such a setting.

This scenario requires no technology that isn't already in widespread use. It only needs somebody to put all the pieces together. If Todd Richter can talk about it, do we have any doubt that several "somebodies" are hard at work to make this sort of health care bidding part of our future? Priceline.com has changed the way the world buys airline tickets. We would be very shortsighted and foolish to think that this innovation will only affect local travel agents. Online bidding could quickly become the new capitation. Are we ready for this?

2. Latanya Sweeney, Assistant Professor of Public Policy and of Computer Science at Carnegie Mellon University, gave a chilling look at the emerging world of computers. Her message: confidentiality is dead. She regaled us with story after story of using her laptop computer to tear away the mask of confidentiality that we think we wear in our daily activities. She took seemingly innocuous research data such as zip code, gender and discharge diagnosis and worked it against car registration data to figure out who in her community was HIV positive. About three hours of work on her trusty laptop extracted the information.

Essentially, we face the choice of making our demographic medical data useless for epidemiological research or running a huge risk of breaking the wall of patient confidentiality for everyone. These are two bad choices. Encryption and public access keys will make no difference here. Our computers are so powerful that they can compare unrelated data bases and come up with amazing results, right now. No current method exists to protect against this sort of intrusion.

Sweeney is not being malicious; this is her area of research. She may be making us all a lot less comfortable, but she is showing us where the danger spots are as we plunge headlong into the information age. The worry, of course, is that if Sweeney can do it, so can many others.

These two examples point out how quickly our world is changing. Both individually and collectively, we must arm ourselves with knowledge about these changes and work to mitigate the possible negative consequences. We can't get stuck fighting last year's battles again and again. The world moves on, and so must we.

In the years to come, organized medicine will be struggling with problems that don't even exist today. Issues such as these two examples require group action. As individuals we can do little or nothing; collectively we can be effective. Now more than ever, we need to support each other and our medical organizations at every level. To quit on organized medicine now is to hand over our future to those who wish to control us in the first place. Don't give up - stay organized!

edpmg@inforum.net