Gone are the days when it was unthinkable for hospitals to flaunt their quality and cost data in public.
Now, hospitals with good news to tell aren't holding back. Instead of waiting for HMOs, the government or the Joint Commission on Accreditation of Healthcare Organizations to issue data, hospitals are publishing their own report cards.
Types of data, presentation and target readership vary widely, but all the reports are meant to feed an increasing consumer demand for accountability.
In many markets, price is still the primary factor in healthcare purchasing decisions. But as prices stabilize, purchasers will pay closer attention to quality, many believe. Report cards are one way to convey the quality message.
"People are beginning to realize that consumers are making decisions based on data," said Scott Harrison, senior vice president at Mercy Hospital Medical Center in Des Moines, Iowa, which published a report card last year. "Those who are forthcoming will have an advantage."
Beth Noppenberger, executive director of market services for Methodist Health Group in Indianapolis, said she's noticed a change in attitude among employers and managed-care companies in recent months. Her job is to sell the services of 928-bed Methodist Hospital of Indiana.
"It used to be you'd say you're a quality institution, and that would be the end. But now they say, `Why? What makes you think you're quality?"' she said.
In January 1994, Methodist issued a report card comparing its outcomes data with national averages. It was well-received, Noppenberger said, although some of the language was too clinical for payers to understand. The hospital is preparing a second report based on 1994 data.
"The fact we are tracking outcomes puts us in a more favorable light," said Susan Tate Stanley, director of marketing. "We anticipate that within the next five years, (healthcare buying) decisions will be made on a variety of factors, including*.*.*.*outcomes."
Hospitals are using report cards in various circumstances:
Boone Hospital Center in Columbia, Mo., released its report, called Healthcare, Your Right to Know, directly to consumers.
The first edition was published in April 1993 to position the 344-bed hospital as the "low-cost, high-quality provider" for direct contracting, said Mary Becker, director of marketing, communications and community relations.
But it took on more importance when two major employers signed with HMOs for which Boone was not a preferred provider. Becker said the report became a tool to steer consumers to plans that offered Boone as a choice.
Last fall, more than 5,000 consumers requested copies of the second edition of the report. Boone is issuing a third edition this year.
Last month, 540-bed Jewish Health System in Cincinnati released a report card in part to get on more HMO provider panels. Jewish Health has been excluded from the panels of the market's two largest HMOs and hopes the report card will prompt consumers and employers to ask why, said Richard Pender, vice president of marketing communications at Jewish Health.
The 16-page brochure, Measures of Care, compares quality, cost-effectiveness and accessibility with other providers locally and nationally, using data from several sources. It was sent to employers, government officials and HMOs. It's also available upon request to individuals.
In response to deductible and copayment increases in Des Moines, 538-bed Mercy Hospital Medical Center issued its "Quality Care Report Card" to demonstrate that its charges are lower and its quality better than those of competitors.
Harrison thinks the report card contributed to a slight increase in Mercy's market share.
One problem with issuing your own report card is credibility. To address this, Jewish Health hired the actuarial firm Milliman & Robertson to verify the accuracy of its information, some of which came from sources that could not be cited because of confidentiality agreements, Pender said.
Boone "footnoted to death" its report card, Becker said.
A related problem is that comparative data from competitors isn't always available, in part because most hospitals remain protective of their data.
Becker said comparative data is becoming harder to locate in Missouri since HCFA stopped releasing outcomes data for Medicare patients. The hospital also participates in the Maryland Hospital Association Quality Indicator Report, but data that would show how Boone stacks up beside competitors is confidential.
Methodist also had a problem comparing itself with the competition, since Indianapolis hospitals agreed not to use data collected by the state hospital association for marketing purposes.