Despite efforts to make more healthcare quality information available, much of it is consumer-unfriendly and its effects on the public and providers are decidedly mixed, said experts at the latest round of hearings by federal regulators on healthcare and antitrust issues.
Last week's panels, conducted by the U.S. Justice Department and the Federal Trade Commission, concentrated on quality information and its effect on the healthcare industry. Although there is much information available, the usefulness of such data is being lost on consumers, speakers concluded.
"Consumers are not aware of the problems in quality issues," said Judith Hibbard, a professor of health policy at the University of Oregon. "No one is taking on that role of telling the public there are problems in the quality of healthcare."
Still, the industry and government regulators are pushing to make information about providers available to the public.
Later this year, HHS' Agency for Healthcare Research and Quality will be issuing its National Healthcare Report to Congress about national trends in healthcare. The Centers for Medicare and Medicaid Services began publishing comparative data about nursing homes last year and on home health agencies earlier this year. Next year, it expects to release information about hospitals.
It also is considering a project to pay hospitals that provide better care-however that may be defined-extra Medicare funds, said Stuart Guterman, director of the Office of Research, Development and Information at the CMS (Sept. 16, 2002, p. 9).
The Leapfrog Group, a coalition of 140 large private employers, is pushing for greater safety standards in hospitals.
Quality reports are meant to educate the public and be a tool for providers to measure their own performances and make necessary improvements. But the reports fall short of their intentions, said Chip Kahn, president of the Federation of American Hospitals and a panelist.
In addition to being expensive for hospitals, "the current mix of quality-reporting approaches has produced incomplete, poorly analyzed, conflicting and even misleading information for clinicians, hospitals and consumers alike," he said.
The federation represents for- profit hospitals.
Another panelist, Nancy Foster, senior associate director of health policy at the American Hospital Association, said, "The challenge we face creating really meaningful data is enormous."
Quality report cards can be broken down into three types, said Daniel Kessler, a professor at Stanford Graduate School of Business: process report cards, survey cards and outcome cards.
Process report cards quantify the kind of care a patient is receiving, such as the number of hours per day a nursing home patient receives care from a nurse. Survey cards record the opinions of patients about their care. Outcome cards describe what happens to a patient after receiving care.
Of the three, outcome report cards can be the most valuable for both patients and providers, Kessler said, but the results can be manipulated by providers who see only the healthiest patients, while ignoring sicker ones.
Such report cards often are overlooked by consumers, panelists said, even if they are aware of them, because many are simply consumer unfriendly. While information such as lengths of stay at a particular hospital may be valuable, the public is unprepared to evaluate much of the data.
"Is it any wonder that people aren't using them?" Hibbard asked.
But even if more understandable information is available to the public, "we have a long way to go before we know consumers will use it," said Suzanne Delbanco, Leapfrog's executive director. According to a Harris Poll conducted last October, 25% of respondents said they had seen hospital ratings reports, but only 3% used them in making decisions about which facility to use.
Instead, the majority of patients rely on the recommendations of family, friends and doctors, according to other surveys.
Indeed, various studies indicate that market share and volume are largely unaffected by hospital report cards, said Patrick Romano, an associate professor of medicine and pediatrics at the University of California-Davis' School of Medicine.
Hospitals and doctors, however, do pay attention to them, and if the information is made public, it can lead to quality initiatives. But, panelists said, providers often take a defensive posture, criticizing the methodology, data and dissemination of the information.