Transparency has some new impetus, as can be gleaned from a commentary in this issue by Healthcare Financial Management Association chief Richard Clarke (p. 58), the expansion of the Hospital Compare program, the recent actions of the Internal Revenue Service and a lot of talk from some presidential candidates.
One has to admire any level of transparency in healthcare, an industry that fought forever against the public knowing anything about its pricing, quality, levels of charity care, medical errorsyou name it. And yet, as positive as this all is, I still find myself rolling my eyes at some of the debate. What is being discussed, while valuable at varying levels, remains fairly peripheral to what payers, providers and patients really need.
For starters, the notion that the average patientno matter how much he or she is on the hook financiallyis ever going to be able to make a rational decision on which medical test or treatment is done for a given condition and with what technology is utopian.
Sure, posting insurance rates is laudable, as is hospitals agreeing to charge the uninsured the average of the negotiated insurance rates (Listen to our interview with Wayne Sensor, chief executive officer of Alegent Health, on that topic at modernhealthcare.com).
And we applaud the IRS for amending its tax forms to force not-for-profit providers to disclose more accurately just what they are doing to earn their tax exemption, and not lumping bad debt and Medicare shortfalls into the pot of charity care, as so many do.
All of this contributes to openness in an industry that badly needs it, and yet it still falls short of the true goal: ensuring that patients get the right care at the right time and place and for the right price. And that is primarily a job for the healthcare industry and government.
So here is a grand unified theory of what transparency ought to really mean in practice:
Every provider works to adopt evidence-based medicine, so we dont have a situation where nearly half of all medical encounters involve substandard care and less than half of adults report being given any advice by doctors on weight, nutrition or exercise. A national entity, perhaps part of the National Institutes of Health, is created to fund and carry out comparative studies of what works best at the right cost.
Real incentives are found to encourage preventive care and for providers, not third-party vendors, to manage the care of the chronically ill, who amount to about 10% of the population but consume more than half the healthcare dollars. And instead of rewarding providers for the quantity of services and procedures they do, they will be rewarded for the quality of care, including outcomes.
Medical errors are reported, publicly, so that everyone can learn from them and reduce them, ending a situation in which all preventable mistakes are reimbursed twice, once to cause the error and once to fix it.
Insurers explanations of benefits are made comprehensible, at least by physicians trying to find out why coverage was denied, and insurers cover all preventive care.
Providers and patientsand only providers and patientsgain access to electronic medical records that can be shared when a patients need demands it. We stop fiddling about with the idea that all the myriad players in the healthcare information technology world are going to magically agree on a common platform, which of course would include sharing private data with every interested party.
Is all of this idealistic? Sure. But perhaps not utopian. The goal of true transparency is to make healthcare just a little bit like other industries, where the consumer is at the center of the enterprise but isnt forced into making all the decisions.