Healthcares push to boost quality and curb costs by publicly reporting on price and performance may be critical to reform efforts, but patients probably have little use for whats currently available, a new Commonwealth Fund/Modern Healthcare survey finds.
Leaders see value in reporting of price, quality data, but effects may be marginal
Greater transparency ranked as a high-priority strategy to curbing preventable illnesses and errors, say eight out of 10 industry insiders, academics and public officials polled by Harris Interactive for the Commonwealth Fund and Modern Healthcare. Half of the opinion leaders rank greater access to price and quality information as very important to improving U.S. healthcares overall performance.
But just as many doubted that patients faced with comparison shopping in coming years will have enough material to make informed decisions. Fifty-three percent said it was unlikely that patients will be able to effectively leverage their buying power with resources expected to be available in the next two or three years. Instead, it may be up to payers to use the data to steer patients to providers who have responded to calls for change by demonstrating high clinical quality and cost efficiency.
Policymakers have looked increasingly to patients as potentially powerful allies in efforts to curb costs and reduce harmful, sometimes fatal, errors. By arming patients with information on providers efficiency and quality, experts contend, market pressure will force hospitals and doctors to compete by cleaning up waste and improving poor health outcomes.
The Commonwealth Fund survey findings underscore frustration voiced by employers, public agencies and patient advocates who argue that consumers still lack access to useful information and often struggle to find and comprehend the few resources that are available. The Web survey was conducted in October, with a response rate of 21%.
By and large, the quality of public reporting is pretty mediocre compared to what it could be and should be, says Shoshanna Sofaer, a healthcare policy professor at the City University of New Yorks Baruch College School of Public Affairs, and one of the surveys 240 respondents.
Quality experts often dont clearly translate jargon-heavy measurements for patients, says Sofaer, who studies how health information gets communicated to the public. Sofaer recently tested consumer-friendly definitions of quality measures such as iatrogenic pneumothorax or failure to rescue with focus groups. If people dont get it, they tell you right away, she says. Consumer resources are also poorly promoted, Sofaer says. Patients do not know where to go, leaving quality reports to languish thanks to plain old unadorned inertia.
Judith Hibbard, a University of Oregon health policy professor, credits that inertia to the publics poor grasp of healthcares widespread and serious quality problems. Hibbards research focuses on healthcare consumers and quality improvement. Not only do patients fail to comprehend the likelihood of preventable error or illness, she says, but consumers typically confuse convenience or customer service with quality.
Polls suggest most consumers do not consult quality information when making decisions. Roughly one-third of U.S. adults have seen quality data for health plans, hospitals or doctors and of those, only half used what they found to make a decision, according to an August 2006 Kaiser Family Foundation survey. However, more adults were aware of medical errors in 2006 than two years earlier, the poll found. Fifty-five percent said they understood the definition of medical error last year, compared with 43% in 2004. The percentage of adults who had never heard the term dropped to 17% in 2006 from 19% in 2004.
Healthcare comparison shopping will only take off as consumers face increasing pressure from rising costs of care, says Sara Rosenbaum, chairwoman of the Department of Health Policy at George Washington Universitys School of Public Health and Health Services. Declining insurance coverage and a shift toward insurance benefits that require patients to shoulder a greater share of expenses will force consumers to be more aggressive. Its a very tough way to teach people, she says.
Gaining access to useful and relevant information wont happen unless employers, patients and publicly financed plans insist on transparency, she says.
Kathy Coltin, who oversees insurer Harvard Pilgrim Health Cares external quality initiatives and also participated in the Commonwealth Fund survey, says her own experience with quality and price data underscores yet another risk to successful reforms. Disjointed reporting often leaves patients unable to match price and quality information for a treatment or procedure, and consumers may simply decide that high cost equals high quality, she says.
When asked who should oversee standards for measuring and reporting information, 56% of respondents called for a new, national public-private organization. Relying on an existing federal agency to handle the task ranked a distant second, with 18%. Another 12% simply said they were not sure who should handle the job; 10% named public and private payers and 4% opted for providers professional societies.
But even as patients clout continues to be hamstrung by access to useful information, survey results suggest healthcare industry insiders may be using results to drive reform.
Slightly more than eight of 10 respondents said greater transparency was important or very important to improving performance, and another 77% said the same for encouraging insurers to recognize or reward quality and efficiency. Karen Davis, president of the New York-based Commonwealth Fund, says the mere fact of reporting focuses the industrys attention on results. It gets providers to pay attention, admit they have a problem and figure out how to solve it, she says.
Davis says the results overall highlight strong healthcare leader support for public reporting. Notably, the survey found support for expanding financial disclosure beyond hospitals and clinics. Roughly 80% of respondents supported or strongly supported public reporting of health plans medical-loss ratios. Slightly more, 84%, supported or strongly supported disclosing drug prices charged to large public insurers, such as Medicare and Medicaid, and major private pharmacy benefit managers. She also noted that respondents indicated that transparency will likely curb spending.
Nearly half said public quality and price information would reduce healthcare spending by at least 1% and 17% said disclosure would cut spending by more than 5%.
Even if patients dont react to quality measures, providers and payers see value in measurement and tracking, says Thomas Garthwaite, chief medical officer for Catholic Health East, a 24-hospital system based in Newtown Square, Pa. The Catholic system recently surveyed its hospitals and found that of those with managed-care contracts that included pay-for-performance measures, half had adopted pay-for-performance in their contracts with hospitalists. Garthwaite says the system is considering an internal pay-for-performance pilot and sought out examples by conducting the systemwide review.
Were strong believers that incentives work and measurement works, he says.
This is the fourth installment of the Commonwealth Fund/Modern Healthcare Opinion Leaders Survey. The online poll is designed to highlight perspectives on the most timely health-policy issues from a panel of the nations leading hospital systems, physician and health plan executives, policymakers and healthcare purchasers. The survey is administered four times annually by Harris Interactive, New York. On pp. 22 and 23, analysts provide independent commentary on the issue of this fourth polltransparency of quality and pricing in healthcare. They are Robert Galvin, director of global healthcare for General Electric Co., and Paul Ginsburg, president of the Center for Studying Health System Change. Meanwhile, the Commonwealth Fund and Modern Healthcare are looking for more industry leaders to take part in future opinion leaders surveys. Go online to http://go.hpolsurveys.com/HCOL to nominate yourself or others you think might qualify. We are looking for top executives of large health systems, hospitals, medical groups and payers. Also, more survey results can be found at the Commonwealth Funds Web site, cmwf.org.
Todd SloaneAssistant Managing Editor/Op-Ed
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