When patients visit the doctor or hospital, they don't know the cost of that care, their odds of actually feeling better as a result, or their risk of being infected or injured in the process. The lack of transparency in healthcare is gradually changing. But for the most part, patients are still kept in the dark about the quality and costs of their care. Modern Healthcare reporter Elizabeth Whitman recently spoke with Leah Binder, CEO of the Leapfrog Group—which advocates for radical transparency in healthcare and last week published its latest round of safety grades for hospitals—about how the healthcare industry is changing for consumers, and how far it has to go. The following is an edited transcript.
Modern Healthcare: What do you consider the most pressing areas in terms of transparency of quality and safety in the next, say, five years?
Leah Binder: We have to learn how to rate individual clinicians, particularly physicians. We need to learn ways to rate them that will be meaningful to consumers and also valid to providers. The first thing that consumers want to know is, how good is the surgeon, how good is this doctor? They ask their friends, their neighbors now. But we're entering an era when people expect to be able to learn important information online or through research on their own. They want more validity, and that's, I think, the biggest challenge. And, it's extremely controversial. There have been attempts to make rating clinicians happen. I think we're at our infancy of being able to do it in any way that's meaningful.
MH: How would you get physicians on board with that?
Binder: They're not going to be on board. They're going to have to struggle with this, and I think the challenge for physicians is finding balance in tolerating a certain amount of scrutiny that they're not accustomed to, in order to build their practice.
MH: How do you balance competing factors—the need for transparency versus issues like risk adjustment—to ensure information that's shared is useful and not misrepresentative?
Binder: You've put your finger on the core issue in transparency. That is the central issue: the balance between on one hand perfect fairness—we want perfectly fair measures—and good enough measures—good enough to give consumers the information they need. We have a body of pretty good measures. They're not perfect. And we don't have all the measures we want, but we have some. Measurement science is moving into its adolescence. Because of value-based purchasing—because of the fact that there's now money on the table so a measure can actually calibrate your payment to some extent—that has changed the tenor. Now, providers are ratcheting up their expectation of perfection. No measure is ever perfect. It's never perfectly fair to all providers under any circumstances. It just never has been. It's just impossible. So, the standard that I think organizations like ours who represent purchasers uphold and the standard that many consumers uphold, it's going to be a good measure with good science that's acceptable to experts and useful to consumers, but the word “good” is deliberate. It doesn't have to be fantastically great. It has to be good. We also have to recognize that when measures are first reported, we frequently find flaws in them. In fact, we find it all the time at Leapfrog. We often use measures when they're first endorsed, and we'll find in the first year that there's something someone hadn't thought of, and so we'll fix it.
MH: Given constraints such as high-deductible plans and limited networks, how much power and agency do consumers really have in picking their healthcare?
Binder: Individual consumers have virtually no power. They are the least powerful stakeholders in all of healthcare. But as a group, with sheer power in numbers, they have almost limitless influence. We are already seeing the influence of consumers as a large entity, as a mass of people, not organized in any way at all but just acting individually. To me, the best example of the change we're seeing in healthcare as a result of this mass consumer mentality is the invention of a brand new title in hospitals, the chief experience officer, whose job is patients—what patients think—because all of a sudden the patient in the bed is also paying a lot of the bill, and suddenly it's like, “Bingo, that's a customer.” But speaking as one person, again, it's a very hard thing. Quality information is still in its infancy or just barely out of it. We're just getting there. And, pricing information is very difficult to obtain. There's no culture. It's very unusual for most of us to say to our doctor, “Well, how much will that cost me? Is that test really needed?” or “I don't know that I can afford it.” We're not used to talking that way to our doctors.
MH: How much actionable and practical information do consumers have? If they go to hospital rating sites, for instance, they see three different ratings for one hospital—from Leapfrog, Hospital Compare and U.S. News and World Report.
Binder: I don't think they have enough information. We're used to comparing different reviews for things that we buy. In fact, I sometimes won't buy something if I don't see any reviews, because I need the reviews. And I know that they're going to disagree with each other. I actually like seeing that because it gives me a better sense. For anything we buy, often the first question we ask is: How much is it going to cost? Always the second question and just as important to us is: Well, what do I get for my money? Why is that coffeemaker three times more expensive than that one? In healthcare, we have some but not enough pricing information. It's never enough. When we have price transparency in healthcare, we're going to have to have the quality right there, too, because otherwise it's not useful. Just having the price is not enough.