One of the biggest health care news stories of 2013 was the lack of price transparency. But consumers need much more than price information to know how to shop for health care services.
They need extensive information on the quality of care physicians, hospitals, and other providers deliver. Unfortunately, data on the quality that physicians and hospitals deliver are not as widespread or as robust as they need to be.
A recent report, “State Report Card on Transparency of Physician Quality Information,” from the Health Care Incentives Improvement Institute (HCI3) addresses the issue, saying:
“… finding information on the quality of physicians remains elusive for most consumers. While Medicare has a public web site that contains information on physicians, it is completely void of any data on the quality of care delivered. That’s all the more surprising since physicians have been reporting a basket of quality measures to Medicare for several years.
“There are commercial websites that provide some information on the quality of physician care, but there’s often a fee to pay for the full report, and the objectivity of the data on those sites has been questioned by many researchers.”
Image by Tim Caynes via flickr.
It’s always a good idea for reporters to think about unintended consequences, especially when we’re talking about the latest, trendiest policy fixes. I’m thinking of such ideas as requiring people who need medical care to put more “skin in the game” and to choose medical services with more attention to the prices. What could go wrong?
In an eye-opening essay for The New Yorker, Lisa Rosenbaum explores the consequences for people with limited means to pay. She makes the case that injecting price transparency into patient-doctor encounters could, if not done thoughtfully, “end up hurting most those we are trying to help.”
Rosenbaum, a cardiologist, starts with a first-person account of suffering a serious injury, and reflects on how pain and fear in such circumstances alter the way we think and make decisions, even among those who are pretty well off: Continue reading
One issued we pursued during the AHCJ webcast last month (The cost of health care: Is transparency possible?) is whether price transparency will drive costs up or down.
The members of our panel reported that price transparency will cause providers to drop their prices, and now new research shows that when reference pricing is combined with price transparency, costs tend to decline as well.
A reference pricing initiative in California motivated hospitals to reduce prices for hip and knee replacements, according to a study released earlier this month by the Center for Studying Health System Change. HSC conducted the research for the National Institute for Health Care Reform.
The HSC report, “Potential of Reference Pricing to Generate Health Care Savings: Lessons from a California Pioneer,” showed that when the California Public Employees’ Retirement System (CalPERS) introduced reference pricing for patients seeking hip and knee replacements, the initiative had two positive results. First, it helped steer patients to lower-price hospitals, and second, it motivated hospitals to reduce prices for these joint replacement procedures. Continue reading
Will increased price transparency in health care drive up costs? That’s what a health plan association executive suggested last week and it’s a question I’ll ask panelists during our webcast on price transparency on Thursday at 1 pm Eastern time: The cost of health care: Is transparency possible?
Once lower-paid physicians see what higher-paid doctors are charging, lower-cost doctors will demand higher rates from health insurers, David Pittman reported in MedPage Today. Quoting Dan Durham, executive vice president for policy and regulatory affairs for American’s Health Insurance Plans, Pittman wrote that by demanding higher prices, low-cost providers would drive up premiums, making coverage less affordable. Continue reading
Three reports – all on various aspects of health care costs – caught my eye today:
The State of the Art of Price Transparency Tools and Solutions
A report released today by Catalyst for Payment Reform examines the price transparency tools and solutions. A summary can be found in the Health Affairs blog. An AHCJ webcast on Dec. 12 will feature CPR’s executive director and Katherine Hempstead of the Robert Wood Johnson Foundation for a discussion about transparency in health care costs. Continue reading
On Jan. 1, many formerly uninsured Americans will have health insurance coverage and thus will be prepared to engage with the health care system.
But the newly insured will be like most Americans using the health care system today: They will lack the information they need about the cost of health care services and about how much of the total cost is their responsibility.
And, like most Americans, many of the newly insured will have high-deductible health plans and thus may face sticker shock when they visit and physician or hospital and learn how much they have to pay out of pocket until they reach their deductible.
This lack of price transparency is widespread in the U.S. health care system. Yet, for years, health insurers and employers have been shifting the responsibility to pay for care to consumers and employees. Clearly there is a pressing need for information on the cost of care.
AHCJ will explore these issues during a one-hour webcast on price transparency on Dec. 12 at 1 p.m. Eastern (10 a.m. Pacific). Continue reading
Efforts to increase the transparency and accessibility of clinical trial data kicked into a higher gear last week.
Some of the major stakeholders in these efforts emerged wearing white hats, while others had more shadowy motives revealed.
First, the good news: GlaxoSmithKline (GSK) announced, in the New England Journal of Medicine, that it has begun to release de-identified patient-level data from its clinical trials.
So far, 200 studies have been added to a new website, with another 200 coming by year’s end, according to the report. And there will be further updates beyond that.
To access the raw data, GSK is asking researchers to submit a proposal, which will also be published on the website. They’re also asking researchers who want access to their data to post summary results on the website and seek publication of their work, “in line with standard scientific practice.” Continue reading
Efforts to correct biased and dangerous medical studies are making more headlines.
Shortly after I posted about a new idea to correct missing and misreported research, I got an email from AHCJ member John Fauber, an investigative reporter at the Milwaukee Journal Sentinel.
His latest story for the Journal Sentinel and MedPage Today involves an extensive undertaking coordinated by Yale University to correct the record on a product made by Medtronic called Infuse. The project is called YODA, for Yale Open Data Access. (Read more..)
Infuse — officially a device — consists of a metal cage fitted around a sponge that is soaked in a genetically engineered protein. The protein is supposed to promote bone growth and healing. It works, but perhaps too well. Side effects linked to its use include bone overgrowth that can trap and irritate nerve roots causing chronic pain. It has also been tied to a complication called retrograde ejaculation, which leads to sterility in men. Patients who receive infuse also experienced more problems with wound healing and more cancer.
All in all, pretty devastating outcomes for patients who were hoping to feel better after their back surgeries. Continue reading
A decision announced Friday would allow the public and journalists access to Medicare claims data about individual doctors.
An injunction barring release of the data had been in place for 33 years, “when a federal court in Florida sided with the American Medical Association’s contention that doctors’ right to privacy trumped the public’s interest in knowing how tax dollars were spent,” according to John Carreyrou of The Wall Street Journal.
“Dow Jones & Co., The Wall Street Journal’s parent company, challenged the injunction in 2011 after the Journal published a series of articles showing how the information could be used to expose fraud and abuse in the $549 billion health-care program for the elderly and disabled.”
Wall Street Journal reporters, who negotiated for eight years worth of data if they did not publish identities, wrote a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud. The Wall Street Journal’s articles have offered a window into the forces driving up health spending and shown that analyzing the data can reveal abuse and fraud in the Medicare system.
“The public has a right to know how much physicians are being paid by Medicare and what services they are providing patients,” said AHCJ President Charles Ornstein. “With analysis and context from journalists, the data could help patients make informed decisions and provide necessary oversight of billions of dollars in federal spending.”
Carreyrou reports the American Medical Association “is considering its options on how best to continue to defend the personal privacy interests of all physicians.”
“The Crushing Cost of Care,” by the WSJ’s Janet Adamy and Tom McGinty, won first place in the Health Policy (large) category of the 2012 Awards for Excellence in Health Care Journalism.
Read more about the Medicare data and the fight to open it to the public:
The Association of Health Care Journalists, along with six other journalism and open-government groups, has called on the U.S. Department of Agriculture to release to the public vital information about the multibillion-dollar food stamps program.
Currently, the USDA refuses to reveal how much money individual retailers make from the Supplemental Nutrition Assistance Program, better known as food stamps. Additionally, the USDA does not disclose which products are purchased with SNAP dollars or how much is spent on each product, in aggregate.
This information could show which businesses benefit from the program and also inform public policy debates about obesity and its causes, the organization argues.
The USDA’s position runs contrary to President Obama’s promise of government transparency, and stands in sharp contrast with practices at other federal agencies. For example, the Temporary Assistance for Needy Families discloses where recipients used their EBT cards to withdraw cash assistance. A wealth of information is available about Medicare and Medicaid. Continue reading