Why Healthcare Cost Reports Fail Consumers
Healthcare cost reports are doing little to help consumers pick quality providers or save money, for themselves or the healthcare system at large, expert says.
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Unfortunately, far too many people equate more care and higher costs with high quality. Further, reports intended to help consumers choose lower-cost healthcare services may have the unintended effect of driving them away from more affordable providers that may in fact be better than more expensive ones.
"People do say that they care about the quality of [health]care," according to Judith H. Hibbard, a senior researcher at the University of Oregon's Institute for Policy Research and Innovation. But does the average American really understand what "quality" means in healthcare? Probably not.
Hibbard helped author an article in the policy journal Health Affairs--published by the well-known charity Project Hope--that suggests public healthcare cost reports are doing little to help consumers pick quality providers and save money, for themselves as well as for the $2.7 trillion-a-year U.S. healthcare sector.
"[T]he evidence to date suggests that many consumers believe more care is better and that higher-cost providers are higher-quality providers. This belief raises the possibility that public reporting of cost measures might have the perverse impact of increasing costs," the article stated.
[ CMS has released new clinical quality standards for eligible providers. Read more at Feds Release New Healthcare Quality Measures. ]
"Consumers might interpret 'lower cost' as evidence of scrimping on care and therefore low quality. This association between costs and quality is powerful. Consumers know that in most aspects of their lives, higher-price goods and services are often better than lower-price goods and services," the authors continued.
Cost reports today also tend to list the overall price tag of various procedures as billed to insurance companies, not the out-of-pocket costs paid by individuals. "Therefore, the majority of consumers have no practical interest in these data," explained the article. "Although the total cost of care contributes to increasing health costs--and, therefore, higher premiums and lower income after expenses for consumers--it is unlikely that most consumers will change their behavior based on these considerations."
Quality--defined as the likelihood of the right patient getting the right care at the right time, without complications, omissions, or other medical errors--barely registers. "Most people don't know that there are widespread quality problems in healthcare," Hibbard told InformationWeek Healthcare. Instead, people tend to choose providers based on unscientific factors such as word-of-mouth, convenience, and whether a doctor or hospital is in their insurance plan's network.
True information about quality tends to be buried in arcane repositories such as Health Affairs and other academic journals, or on hard-to-find Web pages that are not exactly consumer-friendly.
For example, the New York State Department of Health offers a fairly succinct response to the widely held fallacy that good insurance coverage means good, affordable care: "Although having insurance increases access to the healthcare system, it is not sufficient to ensure appropriate use of services or care that is of high quality." However, the department's URL doesn't exactly roll off the tongue: http://www.health.ny.gov/prevention/prevention_agenda/access_to_health_care/. Also, the page is filled with statistics and references that many consumers might not understand.
"We need to find people where they really are," Hibbard said. "Put information in front of them, and make it relevant information."
The study's authors suggested linking quality reports to websites about various medical procedures so consumers can compare infection rates at hospitals in their area. They also created a sample report card for maternity hospitals that ranks each facility by the quality of care for delivering babies, as well as for mothers' out-of-pocket costs based on their specific insurance coverage.
"There are things that we can do now that make a very big difference," Hibbard said.
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