Online access to health-care cost, quality empowers both consumers, providers

Online access to health-care cost, quality empowers both consumers, providers - Optometry Times

ModernMedicine ModernMedicine Community

Publish date: Sep 1, 2009
Source: Optometry Times

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From a consumer perspective, transparency is what health-care reform is all about-being able to see inside the quality and cost of health care. Transparency is one of the main hallmarks of value-driven health care.
Regardless of what happens in the legislative debate over who should be covered and how it should be paid for, the wheels to move health-care delivery toward full transparency are well in motion.

Here's the scenario: A family member is faced with a complicated surgical procedure and the choice of hospital falls to you. Chances are that you would like to know how many of these procedures have been performed at a given hospital and by whom. What about the physician you are considering? Pertinent information: Of the two hospitals you are considering, one of them has a zero secondary infection rate after surgery and the other has an 18% secondary infection rate.

Like most family members, your choice would depend heavily on such information, if it were available to you when selecting health-care providers.

This type of information is now being made available to the public for use in making health-care choices. The reason? Transparency. From a consumer perspective, transparency is what health-care reform is all about—being able to see inside the quality and cost of health care. Transparency is one of the main hallmarks of value-driven health care. Regardless of what happens in the legislative debate over who should be covered and how it should be paid for, the wheels to move health-care delivery toward full transparency are well in motion.

Preparing for clinical outcomes

As health-care providers, assuming we want our practices to be competitive as health care moves in this direction, we must understand the power in knowing our clinical outcomes. When we talk about transparency for the consumer, effectively, what they see are the results of the care we provide, our clinical outcomes. We need to appreciate the power of patients knowing our outcomes and being able to compare them with other providers in our area.

A Web site worth monitoring in this regard is http://www.hospitalcompare.hhs.gov/. Although this Medicare site only reports current hospital quality measures, the ability to report physician quality measures is being developed. In the future, there will be a similar Web page for patients to use in selecting their physicians. As physicians in the Medicare program, optometrists will be included in that reporting process. For a non-Medicare site already reporting on physicians, see http://www.healthgrades.com/, which currently includes some optometrists.

The general process leading from clinical outcomes to transparency is well established:

Providers track outcomes and report them.
Clinical outcomes are analyzed and assigned a cost and quality score.
Scores are made available to the public.
Payers provide incentives to encourage covered patients to use this information to select the best-performing providers.
Providers use this reported information as a benchmark to continue their quality improvement process, identify and incorporate best practices, and improve their own clinical outcomes.

We can see the elements of this system being developed as we look at health care today:

The newest electronic medical records systems are designed specifically to facilitate tracking outcomes.
Medicare has created the Physician Quality Reporting Initiative (PQRI) program to serve as a reporting mechanism.
The national claims processing center analyzes payment information and PQRI reporting data.
Medicare makes results available to the public via the hospital comparison Web site, which can be expanded to include physician reporting.
The health-care reform debate is addressing when and what kind of incentives will be put in place for government-controlled health programs.

Questions abound on how all this will affect eye care. What are the measures that truly represent quality in eye care? Will these measures be collected uniformly, analyzed, and reported in a way that is useful and representative? Will the public be able to interpret these data to make good decisions? The concerns and questions about the process go on and on. Despite these valid questions, the inability for payers—government or private—to continue supporting an unaffordable health-care system is becoming increasingly critical and drives the process to continue.