72015 was a good year for those looking for hopeful answers to quality questions and who want the momentum to carry into next year. Consumer Reports teamed up with the University of California–San Francisco (UCSF) and the California Department of Insurance to create California Healthcare Compare, a quality and price transparency tool. Consumers’ Checkbook unveiled its SurgeonRatings website and ProPublica, the independent investigative news organization, developed the Surgeon Scorecard. The Health Care Incentives Improvement Institute (HCI3), a Newtown, Conn., not-for-profit group that pushes for payment reform and quality improvement, unveiled a tool that consumers can use to evaluate primary care and specialty physicians based on their ability to limit potentially avoidable complications.
Consumers want “provider-specific ratings, and they want summary measures to gauge the strength and weaknesses of provider networks,” says Lynn Quincy of Consumers Union.
Next year, CMS will require all qualified health plans operating on the ACA exchanges to submit data on quality similar to the data health plans submit for CMS’s Quality Ratings System, says Lynn Quincy, director of the Health Care Value Hub for Consumers Union, which publishes Consumer Reports. The program will closely resemble the five-star rating system that CMS uses to grade Medicare Advantage plans, according to Quincy.
But quality tools are not some kind of Field of Dreams that gets built and people come. The fact is that few use the proprietary quality and price transparency apps that health plans provide. Are they not useful? Do people not care? Are health plans not trusted? Answer: all of the above.
The sheer proliferation of websites and tools may sow even more doubts, and we’re bound to start hearing some criticism of the tools that have been developed. For example, François de Brantes, HCI3’s executive director, wrote in a blog post in October that CMS’ methods for putting together Hospital Compare has deteriorated, resulting in an “overall lack of differentiation. It squeezes scores to the average, leaving a handful of outliers on either side of ‘good’ or ‘bad’.”
But some experts think higher deductibles and other moves that shift health care costs to individuals will create fresh demand for useful, reliable quality (and price) data. R. Adams Dudley, MD, director of the Center for Healthcare Value at UCSF, says consumers will ask, “What am I spending all this money on while you’re keeping me in the dark about quality?” And even if individuals don’t push for it, consumer advocates will, he predicts.
“Consumers want even more,” says Quincy, at Consumers Union. “They want provider-specific ratings, and they want summary measures to gauge the strength and weaknesses of provider networks.” Asking consumers to pay more and failing to give them useful and easy-to-use price and quality transparency tools is a good way to drive down patient experience and satisfaction scores that are increasingly used to set payment levels. The crystal ball readings for 2016 show private companies and consumer advocates developing new and more sophisticated ways to evaluate health care provider quality for that reason among many others.
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Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.