Paul Bruning on What It Will Take to Reach True Transparency in Health Care

A Note From CODE: We are pleased to share this thought leadership guest blog from Paul Bruning, Director, Orthopedic Service Line, and a member of AAOE. Read Paul’s other guest blog, Exploring the Real Value of Patient-Reported Outcomes with Paul Bruning

Since Utah Health Care started to publicly report patient-satisfaction survey data in 2012, (Lee, 2017), health care organizations, providers, and staff have discussed the value of transparency in competition and quality improvement. Since 2014, several other health care organizations began to publicly report measures including patient satisfaction, patient charges, quality measures, and outcome data (Piedmont Healthcare, Wake Forest, Baptist Health, Northwell Health, Stanford, Cleveland Clinic, University of Pittsburgh, Duke, and several others: Lee, 2017). However, there is a long journey ahead to provide truly comparable transparency for patient decision-making on health care quality and outcomes. Large databases of measures on quality and outcomes are required to provide benchmarking and statistically significant validation of metric information. This data can be collected from a veritable plethora of sources, such as third-party vendors, individual health care organizations, and internet surveys.

The primary challenge to transparency is consistency.

Although public availability of data increases transparency and reduces the asymmetrical information on health care quality and competition, there are issues with the use and availability of the current data (Austin, McGlynn, & Pronovost, 2016; Lee, 2017). Austin et al. described no common standards for reliability and validity of publicly reported data. They posited that metrics are not subjected to rigorous quality assurance standards. Entities implement measures but deviate from the intended use of the individual metric, and modify or introduce variation into the metric, which results in compromised validity and reliability of the measure. Various third-party vendors may collect data, but at different intervals, making benchmarking and comparison outside that vendor platform irrelevant. These measures are then unable to be used for benchmarking or providing the public with true transparency for comparison of quality and cost.

Why aren’t health care costs transparent yet?

Transparency of cost in health care is difficult as patients often do not consider cost when confronted with health care needs and emergencies. Further, health insurance often insulates patients from the full cost realization and burden. Co-pays and deductibles are used by insurance companies to deter unwarranted seeking of medical care. However, as deductibles have dramatically increased, patients are waiting longer to seek care and may incur larger costs associated to care that has been delayed. Individual health care organizations contract with payers at different rates. These rates are not permitted to be shared between health care organizations to avoid collusion and price fixing. Medicare is the only fixed price payer with public transparency. Despite clear economic predictions and theory on competition improving quality, Zhao (2016) argues that health care markets do not respond in a similar fashion to fixed prices and quality competition. This variation is due to the lack of consistency in quality metrics, reporting, and usability of the information provided by the various health care organizations.

Patients will expect quality measures and outcomes to be transparent

Quality measures and outcomes would guide patients in determining the value of care. A patient’s quality is measured in the patient experience (patient satisfaction) and outcome (patient-reported outcomes). Since cost is insulated or lacks transparency, these factors require public reporting to improve the health care system and the quality providers offer. This transparency can provide patients with the ability to drive the market of health care and insist on true quality of care. In a value-based reimbursement system and patient-centered care organization, these two measures should be publicly reported with process outcome measures. Process outcome measures are evidence-based processes that improve patient outcomes. These metrics are often used in rating hospitals, nursing homes, and other health care system functions.

What will it take to reach true transparency in health care?

Improving transparency in health care requires the use of reliable, validated, and consistently interpreted and reported metrics. Consideration of the literacy of those ingesting the information and using the data for decision-making is imperative to a successful implementation. Otherwise, the program will lack transparency, value, and be questioned by end user, health care systems, and providers. Policymakers, health care leaders, and public entities have an obligation to develop standards for quality and outcomes measures, provide scientifically and statistically reliable and valid comparisons of quality and outcomes, improve on and demand the public reporting of data.

Those health care organizations and providers who provide the most transparency, using reliable and validated metrics, and can demonstrate real value, will drive the value-based market. These organizations will lead value-based reimbursement and patient-centered care. They will have the advantage in marketing their value to the patients seeking quality care.