Transparency Readings
Top Transparency Reads
California Health Care Foundation. Price Check: The Mystery of Hospital Pricing (2005). This study used "mystery shopers" to inquire about prices for common procedures in 64 hospitals. In most instances, it was difficult if not impossible to find this information. Of note is mention of legislation in California (and similar legislation in other states) that requires hospitals and pharmacies to provideFlorida's AHCA State Consumer Health Information and Policy Advisory Council
This site has the current and past activities for this critical group within Florida. It includes comprehensive presentations on the state of health care.
Florida Senate: Review of Medicaid Prescription Drug Pricing: Interim Project Report 2005-141, November 2004.(pdf) This article reviews Florida's pharmacy reimbursement mechanism and changes made to the methodology during the 2004 legislative session.
Follow the Pill: Understanding the U.S. Commercial Pharmaceutical Supply Chain. Health Strategies Consultancy for the Kaiser Family Foundation (March, 2005). An outstanding review of the nuances of drug pricing.
Public Reporting and Pay for Performance in Hospital Quality Improvement. Lindenauer et. al. NEJM 356:486-496, February 1, 2007. Conclusions Hospitals engaged in both public reporting and pay for performance achieved modestly greater improvements in quality than did hospitals engaged only in public reporting. Additional research is required to determine whether different incentives would stimulate more improvement and whether the benefits of these programs outweigh their costs.
From "Soak the Rich" to "Soak the Poor": Recent Trends in Hospital Pricing. Anderson. Health Affairs 26 (3): 780-789, 2007. Abstract: In 2004, the rates charged to many uninsured and other "self-pay" patients for hospital services were often 2.5 times what most health insurers actually paid and more than three times the hospital’s Medicare-allowable costs. The gaps between rates charged to self-pay patients and those charged to other payers are much wider than they were in the mid-1980s, and they make it increasingly more difficult for some patients, especially the uninsured, to pay their hospital bills. This has triggered lawsuits and some recent government efforts involving price transparency. Three specific policy options that could lower the markups are a voluntary effort by hospitals, litigation, and legislation.
Blue Cross - Blue Shield of Massachusetts: How Consumers Make Decisions.
Summary:
- Choosing the right doctor and hospital is one of the most important health care decisions people make, and Massachusetts adults face these decisions often. Approximately half make health care decisions for someone else in their family, and most have chosen a doctor or used ahospital within the last five years.
- Not surprisingly, consumers are eager for information to help them make more educated health care decisions, with more than three in four saying they would be interested in different types of information (e.g., hospital infection rates, information on the doctor’s experience) to help them compare doctors and hospitals.
- Massachusetts consumers are hungry for this kind of information because they are keenly aware that problems with quality and safety exist. Nearly two in three believe medical errors happen often, and one in four have personal experience with medical errors.
- But the kinds of relevant information consumers seek, such as the kinds of information they use for other major purchasing decisions (like buying a car or appliance), are not currently available.
- In light of the dearth of credible information for making health care decisions, consumers often choose doctors and hospitals rapidly and with little information.
Health Care Price Transparency: A Strategic Perspective for State Government Leaders
Produced by the Deloitte Center for Health Solutions. Good overview document emphasizing consumer surveys. This article emphasizes Secretary Leavitt's four cornerstones:
- Connectivity
- Measuring and publishing quality information
- Measuring and publishing pricing information
- Creating positives incentives
The Florida Agency for Health Care Administration’s (AHCA) redesigned web site is the first step in an ambitious program. This site ultimately will give Florida’s health care consumers, purchasers and professionals an unprecedented degree of easy-to-access and understandable information on quality, pricing and performance. Florida Compare Care consists of two adjoining web sites that disseminate comparative health care information to consumers. The MyFloridaHealthStat web site displays price and quality information for hospital services based on risk-adjusted DRG codes. The MyFloridaRx site conveys information on prescription drugs, and anecdotal evidence shows that it is working to lower costs. For example, in Miami-Dade County there was a dramatic decrease in the range of retail prices for the drug Neurontin since the introduction of the price comparison web site. Florida has plans to begin reporting comparative information for health plans and individual physicians in the near future.
Could U.S. Hospitals Go The Way Of U.S. Airlines? Altman et. al. Health Affairs, 25, no. 1 (2006): 11-21.
Abstract:
The market for hospital services, like global markets in general, is becoming more competitive. Increased price transparency and focused competition can squeeze out inefficiencies, restraining prices and making some consumers better off. But competition can have a dark side. U.S. hospitals can treat Medicare and Medicaid patients at less than cost, care for the uninsured, and provide other money-losing services because they can cross-subsidize. By 2025 the need for general hospitals to cross-subsidize will greatly in-crease, but their ability to do so will be diminished. U.S. hospitals could begin to resemble U.S. airlines: severely cutting costs, eliminating services, and suffering financial instability.
Sometimes What's Needed is a "Nudge" - David Leonhardt - NYT - 16-May, 2007
Quoting (subscription required):
"This same sort of complexity has plagued Medicare Part D, the new prescription drug benefit. Almost one-quarter of low-income people eligible for a subsidy aren’t getting it because they have not signed up for the program at all. “It’s sufficiently complicated that people sort of throw up their hands and say, ‘I can’t deal with it,’ ” said Joseph Newhouse, a Harvard economist.
Likewise, there are almost seven million children without health insurance who are eligible for the State Children’s Health Insurance Program but are not in it. A few proposals to make it easier for children to be signed up are now working their way through Congress. In every one of these cases — school choice, Medicare, health insurance — the government can help people make good choices by tearing down bureaucratic hurdles."
National and International Trends in Health Care Financing and Delivery
The Uninsured: A Primer (Kaiser Commission on Medicaid and the Uninsured, 2006)Consumer-Driven Health Care: Lessons From Switzerland. Herzlinger and Parsa-Parsi. JAMA 292 (10): 1213-1220 (September 8, 2004).
Abstract: Switzerland's consumer-driven health care system achieves universal insurance and high quality of care at significantly lower costs than the employer-based US system and without the constrained resources that can characterize government-controlled systems. Unlike other systems in which the choice and most of the funding for health insurance is provided by third parties, such as employers and governments, in the Swiss system, individuals are required to purchase their own health insurance. The positive results achieved by the Swiss system may be attributed to its consumer control, price transparency of the insurance plans, risk adjustment of insurers, and solidarity. However, the constraints the Swiss system places on hospitals and physicians and the paucity of provider quality information may unduly limit its impact. The Swiss health care system holds important lessons, including evidence about its feasibility and equity, for the United States, which is now embarking on its own consumer-driven health care system.
The Swiss Health System: Regulated Competition Without Managed Care. Reinhardt. JAMA 292 (10): 1227-1231 (September 8, 2004).
AHRQ Information Collection Activity (Federal Register Vol 72, no. 88, May 8, 2007, p 26117)
This Comment request deals with "Chartering Value Exchanges for Value-Driven Healthcare." This project proposes to twice annually post a public call for parties interested in becoming chartered as Value Exchanges for Value-driven Healthcare. Anticipated benefits of being a chartered Value Exchange include (1) participation in an AHRQmanaged Learning Network and (2) eligibility to request Medicare-inclusive multi-payer patient de-identified individual physician-level performance measurement results.
To be eligible, interested parties must first be recognized by HHS Secretary Michael O. Leavitt as a Community Leader for Value-driven Healthcare. Follow this link for additional information on Community Leader recognition.
Florida Demographics
Florida Population Statistics (US Census)Florida County Map
Florida Trends in Financing and Delivery
Highlights from the 2004 Florida Health Insurance Study (2004)Florida Insurance Statistics (Kaiser Family Foundation)
Florida Office of Insurance Regulation- Reports
Florida Hospital Association (FHA) Nurse Staffing Survey Findings (2005)
Analysis of Nurse Licensure Data in Florida: Methods and Statewide Results (Florida Center for Nursing, January 2007)
The Southern Regional Educations Board’s 2006 Annual Survey of Nursing Education Programs (Florida Center for Nursing, November 2006)
Quality
A Checkup on Health Care Markets (RWJ, Powers and Painter)Your Guide to Choosing Quality Health Care (AHRQ) . A comprehensive (some would say encylopedic) 44-page document that includes definitions, advice on choosing health plans, hospitals, and doctors, and some advice on maintaining personal health information.
Are Consumers Influenced by Quality Metrics?
The Predictive Accuracy of the New York State Coronary Artery Bypass Surgery Report-card system. Jha and Epstein. Health Affairs 25, no 3 (2006); 844-855. Abstract: We examined the impact of New York State’s public reporting system for coronary artery bypass surgery fifteen years after its launch. We found that users who picked a top-performing hospital or surgeon from the latest available report had approximately half the chance of dying as did those who picked a hospital or surgeon from the bottom quartile. Nevertheless, performance was not associated with a subsequent change in market share. Surgeons with the highest mortality rates were much more likely than other surgeons to retire or leave practice after the release of each report cardPublic Reporting and Pay for Performance in Hospital Quality Improvement. Lindenauer. NEJM 356 (February 1, 2006); 486-496. Conclusions Hospitals engaged in both public reporting and pay for performance achieved modestly greater improvements in quality than did hospitals engaged only in public reporting. Additional research is required to determine whether different incentives would stimulate more improvement and whether the benefits of these programs outweigh their costs.
What Happens to Prescription-Drug Use After Consumer-Directed Health Plan Enrollment? Fairman et. al (Express Scripts). Summary.CDHPs produce considerable savings, both in total drug cost and net-payer cost. These savings are achieved by 1) payment of a greater proportion of cost by the enrollee and 2) reduction in brand use, which is only partially offset by increases in generic use. The chronic-medication-persistency differences observed in the first quarter of the year had mitigated, but not disappeared altogether, by the third quarter. This finding suggests that members may have anticipated the change to CDHP and stockpiled medication prior to the end of 2005, making early (first-quarter) estimates of CDHP impact somewhat misleading.
.....Finally, they curtailed medication use instead of consistently substituting generic for brand medications.
Are providers influenced by quality and performance metrics?
Pay for Performance at the Tipping Point. Epstein. NEJM 356:515-517 (February 1, 2007).Consumer-Directed Health Care And The Courts: Let The Buyer (And Seller) Beware. Jacobson and Tunick. Health Affairs, 26 (3),:704-714 (2007).
Abstract:
In consumer-directed health care, patients will be expected to exert greater control over their spending decisions than before. As consumer-directed care gains market acceptance, courts will inevitably be involved in resolving challenges to the new arrangements. We anticipate that courts will be generally favorable toward consumer-directed care, but the new legal doctrine will not uniformly favor medical professionals and insurers. The information demands inherent in consumer-directed care will present particular legal challenges to physicians and insurers. Even as courts provide flexibility to reflect the new market realities,
