Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense?

Slide presentation from the AHRQ 2011 conference.

On September 20, 2011, Ateev Mehrotra made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (1.3 MB). Plugin Software Help.


Slide 1

Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense?

Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense?

Ateev Mehrotra, MD, MPH
University of Pittsburgh School of Medicine
RAND Health

Slide 2

 Outline

Outline

  1. Current landscape of measures.
  2. Concerns with current model.
  3. Suggestions for improvement.

Slide 3

 New Jersey Hospital Price Compare

New Jersey Hospital Price Compare

Image: A sample table from a report is shown.

Slide 4

 Medicare Hospital Compare

Medicare Hospital Compare

Image: A list of hospitals is shown.

Slide 5

 Florida Agency for Health Care Administration (AHCA) Nursing Home Guide

Florida Agency for Health Care Administration (AHCA) Nursing Home Guide

Image: A page from the AHCA Nursing Guide is shown.

Slide 6

 What is a Cost or Resource Use Measure?

What is a Cost or Resource Use Measure?

Terminology can be confusing:

  • Resource use, value, relative costs, efficiency.
  • "Efficiency" per Institute of Medicine (IOM) is a quality domain.

Distinction between cost & efficiency/value

  • Costs for a given outcome.
  • Health outcomes per dollar.

Cost & Resource Use Measures.

  • Per Member Per Month (PMPM) / patient per year.
  • Per episode costs.
  • Per hospitalization costs.
  • Utilization measures—generic prescribing.
  • Overuse measures.
  • Price transparency—daily price of nursing home.

Slide 7

 Selection Model

Selection Model

Image: Flowchart of the model for the selection of providers is shown.

Berwick et al, 2003, Medical Care.

Slide 8

 Concerns with Selection Pathway

Concerns with Selection Pathway

  1. Consumers typically immune to costs.
  2. Higher costs = higher quality.
  3. Lack of trust and understanding.
  4. Not relevant to decisions actually made.

Our view is that in their current form and absent any financial incentives, publicly reporting of cost measures is unlikely to lead to the hoped for consumer response.

Slide 9

Making Selection Pathway More Viable  

Making Selection Pathway More Viable

 Quality of care for deliveriesHow much you will pay out of your own pocket?
High Quality Hospitals At A Reasonable Price
Hospital AImage: blue star$100
Hospital BImage: blue star$100
Hospital CImage: blue star$100
Other Hospitals
Hospital JImage: black circle$250
Hospital KImage: blue star$250
Hospital LImage: red circle$250
 Click here for details on how quality measuredClick here for how we decide on out of pocket costs

Improvements:

  • Relevant choices.
  • Less is more.
  • Link to quality.
  • Link out of pocket $$.
  • More information.
  • Test, test, test.

Slide 10

 Making Selection Pathway More Viable

Making Selection Pathway More Viable

 Quality of care for deliveriesHow much you will pay out of your own pocket?
High Quality Hospitals At A Reasonable Price
Hospital AImage: blue star$100
Hospital BImage: blue star$100
Hospital CImage: blue star$100
Other Hospitals
Hospital JImage: black circle$250
Hospital KImage: blue star$250
Hospital LImage: red circle$250
 Click here for details on how quality measuredClick here for how we decide on out of pocket costs

Improvements:

  • Relevant choices.

Slide 11

 Making Selection Pathway More Viable

Making Selection Pathway More Viable

 Quality of care for deliveriesHow much you will pay out of your own pocket?
High Quality Hospitals At A Reasonable Price
Hospital AImage: blue star circled in red$100
Hospital BImage: blue star$100
Hospital CImage: blue star$100
Other Hospitals
Hospital JImage: black circle$250
Hospital KImage: blue star$250
Hospital LImage: red circle$250
 Click here for details on how quality measuredClick here for how we decide on out of pocket costs

Improvements:

  • Less is more.

Slide 12

 Making Selection Pathway More Viable

Making Selection Pathway More Viable

 Quality of care for deliveriesHow much you will pay out of your own pocket?
High Quality Hospitals At A Reasonable Price
Hospital AImage: blue star$100
Hospital BImage: blue star$100
Hospital CImage: blue star$100
Other Hospitals
Hospital JImage: black circle$250
Hospital KImage: blue star$250
Hospital LImage: red circle$250
 Click here for details on how quality measuredClick here for how we decide on out of pocket costs

Improvements:

  • Link quality, not value.

Slide 13

 Making Selection Pathway More Viable

Making Selection Pathway More Viable

 Quality of care for deliveriesHow much you will pay out of your own pocket?
High Quality Hospitals At A Reasonable Price
Hospital AImage: blue star$100
Hospital BImage: blue star$100
Hospital CImage: blue star$100
Other Hospitals
Hospital JImage: black circle$250
Hospital KImage: blue star$250
Hospital LImage: red circle$250
 Click here for details on how quality measuredClick here for how we decide on out of pocket costs

Improvements:

  • Link out of pocket $$.

Slide 14

 Making Selection Pathway More Viable

Making Selection Pathway More Viable

 Quality of care for deliveriesHow much you will pay out of your own pocket?
High Quality Hospitals At A Reasonable Price
Hospital AImage: blue star$100
Hospital BImage: blue star$100
Hospital CImage: blue star$100
Other Hospitals
Hospital JImage: black circle$250
Hospital KImage: blue star$250
Hospital LImage: red circle$250
 Click here for details on how quality measuredClick here for how we decide on out of pocket costs

Improvements:

  • More information.

Slide 15

Making Selection Pathway More Viable  

Making Selection Pathway More Viable

 Quality of care for deliveriesHow much you will pay out of your own pocket?
High Quality Hospitals At A Reasonable Price
Hospital AImage: blue star$100
Hospital BImage: blue star$100
Hospital CImage: blue star$100
Other Hospitals
Hospital JImage: black circle$250
Hospital KImage: blue star$250
Hospital LImage: red circle$250
 Click here for details on how quality measuredClick here for how we decide on out of pocket costs

Improvements:

  • Test, test, test.

Slide 16

 Do Consumer Need to Respond?

Do Consumer Need to Respond?

Image: A flowchart shows the steps from Purpose, Goals, and Results (Performance) to Measurement for Improvement and Knowledge.

Slide 17

 Making Reputation Pathway More Viable

Making Reputation Pathway More Viable

Care for Myocardial Infarction

 Higher than Average
Rehospitalizations
Hospital A13.1%
Hospital B12.2%
Hospital C12.1%
Hospital D9.2%
Hospital E8.3%
Average Hospital4.1%

Key points:

  • Focus on reputation.
  • Choice not patient relevant.
  • More complex data.
  • Focus on high cost providers.

Slide 18

 Making Reputation Pathway More Viable

Making Reputation Pathway More Viable

Care for Myocardial Infarction

 Higher than Average
Rehospitalizations
Hospital A13.1%
Hospital B12.2%
Hospital C12.1%
Hospital D9.2%
Hospital E8.3%
Average Hospital4.1%

Key points:

  • Focus on reputation.

Slide 19

Making Reputation Pathway More Viable

Making Reputation Pathway More Viable

Care for Myocardial Infarction (circled in red)

 Higher than Average
Rehospitalizations
Hospital A13.1%
Hospital B12.2%
Hospital C12.1%
Hospital D9.2%
Hospital E8.3%
Average Hospital4.1%

Key points:

  • Choice not patient relevant.

Slide 20

 Making Reputation Pathway More Viable

Making Reputation Pathway More Viable

Care for Myocardial Infarction

 Higher than Average
Rehospitalizations
Hospital A13.1%
Hospital B12.2%
Hospital C12.1%
Hospital D9.2%
Hospital E8.3%
Average Hospital4.1%

Key points:

  • More complex data.

Slide 21

 Making Reputation Pathway More Viable

Making Reputation Pathway More Viable

Care for Myocardial Infarction

 Higher than Average
Rehospitalizations
Hospital A13.1%
Hospital B12.2%
Hospital C12.1%
Hospital D9.2%
Hospital E8.3%
Average Hospital4.1%

Key points:

  • Focus only on high cost providers.

Slide 22

 Key Take Aways

Key Take Aways

  • In current form cost measures unlikely to have the desired impact.
  • Consider which pathway on which to focus.
    • Impacts presentation, choice of measures, link to quality, and financial incentives.
  • Limited scientific evidence base on consumer response.

Slide 23

 Acknowledgements

Acknowledgements

  • Co-authors:
    • Judy Hibbard.
    • Arnie Milstein.
    • Peter Hussey.
  • Paper written for AHRQ National Summit on Public Reporting for Consumers.
  • Questions:
Current as of March 2012
Internet Citation: Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense?. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/mehrotra/index.html