Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense?
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?
Ateev Mehrotra, MD, MPH
University of Pittsburgh School of Medicine
RAND Health
Slide 2
Outline
- Current landscape of measures.
- Concerns with current model.
- Suggestions for improvement.
Slide 3
New Jersey Hospital Price Compare
Image: A sample table from a report is shown.
Slide 4
Medicare Hospital Compare
Image: A list of hospitals is shown.
Slide 5
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?
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
Image: Flowchart of the model for the selection of providers is shown.
Berwick et al, 2003, Medical Care.
Slide 8
Concerns with Selection Pathway
- Consumers typically immune to costs.
- Higher costs = higher quality.
- Lack of trust and understanding.
- 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
| Quality of care for deliveries | How much you will pay out of your own pocket? | |
|---|---|---|
| High Quality Hospitals At A Reasonable Price | ||
| Hospital A | Image: blue star | $100 |
| Hospital B | Image: blue star | $100 |
| Hospital C | Image: blue star | $100 |
| Other Hospitals | ||
| Hospital J | Image: black circle | $250 |
| Hospital K | Image: blue star | $250 |
| Hospital L | Image: red circle | $250 |
| Click here for details on how quality measured | Click 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
| Quality of care for deliveries | How much you will pay out of your own pocket? | |
|---|---|---|
| High Quality Hospitals At A Reasonable Price | ||
| Hospital A | Image: blue star | $100 |
| Hospital B | Image: blue star | $100 |
| Hospital C | Image: blue star | $100 |
| Other Hospitals | ||
| Hospital J | Image: black circle | $250 |
| Hospital K | Image: blue star | $250 |
| Hospital L | Image: red circle | $250 |
| Click here for details on how quality measured | Click here for how we decide on out of pocket costs | |
Improvements:
- Relevant choices.
Slide 11
Making Selection Pathway More Viable
| Quality of care for deliveries | How much you will pay out of your own pocket? | |
|---|---|---|
| High Quality Hospitals At A Reasonable Price | ||
| Hospital A | Image: blue star circled in red | $100 |
| Hospital B | Image: blue star | $100 |
| Hospital C | Image: blue star | $100 |
| Other Hospitals | ||
| Hospital J | Image: black circle | $250 |
| Hospital K | Image: blue star | $250 |
| Hospital L | Image: red circle | $250 |
| Click here for details on how quality measured | Click here for how we decide on out of pocket costs | |
Improvements:
- Less is more.
Slide 12
Making Selection Pathway More Viable
| Quality of care for deliveries | How much you will pay out of your own pocket? | |
|---|---|---|
| High Quality Hospitals At A Reasonable Price | ||
| Hospital A | Image: blue star | $100 |
| Hospital B | Image: blue star | $100 |
| Hospital C | Image: blue star | $100 |
| Other Hospitals | ||
| Hospital J | Image: black circle | $250 |
| Hospital K | Image: blue star | $250 |
| Hospital L | Image: red circle | $250 |
| Click here for details on how quality measured | Click here for how we decide on out of pocket costs | |
Improvements:
- Link quality, not value.
Slide 13
Making Selection Pathway More Viable
| Quality of care for deliveries | How much you will pay out of your own pocket? | |
|---|---|---|
| High Quality Hospitals At A Reasonable Price | ||
| Hospital A | Image: blue star | $100 |
| Hospital B | Image: blue star | $100 |
| Hospital C | Image: blue star | $100 |
| Other Hospitals | ||
| Hospital J | Image: black circle | $250 |
| Hospital K | Image: blue star | $250 |
| Hospital L | Image: red circle | $250 |
| Click here for details on how quality measured | Click here for how we decide on out of pocket costs | |
Improvements:
- Link out of pocket $$.
Slide 14
Making Selection Pathway More Viable
| Quality of care for deliveries | How much you will pay out of your own pocket? | |
|---|---|---|
| High Quality Hospitals At A Reasonable Price | ||
| Hospital A | Image: blue star | $100 |
| Hospital B | Image: blue star | $100 |
| Hospital C | Image: blue star | $100 |
| Other Hospitals | ||
| Hospital J | Image: black circle | $250 |
| Hospital K | Image: blue star | $250 |
| Hospital L | Image: red circle | $250 |
| Click here for details on how quality measured | Click here for how we decide on out of pocket costs | |
Improvements:
- More information.
Slide 15
Making Selection Pathway More Viable
| Quality of care for deliveries | How much you will pay out of your own pocket? | |
|---|---|---|
| High Quality Hospitals At A Reasonable Price | ||
| Hospital A | Image: blue star | $100 |
| Hospital B | Image: blue star | $100 |
| Hospital C | Image: blue star | $100 |
| Other Hospitals | ||
| Hospital J | Image: black circle | $250 |
| Hospital K | Image: blue star | $250 |
| Hospital L | Image: red circle | $250 |
| Click here for details on how quality measured | Click here for how we decide on out of pocket costs | |
Improvements:
- Test, test, test.
Slide 16
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
Care for Myocardial Infarction
| Higher than Average Rehospitalizations | |
|---|---|
| Hospital A | 13.1% |
| Hospital B | 12.2% |
| Hospital C | 12.1% |
| Hospital D | 9.2% |
| Hospital E | 8.3% |
| Average Hospital | 4.1% |
Key points:
- Focus on reputation.
- Choice not patient relevant.
- More complex data.
- Focus on high cost providers.
Slide 18
Making Reputation Pathway More Viable
Care for Myocardial Infarction
| Higher than Average Rehospitalizations | |
|---|---|
| Hospital A | 13.1% |
| Hospital B | 12.2% |
| Hospital C | 12.1% |
| Hospital D | 9.2% |
| Hospital E | 8.3% |
| Average Hospital | 4.1% |
Key points:
- Focus on reputation.
Slide 19
Making Reputation Pathway More Viable
Care for Myocardial Infarction (circled in red)
| Higher than Average Rehospitalizations | |
|---|---|
| Hospital A | 13.1% |
| Hospital B | 12.2% |
| Hospital C | 12.1% |
| Hospital D | 9.2% |
| Hospital E | 8.3% |
| Average Hospital | 4.1% |
Key points:
- Choice not patient relevant.
Slide 20
Making Reputation Pathway More Viable
Care for Myocardial Infarction
| Higher than Average Rehospitalizations | |
|---|---|
| Hospital A | 13.1% |
| Hospital B | 12.2% |
| Hospital C | 12.1% |
| Hospital D | 9.2% |
| Hospital E | 8.3% |
| Average Hospital | 4.1% |
Key points:
- More complex data.
Slide 21
Making Reputation Pathway More Viable
Care for Myocardial Infarction
| Higher than Average Rehospitalizations | |
|---|---|
| Hospital A | 13.1% |
| Hospital B | 12.2% |
| Hospital C | 12.1% |
| Hospital D | 9.2% |
| Hospital E | 8.3% |
| Average Hospital | 4.1% |
Key points:
- Focus only on high cost providers.
Slide 22
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
- Co-authors:
- Judy Hibbard.
- Arnie Milstein.
- Peter Hussey.
- Paper written for AHRQ National Summit on Public Reporting for Consumers.
- Questions:
- Ateev Mehrotra.
- mehrotra@rand.org.
