Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? Ateev...
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![Page 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/1.jpg)
Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make
Sense?
Ateev Mehrotra, MD, MPHUniversity of Pittsburgh School of Medicine
RAND Health
![Page 2: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/2.jpg)
Outline
1. Current landscape of measures
2. Concerns with current model
3. Suggestions for improvement
![Page 3: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/3.jpg)
New Jersey Hospital Price Compare
![Page 4: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/4.jpg)
Medicare Hospital Compare
![Page 5: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/5.jpg)
Florida Agency for Health Care Administration. Nursing Home Guide
![Page 6: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/6.jpg)
What is a Cost or Resource Use Measure?
• Terminology can be confusing • Resource use, value, relative costs, efficiency• “Efficiency” per IOM is a quality domain
• Distinction b’ween cost & efficiency/value • Costs for a given outcome• Health outcomes per dollar
• Cost & Resource Use Measures• PMPM / patient per year• Per episode costs • Per hospitalization costs • Utilization measures – generic prescribing• Overuse measures • Price transparency – daily price of nursing home
![Page 7: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/7.jpg)
Selection Model
Berwick et al, 2003, Medical Care
Selection of Providers
![Page 8: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/8.jpg)
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.
![Page 9: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/9.jpg)
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link to quality
- Link out of pocket $$
- More information
- Test, test, test
![Page 10: Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? Ateev Mehrotra, MD, MPH University of Pittsburgh School of Medicine.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/10.jpg)
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
![Page 11: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/11.jpg)
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
![Page 12: Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? Ateev Mehrotra, MD, MPH University of Pittsburgh School of Medicine.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/12.jpg)
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
![Page 13: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/13.jpg)
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
![Page 14: Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? Ateev Mehrotra, MD, MPH University of Pittsburgh School of Medicine.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/14.jpg)
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
![Page 15: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/15.jpg)
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $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 quality, not value
- Link out of pocket $$
- More information
- Test, test, test
Making Selection Pathway More Viable
![Page 16: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/16.jpg)
Do Consumer Need to Respond?
Reputation
![Page 17: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/17.jpg)
Higher than AverageRehospitalizations
Hospital A 13.1%
Hospital B 12.2%
Hospital C 12.1%
Hospital D 9.2%
Hospital E 8.3%
Average Hospital
4.1%
Care for Myocardial Infarction
Key points - Focus on
reputation - Choice not patient
relevant- More complex data- Focus on high cost
providers
Making Reputation Pathway More Viable
![Page 18: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/18.jpg)
Key points - Focus on
reputation - Choice not patient
relevant- More complex data- Focus on high cost
providers
Higher than AverageRehospitalizations
Hospital A 13.1%
Hospital B 12.2%
Hospital C 12.1%
Hospital D 9.2%
Hospital E 8.3%
Average Hospital
4.1%
Making Reputation Pathway More Viable
Infarction
![Page 19: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/19.jpg)
Higher than AverageRehospitalizations
Hospital A 13.1%
Hospital B 12.2%
Hospital C 12.1%
Hospital D 9.2%
Hospital E 8.3%
Average Hospital
4.1%
Making Reputation Pathway More Viable
Care for Myocardial Infarction Key points - Focus on
reputation - Choice not patient
relevant- More complex data- Focus on high cost
providers
![Page 20: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/20.jpg)
Higher than AverageRehospitalizations
Hospital A 13.1%
Hospital B 12.2%
Hospital C 12.1%
Hospital D 9.2%
Hospital E 8.3%
Average Hospital
4.1%
Making Reputation Pathway More Viable
Care for Myocardial Infarction Key points - Focus on
reputation - Choice not patient
relevant- More complex data- Focus on high cost
providers
![Page 21: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/21.jpg)
Higher than AverageRehospitalizations
Hospital A 13.1%
Hospital B 12.2%
Hospital C 12.1%
Hospital D 9.2%
Hospital E 8.3%
Average Hospital
4.1%
Making Reputation Pathway More Viable
Care for Myocardial Infarction
Key points - Focus on
reputation - Choice not patient
relevant- More complex data- Focus only on high
cost providers
![Page 22: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/22.jpg)
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
![Page 23: 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.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfe21a28abf838cb4831/html5/thumbnails/23.jpg)
Acknowledgements
• Co-authors– Judy Hibbard– Arnie Milstein– Peter Hussey
• Paper written for AHRQ National Summit on Public Reporting for Consumers
• Questions– Ateev Mehrotra– [email protected]