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Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? Ateev...
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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
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Transcript of Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? Ateev...
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
Outline
1. Current landscape of measures
2. Concerns with current model
3. Suggestions for improvement
New Jersey Hospital Price Compare
Medicare Hospital Compare
Florida Agency for Health Care Administration. Nursing Home Guide
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
Selection Model
Berwick et al, 2003, Medical Care
Selection of Providers
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.
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 $$
- More information
- Test, test, test
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
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 $$
- More information
- Test, test, test
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
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 $$
- More information
- Test, test, test
Quality of care for deliveries
How much you will pay out of your own pocket?
HIGH QUALITY HOSPITALS AT A REASONABLE PRICE
Hospital A $100
Hospital B $100
Hospital C $100
OTHER HOSPITALS
Hospital J $250
Hospital K $250
Hospital L $250
Click here for details on how
quality measured
Click here for how we decide on out of pocket
costs
Making Selection Pathway More Viable
Improvements
- Relevant choices
- Less is more
- Link quality, not value
- Link out of pocket $$
- More information
- Test, test, test
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
Do Consumer Need to Respond?
Reputation
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
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
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
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
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
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
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]
