A Look inside Healthcare Transparency

The Hospitalist. 2007 January;2007(01):

January 1, 2007 | The Hospitalist

House Legislation: Make Prices Public

Comprehensive pricing transparency may also be required on a state level. On Sept. 13, 2006, Representative Michael Burgess (R-Texas) introduced the Health Care Price Transparency Act of 2006 in the House. This American Hospital Association (AHA)-supported legislation would require states to publicly report hospital charges for specific inpatient and outpatient services and would require insurers to give patients, on request, an estimate of their expected out-of-pocket expenses.

The good news is that hospitalists may be the single best-prepared group of physicians [for transparency] because we’re already doing it.

—Eric Siegal, MD

The bill would also require the Agency for Healthcare Research and Quality to study what type of healthcare price information consumers would find useful and how that information could be made available in a timely, understandable form.

Thirty-two states already require hospitals to report pricing information, and six more are voluntarily doing so, but this legislation would likely change the information that hospitals and other providers are gathering and providing.

At press time, the legislation had been referred to the House Subcommittee on Health.

Slow Adoption of Electronic Records

Researchers at Massachusetts General Hospital (Boston) and George Washington University (Washington, D.C.) unveiled the first comprehensive study on the use of electronic medical records (EMR). The conclusion: A mere 9% of doctors currently use EMRs. Least likely to use the technology were physicians over age 55 and those in small private practices with one to three doctors. The researchers estimate that if the current rates of adoption continue, only half of U.S. doctors will have systems in place by 2014—the deadline set for widespread deployment by President Bush.

IOM Makes P4P Recommendations for Medicare

The Institute of Medicine (IOM) recently released the report “Rewarding Provider Performance: Aligning Incentives in Medicare,” which highlights the deficiencies of the current Medicare physician payment system and offers thoughtful recommendations for implementing a pay-for-performance payment program within the Medicare program. The report, released in September 2006, is available online at www.iom.edu/CMS/3809/19805/37232.aspx.

New Quality Measures for Voluntary Reporting

More quality measures will be added to the Centers for Medicare and Medicaid Services (CMS) Physician Voluntary Reporting Program (PVRP) in 2007, possibly including more that will be relevant for hospitalists. CMS released a list of 86 quality measures in the fall of 2006, stating that it plans to select a subset as the 2007 PVRP measures. The goal is to achieve an appropriate balance in measures to be reported by different specialties. Most of the reporting measures have been developed by medical associations involved in the AMA’s Physician Consortium for Quality Improvement. SHM is participating in this process.—JJ

How Transparency Will Roll Out

While the House legislation is in limbo, the executive order will have an immediate effect on healthcare, starting this year. The quality measures to be included in reporting will be developed from private and government sources, including local providers, employers, and health plans and insurers.

After the data are gathered and the information technology (IT) infrastructure is set up, consumers will be able to access specific information on pricing and quality of services performed by doctors, hospitals, and other healthcare providers. This information may be available through a variety of sources, including insurance companies, employers, and Medicare-sponsored Web sites.

One of the keys to success will be in the collaboration among the agencies involved. “There’s a keen understanding among the major players that if everyone does their own thing, we’ll have chaos,” says Dr. Siegal. “There has to be a significant degree of harmonization [among] physician measures, hospital measures, inpatient measures, and outpatient measures.”