Gail R. Wilensky, PhD
Senior Fellow, Project HOPE
In August, during a stop in Minnesota, President Bush “went public” about
transparency--urging that better information be made available to the public about the costs and quality of health care. The president then signed an executive order requiring four federal agencies to compile information about the price of care and the quality of care they receive and to make that information available to the public and to each other. The four agencies are the Department of Health and Human Services, the Department of Defense, the Department of Veterans Affairs, and the Federal Employees Health Benefits Program.
These agencies are directed, where possible, to complete four actions:
- Make their information systems “interoperable”--i.e., be able to interact with each other
- Enact quality measurement programs that have developed with the private sector
- Make price information on common procedures available to beneficiaries
- Identify practices that promote high-quality care
The executive order also specified that these actions should not incur additional costs to the federal government--a point that may not please those private-sector providers that continue to look to the federal government to pay for such efforts.
This event represents an important next step in the administration’s campaign to increase transparency in health care. Earlier in 2006, the president participated in a panel discussion at HHS, which had been arranged to promote the availability of information on price and quality. Increased availability of information along with the expanded use of consumer-directed healthcare plans have become a centerpiece of the administration’s strategy to use market forces to moderate spending on health care....
Most providers support the concept of transparency in principle--somewhat less in practice. They worry that the data will be inaccurate or misinterpreted. And although there are skeptics who think providers would just as soon not have this information readily available, there are legitimate issues of concern. One is the appropriate unit of cost. For example, it is not physician fees per se that reflect the total cost of care; rather, it is the costs associated with the entire medical episode that are most relevant, even though patients and insurers may be more interested in the component information, including physician fees. Shifting the focus to episode-of-illness costs may take time as these measurements are just beginning to be used.
It also is important to provide information on quality and outcomes as well as on price, however defined. Quality and outcome measures also need to be adjusted for patients’ severity of illness. Measurements in these areas are even less well-developed than cost measurement, but many groups are hard at work to rectify this problem.
The problems with cost/quality measurement and reporting will improve over time as long as interest in making such information available continues. The question that remains is whether purchasers--be they health plans or patients--will use the information. Health plans are already indicating a real interest, as a strategy to both moderate spending and improve patient safety. Patients have appeared less interested, but with the growth of consumer-directed health plans and health savings accounts, it is likely that their interest will soon increase substantially.
[This piece is an excerpt from Dr. Wilensky's Eye on Washington column, which will appear in the October issue of hfm magazine.]
