transparency

Senate advises greater disclosure of healthcare costs

Anne Zieger — Tue, 14 Oct 2008 10:30:04 -0400

Consumers have been asking for it--and now the U.S. Senate may oblige. The Senate has released a discussion draft of legislation that they think would help contain healthcare costs through greater disclosure of such costs.

The legislation would force an employer to disclose on the employee's annual Form W-2 how much it pays for the employee's healthcare, including the combined value if the employee holds several separate plans such as medical, dental and vision coverage.

Senate officials proposing the bill believe that if workers knew how much they were paying for healthcare, they would either find ways to be more efficient or demand that their employers make changes to help save them money. Their assertion follows on testimony from the Congressional Budget Office, which contended that such disclosures would be a good way to help contain healthcare costs.

To learn more about this legislation:
- Read this Healthcare Finance News piece

Trend: Hospitals apologize for mistakes publicly

Anne Zieger — Fri, 08 Aug 2008 13:35:47 -0400

Typically, hospitals have shied away from the legal exposure and bad publicity that come with apologizing publicly for mistakes. Lately, however--prompted by the industry's increasing push toward transparency--a number of hospitals have gone public with mistakes made by their teams. This includes a recent episode at Park Nicollet Methodist Hospital in which the wrong, non-cancerous kidney was removed from a patient due to incorrect documentation in the patient's chart. Park Nicollet and at least five other health care organizations faced with undeniable errors that caused serious harm have let the world know that they're sorry.

Right now, five states require some type of adverse-event disclosure to patients, and even require reporting of 28 "never events" identified by the National Quality Forum. Now, as laws protecting expressions of empathy, regret and apologies from admissibility in court become more common, hospitals are growing bolder. While some critics fear that the apologies will generate too much legal exposure for doctors, others hail the disclosures as a big step forward for patients.

In theory, such disclosures are a smart public relations strategy, as experts on public disclosure of bad news generally suggest the institution disclose the news on its own. But hospital administrators say that they're doing this because it's the right thing to do, because it enhances trust, and because it helps professionals learn from each other.

To learn more about this trend:
- read this AMNews article

Related Articles:
Saying 'I'm sorry' grows more popular in med mal cases
Programs help doctors, hospitals say 'I'm sorry'
Avoiding medical error discussion can cause problems
Laws would protect physicians who apologize

SPOTLIGHT: A hospital CEO's pitch for transparency

Anne Zieger — Thu, 31 Jul 2008 01:54:19 -0400

While we, as consumers, demand transparency from the other professionals we deal with--including insurance companies, car dealers, computer sales specialists, stock brokers, architects and more--is the industry prepared to step up and offer detailed information on its operations to consumers? In this column, hospital CEO Nick Jacobs offers his reasons why he feels we can't put off doing so anymore. Blog

Boston hospital discloses wrong-side surgery

Anne Zieger — Mon, 07 Jul 2008 08:07:11 -0400

A surgeon at Beth Israel Deaconess Medical Center operated on the wrong side of a patient this week--and in a rare act of transparency, hospital officials disclosed the event promptly in an email to staff members. The surgical mistake happened during an elective orthopedic procedure that didn't involve removal of organs and didn't cause permanent damage to the patient. However, state authorities are still investigating the matter. This is one of five wrong-side surgeries reported to authorities statewide during the first five months of the year, according to the state's Bureau of Health Care Safety and Quality.

The error occurred despite the fact that medical workers had used a marker to label the correct side of the patient for the operation. However, the surgeon failed to notice the mark. Experts note that this problem might have been avoided if the surgical team took a "time out" before the procedure, under which operating teams stop and verbally call out, "Right patient, right procedure, right location."

To learn more about the surgery:
- read this item from The Boston Globe

Related Articles:
RI hospital faces third fine for wrong-side brain surgery
Study: Wrong-site surgeries, close calls common
Study: Pre-op briefing can lower surgical error rates

Transparency getting big boost in Boston metro

Tue, 10 Jun 2008 06:59:58 -0400

A few developments are emerging in Boston that suggest that it may become one of the leading regions in the U.S. for disclosure of price and provider ranking information.

On one hand, a growing number of health plans are beginning to rate individual physicians or making plans to do so. The latest are Tufts Health Plan, the state's third-largest health insurer, which is expanding its "Navigator" doctor rankings plan. Meanwhile, Harvard Pilgrim Health Care is considering offering health plans with doctors rankings to consumers not covered through the commission negotiating municipal and state employee coverage. These moves already excited a fight over the Group Insurance Commission's rankings, which are opposed by the Massachusetts Medical Society as being unduly influenced by physician fees.

Meanwhile, by late summer, the Massachusetts Health Care Quality and Cost Council will soon launch a website listing insurance payments for as many as 40 procedures, including about 20 inpatient and 20 outpatient procedures.

To learn more about the dispute:
- read this article in The Boston Globe
- read this Boston Business Journal piece

OH plans, providers share pricing and quality information

Fri, 23 May 2008 06:59:55 -0400

This week seems to be a big one for transparency. Not only did Cigna roll out its nationwide physician and hospital rankings program nationwide, central Ohio got into the action, too. Anthem Blue Cross and Blue Shield in Ohio has published pricing information on medical procedures on a site accessible only to its members this week. Anthem's tool tells members what's paid to providers after contract discounts for 39 common elective procedures.

The move follows similar steps by providers, for example, local health system OhioHealth, which began publishing CMS data on patient care and satisfaction a couple of weeks ago. Also, OSU Medical Center published its data from CMS in late March, with Nationwide Children's Hospital planning to follow up with its own data this summer.

Aetna, meanwhile, has offered its members price information for physicians in central Ohio since 2006, along with a system rating doctors with stars, as well as by rates of patients readmitted to hospitals within 30 days after discharge.

To learn more about transparency in central Ohio:
- read this Business First of Columbus piece

Related Articles:
Critics doubt benefit of posting hospital prices online
Tennessee hospitals put prices online
MN group posts hospital prices to Web
Maryland adds pricing to hospital guide

Case study: OH hospital pays for bills for competing hospitals

Tue, 13 May 2008 06:59:55 -0400

One Ohio hospital is so bent on putting together a comparison shopping tool that it's willing to pay patients for competitive information. Alliance (OH) Community Hospital is paying patients $100 for copies of bills--and corresponding explanations of insurance benefits forms--from competing hospitals. Once it gets enough information, it plans to post prices and related reimbursement levels for leading insurers on its website.

An Ohio law in effect since November 2006 already requires state hospitals to post prices for common procedures on their websites, as well as making hard copies of price lists available to patients. However, Alliance wanted to take things further in an effort to help consumers comparison-shop, CEO Stan Jonas told AMNews.

To learn more about the hospital's plans:
- read this AMNews piece

Related Articles:
Transparency goes mainstream
TX site offers hospital price comparisons
Critics doubt benefit of posting hospital prices online
HCA posts hospital prices online

CO bill would set standards for physician rating, tiering

Fri, 02 May 2008 06:59:55 -0400

Colorado's governor is considering a bill that would require the state's health plans to disclose the data and methods they use to create physician tiers. In so doing, the state would follow the lead of New York, which has taken aggressive steps to regulate physician rating programs, including proposed legislation and a model standard set by the state attorney general.

With tiering programs, health plans rank physicians based on their preferred quality ratings, then offer members discounts for those who only see the highest-rated tier of physicians. In addition to demanding transparency on what they're doing, the Colorado bill would set standards for how data is used, requiring, for example, that plans utilize risk-adjusted data, base grades and ratings at least partly on nationally-recognized quality standards.

To learn more about the bill:
- read this AMNews article

Related Articles:
NY considers physician-ranking legislation
Physician ratings are here to stay
Errors force BCBS of TN to postpone doctor ratings
Restaurant ratings firm Zagat, WellPoint rate doctors

Study: Very few child drug trials get outside oversight

Thu, 20 Mar 2008 07:59:55 -0400

A new study suggests that drug trials involving children get shockingly little oversight from outside safety monitoring groups. The study, which reviewed 739 international trials mounted between 1996 and 2002, concluded that only one of every 50 such drug trials were overseen by outside safety groups. Of those that did use monitoring groups, six were stopped because of signs of toxicity. Also, adverse side effects were reported in 37 percent of all trials, and about one in ten produced moderate to severe--and sometimes life-threatening--side effects.

Why such a lapse in oversight? Experts note that drug trials for children are, themselves, a relatively new thing. In the past, children have been given the same medicines as adults without there having been any separate trials, despite the differing metabolisms.

To learn more about this research:
- read this FierceBiotech piece

Related Articles:
Study: Blacks avoid clinical trials. Report
Researchers fight for diversity in clinical trials. Report
Clinical trials registry legislation proposed. Report
Clinical trials Web site may increase transparency. Report

A potentially costly discovery?

Fri, 22 Feb 2008 06:59:59 -0500

As I understand it, basic economic theory suggests that buyers can't make rational decisions unless they can get and compare prices for equivalent products and services. If it's costly or difficult to get pricing information, that tends to drive prices up, and in essence, people don't know if they're being ripped off.

However, this week, a study (.pdf) came out from the Reg-Markets Center, American Enterprise Institute and Criterion Economics that draws the opposite conclusion. The study, which critiques the recently-introduced Transparency in Medical Device Pricing Act of 2007 (SB 2221), argues that if medical device prices were widely available, prices actually would go up. (Did we mention that the study also was backed by the Advanced Medical Technology Association, the device makers' trade group?)

The researchers say that at present, competing device maker firms don't know their rivals' prices, that there only are a few firms that have substantial shares of the medical device industry and that few substitutes exist for many devices. Given these factors--and a few others--disclosing prices might actually drive firms to mark up their prices, the report argues. On top of all of that, the analysis suggests that even if prices went down, patients wouldn't benefit, as healthcare providers wouldn't pass on the savings they'd gained--which would contradict the bill's stated purpose.

Now, although I left my PhD in economics at home (OK, I don't have one), something feels fishy about all of this to me. I admit that if my doctor wants to use a drug-eluting heart stent sold by Johnson & Johnson, he's probably not going to consult with me regarding the extra $100 it costs in comparison to the Boston Scientific model. And as a consumer, I'm not going to get involved; I'm just not qualified to make this kind of decision.

That being said, there is a large and powerful interest group--health plans--that use price as a criterion to make delicate medical decisions every day. Doctors are just as loyal to their favorite drugs, but health plans and pharmacy benefit managers have never hesitated to use aggressive tactics to move them to cheaper, allegedly equal alternatives.

If health plans have free and open access to medical device information, I'm betting they'll start using it like a club in record time to favor cheaper products. This might even do something to put a damper on backdoor deals where hospitals or doctors get volume discounts, then mark things up big time for health plans.

Ultimately, it's hard to imagine that this wouldn't put some downward pressure on prices, even in a concentrated market with few competitors. But of course, I don't work for the American Enterprise Institute or AdvaMed. In their world, it seems, more information is bad. Doesn't that make you just a little bit uncomfortable? -Anne

P.S. During the first half of next week, I'll be reporting from the HiMSS08 health information technology conference in Orlando. Look for ongoing coverage on the FierceHealthIT site, including the scoop on the Tuesday keynote scheduled to be delivered by HHS Secretary Mike Leavitt.