Health Care Quality Transparency Initiatives

Raising Awareness of Quality Gaps Key to Consumer Use; Well-Designed Programs Can Foster Hospital-Physician Buy In

News Release
July 22, 2009

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Until consumers are motivated to investigate differences in hospital and physician quality, the main value of public quality reporting will likely be to spur providers to improve their performance, according to a Commentary published today by the Center for Studying Health System Change (HSC).

"In recent years, significant energy has been invested in developing health care price and quality information in hopes of engaging consumers to be more active when making health care choices. Although research shows that provider quality can vary greatly, many Americans still rely on friends and family when choosing a physician or hospital," according to the Commentary by HSC President Paul B. Ginsburg, Ph.D., and Nicole M. Kemper, M.P.H., an HSC health research analyst.

"For public and private payers seeking to encourage consumers to use quality information when choosing physicians, hospitals and other providers, a critical first step is to raise consumer awareness of the existence and serious implications of provider quality gaps," the authors conclude.

In a separate Issue Brief released today, HSC Senior Researcher Ha T. Tu, M.P.A., and HSC Health Research Analyst Johanna R. Lauer highlight two quality transparency initiatives—CalHospitalCompare, a report card for hospitals, and Massachusetts Health Quality Partners, a report card for primary care physician groups—that can be considered success stories in being thoughtfully designed and implemented and presenting usable and useful quality information.

HSC is a nonpartisan policy research organization funded in part by the Robert Wood Johnson Foundation (RWJF), which supported both the Commentary and Issue Brief through its general support of HSC.

The Issue Brief identified common features of both quality transparency programs that other quality transparency programs may be able to draw from and replicate, including:

• Collaborating with the provider community from the outset—Engaging providers from the beginning increases participation (in voluntary transparency initiatives), helps ensure clinical and practical relevance of the measures, and helps increase acceptance by providers of the program’s measures and methods.
• Ensuring high-caliber quality data are reported—How accurately data are abstracted, coded, aggregated, audited, validated and reported can profoundly affect the usefulness of performance ratings. If two quality transparency programs report the same measures, one can have a much greater positive impact by devoting resources to such activities as training vendors and staff at provider sites to collect data in an accurate, standardized manner; auditing sufficient samples of records; and validating datasets by checking for omissions, misclassifications and other errors.
• Presenting quality data in easy-to-understand formats—Presenting only numerical point estimates, confidence intervals or bar charts leaves many consumers confused about whether the differences across providers are significant. In addition, presenting ratings where almost all providers fit into the "average" category leaves consumers frustrated. An alternative-using multiple benchmarks to rank providers—helps to create meaningful categorizations of high and low performers that consumers find more useful.
• Providing hospitals and physicians with detailed information on their performance—Transparency initiatives can impact quality through the "sunshine effect," by which providers—seeing their quality metrics publicly compared to their competitors—are motivated to improve quality to protect their public and professional reputations and to adhere to professional norms. Effective programs typically give provider more-detailed data than the information publicly reported.

Both the Commentary—Health Care Quality Transparency: If You Build It, Will Patients Come?—and the Issue Brief—Designing Effective Health Care Quality Transparency Initiatives—are available online at www.hschange.org.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.