Price & Quality Transparency: Become a Positive Deviant Part I

Today begins a more detailed, multi-part editorial examining pricing/quality transparency.

On 6.26.07 we took a gander at West VA's price transparency site, CompareCareWV.

I used the hypothetical example of a total knee replacement (TKR) to take the site for a spin.

Now let's step back and take the larger issue out for a test drive.

One could argue, perhaps quite successfully, that there's no such thing as an average price for a TKR, and that WVa's tool, while interesting and helpful, is still in the Stone Age devlopmentally and as such should be used only as a starting point for patients to discuss options with prospective care providers.

Let's try a little experiment based very loosely on anectodal evidence.

How many of you, dear readers, have ever asked your doctor how much XYZ is going to cost? (or, if you are a doc, how many have asked yourselves how much XYZ will cost your patient?)

If you've done a bit of interrogating, were you met with a stare, an "I don't know, you'll have to call the hospital, your insurance company?" or a friendly pat followed by some variation on the standard issue "Don't worry about that now, let's just get you better?"

If you haven't yet asked a medical care provider about cots, give it a whirl. Whatever the response, the results will be interesting (expect near hysterical laughter in approximately 23.4689 percent of cases).

The essential point is this: We can talk about transparency (especially in the hospital setting) until we're blue in the face, but for it to work, some percentage of both consumer and physician populations must buy in to the benefits of shared decision making.

And this is a lot of buying in to do - especially based on the rabbit-warren-like complexities of our current system and medical culture, which embraces a physician-driven "Prescribe, Accept, Perform" process.

The questions price and quality transparency advocates must consider from the provider side include the following:
  • How does making very generalized pricing structures available to consumers change the amount of time spent/pattern of current patient interactions? (i.e. will average appointment times increase once patients begin to question docs about costs?)
  • If docs have to answer questions related to pricing as well as process while with a patient, how much longer will preop appointments take? Annual physicals? OB/GYN exams? (I think you get the idea - each service line will need to measure and analyze how time spent with patients morphs after cost/quality data is released - staffing models may need revision as a result).
  • What is the planned process for releasing quality and pricing data? In-house release followed by online rollout on the hospitals website? Does the hospital's marketing/PR/community relations department then follow up by arranging interviews, open seminars, coverage in the local press, etc.?
  • What is the planned process for analyzing results of transparency? Which departments will gather & distribute this information? Where does the information "live" and can both internal and external constituencies provide comments/suggestions via a simple, easy to use format?
  • At what point will transparency saturate every area of operations, for instance - during preadmission phases...at what point will our facility begin providing basic lists/pricing along with consent forms?
  • What incentives, other than altruistic motives to keep patients actively engaged in their own care processes, are needed to foster widespread adoption among different internal populations (nursing staff, physicians, lab, etc.)?
  • How will you handle consumers who choose to stay in the dark about specifics of their care, those who just want you to fix it and don't care about the names of their meds, the specifics of their care, OR the costs involved?
  • How do you communicate the benefits of active patient engagement and accepting personal responsibility for self advocacy in terms patients will understand and value, such as reduced medical errors, increased engagement/interest among care providers, earlier ID of potential complications, etc.?
In the next posting, we'll examine potential impacts of transparency on patient involvement.

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