Price & Quality Transparency: Become a Positive Deviant Part II

We've built a system that encourages the medical care team to make almost all necessary tough calls in patient care (followed by efforts to gain patient consent based on predetermined courses of treatment), and saddled this same team with almost total responsibility for outcomes.

Of course, just because pricing and quality data emerges doesn't mean we'll face total patient-driven anarchy - medical professionals have the knowledge and the skills - this is the reason we call you docs and trust you with life and limb. I'm not advocating patients run amok through the halls screaming "Carpe diem" and docs rush from the rooms yelling back "Patients, heal thy damn selves!"

For price transparency trends to truly impact the continuum of care though, some population of patients (I won't go so far as to suggest a majority) must become active, engaged partners who are willing to select the level of information required to have some sort of understanding of their care - and make informed decisions.

Monkey see, monkey do: Once patients can see data, some of us begin to make choices based on that information (Shocking right? But have we thought about what this really means? What if our Cancer Center of Excellence turns out to be not so excellent? Will certain facilities shunt poorly performing service lines if patients don't choose to come in for treatment based on price/quality data?).

This leads us to perhaps the largest stumbling block of all - patients will share, to some small extent, the responsibility for outcomes.

If we begin to choose our doctors, our hospitals, based on how much they will cost and their quality rankings on some sort of national or per-patient scale, we now carry some of the burden inherent in making these choices.

At this point, it becomes difficult to predict how this sort of responsibility ("If I'd elected to take my daughter to the number 5 cystic fibrosis facility in the U.S. instead of the 35th, would she have lived to see 40?") will transform our system - from the patient side, from the provider side, from the legal/regulatory side.

Before planning a process to release pricing and quality data, we must first ask the essential "whys:"

• Why should I care how much it costs for patients?
  
• Why should I care who's already doing it and what their transparency campaigns look like?
  
• Why should I consider making decisions based on this information?
  
• Why should I provide pricing/quality information at all?
  
• Why should I consider sharing it with staff first?
• Why should I consider taking the time/money to gather this information for release?
  
• Why should I consider sharing this level of information with patients?
  
• Why would it do any of us any good?

Asking these "whys" may seem like an exercise in futility, but the more questions you ask before a transparency campaign, the easier it will be to answer questions from the peanut gallery after you release pricing/quality data.

Answering the "whys" is, undoubtedly a far more insidious process than it appears in a simple blog posting, requiring a complex, multifaceted revision of many current patient education processes. You'll also have to perform some undoubtedly unpleasant and onerous internal data gathering procedures to get your hands on the figures.

And after you get the data, and get internal buy-in, there's the far more challenging issue of convincing patients why they should care.

Some patients undoubtedly don't wish to change their roles from passive receivers of prescribed care to active, informed participants.

In an ideal world, all patients would be proactive and capable of deciding for themselves, but medicine, though somehow miraculous, is not an ideal world.

Proxy caregivers will sometimes need to make these calls, and medical staff will still need to communicate risks and benefits of treatment - so how do we make such information available for thorough review?

The web is, of course, a good start, but we then also need to make sure hospitals are wired to allow internet access at all points of service (gasp).

In addition, we need to be sure transparency data is communicated in a variety of ways that is not inherently prejudiced - we need to offer it in a manner that doesn't prohibit certain patient populations from accessing it (illiterate, impaired, non-English speaking, etc).

A well-planned transparency campaign that releases information (both pricing & quality) will need to attack three main fronts by providing answers to the "whys" above:

1. Internal & External web-based media/editorials including blogging, online news, etc.
2. Internal stakeholders including employees, Board of Directors, donors, etc.
3. External stakeholders including patient populations (past, current and future), media, community organizations, suppliers, etc.

Of course, the first group that must demonstrate unilateral buy in and understanding of the "whys" is the executive/administrative team - if you aren't all on the same page regarding the transparency campaign rally the troops before proceeding.