Empowering Consumers and Improving Healthcare Value with Provider Quality Ratings

Sep 06, 2016
While consumers are increasingly expected to take the lead in major healthcare decisions such as where to have surgery, "in 1938 we knew more about the safety of a hair permanent, and in 2013 we knew more about the safety of laundry detergent, than we do in 2016 about procedures such as total joint replacement," noted Steven Schutzer, MD, Medical Director of Connecticut Joint Replacement Institute and President of Connecticut Joint Replacement Surgeons, LLC, at an April 29 breakfast program of the Connecticut Health Council in Hartford.

The Council’s program, "Provider Quality Ratings: Consumer Use and Marketplace Change," examined the potential of provider quality ratings to help consumers and providers achieve more healthcare value. Doris Peter, PhD, Director of the Consumer Reports (CR) Health Ratings Center, gave the keynote address.

CR is perhaps best known as a magazine that tests and rates products from insect repellent to cars, but it also publishes ratings of hospitals, heart surgeon groups and more. The goal, says Dr. Peter, is to empower consumers in their decision making - but the organization also sees itself as holding providers accountable for their performance.

Healthcare safety is a high-stakes proposition and, according to Dr. Peter, it is also healthcare consumers' top concern. Dr. Peter recalled the example of John McCleary, who died from a hospital-acquired MRSA infection following an ankle fracture - one of more than 75,000 deaths each year from healthcare-acquired infections.  Cases like this are why the Health Ratings Center created its Hospital Safety Score, which reflects the rate of hospital-acquired infection, readmission and mortality; communication about drugs and discharge; and other factors.

A nonprofit organization, CR is respected among healthcare consumers, providers and payers alike for its impartiality because it does not accept advertising or corporate donations. Because CR’s Health Ratings Center can't directly test healthcare procedures, it relies on outside data gathered through collaboration with organizations such as The Leapfrog Group (for C-section rates) and the Society of Thoracic Surgeons (STS, for bypass surgery performance data), as well as public sources of data (like CMS, and state departments of health). It has also worked with quality collaboratives across the country to collate data on local primary care physician groups.

CR and its collaborators face a number of challenges in collecting and analyzing provider data, including issues with data quality and timeliness, sample sizes, and changes in technology and billing models. In some cases, providers deliberately choose not to report certain data - which ultimately deprives consumers of information they need to make wise decisions.

"In situations where reporting is voluntary, we know why hospitals are not reporting data [mainly due to low ratings] and when they don't, we will tell [consumers] to find another place to go. And STS backs us up on this,” noted Dr. Peter. Even so, she said, the focus is on driving conversations: "We're not trying to get in the middle of the provider-patient relationship; we're trying to enhance that relationship."

Even with optimal data quality, transparency and access, translating provider quality ratings into consumer action is often easier said than done, noted Dr. Peter. Healthcare consumers often have limited ability to choose or change providers, and payment models do not always reward a focus on quality. She also pointed out that consumerism - or as she put it, "financial 'skin in the game'" - has its limits. "The more we shift the cost burden to the consumer, the less they are actually using both high value and low value services," and even medical professionals themselves are skipping preventive screenings.

She hopes the future will bring shared, unbiased quality and cost information, deeper consumer engagement, and more research into the comparative effectiveness of different treatment interventions and approaches to payment.

Dr. Peter’s remarks were followed by a panel discussion with experts including Sudeep Bansal, MD, MS, Chief Medical Informatics & Quality Officer, Saint Francis HealthCare Partners; Carol Carlson, CPA, MBA, Vice President, Market Engagement, UnitedHealthcare Health Care Measurement & Engagement Group; Paul Grady, MBA, Partner, Mercer; and Vicki Veltri, JD, LLM, Healthcare Advocate, State of Connecticut.
The program was sponsored by Connecticut Joint Replacement Institute at Saint Francis, Saint Francis Hospital and Medical Center and Connecticut Children's Medical Center.

To learn more about the Connecticut Health Council, visit www.cthealthcouncil.com.
To learn more about the Consumer Reports Health Ratings Center, click here.