State Report Card on Transparency of Physician Quality Information
December 16, 2014
This second annual State Report Card on Transparency of Physician Quality Information illustrates the divide that continues to separate states that take the protection and rights of consumers seriously, with those that seem to believe that market opacity is perfectly ok. How any legislator or public official, whose very job and oath is to protect the citizens of their state, can willingly accept the lack of information on the quality of physicians is puzzling and sad. Over half of all insured Americans spend less on health care during the course of any year than the total amount of their deductible. Practically speaking, that means these consumer-patients are in a full retail market. Every penny paid for routine sick care, or for the management of a condition, including, for some, the full cost of a pregnancy and delivery, is coming out of their pocket. And yet, in two thirds of the states in the Union, these consumer-patients have no information with which to compare the quality of physician care. What they might get through their health plan’s website is either nonexistent, incomplete, and/or judged to be subjective.
We therefore applaud the few that have made the decision to collect and publish information that can help consumers make more informed choices. What they have shown through their efforts is that the process of measuring physician quality is achievable, and that designing a website to publish that information is perfectly feasible. In other words, by their actions, they accentuate the failures of the other states. For all those who got an F, there is no excuse. And how can there be? Studies abound showing the variations in quality of care and the harm to patients from the underuse, overuse and misuse of health care services. Even medical specialty societies, through the Choosing Wisely campaign, have openly admitted that there are certain tests and procedures that are significantly overused and provide no value at all to patients. Some can even harm them. Yet even when faced with all this evidence, states fail to take action to offer the most basic protection to their residents. The very first book on economics states unambiguously that markets cannot function when the buyer and the seller do not have adequate information from which to make a purchasing decision. In states across the country, the buyers of health care – ordinary citizens – have no information on which to base their decision, and the failures of the market continues to impact them in the form of higher premiums and costs. While state budgets are strained by higher costs, including the costs of covering state employee health benefits, the leaders of these states fail to acknowledge the importance of making information on the cost and quality of health care providers widely available. We hope this report card will jumpstart efforts nationwide.
And states aren’t alone. The federal government, who in the past led the pace in collecting and disseminating information on the quality of hospitals, has also fallen behind. Earlier this year, the Health Care Incentives Improvement Institute (HCI3) conducted a thorough study of available hospital quality measures with a very simple objective: to consolidate them into a single score by disease or procedure in order to better help consumers differentiate the quality of care from one hospital to another. What we discovered is also alarming and more fully delineated in Appendix B. The upshot is that in 2014, fifteen years after the publication of “To Err Is Human” by the Institute of Medicine, there is little, if any, useful and meaningful information on the quality of care provided by hospitals.
Consumers are flying blind when it comes to selecting hospitals and physicians, and public and private sector purchasers cannot hope to improve the overall quality and affordability of American health care if they don’t find a way to solve this problem. Some states have and every other state in the Union should follow suit.